VIRAL STUDIES OF MOTHERS WITH HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION AT DELIVERY AND THEIR INFANTS IN THE FIRST 3 DAYS OF LIFE

Objective. We studied 49 mother-infant pairs for human immunodeficienc y virus (HIV) (a) to assess the virological and immunological status o f HIV-infected mothers at delivery and their infants within the first 3 days of the infant's life, and (b) to correlate these findings with eventual infection outcome in the infant. Method. Maternal blood from women in labor and infant's blood within 3 days of life were tested fo r the titer of HIV immunoglobulin G (IgG) antibody, for presence of HI V by culture, for p24 antigen, for HIV DNA by polymerase chain reactio n (PCR), and for absolute T-helper cell count (CD4). Results. Eight in fants were in the confirmed infected (CI) group, with a transmission r ate of 21%. Thirty infants were in the confirmed uninfected (CU) group . In the mother, mean anti-HIV IgG titer was 1:2600 (CI group) and 1:3 350 (CU group); in the infant, the mean titer was 1:3250 (CI group) an d 1:2710 (CU group). Eighty-seven percent of the mothers were culture- positive in the CI group compared to 33% in the CU group (p = 0.005). Eighty-seven percent of CI infants were PCR-positive at birth; none wa s PCR-positive in the CU group (sensitivity = 87%; specificity = 100%) . Sixty-two percent of CI infants were culture-positive at birth, wher eas none was positive in the CU group (sensitivity = 62%; specificity = 100%). Of the uninfected infants, 23% were positive for p24 antigen at birth. Conclusions. HIV IgG antibody titers in mothers and their in fants at birth were markedly elevated in both CI and CU groups but wer e not protective against infection. However, the high titers explain t he long duration of this antibody in the blood of infants born to infe cted mothers. Culture positivity in the mother at delivery correlated highly with eventual infection in the infant (p = 0.005). HIV antigen, specifically p24 antigen, was detectable in uninfected infants when t ested at birth.