Journal
JOURNAL OF INFECTIOUS DISEASES
Volume 210, Issue -, Pages S631-S640Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/infdis/jiu344
Keywords
breast milk; cell-associated virus; cell-free virus; genital secretions; HIV-1; infected leukocytes; mother-to-child transmission
Categories
Funding
- National Institutes of Health (NIH) [R01 AI076105]
- NIH [T32 AI083203]
- NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES [T32AI083203, R01AI076105] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES [T32GM007266] Funding Source: NIH RePORTER
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Mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) continues to contribute to the global burden of disease despite great advances in antiretroviral (ARV) treatment and prophylaxis. In this review, we discuss the proposed mechanisms of MTCT, evidence for cell-free and cell-associated transmission in different routes of MTCT, and the impact of ARVs on virus levels and transmission. Many population-based studies support a role for cell-associated virus in transmission and in vitro studies also provide some support for this mode of transmission. However, animal model studies provide proof-of-principle that cell-free virus can establish infection in infants, and studies of ARVs in HIV-infected pregnant women show a strong correlation with reduction in cell-free virus levels and protection. ARV treatment in MTCT potentially provides opportunities to better define the infectious form of virus, but these studies will require better tools to measure the infectious cell reservoir.
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