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Perinatal transmission of HIV infection

Objective

The European Collaborative Study (ECS) on children born to HIV-seropositive women is a multidisciplinary study, and involves epidemiologists, statisticians, paediatricians, virologists, immunologists and obstetricians. Over the past 6 years, the ECS has contributed substantially to knowledge on mother-to-child transmission of HIV infection. The mother-child pairs enrolled form a unique cohort, not only in numbers enrolled and detail of data collected, but also in length and completeness of paediatric follow-up. Over the years, the study objectives have evolved and changes in the protocols have been introduced, as and when appropriate. The ECS still has a great deal to contribute and achieve.

The objectives of the ECS are to determine the rate of vertical transmission of HIV infection, to identify risk factors for mother-to-child transmission of HIV infection, and to elucidate the natural history of paediatric HIV infection. The identification of interventions to reduce the risk of vertical transmission has now become an additional objective.
The European Collaborative Study (ECS) on children born to human immunodeficiency virus (HIV) infected women was established in 1986 and to date more than 1500 mother child pairs have been enrolled from paediatric and obstetric centres throughout Europe. The rate of transmission from mother to child has been estimated to be about 15% in this cohort of mainly white, asymptomatic women, many of whom have a history of intravenous drug use. Maternal clinical and immunological status, premature delivery and breastfeeding have been identified as risk factors for an increased risk of mother to child transmission. Mode of delivery was found to be associated with the rate of vertical transmission and a caesarean section delivery approximately halves the risk of infection for the child. Indirect evidence from this and other studies suggests that a substantial, but as yet unquantified, proportion of vertical transmission occurs around the time of delivery. Possibilities for intervention to prevent mother to child transmission are now being explored and these will need to be evaluated in the context of a vertical transmission study. This European network provides an ideal opportunity. About a quarter of HIV infected children develop acquired immune deficiency syndrome (AIDS) and about 20% die of HIV related disease within the first year of life. The progression of disease in the remaining infected children is slower and the long term prognosis remains to be established. It is essential that this unique paediatric cohort continues to be followed to clarify the natural history at later ages.
The European Collaborative Study (ECS) on children born to HIV-infected women was set up in 1986, and to date more than 1500 mother-child pairs have been enrolled from paediatric and obstetric centres throughout Europe. The rate of transmission from mother-to-child has been estimated to be about 15% in this cohort of mainly white, asymptomatic women, many of whom have a history of intravenous drug use. Maternal clinical and immunological status, premature delivery and breastfeeding have been identified as risk factors for an increased risk of mother-to-child transmission. Mode of delivery was found to be associated with the rate of vertical transmission, and a caesarean section delivery approximately halves the risk of infection for the child.

Indirect evidence from this and other studies suggests that a substantial, but as yet unquantified, proportion of vertical transmission occurs around the time of delivery. Possibilities for intervention to prevent mother-to-child transmission are now being explored, and these will need to be evaluated in the context of a vertical transmission study. This European network provides an ideal opportunity.

About a quarter of HIV infected children develop AIDS and about 20% die of HIV related disease within the first year of life. The progression of disease in the remaining infected children is slower and the long-term prognosis remains to be established. It is essential that this unique paediatric cohort continues to be followed, to clarify the natural history at later ages.

Funding Scheme

CON - Coordination of research actions

Coordinator

Institute of Child Health
Address
30 Guildford Street
WC1N 1EH London
United Kingdom