EARLY DIAGNOSIS AND IMMUNOLOGICAL CHANGES IN HIV-1-INFECTED PREGNANT-WOMEN AND THEIR CHILDREN

The diagnosis of HIV infection in pregnant women is usually based on t he detection of HIV-specific antibodies. These tests become positive a few weeks to months after infection. In the United States, it is reco mmended that tests be offered to all women and encouraged where the ra te of infection is greater than or equal to 1/1,000 or the woman is at increased risk for infection. The great majority of infected pregnant women are asymptomatic, and questioning patients about risk behavior will identify only about one-half of the infected women. In Washington , D.C. about 1.5% of the pregnant women who reside in the city are HIV positive. The diagnosis of HIV in the child in the first month of lif e is difficult and requires the use of polymerase chain reaction tests and/or culture. Other tests become positive later. Immunological test s in most HIV-infected mothers in the USA are normal; however, about 1 2% of patients are symptomatic and show decreased CD4 T cell counts an d 6% have AIDS. These patients may have other evidence of decreased T cell responses and are at increased risk for opportunistic infections. At birth, almost all children of HIV-infected mothers have normal imm unological findings. However, about 50 of these children become ill by 1 year of age and many develop decreased T cell counts and other immu nological changes.