Natural history and serologic diagnosis of infants born to human immunodeficiency virus-infected women
J. P. Johnson, P. Nair, S. E. Hines, S. W. Seiden, L. Alger, D. R. Revie, K. M. O'Neil and R. Hebel
Department of Pediatrics, University of Maryland School of Medicine, Baltimore 21201.
Perinatal transmission of human immunodeficiency virus is thought to occur
in 25% to 50% of the offspring of infected women. Standard diagnostic
methods do not permit identification of the infected newborns. To assess
diagnostic methods and document the natural history of perinatal human
immunodeficiency virus infection, 20 children born to human
immunodeficiency virus-infected women were followed prospectively for 18
months by measuring antibody titer, Western blot profiles, and antigenemia,
and the results were compared with clinical outcome. Endogenous synthesis
of anti-human immunodeficiency virus IgG was demonstrated in 6 of the 8
infected children. Four children synthesized IgM against human
immunodeficiency virus. Five had demonstrable p24 antigenemia. No
significant differences between infected and noninfected children were
noted at birth except drug withdrawal, which occurred more frequently in
noninfected infants. The incidence of adenopathy, hepatomegaly, and
neurologic and immunologic abnormalities in the infected children were
compared with noninfected children. The distinguishing illnesses were the
opportunistic infections, lobar pneumonia, and failure to thrive. Seven of
the 8 infected children had human immunodeficiency virus-mediated disease
by 1 year of age (Centers for Disease Control [Atlanta, Ga] P2
classification), and four had acquired immunodeficiency syndrome (Centers
for Disease Control P2D). These studies offer an approach to diagnosis of
human immunodeficiency virus infection in infants and document the natural
history and possible outcomes of infected children.
