Nutrition and HIV/AIDS: A Training Manual - Linkages Project

• A viral, bacterial, or parasitic placental infection in the mother duringpregnancy• HIV infection of the mother during pregnancy• Severe immune deficiency associated with advanced AIDS in the mother (WHO1999)• Malnutrition (Semba 1997)HIV transmission during labor and delivery (slides 9, 10)There is a 10 percent-20 percent risk of transmission of HIV during labor anddelivery. WHO/UNAIDS/UNICEF (1998) consider transmission to have occurredintrapartum if the results of the diagnostic tests were negative during the first 48hours after delivery but became positive in subsequent samples taken within 7-90days of delivery. During labor and delivery transmission most often occurs whenbabies suck, imbibe, or aspirate maternal blood or cervical secretions containingHIV. Higher risks of HIV transmission during labor and delivery are associated withduration of membrane rupture, acute chorioamnionitis resulting from untreatedsexually transmitted infections (STIs) or other infections, and invasive deliverytechniques that increase the baby’s contact with the mother’s blood (WHO 1999).HIV transmission during breastfeeding (slides 11, 12)There is a 10 percent-20 percent risk of transmission of HIV through breastfeeding.The time that HIV transmission occurs following birth is difficult to determineprecisely. The presence of maternal antibodies, combined with a period of timeduring which the infection is undetectable, makes it difficult to determine whetherinfection occurred during delivery or through breastfeeding. Late post-nataltransmission (after 3-6 months) can be estimated with the PCR test. A meta-analysisof five studies concluded that the best available estimate of the risk of breastmilktransmission is 14 percent (Dunn et al 1992). The risk of HIV transmission throughbreastfeeding can be calculated for a particular population with the followingformula: percentage of HIV-infected mothers at time of delivery multiplied by 14percent.189