Each year, 1400-2200 infants acquire HIV infection by means of vertical (mother-to-infant) transmission. The HIV seroprevalence rate in pregnant women is as high as 0.3%. The seroprevalence of women infected with HIV is highest in the Northeast followed by the South. Perinatal HIV transmission rates are 25% and 4% in untreated women and treated women, respectively. HIV infection is the seventh leading cause of death in young children. In the United States, most children with AIDS live in metropolitan areas.
HIV-1 is the most common cause of HIV infection in the Americas, Europe, Asia, and Africa. HIV-1 subtypes differ by geographic region. HIV-1 subtype B is predominant in the United States, although non-B subtype HIV-1 infections are increasing.
Of the 25 million infected individuals worldwide, 90% are in developing countries. HIV has infected 4.4 million children worldwide and has resulted in the deaths of 3.2 million children. Approximately 7% of the population in sub–Saharan Africa is infected with HIV; these individuals represent 68% of the world’s population with HIV.
The HIV seroprevalence rate among pregnant women in South America ranges from 1-5%, and in sub–Saharan Africa, it ranges from 35-45%. In Europe, the HIV seroprevalence is much higher in the West; France, Spain, and Italy have the highest incidences. Pregnant women in urban portions of these countries have a seroprevalence rate as high as 1%. An AIDS epidemic started recently in Asia; the available epidemiologic data and treatment protocols are limited. The magnitude of HIV infection, however, is significant. The seroprevalence rate in pregnant women is already 2%, and the vertical transmission rate is 24% without breastfeeding. Indian mothers infected with HIV routinely breastfeed and have a transmission rates as high as 48%.
Perinatal transmission rates are lower in Europe and higher in Africa, independent of treatment. Untreated women infect 13% and 40% of children in Europe and those in Africa, respectively. The rate of postnatal transmission in Africa and other developing countries is higher because of the need to breastfeed.
HIV-1 is the most common cause of HIV infection in the Americas, Europe, Asia, and Africa. HIV type 2 (HIV-2) has caused epidemics in West Africa, although this virus also is found in European countries. HIV-1 subtypes differ by geographic region. Non-B subtypes are particularly prevalent in Africa and Asia. The high transmission rate from Africa to Europe has increased the diversity of subtypes in Europe.
- The progression of vertically acquired HIV infection appears to have a trimodal distribution. Approximately 15% of children have rapidly progressive disease, and the remainder have either a chronic progressive course or an infection pattern typical of that in adults. Mean survival is about 10 years.
- The progression and prognosis of children with HIV infection is represented by a Centers for Disease Control and Prevention (CDC) classification system. This classification system is outlined in Prognosis.
- Black and Hispanic children are disproportionately affected. HIV infection is the fourth and fifth leading cause of death in young black children and Hispanic children, respectively.
- The majority (58%) of children with AIDS are black.
Sex: Women of childbearing age account for one of the fastest growing groups with AIDS, representing 20% of AIDS cases in adults.
- Vertical HIV infection occurs during 1 of 3 periods.
- Period 1: Prenatally, the fetus can be hematologically infected by means of transmission across the placenta or across the amniotic membranes, especially if the membranes are inflamed or infected.
- Period 2: Most vertical infections occur during delivery, and many factors affect the risk of infection during this period (see Deterrence/Prevention). In general, the longer and the greater amount of contact the neonate has with maternal blood and cervicovaginal secretions, the greater the risk of vertical transmission. Premature and low-birthweight neonates appear to have an increased risk of infection during delivery because of their reduced skin barrier and immunologic defenses.
- Period 3: Postnatal vertical transmission occurs with the ingestion of HIV in the breast milk.
- The age of presentation can be highly variable in a high-risk child who was previously unidentified.
- Children can be asymptomatic for many years, and the appearance of an opportunistic infection in a 10-year-old child in whom AIDS is subsequently diagnosed is not rare.
- Children who acquire HIV by means of nonvertical transmission may have an illness during the acute phase of the retroviral syndrome, or they may present many years later with opportunistic or recurrent infections.
- Prior to 1985, contaminated blood products were the vehicles for transmission in many cases. Now, nonvertically transmitted HIV usually occurs by means of sexual contact and IV drug use.
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