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Estimating the rate of mother-to-child transmission of HIV. Report of a workshop on methodological issues, Ghent (Belgium), 17-20 February 1992.
AIDS. 1993 Aug; 7(8):1139-48.A meeting was held in 1992 in Ghent, Belgium, under the auspices of the European Economic Community AIDS Task Force in collaboration with the WHO Global program on AIDS and UNICEF. THe objective were: 1) to address methodological issues in the estimation of the rate of mother-to-child (MTCT) transmission of HIV-1, with special reference to developing countries, and 2) to present a critical evaluation of selected perinatal studies using a standardized methodological approach. The discussions and recommendations made during the workshop are summarized. In the previous 8 years, numerous studies had been conducted to estimate the rate of MTCT of HIV. Many of these had encountered problems in data collection and analysis, making it difficult to compare transmission rates between studies. 14 teams of investigators participated, representing studies from central (5) and eastern Africa (3), Europe (2), Haiti (1), and the US (3). A critical evaluation of the projects was carried out under 4 headings: 1) enrollment and follow-up procedures, 2) diagnostic criteria and case definitions, 3) measurement and comparison of MTCT rats, and 4) determinants of transmission. The different estimations of the rate of HIV MTCT reported ranged from 13-32% in industrialized countries and from 26-48% in developing countries. For the purpose of calculating the rate of HIV MTCT, it is important to establish whether a child who dies before 15 months is HIV-infected. 3 definitions were proposed for children who died before their infection status could be determined by serology. Factors identified as possible risk factors for HIV MTCT included impaired maternal clinical and immunological status, HIV-seroconversion during pregnancy, shortened duration of pregnancy, choriamnionitis, vaginal delivery, prolonged and/or complicated labor, and breast-feeding. Maternal age and parity did not appear to be associated with MTCT in most studies.