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March 1994

Human Immunodeficiency Virus Infection in Infants During the First 2 Months of LifeReliable Detection and Evidence of In Utero Transmission

Arch Pediatr Adolesc Med. 1994;148(3):250-254. doi:10.1001/archpedi.1994.02170030020004

Objective:  To evaluate the clinical utility of a polymerase chain reaction (PCR) method for detecting human immunodeficiency virus (HIV) infection in infants 2 months of age or younger who were born to HIV-positive mothers.

Design:  Prospective, longitudinal study lasting 3 years. The PCR tests were performed with coded peripheral blood mononuclear cell lysates, and results were compared with findings using Centers for Disease Control and Prevention (CDC) (Atlanta, Ga) criteria defining HIV infection in children.

Setting:  Hospitals, particularly a pediatric hospital in Washington, DC.

Patients:  Newborns, young infants, and HIV-infected mothers.

Outcome Measure:  Presence or absence of pediatric HIV infection using CDC criteria compared with a diagnosis based on the detected presence or absence of HIV proviral DNA using PCR testing.

Results:  One or more blood samples obtained by 62 days of age from 30 (94%) of 32 HIV-infected infants were positive for HIV by routine PCR testing. Blood samples from 32 infants now confirmed to be uninfected tested negative for HIV. Human immunodeficiency virus DNA was detected in blood samples obtained within 48 hours of birth from eight of nine infected infants. In six of these newborns as well as most older infants, HIV DNA was present in such quantity that it was detectable in specimens equivalent to 0.01 mL or less of the original blood sample.

Conclusions:  Our PCR procedure can reliably detect the presence or absence of HIV infection during the first 2 months of life. The frequent presence and not uncommon high titer of HIV DNA within 48 hours of birth suggest that much of the transmission of HIV from mother to infant occurs well before birth.(Arch Pediatr Adolesc Med. 1994;148:250-254)