Abstract
Mother-to-infant transmission of human immunodeficiency virus (HIV) is a worldwide problem. Between 7 and 40% of infants born to HIV-positive mothers become infected. The prognosis of these infants is poor, with most developing early and rapidly progressive disease. A number of advances in diagnosis and therapy offer opportunities to reduce the rate of vertical transmission and to improve the outlook of infected infants. Antiretroviral therapy during pregnancy and the neonatal period can markedly reduce the risk of mother-to-infant transmission. Recognition that 50% or more of infections are transmitted peripartum offers scope to further reduce the rate of transmission. However there is currently no consensus on the optimal management of pregnancy in HIV-infected women, and there is an urgent need for large randomized controlled trials. The development of polymerase chain reaction and p24 antigen assays has greatly facilitated the diagnosis of neonatal HIV infection, thereby enabling earlier supportive and anti-retroviral therapy. The place of zidovudine in paediatric HIV infection is now well-established, but the future will undoubtedly bring combination anti-retroviral therapy. Optimism about the prospects for developments in the prevention and treatment of paediatric acquired immunodeficiency syndrome must be tempered by the fact that the majority of cases occur in countries where patients have little or no access to medical care.
Collapse