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Perinatal Transmission of the Human Immunodeficiency Virus Type 1 to Infants of Seropositive Women in Zaire

List of authors.
  • Robert W. Ryder, M.D., M.SC.,
  • Wato Nsa, M.D.,
  • Susan E. Hassig, DR.P.H.,
  • Frieda Behets,
  • Mark Rayfield, Ph.D.,
  • Bayende Ekungola, M.D.,
  • Ann M. Nelson, M.D.,
  • Utshudi Mulenda, M.D.,
  • Henry Francis, M.D.,
  • Kashamuka Mwandagalirwa,
  • Farzin Davachi, M.D.,
  • Martha Rogers, M.D.,
  • Nzila Nzilambi, M.D.,
  • Alan Greenberg, M.D.,
  • Jonathan Mann, M.D.,
  • Thomas C. Quinn, M.D.,
  • Peter Piot, M.D., Ph.D.,
  • and James W. Curran, M.D., M.P.H.

Abstract

To examine perinatal transmission of the human immunodeficiency virus type 1 (HIV-1) in Zaire, we screened 8108 women who gave birth at one of two Kinshasa hospitals that serve populations of markedly different socioeconomic status. For up to one year, we followed the 475 infants of the 466 seropositive women (5.8 percent of those screened) and the 616 infants of 606 seronegative women matched for age, parity, and hospital. On the basis of clinical criteria, 85 of the seropositive women (18 percent) had the acquired immunodeficiency syndrome (AIDS).

The infants of seropositive mothers, as compared with those of seronegative mothers, were more frequently premature, had lower birth weights, and had a higher death rate in the first 28 days (6.2 vs. 1.2 percent; P<0.0001). The patterns were similar at the two hospitals. Twenty-one percent of the cultures for HIV-1 of 92 randomly selected cord-blood samples from infants of seropositive women were positive. T4-cell counts were performed in 37 seropositive women, and cord blood from their infants was cultured. The cultures were positive in the infants of 6 of the 18 women with antepartum T4 counts of 400 or fewer cells per cubic millimeter, as compared with none of the infants of the 19 women with more than 400 T4 cells per cubic millimeter (P = 0.02). One year later, 21 percent of the infants of the seropositive mothers had died as compared with 3.8 percent of the control infants (P<0.001), and 7.9 percent of their surviving infants had AIDS.

We conclude that the mortality rates among children of seropositive mothers are high regardless of socioeconomic status, and that perinatal transmission of HIV-1 has a major adverse effect on infant survival in Kinshasa. (N Engl J Med 1989; 320:1637–42.)

Funding and Disclosures

We are indebted to Drs. William Heyward, M. Oxtoby, M. Binyingo, E. Paquot, Uwa Kabagabo, Manzila Tarande, Nsanga Badi, Medi Mvula, Nsuami Malanda, Matela Baangi, Robert Colebunders, and Ngaly Bosenge; to Dr. Ngandu Kabeya, Minister of Health, Republic of Zaire; to Citizens Mwungura Gatungo, Kasali Mwamba, Mosengo Mputu, Lobengo Bokito, Zola Banuata, Mposo Ntumbandzondo, and Ephrem Mpozayo; and to Ms. Susan Furste.

Author Affiliations

From Projet SIDA, Department of Public Health, Kinshasa, Zaire (R.W.R., W.N., S.E.H., F.B., B.E., A.M.N., H.F., K.M., N.N.); the AIDS Program. Centers for Disease Control, Atlanta (R.W.R., M.R., U.M., M.R., A.G., J.W.C.); the Departments of Pediatrics and Medicine, Mama Yemo Hospital (F.D.) and Cliniques Ngaliema (F.B.), Kinshasa; the Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, Bethesda, Md. (H.F., T.C.Q.); the Boston University School of Public Health, Boston (R.W.R.); Tulane University, New Orleans (S.E.H.); the Armed Forces Institute of Pathology, Washington, D.C (A.M.N.); the Global Programme on AIDS, World Health Organization, Geneva, Switzerland (J.M.); and the Institute of Tropical Medicine, Antwerp, Belgium (F.B., P.P.). Address reprint requests to Dr. Ryder at the AIDS Program, Centers for Disease Control, 1600 Clifton Rd., N.E., Atlanta, GA 30333.

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