HIV infection in children

HIV in the neonate

Mother-to-infant transmission of human immunodeficiency virus (HIV) is a worldwide problem. Between 7 and 40% of infants born to HIV-positive mothers become infected. The prognosis of these infants is poor, with most developing early and rapidly progressive disease. A number of advances in diagnosis and therapy offer opportunities to reduce the rate of vertical transmission and to improve the outlook of infected infants. Antiretroviral therapy during pregnancy and the neonatal period can markedly reduce the risk of mother-to-infant transmission. Recognition that 50% or more of infections are transmitted peripartum offers scope to further reduce the rate of transmission. However there is currently no consensus on the optimal management of pregnancy in HIV-infected women, and there is an urgent need for large randomized controlled trials. The development of polymerase chain reaction and p24 antigen assays has greatly facilitated the diagnosis of neonatal HIV infection, thereby enabling earlier supportive and anti-retroviral therapy. The place of zidovudine in paediatric HIV infection is now well-established, but the future will undoubtedly bring combination anti-retroviral therapy. Optimism about the prospects for developments in the prevention and treatment of paediatric acquired immunodeficiency syndrome must be tempered by the fact that the majority of cases occur in countries where patients have little or no access to medical care.

Organizing health care for families affected by HIV

HIV models of care focus primarily on the needs of individuals and may not successfully meet the needs of the whole family. Family-centred care represents an approach to care and management that focuses on the needs of the family as a whole rather than solely on the needs of the child or the needs generated by his/her illness. Family-centred care requires a multidisciplinary approach. A barrier is the desire of individual professional groups to maintain control over their own area of expertise.

Detection of IgA and IgM antibodies to HIV-1 in neonates by radioimmune western blotting

OBJECTIVE

To detect infection with HIV-1 by IgA and IgM response at birth in children born to HIV-1 seropositive mothers.

DESIGN

Western blotting and radioimmune western blotting on stored sera from infected and uninfected babies born to HIV-1 seropositive mothers. Sera were pretreated to remove IgG.

SETTING

Parma and Bologna, Italy.

SUBJECTS

12 infected and five uninfected babies born to HIV-1 seropositive mothers and three babies born to seronegative mothers.

MAIN OUTCOME MEASURES

Effectiveness of western blotting and radioimmune western blotting in detecting antibodies to HIV-1 gene products.

RESULTS

With conventional western blotting we found IgA class antibodies to HIV-1 proteins in serum from three out of 12 infected children; in two of these three the serum was collected at age 3 months (positive controls). Radioimmune western blotting detected both IgA and IgM antibodies in serum from all infected children tested, whereas all serum from uninfected children born to seropositive and seronegative mothers showed no such antibodies.

CONCLUSION

Although the technique should be tested on more patients, radioimmune western blotting seems to be a valuable tool for serological diagnosis of congenital HIV-1 infection at birth in neonates born to seropositive mothers.