Pregnancy outcomes among mothers infected with human immunodeficiency virus and uninfected control subjects

Article Abstract:

The proportion of neonates born with antibodies to HIV (human immunodeficiency virus, associated with AIDS) is thought to be 0.66 percent in New York State, and studies have revealed that more than 5,000 HIV-infected women give birth each year in the US. To learn more concerning the effects of HIV infection on the outcome of pregnancy, a prospective study was carried out of 91 seropositive and 126 seronegative pregnant women served by the same prenatal clinics in the Bronx and Brooklyn. After determination of their serologic status, the patients were followed until they gave birth. Results showed that seropositive patients had more sexually transmitted diseases than those who were seronegative (17.6 percent versus 7.1 percent). No differences between the groups were seen in the rate of occurrence of chorioamnionitis, endometritis, or maternal fever (inflammation of the fetal membranes or uterine lining, or elevated temperature on two or more readings, respectively). Premature rupture of the membranes surrounding the fetus was not more common among seropositive than seronegative mothers, nor were other obstetrical complications noted more often in the former group. Seropositive women, though, had a higher rate of medical complications (43 versus 25 percent). Nor were factors related to infant well-being different for the two groups: birth weight, gestational age at birth, head circumference, and Apgar scores (a measure of physical function in newborns) were similar. Overall, HIV infection in the absence of AIDS symptoms (only three percent of the women had such symptoms) does not appear to be associated with negative pregnancy or neonatal outcomes. These results differ from those in Africa, where birth weights are lower among babies born to seropositive women. HIV-infected women in the US should be offered the full range of prenatal care, to minimize other risk factors such as smoking or drug use that might adversely affect the neonate. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Complications and side effects, Statistics, Diseases, Infants (Newborn), Pregnancy, Neonatal diseases, AIDS (Disease) in pregnancy, HIV seropositivity, HIV positive, AIDS (Disease) in children, Pediatric AIDS (Disease)

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Clinical utility of HIV-IgA immunoblot assay in the early diagnosis of perinatal HIV infection

Article Abstract:

The conventional test for HIV infection is an assay that screens for the presence of immunoglobulin G (IgG) type antibodies specific for HIV. Because maternal IgG antibodies cross the placenta, infants born to HIV-infected mothers may test positive for these antibodies for up to 15 months following birth, even when they are not infected with the virus. A more accurate HIV test is needed for infants born to HIV-infected mothers. Immunoglobulin A (IgA) type antibodies do not cross the placenta. This study examined if an HIV test (an assay) that looks for IgA antibodies is accurate in detecting HIV infection in these high-risk infants. Blood samples were taken from 58 infants, 40 born to infected mothers and 18 born to uninfected mothers, at ages 1, 3 and 6 months. Thereafter, blood samples were obtained from children born to infected mothers every three to six months up to four years. For the 18 children born to uninfected mothers, all samples were negative for HIV-IgA. Of the 40 children born to infected mothers, 18 initially tested positive for infection by the traditional IgG assay, but had negative results on later tests. All samples from these children tested negative for HIV-IgA. Of the samples from the 22 children infected with HIV, IgA was detected in only 1 of 17 samples taken at one month of age, in 13 of 21 taken at 3 months of age, and in 17 of 22 samples taken at 6 months of age. Five children who went on to develop AIDS did not test positive for IgA at six months of age. These results indicate that the IgA test is very effective for the early diagnosis of perinatal HIV infection in infants older than three months of age. This test may make it possible to begin treatment for HIV-infected children before they develop symptomatic HIV disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Diagnosis, Measurement, Testing, Physiological aspects, HIV infection in children, Pediatric HIV infections, HIV patients, Immunoglobulin A, HIV antibodies

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Serious infections in pregnancy among women with advanced human immunodeficiency virus infection

Article Abstract:

Although thousands of women infected with human immunodeficiency virus (HIV) give birth annually, there is much more data available on the maternal transmission rate of HIV and the outcome of the pregnancy than there is on HIV-associated infections during pregnancy. To facilitate the care of HIV-positive women, 56 pregnant, HIV-positive women were observed along with 77 HIV-negative, pregnant control patients. Each woman had at least one measurement of the number of CD4 positive cells during her pregnancy. CD4 is a marker protein for T lymphocytes, and the number of CD4 cells in the blood can be determined by microscopically observing cells stained with a fluorescent antibody. A low CD4 count was an excellent predictor of illness in the HIV-positive pregnant women. Among the 40 HIV-positive women who had more than 300 CD4 cells per cubic millimeter, none experienced any HIV-related illness. Of the 16 HIV-positive women with CD4 counts of less than 300, seven developed serious infections. Although two of the control women had CD4 counts of less than 300, none developed any serious infection. It is recommended that HIV-positive pregnant women have a CD4 count taken at least once each trimester, and those who test lower than 300 cells per cubic millimeter be considered candidates for prophylaxis of Pneumocystis carinii. Although the appropriate drugs for prophylaxis against Pneumocystis carinii pneumonia have not be demonstrated to be safe for use during pregnancy, the danger to the fetus of a life-threatening maternal infection must be taken into account. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Risk factors, T cells, Opportunistic infections, Blood cell count

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