HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION IN INFANTS DURING THE 1ST 2 MONTHS OF LIFE - RELIABLE DETECTION AND EVIDENCE OF IN-UTERO TRANSMISSION

Objective: To evaluate the clinical utility of a polymerase chain reac tion (PCR) method for detecting human immunodeficiency virus (HIV) inf ection in infants 2 months of age or younger who were born to HIV-posi tive mothers. Design: Prospective, longitudinal study lasting 3 years. The PCR tests were performed with coded peripheral blood mononuclear cell lysates, and results were compared with findings using Centers fo r Disease Control and Prevention (CDC) (Atlanta, Ga) criteria defining HIV infection in children. Setting: Hospitals, particularly a pediatr ic hospital in Washington, DC. Patients: Newborns, young infants, and HIV-infected mothers. Outcome Measure: Presence or absence of pediatri c HIV infection using CDC criteria compared with a diagnosis based on the detected presence or absence of HIV proviral DNA using PCR testing . Results: One or more blood samples obtained by 62 days of age from 3 0 (94%) of 32 HIV-infected infants were positive for HIV by routine PC R testing. Blood samples from 32 infants now confirmed to be uninfecte d tested negative for HIV. Human immunodeficiency virus DNA was detect ed in blood samples obtained within 48 hours of birth from eight of ni ne infected infants. In six of these newborns as well as most older in fants, HIV DNA was present in such quantity that it was detectable in specimens equivalent to 0.01 mL or less of the original blood sample. Conclusions: Our PCR procedure can reliably detect the presence or abs ence of HIV infection during the first 2 months of life. The frequent presence and not uncommon high titer of HIV DNA within 48 hours of bir th suggest that much of the transmission of HIV from mother to infant occurs well before birth.