PHYTOHEMAGGLUTININ-INDUCIBLE P24 IN PERIPHERAL-BLOOD MONONUCLEAR-CELLS AS A PREDICTOR OF HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1 VERTICAL TRANSMISSION AND INFANT CLINICAL STATUS

We sought to determine whether the detect-ability of phytohemagglutini n-inducible p24 (PHA-p24) in short term cultures of peripheral blood m ononuclear cells correlates with an increased risk of vertical transmi ssion among human immunodeficiency virus type 1 (HIV-1)-infected pregn ant women and more severe symptomatology among HIV-1-infected infants. The assay for PHA-p24 was performed on specimens obtained from HIV-1- infected women during their pregnancy and from infants during the firs t 6 months of life. Infants were followed prospectively to determine H IV-1 infection outcome and symptomatology. Among PHA-p24 positive wome n 9 of 19 (47.4%) gave birth to HIV-1-infected infants compared with 4 of 25 (16.0%) of PHA-p24-negative women (P = 0.02). Among women who t ested PHA-p24-positive and had a CD4(+) lymphocyte count <500 cells/mm (3), 8 of 15 (53.3%) gave birth to HIV-1-infected infants compared wit h 4 of 26 (15.4%) not meeting these conditions (P = 0.01). Among HIV-1 -infected infants 4 of 5 (80%) of those testing PHA-p24 positive by on e month of age developed an opportunistic infection or encephalopathy by 12 months of age, compared with none of the 11 infants testing PHA- p24-negative (P = 0.003). We conclude that PHA-p24 may be a useful in vitro measure for increased risk of vertical transmission among HIV-1- infected pregnant women and increased risk for rapid development of se vere disease among HIV-1-infected infants.