Broad spectrum of time of detection, primary symptoms and disease progression in infants with HIV-1 infection

The relationship between time of HIV-1 detection, appearance of symptoms an d disease progression was studied in all 24 HIV-1-infected infants from a c ohort of 117 children who were born to HIV-1-infected mothers and monitored from birth. HIV isolation from plasma and mononuclear cells, HIV-1 DNA PCR (polymerase chain reaction) and, retrospectively, a quantitative assay for HIV-1 RNA were used for virus detection. Two infants possibly exhibited a symptomatic primary HIV infection. More children with than without symptoms during the first year of life progressed to immunological class 3 (P=0.013 ) and to AIDS or death (P=0.003) during follow-up. HIV-1 was detected withi n 4 days of age in 4 of 16 infants: 3 of them became symptomatic within 1 y ear, as did 6 of the remaining 12 infants (not statistically significant). All four infants in whom virus was detected within 3 days of age progressed to severe immunosuppression, compared to 6 of 14 in whom the virus detecti on test was initially negative prior to the first positive result (n.s.). T wo children with previous repeatedly negative HIV detection tests were diag nosed with HIV-1 infection at 8 and 9 months, respectively. Repeated blood sampling is needed for the diagnosis of HIV-1 infection in perinatally expo sed infants, and virus detection tests for exclusion of HIV-1 infection mus t be used with caution.