VERTICAL TRANSMISSION OF HIV IN NEW-YORK-STATE - A BASIS FOR STATEWIDE TESTING OF NEWBORNS

Infants (n = 313) of HIV-infected mothers were enrolled (mean age 1.9 weeks, range 0-8 weeks) in a 3-year prospective study of vertical tran smission. Fifty-six infants (17.9%) had laboratory and clinical eviden ce of HIV infection. Polymerase chain reaction (PCR) provided early an d reliable identification of infected infants. Thirty-one of the 56 in fected infants had specimens submitted when the infants were 4 weeks o f age or less and 30 (97%) tested PCR positive. This percentage increa sed to 100% by 8 weeks of age when 51 of the 56 infected infants had s pecimens tested for that time period. Immune complex dissociation (ICD ) antigen testing was a sensitive method for diagnosis of infection bu t only in infants older than 1 month. p24 antigen testing, although fr ee of false positives, is less sensitive than either of the other meth ods. Among surrogate markers of HIV infection, elevation of soluble CD 8 levels precedes an increase in immunoglobulin levels or a decline in CD4 T lymphocytes. Vertical transmission is significantly lower in Ce ntral and Western New York State than other regions. Transmission is s ignificantly higher in low birthweight babies and in infants whose mot hers have CD4 counts < 500. This study provided the basis for establis hing a Pediatric HIV PCR Testing Service for the early diagnosis of HI V infection in neonates.