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Lancet. 1996 Sep 28;348(9031):863-8.

Paediatric HIV infection.

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Laboratory of Immunobiology, Centro San Luigi, San Raffaele Scientific Institute, Milan, Italy.


By the year 2000 there will be six million pregnant women and five to ten million children infected with HIV-1. Intervention strategies have been planned and in some instances already started. A timely and cost-effective strategy needs to take into account that most HIV-1 infected individuals reside in developing countries. Further studies are needed on immunological and virological factors affecting HIV-1 transmission from mother to child, on differential disease progression in affected children, and on transient infection.


At the end of 1984, there were about 1.5 million children worldwide infected with HIV-1. 75% of these children lived in sub-Saharan Africa and Latin America. The rate of mother-to-child transmission of HIV-1 is estimated to range from 13% to 42%. It is twice as high in Africa as it is in Europe. By the year 2000, 6 million pregnant women and 5-10 million children will be infected with HIV-1. It appears that clearance of HIV-1 infection occurs in 2.7% to 6.4% of infected infants. Possible intervention strategies to reduce perinatal HIV-1 transmission include antiretroviral therapy with zidovudine, recommending breast feeding only in areas where it is clearly necessary, cesarean section, passive immunotherapy with anti-HIV immunoglobulins, and viral envelope subunit vaccines. An accurate diagnosis of HIV-1 infection can occur in non-breast fed infants born to seropositive mothers by the age of 3 months. Most children (80-90%) with HIV-1 infection develop features of HIV-1 infection within the first year of life. Common manifestations in the first year are lymphadenopathy, splenomegaly, and/or hepatomegaly. Young infants, especially those 3-6 months old, are more likely to be diagnosed with Pneumocystis carinii pneumonia (PCP) than older HIV-1 infected children. HIV-1 infected children are more likely to develop PCP, serious bacterial infections, cytomegalovirus infection, lymphoid interstitial pneumonitis, and encephalopathy than adults. They are, however, less likely to develop other opportunistic infections (e.g., toxoplasmosis, tuberculosis, cryptococcoses, and histoplasmosis). Possible underlying mechanisms of disease progression in HIV-1 infected children include presence of rapidly replicating syncytium-inducing HIV-1, high virus burden, persistent neutralizing antibody response, antibody-dependent cellular cytotoxicity against HIV-1, and transplacental passage of maternal neutralizing antibodies.

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