Mother-to-child transmission of human immunodeficiency virus.

Transmission of HIV virus from an infected mother to her offspring is becoming the leading cause of spreading in the pediatric population. This is particularly burdensome in the pattern II countries where HIV infection has reached epidemic proportions and infection rates affect more women of childbearing age than men. During the last few years considerable effort has been directed at defining the optimal methods for identifying infants of HIV-infected mothers who will themselves prove to be infected because conventional serological assessment is impaired due to placental transfer of maternal IgG. At present, detection of specific IgA to HIV proteins, evaluation of autochthonous antibody production in vitro from infants' lymphocytes, and gene amplification of HIV DNA/RNA by polymerase chain reaction are the most promising procedures for early diagnosis within the first 6 months of life. Nevertheless all these techniques are cumbersome when evaluating specimens from the newborn child. Many studies have been performed to identify those maternal factors affecting the risk of vertical transmission. So far, none of them has shown real prognostic value. However, evaluation of maternal antibody response to functional epitopes of HIV envelope proteins such as the principal neutralizing domain, in some epidemiological settings, seems to correlate to a reduced rate of mother-to-child transmission.