Use of the Polymerase Chain Reaction for Early Detection of the Proviral Sequences of Human Immunodeficiency Virus in Infants Born to Seropositive Mothers

New York City Collaborative Study of Maternal HIV Transmission and Montefiore Medical Center HIV Perinatal Transmission Study Group

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Abstract

The early diagnosis of infection with human immunodeficiency virus (HIV) in infants born to infected mothers is essential for early treatment, but current tests cannot detect HIV infection in newborns because of the presence of maternal antibodies. We used the polymerase chain reaction, a new technique that amplifies proviral sequences of HIV within DNA, to detect HIV infection in peripheral-blood mononuclear cells obtained from infants of seropositive women during the neonatal (age less than 28 days) and postneonatal periods. In blood obtained during the neonatal period, the polymerase chain reaction was positive in five of seven infants in whom the acquired immunodeficiency syndrome (AIDS) later developed (a mean of 9.8 months after the test). The test was also positive in one of eight newborns who later had nonspecific signs and symptoms suggestive of HIV infection (mean follow-up, 12 months). No proviral sequences were detected in neonatal samples from nine infants who remained well (mean follow-up, 16 months). HIV proviral sequences were detected in samples obtained during the postneonatal period (median age, five months) in all of 6 infants tested who later had AIDS and in 4 of 14 infants with nonspecific findings suggestive of HIV infection. No proviral sequences were detected in 25 infants who remained well (mean follow-up, 17 months) after being born to HIV-seropositive mothers, or in 15 infants born to HIV-seronegative mothers. We conclude that the polymerase chain reaction will be a useful technique to diagnose HIV infection in newborns and to predict the subsequent development of AIDS. However, larger studies will be required to determine the sensitivity and specificity of the test. STUDIES have shown that 30 to 50 percent of the infants born to women with human immunodeficiency virus (HIV) infection will acquire the virus from their mothers in utero, during labor and delivery, or post partum through breast-feeding.1 2 3 4 5 6 The diagnosis of HIV infection in infants has been hampered by the presence of passively acquired maternal antibody, the difficulty in performing viral culture, the lack of reliable tests for HIV-specific IgM, and the presence of nonspecific signs and symptoms of HIV infection in infants. In addition, serum antigen is usually not detected when excess serum antibody is present, as in infants…

Original languageEnglish (US)
Pages (from-to)1649-1654
Number of pages6
JournalNew England Journal of Medicine
Volume320
Issue number25
DOIs
StatePublished - Jun 22 1989

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  • Medicine(all)

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New York City Collaborative Study of Maternal HIV Transmission and Montefiore Medical Center HIV Perinatal Transmission Study Group (1989). Use of the Polymerase Chain Reaction for Early Detection of the Proviral Sequences of Human Immunodeficiency Virus in Infants Born to Seropositive Mothers. New England Journal of Medicine, 320(25), 1649-1654. https://doi.org/10.1056/NEJM198906223202503