VIRAL LOAD AND DISEASE PROGRESSION IN INFANTS INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1

Background There are only limited data on human immunodeficiency virus type 1 (HIV-1) RNA in perinatally infected infants. Understanding the dynamics of HIV-1 infection and its relation to disease progression m ay help identify opportunities for effective antiviral treatment in in fected infants. Methods We obtained plasma samples from 106 HIV-infect ed infants at birth; at 1, 2, 4, 6, 9, 12, 15, and 18 months of age; a nd subsequently every 6 months. HIV-1 RNA was assayed by means of a re verse-transcription polymerase chain reaction. The infants were born b etween 1990 and 1993, and only 21 percent of the infants' mothers rece ived any treatment with zidovudine during pregnancy. Results Plasma HI V-1 RNA levels increased rapidly after birth, peaked at 1 to 2 months of age (median values at 1 and 2 months, 318,000 and 256,000 copies pe r milliliter, respectively), and then slowly declined to a median of 3 4,000 copies per milliliter at 24 months. Newborns with a first positi ve HIV-1 culture within 48 hours after birth had significantly higher HIV-1 RNA levels, although only during the first two months of life, t han those with a first positive culture seven or more days after birth . Infants with a rapid progression of disease had higher peak HIV-I RN A levels in the first two months of life than those without rapid prog ression (median value, 724,000 vs. 219,000 copies per milliliter; P=0. 006), as well as a higher geometric mean value during the first year o f life (median value, 330,000 vs. 158,000 copies per milliliter; P=0.0 01). Conclusions in perinatally infected infants, HIV-1 RNA levels are high and decline only slowly during the first two years of life. Infa nts with very high viral loads in the first months of life are at incr eased risk for a rapid progression of disease, which suggests that ear ly treatment with antiretroviral agents may be indicated for these inf ants. (C)1997, Massachusetts Medical Society.