The natural history of human immunodeficiency virus 1 infection in Haitianinfants

Objectives, The current study followed HIV-infected women through pregnancy and their infants through the first 2 years of life to determine the rate of vertical transmission of HIV infection from Haitian women, factors in ma ternal health and obstetrical history that might influence such transmissio n and the natural history of HIV infection in their affected offspring. Study design. The medical histories of 81 infants born of HIV-infected wome n and of a control group of 88 infants born to uninfected women were docume nted with close clinical and serologic follow-up. In addition to standard t ests for persistence of HIV antibodies, the use of acid-dissociated p24 ass ays enabled us to assign some additional infants to the HIV-infected cohort hort. Results. Transmission could be documented in 27% of infants born to HIV-inf ected women. Excess early deaths occurred in infants of HIV-infected women in Port-au-Prince with 60% of infected infants dead by 6 months of age. Thi s is a more accelerated mortality than that in a group of 42 HIV-infected i nfants born of Haitian mothers living in Miami where 10% were dead at 6 mon ths. Clinically, in 6 of 19 deaths in HIV-infected children in Haiti, failu re to thrive and gastroenteritis lead to a systemic infection manifested as meningitis, sepsis or pneumonia as the immediate cause of death. Conclusions. Early mortality attributable to perinatally acquired AIDS was identified in Haiti. The comparison of data from Miami and Port-au-Prince s uggests that environmental exposures in developing countries may be more op erative in this early mortality than viral strain or maternal host factors, both of which might be expected to be similar between the two groups of Ha itian ethnicity.