Maternal clinical factors influencing HIV-1 transmission.

The complex puzzle of maternal factors involved in mother-to-child human immunodeficiency virus type 1 (HIV-1) transmission is being put together. The risk of perinatal infection increases with mother's disease progression, but it remains stable in women seroconverting to HIV-1 during pregnancy and in consecutive pregnancies. Thus, transmission correlates with the HIV-1 progression rather than the duration of infection in the mother. Nutritional alterations such as vitamin A deficiency may also have a significant impact, whereas geographic origin and mode of maternal infection are of no influence. Placenta membrane inflammation and concurrent sexually transmitted diseases are other significant covariates. The rate of transmission appears directly correlated with maternal age and inversely with length of gestation. A protective effect of caesarean section has been reported in some observational studies but, being controversial, these results need to be corroborated by randomized trials.