[Mother-to-fetus transmission of the human immunodeficiency virus]

This article discusses the transmission of the human immunodeficiency virus (HIV) from mother to child; it indicates that the rate of this transmission has decreased considerably since the institution of antiretroviral prophylaxis in pregnant women infected with HIV. It is indicated that this mother-to-fetus transmission boosted by the severity of the maternal infection occurs transplacentally during pregnancy by contact with genital secretions containing HIV during labor and through breastfeeding after birth. The consequences of this transmission depend on the time of contamination; they result in a severe and often-fatal prognosis for children infected early in utero. Those that are infected at the end of pregnancy remain asymptomatic for a long time and their course closely resembles that of adults. The diagnosis of infection in the newborn is based on the isolation of the HIV virus in the blood; serologic evaluation should be pursued until the infection is confirmed or denied. Therapeutic management in turn consists of systematic serological screening of all pregnant women. Treatment of the infected mother during the last trimester of pregnancy reduces the risk of perinatal infection. The importance of prophylactic cesarean delivery is being recognized more and more. After birth the newborn should receive preventive treatment and regular monitoring; in the area of nutrition breastfeeding should be proscribed. In conclusion it is suggested that treating newborns during the first six weeks of life reduces the risks of transmission of HIV infection to the child.