“A recent report by the AIDS Law Project lists 42 children with HIV infections whose mothers are HIV-negative.”

“Overall, 966 boys and 998 girls were enrolled [in this study in Malawi]. The rate of HIV transmission at birth was 9.5% (187 of 1964 infants). However, at birth significantly more girls (12.6%) than boys (6.3%) were infected with HIV. This association remained significant after controlling for maternal viral load and other factors.”

“We implemented the nevirapine regimen in a real-life situation in Kenya. The perinatal HIV-1 transmission rate at 14 weeks was 18.1%, similar to the 21.7% before the intervention.”

“In 61 (1.1%) of 5593 child-mother pairs, the child was HIV-positive with an HIV-negative mother; only three of these 61 children had been transfused”

“Dr Mark Cotton, a paediatrician at Tygerberg Hospital [in South Africa] and senior author of the study, said the children, who were studied between 1997 and 2003, might be the tip of an iceberg. ‘The fact that we often come into contact with children who contracted the virus in inexplicable ways is something that should be studied by epidemiologists urgently,’ he said…in the latest research, the mothers of all 14 children were HIV-negative. The possibility of contaminated blood was excluded in the case of children who had received blood transfusions. As far as researchers could establish, the children were not breastfed by surrogate mothers nor were they sexually abused. What the study did establish was that 12 of the 14 were given intravenous draining lines or medicine in hospitals before diagnosis. [which doesn’t explain how the other 2 children became HIV-positive, assuming that HIV antibodies are reflective of a transmissible infectious agent]”

“In 9 studies, the proportion of paediatric patients with HIV infections ranged from one to three times the proportion of HIV-infected women in antenatal settings within the same communities. This is considerably higher than HIV prevalence among children from vertical transmission, which is estimated above to be less than one-sixth the HIV prevalence in antenatal women. In the DRC [Democratic Republic of the Congo], for example, 11% of a sample of paediatric inpatients aged 2 - 14 years were HIV-positive during 1984/85 compared with 5.9% of antenatal women. Similarly, in a hospital in Durban in 1998, 62.5% of paediatric inpatients were HIV-infected compared with 19.2% of urban antenatal women nationally…From 1984 through early 2003, at least 312 African children with non-vertically transmitted HIV infection have been reported in medical articles, conference abstracts, and other publications. Several of these publications reported results from case control studies showing that HIV-positive children with HIV-negative mothers had more and/or more frequent medical injections than HIV-negative children with HIV-negative mothers. In a study in South Africa, most infected children with HIV-negative mothers had been hospitalised and had had an intravenous line. Although 124 (40%) of 312 children with anomalous HIV infections were reported to have received blood or blood products, few studies traced donors to confirm epidemiological linkage. In addition to iatrogenic exposures, several other explanations have been supposed and/or demonstrated to account for non-vertical paediatric infections including transmission by an HIV-infected wet nurse, accidental switching of babies at birth, sexual abuse, and precocious sexual activity. Considering the low efficiency of HIV transmission through sexual exposure — even for child rape — sexual abuse and premature sexual activity cannot explain more than exceptional cases; similarly, infected wet nurses and the switching of babies are unlikely to account for more than rare cases. In many studies, more than 10% of HIV-infected children had HIV-negative mothers, suggesting that non-vertical infections are common in many communities; hence, iatrogenic transmission [i.e. dirty needles] would seem to be the best explanation for most cases.”

“[Table 2 shows that AZT was associated with a risk of HIV infection of 25.8% at 18 months after birth (the other treatment arm, Nevirapine, was associated with a 15.7% risk). Yet other studies showed a risk of HIV infection of about 25% with placebo, and a much lower risk with AZT. Without a placebo in this study, is AZT ineffective, was the previous result a fluke, or would placebo have been associated with a much higher risk or, perhaps even a lower risk?]”

“Two small subanalyses of data from [a South African] study shed further light on a liberal upper limit of what proportion of children’s HIV infections might be due to mother-to-child transmission. In the first, it was found that among whites in this sample, children had an HIV prevalence of 11%, but the adult prevalence was only 5.7%…The second subanalysis involved 20 seropositive children (aged 2-11) matchable to a biological parent with a known HIV test result. Only 5 of these children had an HIV positive parent, implying that three-quarters of infections come from a source other than their mothers. [These] data are consistent with other African reports of seropositive children of seronegative mothers…only 1.4% of 12-14 year olds in the HSRC sample reported being sexually experienced. Even assuming underreporting of sexual experience, the amount of sexual activity needed to produce these prevalences would need to be enormous given the inefficiency of HIV transmission even in child rape (less than 1% seroconversion in South African studies), and unlikely to be overlooked by pediatricians. Furthermore, the recent large multicenter study in four African cities found that sexual behavior and lack of condom use did not differentiate cities with high, from cities with low, HIV prevalence, and thereby offering little support for the hypothesis of significant heterosexual HIV transmission across Africa [the authors blame the transmission on child-to-child transmission, e.g. by re-used needles, but they do not consider non-infectious explanations for positive HIV tests]”

“Multivitamins had no effect on the overall risk of transmission of HIV-1 [actually a non-statistically-significant 4% increase]. Total child mortality by 24 months of age, including fetal deaths was [about 20%] lower [and a non-significant 10% decrease in mortality after birth]…Children born to women with low maternal lymphocyte counts and low plasma Vitamin E levels at baseline had better chances of survival up to 24 months if the mothers received multivitamins…Multivitamins were associated with a reduction in mortality among children who were HIV negative at birth but not among children who were HIV infected at birth [actually a 10% reduction was observed in mortality, but it was not statistically significant]…Antioxidant vitamin status may be associated with a reduced risk of mastitis, an inflammation of breast tissues that is associated with a higher viral load in breast milk and a greater risk of vertical transmission. The provision of multivitamins (including B vitamins, and vitamins C and E) to mothers in our study population may also have resulted in improved milk quality, including the concentrations of micronutrients and immunological properties. Improved micronutrient intake by babies may enhance their developing immune system, and hence reduce their risk of morbidity and mortality.”

“The maintenance of seronegativity despite exposure to HIV has been observed in sexual partners of HIV infected persons [7 references given], infants born to HIV-infected mothers [3 references], commercial sex workers [4 references] and health care workers occupationally exposed to HIV-contaminated body fluids [2 references]”

“At 24 months, overall CR [cumulative risk] of MTCT [Mother-to-child transmission of HIV] were 22.5% in the zidovudine [AZT] and 30.2% in the placebo group...Among children born to women with CD4 cell counts <500/ml at enrollment, CR of MTCT were similar, 39.6% in the zidovudine and 41.3% in the placebo group. Among children born to women with CD4 cell counts >= 500/ml, CR of MTCT were 9.1% in the zidovudine and 22% in the placebo group”

“The estimated detection rate of HIV-1 at birth was slightly higher among the 90 children born by cesarean section delivery (40%) than among the 332 children delivered vaginally (35%), although this difference was not statistically significant [although it is usually stated that vaginal delivery makes infection more likely]...Neither the use of maternal nor neonatal antiretroviral therapy was associated with the detection rate of HIV-1 at birth [yet antiretroviral therapy is supposed to reduce the likelihood of infection]”

“In this report, infants were classified as HIV-infected if they had at least one positive PCR test at age >= 4 weeks, and as HIV-uninfected if they had no positive PCR tests with at least one negative PCR at age >= 4 weeks [with no word on how ‘indeterminate’ infants were treated]”

“Infants were defined as not infected if in at least two separate blood samples there was no evidence for HIV according to qualitative and quantitative polymerase chain reaction (Reverse-transcription PCR, Amplicor Monitor, Roche Diagnostic Systems, Branchburg, New Jersey, USA) and nucleic acid sequence-based amplification (NASBA) of plasma (Organon Technika), and in the absence of HlV-related symptoms. Infants were classified as definitively HIV negative if they became antibody negative [26].”

“Maternal plasma HIV-1 RNA level [‘viral load’]…was not associated with perinatal transmission [in this group of women with moderately advanced HIV-1 infection and ZDV/AZT drug resistance]”

“Of these 24 women, 7 transmitted HIV-1 to their infants and 17 did not [yet, these women were provided with antiviral therapy that is supposed to reduce transmission from about 25% to about 8%!]”

“Presence of HIV-infection was assessed in 158 children [of HIV-positive mothers]…Overall, 19 children were diagnosed as HIV-infected [12%, even though there was no access to antiretroviral therapy or other interventions]”

“One puzzling finding in our study was the trend toward a decline in the mother-to-child transmission rate 2 years before zidovudine prevention was introduced. None of the numerous variables recorded explains this gradual decline, which was unaffected by the mode of delivery [vaginal or cesarean] and which zidovudine [AZT] prophylaxis considerably amplified”

“In our cohort, no relation has been observed between the mode of delivery [vaginal/cesarean] and transmission rate”

“During the past two decades, more than 15 000 HIV-infected infants were born in the United States, and approximately 7000 of these children have developed AIDS”

“Current laboratory techniques cannot distinguish the mode of vertical transmission (intrauterine, intrapartum, or postnatal) of human immunodeficiency virus type 1 (HIV-1) from mother to infant. The ability to transmit HIV-1 via breast feeding has been established in 24 case reports, primarily involving mothers who seroconvert after delivery. Whether breast-feeding adds a notable additional risk of HIV-1 infection to the risk from pregnancy is controversial...The Centers for Disease Control and Prevention was the first to state a position against breast-feeding by women with HIV infection. Policy was formulated for the United States on the basis of a case report of breast-milk transmission after a postpartum transfusion from an HIV-infected donor and data reported in a letter to the editor.”

“Our study shows that vitamin A deficiency is common among pregnant women who are infected with HIV in Africa and that deficiency is strongly associated with increased mother-to-child transmission of HIV...Vitamin A deficiency was associated with a 3-to-4-fold increased risk of mother-to-child transmission of HIV.”

“We attempted to detect, by means of an immunohisochemical method, HIV proteins in frozen placentas from 75 HIV-1-positive women (30 at term, 45 induced abortions). In addition, in situ hybridization using HIV-specific probes was performed in three cases. Neither HIV proteins nor nucleic acid sequences were detected.”

“Both vaginal delivery and breast-feeding have been proposed as risk factors for HIV-1–infected infants. In this study a relationship between route of delivery and the infection status of the infants was not found. Other investigators have also reported the absence of a correlation between these factors.”

“Until 1985, the majority of mothers of children with AIDS seen in our clinic acquired their HIV infection through intravenous drug abuse and/or promiscuity. At present being a sexual partner of a male at risk for AIDS is the only risk factor in a large percentage of mothers of our paediatric AIDS patients [and if this men are IV drug users, it's quite likely that the women are non-IV drug users, e.g. of crack cocaine]”

“We have studied 27 children aged 1 day to 42 months and at risk for acquired immunodeficiency syndrome (AIDS). Except 1 who had been transfused, all had drug-addict mothers”