HIV-1 SPECIFIC IMMUNOGLOBULIN-A ANTIBODIES AS AN EFFECTIVE MARKER OF PERINATAL INFECTION IN DEVELOPING-COUNTRIES

HIV-1 specific IgA antibody testing using commercially available reage nts was evaluated at birth to 15 months in a group of infants born to HIV-seropositive South African women. Following IgG depletion of serum samples, 33/35 (94 per cent) of the infected infants and 3/99 (3 per cent) of the uninfected infants showed positive IgA reactivity, Sensit ivity at birth was 24 per cent add improved with age; 82 per cent at 3 months, 87 per cent at 6 months and 94 per cent at 12 months. The ove rall positive and negative predictive values were 92 and 98 per cent, respectively, An evaluation of TEA and PCR in a subsample of infants i ndicated a better sensitivity of PCR within 3 months of birth, but IgA detection offered a higher overall sensitivity (87 v. 83 per cent) an d specificity (91 v. 85 per cent). No significant difference in IgA le vel was observed between transmitting mothers and non-transmitting mot hers, A moderate correlation existed between IgA level in the infant a nd the cumulative morbidity score, however a stronger association was observed between high IgA levels in the infected infant and rapid dise ase progression, The viral specific IgA assay is a simple, reliable an d cost-effective diagnostic and prognostic test for perinatal HIV infe ction in developing countries.