T-helper cell responses to HIV envelope peptides in cord blood: protectionagainst intrapartum and breast-feeding transmission

Background: Acquired HIV-specific cell-mediated immune responses have been observed in exposed-uninfected individuals, and it has been inferred, but n ot demonstrated, that these responses constitute a part of natural protecti ve immunity to HIV. This inference was tested prospectively in the natural exposure setting of maternal-infant HIV transmission in a predominantly bre ast-fed population. Methods: Cord blood from infants of HIV-seropositive women in Durban, South Africa, were tested for in vitro reactivity to a cocktail of HIV envelope peptides (Env) using a bioassay measuring interleukin-2 production in a mur ine cell line. Infants were followed with repeat HIV RNA tests up to 18 mon ths of age to establish which ones acquired HIV-infection. Results: T-helper cell responses to Env were detected in 33 out of 86 (38%) cord blood samples from infants of HIV-seropositive women and in none of n ine samples from seronegative women (P = 0.02). Among infants of HIV-seropo sitive mothers, three out of 33 with T-helper responses to Env were already infected before delivery (HIV RNA positive on the day of birth), two were lost to follow-up, and none of the others (out of 28) were found to be HIV infected on subsequent tests. in comparison, six out of 53 infants unrespon sive to Env were infected before delivery, and eight out of 47 (17%) of the others were found to have acquired HIV infection intrapartum or post-partu m through breast-feeding (P = 0.02). Conclusions: T-helper cell responses to HIV envelope peptides were detected in more than one-third of newborns of HIV-infected women; no new infection s were acquired by these infants at the time of delivery or post-natally th rough breast-feeding if these T-helper cell responses were detected in cord blood. (C) 2001 Lippincott Williams & Wilkins.