Fetal transmission of AIDS through the mother's womb

The acquired immune deficiency syndrome (AIDS) was first described in adults in 1981. Since then, it has continued to spread rapidly among the groups known to be at risk. To facilitate uniform surveillence studies, a case definition has been proposed by the Centers for Disease Control (CDC) in Atlanta. According to this definition, AIDS is a syndrome occurring in previously healthy men or women under the age of 60 years who have evidence of cellular immunodeficiency and of unusual opportunistic infections. It soon became evident that this definition does not include all persons with morbidity suggestive of AIDS, specifically, those who do not have opportunistic infections. Disease in patients such as these was termed Pre-AIDS or AIDS-Related Complex (ARC). Patients with Pre-AIDS or ARC were defined by the CDC as previously healthy adults under the age of 60 years with generalized lymphadenopathy for more than three months, with or without oral thrush and immunologic abnormalities associated with AIDS. The relationship between AIDS and Pre-AIDS has not been clearly established to date. In some adults with ARC the disease prodome lasts for years with minor clinical symptomatology, without obvious disease progression. Conversely, in others, rapid deterioration with ensuing opportunistic infections occurs. AIDS in children was first recognized in 1982, and since then, the number of infants presenting with the disease has increased steeply. At the Albert Einstein College of Medicine, 78 children with AIDS are being treated. Nationwide, the number is estimated at 300 children. Because of its unique clinical and immunological features, the disease in infants was not immediately accepted by the scientific community as having any relationship to AIDS in adults. Most misleading was the observation that the majority of children with an AIDS-like syndrome did not have opportunistic infections and therefore did not fulfill the criteria of the CDC case definition for AIDS in adults. Consequently, the pediatric patients were initially labeled as having an AIDS-like syndrome or ARC. However, children with ARC exhibited increased morbidity and mortality compared to adults with ARC. With few exceptions, the infants disease was relentlessly progressive and often fatal, but without documented opportunistic infections. As a result, a new pediatric AIDS case definition has been proposed to include patients without opportunistic infections. These infants and children share all symptoms and immunologic aberrations, short of opportunistic infections, of classical AIDS cases. Recent serologic studies have confirmed that these infants have also been exposed to the human T-cell lymphotropic retrovirus (HTLV-III), the so-called AIDS-virus.