Prognostic significance of immunologic changes in 675 infants perinatally exposed to human immunodeficiency virus. The Italian Register for Human Immunodeficiency Virus Infection in Children.
Neutrophil, lymphocyte, and T-cell subset numbers and immunoglobulin levels were evaluated at birth to age 2 years in 675 children born to mothers infected with the human immunodeficiency virus type 1 (58 infected symptom-free subjects (P-1), 203 infected subjects with symptoms (P-2), and 414 uninfected subjects). The P-2 patients had (even at birth to age 1 month) lower CD4+ lymphocyte and higher IgA and IgM values than P-1 and uninfected children had. Increased IgG values (from 1 to 6 months of age) and increased CD8+ lymphocyte numbers (at 13 to 24 months of age) were also observed. The P-1 children differed from uninfected children only at 13 to 24 months of age (decreased CD4+ and increased CD8+ lymphocytes). Progressive immunologic changes were found in P-2 patients who had severe clinical conditions and in those who died. To evaluate the predictive meaning of the immunologic changes, we selected 164 children (25 P-2, 15 P-1, and 124 uninfected children) because they had been examined sequentially from birth and they were classified as in the indeterminate state of infection (P-0) at immunologic evaluations at birth to age 1 and at 1 to 6 months of age. During the 1- to 6-month period, P-2 patients had higher immunoglobulin and lower CD4+ lymphocyte values than P-1 and uninfected children had; no difference was found between P-1 and uninfected subjects. These results indicate that in infants with perinatal human immunodeficiency virus type 1 infection, immunologic abnormalities correlate with the clinical condition and are predictive of the clinical outcome rather than the infection status.
Department of Pediatrics, University of Florence, Italy.
M
M
de Martino
P A
PA
Tovo
L
L
Galli
C
C
Gabiano
S
S
Cozzani
C
C
Gotta
G
G
Scarlatti
A
A
Fiocchi
P
P
Cocchi
P
P
Marchisio
D015496:CD4-Positive T-Lymphocytes / Q000473:pathology; D002675:Child, Preschool; D005260:Female; D015483:HIV Antibodies / Q000032:analysis; D015658:HIV Infections / Q000276:immunology* / Q000473:pathology / Q000635:transmission; D006679:HIV Seropositivity / Q000276:immunology*; D015497:HIV-1 / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D007074:Immunoglobulin G / Q000032:analysis; D007075:Immunoglobulin M / Q000032:analysis; D007223:Infant; D007231:Infant, Newborn; D007558:Italy; D007958:Leukocyte Count; D008214:Lymphocytes / Q000473:pathology; D008297:Male; D008431:Maternal-Fetal Exchange; D009504:Neutrophils / Q000473:pathology; D011247:Pregnancy; D011379:Prognosis; D012042:Registries; D013602:T-Lymphocytes, Cytotoxic / Q000473:pathology; D006377:T-Lymphocytes, Helper-Inducer / Q000473:pathology
D015483:HIV Antibodies; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M