PEDIATRICS Vol. 90 No. 3 September 1992, pp. 369-374
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Mother-to-Child Transmission of Human Immunodeficiency Virus Type 1: Risk of Infection and Correlates of Transmission

Clara Gabiano MD1, Pier-Angelo Tovo MD2, Maurizio de Martino MD3, Luisa Galli MD3, Antonio Mazza MD4, Carlo Giaquinto MD4, Anna Loy MD5, Antonio Ferrazzin MD5, Mariangela Clerici Schoeller MD6, Marcello Giovannini MD7, Gabriella Ferranti MD8, Laura Rancilio MD9, Desireé Caselli MD10, Giuseppe Segni MD11, Susanna Livadiotti MD12, Aristide Conte MD13, Marco Rizzi MD14, Domenico Viggiano MD15, Alberto E. Tozzi MD16, and Nazario Cappello MD17

1 From the Istituto di Clinica Pediatrica, Universita' di Torino, and From Dipartimento di Pediatria, Uniiversitá di Padova, Italy
2 From the Istituto di Clinica Pediatrica, Universita' di Torino, Italy
3 From the Dipartimento di Pediatria, Universita' di Firenze, Italy
4 From the Dipartimento di Pediatria, Uniiversitá di Padova, Italy
5 I Clinica di Malattie Infettive, Universita' di Genova, Italy
6 Clinica Pediatrica I, Universita' di Milano, Italy
7 Clinica Pediatrica V, Universita' di Milano, Italy
8 Pediatria Preventiva e Neonatologia, Universita' di Bologna, Italy
9 USL 75/1, ICP Mangiagalli, Milano, Italy
10 Clinica Pediatrica, Universita' di Pavia, Italy
11 Istituto di Clinica Pediatrica, Universita' Cattolica"Sacro Cuore", Roma, Italy
12 Ospedale Bambino Gesu', Roma, Italy
13 Mallattie Infettive, Ospedale Spallanzani, Roma, Italy
14 Mallattie Infettive, Ospedali Riuniti di Bergamo, Italy
15 Patologia Neonatale, II Policlinico, Universita' di Napoli, Italy
16 Istituto Superiore di Sanita', Roma, Italy
17 Dipartimento di Genetica, Biologia e Chimica Clinica, Universita' di Torino, Italy

One thousand eight hundred eighty-seven children born to human immunodeficiency virus type 1 (HIV-1) seropositive mothers, including 1045 infants prospectively followed up from birth, were studied. Intravenous drug use was the most frequent maternal risk factor, although the percentage of women infected by sexual contact increased from 5.8% in 1985 to 28.5% in 1990. Of the 551 first children followed up from birth and older than 15 months of age, 101 (18.3%) acquired infection and seroconverted to HIV-1. Another 31 (5.6%) asymptomatic seronegative children showed the presence of viral markers, for an apparent mother-to-off-spring transmission rate of 23.9%. Overlapping results were seen in 22 second-born children followed up from birth. Of 59 sibships with definite infection status, when the first child was infected, 14 (40%) of 35 second children were infected, whereas when the first child was not infected, only 2 of 24 (8.3%) second children were infected. Discordance in HIV-1 transmission was found in 1 of 18 pairs of twins. Univariate and multivariate analyses of possible risk factors for HIV-1 transmission performed on the entire population of children and in the cohort of those followed up from birth were basically in agreement in indicating that the development of symptoms in the mother before delivery and breast-feeding (indeed adopted in only 22 infants in whom HIV-1 infection was identified at birth) were significantly and independently associated with a higher transmission rate. In addition, girls were more frequently infected than boys. Preterm delivery and low birth weight correlated with maternal drug use. Child's infection status did not influence gestational age nor birth weight. In contrast, maternal infection itself seemed to reduce fetal growth, which was further impaired when the mother was symptomatic.

Key Words: human immunodeficiency virus • perinatal transmission • siblings • twins • mother's clinical condition • vaginal delivery • breast-feeding

Submitted on January 18, 1991
Accepted on February 10, 1992




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