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KMID : 0377619980630020193
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Korean Jungang Medical Journal
1998 Volume.63 No. 2 p.193 ~ p.204
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Issues in Perinatal HIV Infection in Nursing Perspectives
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Young Sook Suh
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Abstract
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The estimated rates, risk factors, and some of perinatal prevention strategies of recent
issues on mother-to-child transmission of human immunodeficiency virus(HIV) are
reviewed. The transmission rate from a study of European cohorts(14%) to that from
the study of Central African population(40.4%), risk factors from a high maternal HIV-
ⅠRNA level at delivery in a study of 1997 to breast feeding, a study of 1992, and
prevention strategies from an antiretroviral(zidovudine) trial to chlorhexidine vaginal
lavage at delivery are summarized.
To be familiar with the experiences in the area with high Prevalence of the disease,
earlier issues in HIV infection related to pregnancy and childbirth in the United States
in 1980s in terms of risks involving perinatal HIV transmission, antibody testing and its
legal implications are discussed in nursing perspectives.
Introduction
Social attitudes and scientific pronouncements have influenced greatly each other since
the identification of cases with acquired immunodeficiency syndrome(AIDS) Related
Complex in 1981 in New York and California among young healthy homosexual men in
the United States.
As denoted in the name of the virus, human T Iymphotropic virus(HTLV) previously
called, human impunodeficiency virus which causes AIDS is a retrovirus that has a
marked preference for the helper-inducer sub-set of Iymphocytes. HIV displays an
affinity for these Iymphocytes because the CD4(T4) surface marker protein on these
cells serves as a receptor site for the virus(Time,1986 Nov.).
In the past, acquisition of AIDS in children were usually related to the receipt of
unscreened blood or blood product or from the mother being infected with HIV during
pregnancy. To date, the incidence of perinatally acquired HIV infection in most children
is likefy to increase associated with an increase in the cases of heterosexual HIV
infection. As more women of childbearing age have become infected, the incidence in
children also increases worldwide. As of 1994, it is estimated that about 12 thousand
children in the United States are HIV indicted(Davis, et al., 1995) and almost all HIV
infection among infects and young children are from mother-to-infant
transmission(Newell In Peckham, 1993).
Perinatal HIV transmission has been documented to occur prenatally, during labor and
delivery, and after birth through breastfeeding(Stiehm, 1996), but the relative contribution
of each of these routes remains unclear with the estimates of vertical transmission rate
ranging from 14% to Bo%, showing the lowest rate in the European study and the
highest, in the African study (WHO, 1995 , Lallemant, et at.,1994).
Maternal, immunological, and verological factors have been implicated in transmission,
however, association delineated from many studies are varied from a high matemal viral
RNA load in plasma at delivery to a low level of prenatal vitamin A(Coll, et at., 1997;
Semba, et at., 1994). So far, relationship il not yet well defined.
In Efforts of preventing adolescent pregnancy, exposure to HIV, and other sexually
transmitted diseases (STDs), some researchers suggest that approaches like school
health education on AIDS are in need of implementation in Korea(Ahn, et al., 1997).
Based on a report from the Korean AIDS prevention Association at the end of January
1996, the group fo HIV infected cases, especially in the group of childbearing age from
20 to 29(166, male ; 23, female) are considerably high, revealing 23 out of 527 total
number of infected cases. And the age of those who are first infected to HIV is on the
downward trend(age group of 10-19 ; 18, male ; 2, female)(Sung, 1996).
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KEYWORD
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