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Research on methods for preventing HIV transmission from pregnant women to their babies in developing countries focuses on breastfeeding, the potential toxicity of AIDS drugs to the fetus, and the development of drug resistance on the part of the virus. Between 15% and 40% of pregnant women in eastern and southern Africa are HIV-positive.

Since 1999, many African governments have launched programs to offer short-course antiretroviral drug regimens to reduce mother-to child transmission of HIV. HIV testing in prenatal care is the gateway to these antiretroviral regimens. Pilot projects in Africa show an uptake of antiretroviral drugs in 8% to 50% of pregnant women presumed to be HIV infected; often, a minority of eligible women in care received these regimens. Use of lay counselors and rapid onsite HIV testing may alleviate health service barriers. Community education to promote voluntary counseling and testing, which involves men, is the long-term solution. In the short term, possibilities to enhance delivery of an effective intervention include group pretest counseling, universal offer of testing with women having the right to 'opt out,' universal treatment (mass treatment for those whose HIV status is not determined by voluntary counseling and testing), universal testing with women having the right to 'opt out' of learning their test results, and mass treatment for all without testing.

In June 2001 the United Nations Special Assembly on HIV/AIDS set reduction targets of 20% and 50% for the numbers of children newly infected with HIV by 2005 and 2010 respectively. Are these targets achievable? Antiretroviral monotherapy during pregnancy, delivery, and the neonatal period can reduce the rate of mother-to-child transmission of HIV-1 by two-thirds in non-breastfeeding populations. Shorter and simpler regimens of monotherapy have been associated with a reduction of 50% in such transmission among non-breastfeeding populations and of up to 40% in breastfeeding populations. Delivery by elective caesarean section is associated with a halving of the risk of mother-to-child transmission. However, breastfeeding poses a substantial additional risk of acquisition of HIV, and if prolonged it more than doubles the overall rate of transmission. Rates below 2% are being reported from settings where combination therapy is applied during pregnancy and delivery, delivery is by elective caesarean section, and breastfeeding does not take place. In breastfeeding populations where elective caesarean delivery is not an option but peripartum antiretroviral therapy is used, rates at six weeks are about 10% but can be 25% or more after 18 months of breastfeeding. More widely applicable interventions are being developed, such as cleansing of the birth canal and antiretroviral therapy during the breastfeeding period. Keywords Acquired immunodeficiency syndrome/transmission/drug therapy; Disease transmission, Vertical/ prevention and control; Breast feeding/adverse effects; Cesarean section; Anti-HIV agents/pharmacology/adverse effects; Zidovudine/adverse effects; Nevirapine/adverse effects; Risk factors (source: MeSH). Mots cles SIDA/transmission/chimiotherapie; Transmission verticale maladie/prevention et controle; Allaitement au sein/effets indesirables; Cesarienne; Agents anti-HIV/pharmacologie/effets indesirables; Zidovudine/effets indesirables; Nevirapine/effets indesirables; Facteur risque (source: INSERM). Palabras clave Sindrome de inmunodeficiencia adquirida/transmision; Transmision vertical de enfermedad/ prevencion y control; Lactancia materna/efectos adversos; Cesarea; Agentes anti VIH/farmacologia/efectos adversos; Zidovudina/efectos adversos; Nevirapina/efectos adversos; Factores de riesgo (fuente: BIREME). Bulletin of the World Health Organization, 2001, 79: 1138-1144., Introduction Mother-to-child transmission (MTCT) of HIV-1 can occur before, during, and after delivery (1). Transmission is rare during early pregnancy and relatively frequent in late pregnancy and during delivery. Breastfeeding [...]

The authors discuss a study done of recently-born infants of HIV-infected women to learn their physiological responses to various methods of feeding. This was an extension of knowledge that infants who were exclusively breast-fed had a lower rate of mother-to-infant HIV transmission than infants fed breast milk and additional foods. They found certain characteristics in infant intestinal permeability, but nothing that would explain why HIV transmission varies in the way stated above.

Many HIV-infected pregnant women may be transmitting a drug-resistant form of the virus to their baby. In a study of 34 babies born to HIV-infected mothers, 7 (20%) had a viral strain that was resistant to zidovudine (AZT). In four of these babies, it was clear that the virus came from the mother.

Women who first test positive for HIV during their pregnancy are no more likely to transmit the virus to their baby than those who tested positive before their pregnancy. This was the conclusion of a study in Thailand before HIV-infected pregnant women were given AIDS drugs to prevent transmission.

Pregnant women who are infected with HIV can transmit the virus to the baby before birth. In a study of 129 pregnant women in Zimbabwe, 90% had HIV in their blood and 38% of the newborn babies had HIV in their umbilical cord blood.

The risk of HIV transmission from a pregnant, infected woman to her child increases with the maternal viral load. Researchers compared 552 HIV-positive women and their infants for factors influencing viral transmission. For women with viral loads below 1,000 copies/ml, no infant infections occurred. For women with viral loads above 100,000 copies/ml and not taking antiviral drugs, 63% of the resultant children were HIV-infected. Maternal viral load was not associated with the timing of viral transmission during pregnancy.

Pregnant women infected with HIV and treated with zidovudine are less likely to transmit the virus to their infant if their viral load is low. Researchers compared 480 HIV-positive women for factors that might influence perinatal transmission of the infection. Women with viral loads below detectable limits, indicating effective viral suppression by the antiviral drug, are unlikely to infect their child during pregnancy or delivery.

The prophylactic use of zidovudine (AZT) to reduce the incidence of maternal-fetal transmission of HIV virus seems to be highly effective, even when used in an abbreviated course of treatment. The initial three-part regimen which provides treatment before and during labor, and after birth, to the newborn reduced the rate of transmission from 25.5% to 8.3%. Even a shortened course of treatment starting during labor or in the first two days of life were effective in reducing the rate of infection.

A genetic mutation which may protect adults against HIV infection might not prevent infection of infants born to HIV-infected mothers. A variant of the CCR5 chemokine receptor gene might prevent HIV from infecting cells. Researchers in France studied the gene in 512 children born to HIV-positive mothers. About 10% of both infected and non-infected children had the mutation. Children with the mutation were less likely to have developed serious HIV-related diseases by age 3. This mutation does not prevent mother-to-child HIV transmission, but it may slow disease progression., Context.--Studies suggest that adults with the CCR5[Delta]32 deletion are less likely to become infected with the human immunodeficiency virus (HIV) and to develop HIV-related disease progression, but the effect of the mutation in children is not known. Objective.--To study the effect of the CCR5 chemokine receptor mutant allele on mother-to-child transmission of HIV type 1 (HIV-1) and subsequent disease progression in infected children. Design.--Multicenter, prospective study of infants born to mothers seropositive for HIV-1. Setting.--A total of 52 medical centers participating in the French Pediatric HIV Cohort studies. Participants.--The CCR5[Delta]32 deletion was studied in 512 non-African children, born between 1983 and 1996 to HIV-1--infected mothers. Among them, 276 children were infected and 236 were not. Main Outcome Measures.--HIV-1 infection status and, in infected children followed up since birth, incidence of category B and C disease events and severe immunosuppression as defined in the new pediatric Centers for Disease Control and Prevention (CDC) classification, according to CCR5 genotype. Results.--The 32-base pair deleted allele was detected at a frequency of 0.05. Only 1 infant, not infected by HIV-1, was homozygous for the [Delta]32 deletion. The 49 heterozygous children (9.6% of the total; 95% confidence interval [CI], 7.1-12.2) were equally distributed into the infected (9.8%) and uninfected (9.3%) groups. The incidence of stage C symptoms in heterozygous infected children was 9% at 36 months vs 28% in children homozygous for the normal allele (P

Pregnant women who are HIV-positive should be given zidovudine to prevent the transmission of the virus to the infant. In a study of 402 pregnant women, zidovudine lowered the transmission rate from 22.6% in women who took a placebo to 7.6% in those who took zidovudine. Women with greater amounts of virus in their blood were more likely to transmit the virus. However, zidovudine reduced transmission rates independently of its effect on lowering viral counts. It was effective even in women with low viral counts.

A new method of estimating the HIV transmission rate in mother-to-child cases and the age distribution of diagnosis, otherwise known as the pediatric AIDS incubation period, is introduced. Unlike other methods which lead to biased estimates, it employs the EM algorithm to determine the maximum likelihood estimates of vertical transmission rates, sensitivity of virus tests, age distribution at antibody loss and pediatric AIDS incubation period using clinical, immunological and virological information., This article considers the estimation of the rate of vertical human immunodeficiency virus (HIV) transmission and the pediatric acquired immune deficiency syndrome (AIDS) incubation period using data from birth cohort [...]

The Lazarus and Folkman's stress, appraisal, and coping framework can be used to study the needs of HIV-infected mothers. Social support was found to aid in the mothers' coping with the disease both physically and psychologically. The mothers who retained the responsibility of caring for their children displayed better mental health. Children appeared to serve as a healthy motivating factor for HIV-infected women.

HIV-infected pregnant women whose membranes rupture more than four hours before delivery may have a greater risk of transmitting the virus to their newborn baby. Among 509 HIV-infected women enrolled in the Women and Infants Transmission Study, those whose membranes ruptured more than four hours before delivery had almost twice the risk of transmitting the virus compared to women whose membranes ruptured less than four hours prior to delivery. Illegal drug use also doubled the risk as did low birth weight. A low CD4 count almost tripled the risk.

Health care workers in North Carolina appear to have reduced the rate of perinatal transmission of HIV by promptly identifying HIV-positive pregnant women and their babies and treating both with zidovudine. A total of 877 HIV-positive women gave birth to 881 babies in North Carolina between 1990 and 1994. Eighty-five percent were black and 56% lived in rural parts of the state or small metropolitan counties. By the last quarter of 1994, over 90% of HIV-exposed newborn infants were identified, up from 63% just one year before. Almost half were identified within one week of birth, 73% by 6 weeks and 91% by three months. Forty-one percent were born in rural counties. Six percent of the babies who were exposed to zidovudine before or after birth became infected compared to 19% of those never exposed to zidovudine. HIV transmission rates from mother to child decreased from 21% in 1993 to 8.5% in 1994., Objectives. - To assess health care providers' identification of human immunodeficiency virus (HIV) - exposed infants, to ascertain the prevalence of transplacental or oral zidovudine treatment among infants exposed to HIV, and to estimate the impact of zidovudine use on perinatal transmission in rural and urban North Carolina. Design. - Survey of North Carolina newborns tested for HIV infection in 1993 and 1994 compared with the number of anonymous Hiv-positive childbearing women. Setting. - North Carolina hospitals, public health clinics, and private physicians' offices. Main Outcome Measures. - Rates of identification of HIV-exposed infants and of perinatal HIV-1 transmission, determined by HIV culture and polymerase chain reaction testing in the infants. Results. - The proportion of HIV-exposed children in North Carolina who were identified and tested increased from 60% in 1993 to 82% for all of 1994, and to more than 90% for the last quarter of 1994. The HIV-exposed infants born in rural counties were more likely to be recognized than those born in urban counties (P

Measurement of HIV RNA in the blood of pregnant HIV-infected women at delivery may best predict the risk of transmitting the virus to the baby. Researchers measured HIV RNA in blood samples from 92 HIV-positive women through pregnancy and at delivery. Twenty of the 97 babies born became HIV-positive either in utero (12) or during birth (8). Women who did not transmit the virus had fewer than 100 copies of HIV RNA per milliliter (ml) up to 67,862 copies. Women who transmitted the virus had from 25,262 copies/ml up to 791,341 copies/ml. Probability analysis showed that more than 50% of the women with more than 50,000 copies/ml would infect their babies. Forty-two women took zidovudine during pregnancy. Zidovudine reduced HIV RNA levels from 4- to 10-fold. Nine percent of babies born to women on zidovudine became infected compared to 30% of babies born to untreated women., Objective.--To determine if there are levels of human immunodeficiency virus type 1 (HIV-1) associated with a high or low risk of perinatal transmission and to ascertain the mechanism by which zidovudine treatment reduces perinatal transmission. Design.--A nonrandomized prospective cohort study. Setting.--University medical center and two general hospital affiliates fr-om May 1989 to September 1994. Patients.--Ninety-two HIV-1 -seropositive women (95 pregnancies) and their 97 infants. Intervention.--Forty-two mothers (43 pregnancies) received zidovudine therapy during pregnancy and/or during labor and delivery. Eleven infants received prophylactic zidovudine for the first 6 weeks after delivery. Main Outcome Measure.--HIV-1 infection status of the infant. Results.--Twenty of the 97 infants were perinatally infected with HIV-1. Transmitting mothers were more likely to have plasma HIV-1 RNA levels higher than 50 000 copies per milliliter at delivery than nontransmitting mothers (1 5 [75.0%] of 20 transmitters vs four [5.3%] of 75 nontransmitters; P

Certain factors in infants of HIV-positive mothers appear to associate with increased likelihood of HIV infection and early death. Among 351 infants born to HIV-positive mothers, 24% were eventually found to be infected. Among these, researchers collected data and compared outcomes for 248 uninfected and 84 infected infants. Fifty-eight percent of mothers of infected infants had CD4 counts less than 500 and 21% had AIDS whereas 39% of noninfecting mothers had CD4 counts that low and 11% had AIDS. Three percent of mothers taking zidovudine infected their infants versus 11% of mothers not taking zidovudine. Infected infants were twice as likely to be born before 37 weeks gestation and almost four times as likely to be born before 34 weeks. Infected infants were twice as likely to be low birth weight, low birth weight at full term, or small for gestational age. Ten percent of infected newborns had generalized infections versus 3% of uninfected infants., ABSTRACT. Background and Methods. Differences in newborn outcome measures for human immunodeficiency virus (HIV-1-infected and HIV-1-exposed but uninfected infants have been found in several studies, but not in others. Eighty-four infected and 248 uninfected children born to HIV-1-seropositive mothers followed prospectively in a multicenter, perinatal HIV-1 transmission cohort study were compared for differences in maternal demographics, health status, and newborn outcome measures, including delivery complications, physical examination findings, neonatal complications, and laboratory results. Results. Mothers of HIV-1-infected infants were more likely than those of uninfected infants to have acquired immunodeficiency syndrome (AIDS) diagnosed through 2 weeks postpartum (21% vs 11%, P = .04); the transmission rate for the 38 women with AIDS was 37% compared with 22% for the 245 women without AIDS. Two of 27 (7%) women receiving zidovudine during pregnancy had infected infants compared with 73 (27%) of 275 women who did not receive zidovudine (P = .033). Mean gestational age was significantly lower among HIV-1-infected (37 weeks) than among uninfected infants (38 weeks; P < .001). Infected infants had significantly higher rates of prematurity (gestational age less than 37 weeks) (33% vs 19%, P = .01) and extreme prematurity (gestational age less than 34 weeks) (18% vs 6%, P = .001) than uninfected infants. Infection was associated with lower birth weight (2533 g vs 2862 & P < .001) and smaller head circumference (32.0 cm vs 33.1 cm, P = .001). HIV-1-infected infants were significantly more likely to be small for gestational age (26% vs 16%, P = .04) and low birth weight (less than 2500 g) (45% vs 29%, P = .006) than infants who were uninfected. Twenty-two (26%) HIV-1-infected children died during a median follow-up of 27.6 months (range 1.9 to 98.3 months). Prematurity was predictive of survival: by Kaplan-Meier, an estimated 55% (95% confidence interval, 31% to 72%) of preterm infected children survived to 24 months compared with 84% (95% confidence interval, 70% to 92%) of full-term infected children (P = .005). Conclusion. Infants born to women with AIDS are at higher risk for HIV-1 infection than are infants born to HIV-1-infected women with AIDS not yet diagnosed. Women receiving zidovudine appear less likely to transmit HIV-1 to their infants. Significantly higher rates of prematurity and intrauterine growth retardation were found among HIV-1-infected infants than among those in the uninfected, HIV-1-exposed control group. Prematurity was associated with shortened survival in HIV-1-infected infants. Measures of intrauterine growth and gestation appear to be important predictors of HIV-1 infection status for seropositive infants and of prognosis for the infected infant. Pediatrics 1995;96:451-458; neonatal predictors of HIV-1 infection, pediatric HIV-1, prematurity., ABBREVIATIONS. AIDS, acquired immunodeficiency syndrome; HIV, human immunodeficiency virus; CDC, Centers for Disease Control and Prevention; ZDV, zidovudine; SGA, small for gestational age; LBW, low birth weight; PCP, Pneumocystis carinii; [...]

Zidovudine treatment of pregnant women who are HIV-positive may prevent transmission of HIV infection to their infants. Among 409 pregnant women infected with HIV, 205 were treated with zidovudine and 204 received a placebo. The women were between 14 and 34 weeks' gestation and all had CD4+ T-lymphocyte counts above 200. The women in the zidovudine group took 100 milligrams (mg) orally five times a day before birth and received intravenous zidovudine during labor. Their infants were also treated with zidovudine for six weeks. Among 180 infants in the zidovudine group for whom results were known, 13 tested positive for HIV, compared to 40 among 183 infants in the placebo group. The estimated proportions of infants infected at 18 months were 8.3% in the zidovudine group and 25.5% in the placebo group. This indicates that zidovudine treatment can reduce the risk of HIV transmission from mother to infant by approximately two-thirds.

The HIV-1 virus in infected mothers appears to exhibit varying factors that can influence whether or not the virus is transmitted to children during pregnancy or delivery. Blood samples from 12 non-transmitting mothers were compared with blood samples from six transmitting mothers. The HIV-1 virus from transmitting mothers appeared to be better able and quicker at replicating itself. It also appeared to infect a larger variety of T-lymphocytic cell types. The virus isolates from non-transmitting mothers appeared to have a greater chance of being neutralized by the mothers' serum. A number of factors appear to influence whether or not the HIV-1 virus will be transmitted from an infected mother to her unborn child., Objective.--To evaluate the biological and serological properties of the human immunodeficiency virus type 1 (HIV-1) for factors potentially involved in the mother-to-child transmission of HIV-1. Design.--Isolates of HIV-1 were recovered from the blood of 12 of 44 nontransmitting mothers and six of eight transmitting mothers and their corresponding infants. These 24 HIV-1 isolates were compared for their biological and immunologic properties to discern any parameters that correlate with vertical transmission of HIV-1. Main Outcome Measures.--Replication capabilities of the above-mentioned HIV-1 isolates in human peripheral blood mononuclear cells (PBMCs), human macrophages, and various T-cell lines and the susceptibilities of the viruses to neutralization or enhancement by anti-HIV-1 antibodies in autologous serum samples from mothers and infants. Setting.--San Francisco Bay Area, California. Participants.--A cohort of 52 HIV-1-infected women and their infants in a prospective study on perinatal HIV transmission by the Bay Area Perinatal AIDS Center. Results.--The viral isolates from the transmitting mothers and their infants differed from the isolates from the nontransmitting mothers in their efficient replication in human PBMCs and in their ability to infect one or more human T-lymphocytic cell lines. All the HIV-1 isolates were able to infect human macrophages with only low-level replication and were unable to form syncytia in the MT-2-lymphocytic cells. No correlation between transmission and reactivity of maternal serum samples to the peptide corresponding to the principal neutralization domain of the third hypervariable region of the viral envelope was observed. However, the majority (9/12) of maternal isolates from the nontransmitters were neutralized by their autologous serum samples compared with only two among six in the transmitter group (P

The rate of transmission of the HIV-1 virus from mother to child appears to be much greater than the rate of transmission of the HIV-2 virus. Over 18,000 women who gave birth between 1990 and 1992 in Abidjan, Ivory Coast, were tested for HIV infection. The rate of HIV-1 infection was 9.4% in pregnant women, and the rate of HIV-2 infection was 1.6%. An additional 1.0% were infected with both viruses. The rate of transmission of the HIV-1 virus from mother to child was 24.7%, while the rate for HIV-2 infection was 1.2%. Children of mothers who were infected with both viruses had a 19.0% rate of infection, and all but one of the children were reactive only to the HIV-1 virus. The mortality rate of children born to HIV-1 infected mothers was 15.1%. Corresponding rates for those born to dually infected mothers, HIV-2 infected mothers and uninfected mothers were 13.0%, 6.5% and 3.4%, respectively. HIV-1 infection appears to be more communicable and fatal than HIV-2.

Objectives, Circumstances of delivery among children with acquired immunodeficiency syndrome (AIDS) were investigated to assess whether they were consistent with predictions that intrapartum factors affect the risk of maternal-infant human immunodeficiency virus (HIV) transmission. Methods. Pediatric AIDS patients (maternal-infant transmission; n = 632) reported to the New York City Health Department through 1991 were compared with a series of infants born to predominantly uninfected women. For each case patient, five control subjects were selected and matched from birth certificate files. Hypothesized case-control comparisons for mode of delivery and preselected complications were tested. Results. Compared with control subjects. case patients were less likely to have been delivered by cesarean section without complications (odds ratio [OR] = 0.77; 95% confidence interval [CI] = 0.59, 1.01) and more likely to have been delivered with complications, whether delivery was by cesarean section (OR = 1.54; 95% CI = 0.98, 2.43) or vaginal (OR 1.66; 95% CI = 1. 15, 2.39). Conclusions. Assuming that HIV-infected and uninfected women have comparable circumstances of delivery. conditional on sociomedical characteristics, these results suggest that intrapartum events may be associated with maternal-infant HIV transmission. (Am J Public Health. 1994;84:1110-1115), HIV-positive children born to HIV-positive mothers appear more likely to have had complicated deliveries than children born to HIV-negative mothers and this may increase their risk of contracting the virus. The medical records of 632 children diagnosed with AIDS as a result of maternal-infant transmission were reviewed and compared with the records of 3,160 children born to HIV-negative mothers. Almost 18% of the HIV-positive children were delivered by cesarean section compared with 19.3% of the children born to HIV-negative mothers. However, only 13.3% of the cesarean sections on HIV-positive mothers were uncomplicated compared with 16.2% of those on HIV-negative mothers. HIV-positive children were significantly more likely to have experienced birth complications, whether delivered vaginally or by cesarean section, than the children born to HIV-negative mothers. Prolonged exposure to maternal blood or body fluids during birth may play a role in mother-to-infant HIV transmission.

Zidovudine appears to greatly reduce the rate of maternal-fetal HIV-1 transmission. Twenty-six out of 63 HIV-positive pregnant women tookzidovudine during pregnancy or delivery. Thirteen of the 68 children born were infected with HIV. Fetal exposure to maternal bleeding and the occurrence of immune complex dissociated p24 antigen both increased the likelihood of HIV transmission. The rate of maternal-fetal transmission in the 26 mothers treated with zidovudine was 4%. The rate of transmission in mothers not treated with zidovudine was 29%. Zidovudine was effective in reducing transmission even in women with lowered CD4 cell counts. Multiple events during pregnancy or delivery can increase the risk of maternal-fetal transmission of HIV. Zidovudine appears to minimize such risks and cut down the need for prolonged treatment of newborns., Objective. - To assess maternal risk factors potentially influencing vertical transmission of human immunodeficiency virus, type 1 (HIV-1), including maternal CD4 cell count; presence of immune complex dissociated (ICD) p24 antigen; maternal zidovudine therapy during pregnancy and/or delivery; complications of pregnancy, such as preterm labor and birth; and obstetric events during labor and delivery, such as duration of labor, mode of delivery, chorioamnionitis, and maternal blood exposure. Design and Setting. - A nonrandomized prospective cohort study at a university medical center and two general hospital affiliates. Patients. - Sixty-three HIV-1-seropositive pregnant women and their 68 infants. Intervention. - Twenty-six mothers received zidovudine therapy during pregnancy and/or during labor and delivery. Main Outcome Measure. - HIV-1 infection status of the infant. Results. - Thirteen of the 68 infants were vertically infected with HIV-1. Mothers with events involving fetal exposure to maternal blood were more likely to transmit infection (four [31%] of 13 vs three [5%] of 55, P=.02), as were women with plasma ICD p24 antigenemia at delivery (six [67%] of nine vs 11 [25%] of 44, P=.02). Zidovudine treatment was associated with a significant reduction in vertical transmission (one [4%] of 26 mothers treated with zidovudine vs 12 [29%] of 42 mothers not treated with zidovudine, P=.01). There was a significant protective effect of zidovudine treatment despite lower mean absolute CD4 cell counts (0.37x[10.sup.9]/L) in the 24 zidovudine-treated nontransmitters and in the nine non-zidovudine-treated transmitters (0.37x[10.sup.9]/L) than in the 24 non-zidovudine-treated nontransmitters (0.62x[10.sup.9/L) (P=.008). Conclusion. - Maternal-fetal HIV-1 transmission is multifactorial, with increased risk associated both with ICD p24 antigenemia at term and with intrapartum events that increase fetal exposure to maternal blood. Zidovudine therapy given during pregnancy and/or labor and delivery was associated with a significant reduction in vertical transmission. These data suggest that the beneficial effects of zidovudine therapy in reducing maternal-fetal HIV-1 transmission recently found in protocol 076 of the placebo-controlled Acquired immunodeficiency Syndrome Clinical Trials Group Study may extend to women with lower CD4 cell counts and suggest that prolonged treatment of infants may not be necessary. (JAMA. 1994;271:1925:1930)