Broad spectrum of time of detection, primary symptoms and disease progression in infants with HIV-1 infection.
The relationship between time of HIV-1 detection, appearance of symptoms and disease progression was studied in all 24 HIV-1-infected infants from a cohort of 117 children who were born to HIV-1-infected mothers and monitored from birth. HIV isolation from plasma and mononuclear cells, HIV-1 DNA PCR (polymerase chain reaction) and, retrospectively, a quantitative assay for HIV-1 RNA were used for virus detection. Two infants possibly exhibited a symptomatic primary HIV infection. More children with than without symptoms during the first year of life progressed to immunological class 3 (P=0.013) and to AIDS or death (P=0.003) during follow-up. HIV-1 was detected within 4 days of age in 4 of 16 infants: 3 of them became symptomatic within 1 year, as did 6 of the remaining 12 infants (not statistically significant). All four infants in whom virus was detected within 4 days of age progressed to severe immunosuppression, compared to 6 of 14 in whom the virus detection test was initially negative prior to the first positive result (n.s.). Two children with previous repeatedly negative HIV detection tests were diagnosed with HIV-1 infection at 8 and 9 months, respectively. Repeated blood sampling is needed for the diagnosis of HIV-1 infection in perinatally exposed infants, and virus detection tests for exclusion of HIV-1 infection must be used with caution.
Navér
L
L
Department of Pediatrics, Huddinge University Hospital, Stockholm, Sweden. lars.naver@klinvet.ki.se
Ehrnst
A
A
Belfrage
E
E
Blomberg
J
J
Christensson
B
B
Forsgren
M
M
Lidin-Janson
G
G
Lindgren
S
S
Ljung
R
R
Sönnerborg
A
A
Bohlin
A B
AB
D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis*; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D016133:Polymerase Chain Reaction; D011247:Pregnancy; D011446:Prospective Studies; D012367:RNA, Viral / Q000032:analysis; D013997:Time Factors
D004279:DNA, Viral; D012367:RNA, Viral