LONGITUDINAL-STUDIES OF CHILDREN BORN TO HIV-1 ANTIBODY-POSITIVE FILIPINO COMMERCIAL SEX WORKERS (CSW) - DIAGNOSTIC DILEMMAS

Fifteen term babies born to 12 HIV-1 antibody positive Filipino CSW ha ve been monitored for signs and symptoms of HIV-1 infection. Eleven ba bies were enrolled in the study within the first 6 months after birth; 4 others were enrolled at 4, 9, 11 and 21 months of age respectively. Every 3 months after enrolment, each baby received a physical examina tion, serum was tested for HIV-1 antibodies and p24 antigen and periph eral blood mononuclear cells were cultured for isolation of virus. Aft er a mean follow-up period of 39.3 months (range 7-72 months), virus i solation and serum p24 antigen assays confirmed that 2 babies have bee n infected with HIV-1. If the 4 babies less than 18 months of age were excluded, the vertical transmission rate was 18.2%. Seven babies who have been monitored for a minimum of 25 months (range 31-60 months) lo st their maternal antibodies but 6 of them subsequently developed inde terminant Western blots (WB); reactivity to p24 and/or gp120/160 but n o reactivity to gp41. Of the remaining 6 babies, still less than 25 mo nths of age (range 7-24 months), 2 lost their maternal antibodies with in one year. The other 4 continued to recognize either p24 or gp120/16 0 well after the accepted 15-month period for loss of maternal antibod y. Although a diagnosis could not be established upon the basis of the se laboratory findings, clinical observations (failure to thrive, aner gy, persistent generalized lymphadenopathy and recurrent pneumonias) m imicked HIV-1 infection. However, because these clinical features are common among many babies in the developing world.