The effect of HIV-1 infection during pregnancy and the perinatal period on maternal and child health in Africa.
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In 1989 the Global Program on AIDS (GPA) of the World Health Organization estimated that there were 2.5 million women and half a million children infected with HIV-1 in Africa. A study carried out in two maternities in Kinshasa, Zaire, in 1988 showed higher mortality rates in previously born children of seropositive mothers compared with children of seronegative mothers (43% vs. 32%, p 0.01). A case control study in Nairobi of patients admitted with an acute spontaneous abortion indicated that HIV-1 infection was significantly associated with spontaneous abortion (13.8% vs. 6.2%. p = 0.02). In another study from Nairobi the mean birth weight of infants born to seropositive mothers was slightly but significantly lower than the birth weight of infants with seronegative mothers (3090 vs. 3220 g, p = 0.005). In the Kinshasa study more infants born to HIV-1 seropositive mothers with symptomatic infection were delivered before 38 weeks of gestation compared with neonates of HIV-positive asymptomatic or seronegative women (18%, 12%, and 3%, respectively, p 0.01). In the Nairobi study abnormalities were noted in 115 stillborn neonates, and maternal HIV-1 infection (odds ratio of 2.7) was a contributory factor. Among the 68 live-born infants with HIV-1 seropositive mothers in the Kinshasa study, there were 29 (6.2%) neonatal deaths compared with 8 (1.3%) among infants of seronegative women (p 0.0001). In addition, chorioamnionitis was found significantly more often in the placentas of infants of HIV-1 seropositive mothers with AIDS than among placentas of infants born to asymptomatic seropositive women or seronegative controls (21.4% vs. 1.0% and 2.9%, respectively, p 0.01). In another Nairobi study in 1990 a single session of counseling of HIV-1 seropositive women did not seem to influence their subsequent condom use or reproductive behavior. Pregnancy seemed to accelerate the progression of the disease because of its immunosuppressive effect. The diagnosis of perinatal HIV infection has been difficult and the use of the polymerase chain reaction method has been the most sensitive test.