Frequent detection of HIV-1 in the gastric aspirates of neonates born to HIV-infected mothers

Objective: To evaluate the frequency and correlates of oral route exposure of infants born to HIV-1-infected women. Methods: A multicenter study was performed within the prospective French Pe rinatal Cohort Study of mother-to-child HIV transmission. Oropharyngeal and gastric aspirates from 122 neonates were studied by reverse transcriptase (RT) polymerase chain reaction (PCR) for the presence of HIV-1, as well as for standard microbiology (Gram staining and culture). Results: Aspirates from 101 neonates were analyzed by RT-PCR; 28% of these were positive for HIV RNA. Another 21 aspirates could not be tested because of PCR inhibition. The median concentration of HIV RNA in the positive asp irates was 126 copies/ml (range: 8-1270). Detection of HIV-1 in the aspirat e was significantly related to high maternal plasma viral load, presence of blood in the aspirate, positive Gram stain or culture, episiotomy or perin eal lesions, and sexually transmitted infections during the pregnancy. Most of the mothers received zidovudine prophylaxis during pregnancy and delive ry. Among the six infants who were infected with HIV, three had positive as pirates. Of the three assumed to have acquired the infection intrapartum, o nly one had an HIV RNA-positive aspirate. Conclusion: Exposure of the fetus to HIV via the oral route occurs Frequent ly, even in the presence of zidovudine prophylaxis, and is likely to be one of the mechanisms of intrapartum transmission, but not the only one, (C) 1 999 Lippincott Williams & Wilkins.