RAPID INCREASES IN LOAD OF HUMAN-IMMUNODEFICIENCY-VIRUS CORRELATE WITH EARLY DISEASE PROGRESSION AND LOSS OF CD4 CELLS IN VERTICALLY INFECTED INFANTS

The relationship between viral burden, timing of transmission, and cli nical progression was investigated in 110 children at risk for vertica l human immunodeficiency virus (HIV) infection using quantitative poly merase chain reaction, coculture, and immune complex-dissociated p24 a ntigen assay. In a cross-sectional study, the mean HIV DNA copy number in 19 symptomatic children was significantly higher than in 31 infect ed, asymptomatic children (420 +/- 125 vs. 87 +/- 78; P < .0001). In a second group of 8 vertically infected infants followed prospectively from birth, 4 defined as infected in utero showed a more rapid increas e in virus load, an accelerated loss of CD4 cells, and early progressi on to symptomatic disease (3-12 weeks) compared with 4 children with l ate in utero or intrapartum transmission (10-31 months). These data su ggest that a direct relationship exists between HIV replication, the t iming of transmission, and onset and progression of HIV disease in ver tically infected children.