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Understanding the Timing of HIV Transmission From Mother to Infant

Athena P. Kourtis, MD, PhD; Marc Bulterys, MD, PhD; Steven R. Nesheim, MD; Francis K. Lee, PhD
JAMA. 2001;285(6):709-712. doi:10.1001/jama.285.6.709.
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Mother-to-infant transmission of human immunodeficiency virus (HIV) occurs, without any intervention, at rates of 14% to 42% in various settings.1,2 Determining the timing of such transmission is of great clinical relevance for implementing cost-effective prophylaxis.3,4 Based on virologic detection of HIV during the infant's first 2 days of life, it is generally accepted that about one third of transmissions in nonbreastfeeding women occur during gestation and the remaining two thirds during delivery.59 Further support for the notion that most HIV transmission occurs intrapartum includes the association of transmission with prolonged duration of membrane rupture,1012 the protective effect of elective cesarean delivery,1316 and a virologic and immunologic pattern of acute primary HIV infection in a majority of affected infants.17 However, these findings could be explained by transmission either very late in gestation or during labor.

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Figure. Estimation of Timing of Perinatal HIV Transmission Rates
Graphic Jump Location
Estimated rates are for different times of gestation and delivery in non-breastfeeding populations. Estimates are based on a hypothetical cohort of 100 children born to HIV-infected women without any interventions. HIV indicates human immunodeficiency virus. Boldface numbers indicate number of children at risk for infection.



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