A study to implement early diagnosis of HIV infection in infants born to infected mothers

A protocol for detecting HIV DNA from specimens collected on filter papers and the effect of storage temperatures on determination of HIV DNA from dried blood spots has been developed and optimized. Blood specimens collected from HIV-1 infected and normal persons were spotted onto blood collection cards (Whatman BFC 180). The HIV DNA was extracted by phenol-chloroform-isoamyl alcohol and was detected for C2V4 of HIV-1 env by nested polymerase chain reaction (nested PCR). One set was stored at -20 degrees C for 14 weeks, another at 37 degrees C for 1 week and then kept at -20 degrees C for 13 weeks and a third set at 25 degrees C for I week and then -20 degrees C for 13 weeks. The dried blood spots from each set were detected for the HIV DNA every 2 weeks for 14 weeks. The C2V4 region of HIV env DNA was determined from small amounts of the dried blood collected on the filter papers. The nested PCR procedure could detect as few as 5 copies of HIV proviral DNA, and HIV DNA could be detected from specimens with viral loads of 2x 10(4) copies/ml. HIV DNA could be detected from specimens collected at all temperatures tested for at least 14 weeks. Therefore, laboratory diagnosis of HIV infection can be done by PCR on dried blood spots. These techniques will be useful as a tool for studying the epidemiology of HIV infection among populations of interest such as mother to child infection using newborn screening specimens.     

Sensitization to Schistosoma mansoni antigen in uninfected children born to infected mothers.

Sensitization to Schistosoma mansoni antigen in uninfected children born to infected or uninfected mothers was studied by intradermal reaction. Immediate skin reaction, Arthus phenomenon, and delayed skin responses were noted. The skin response at 24 hr was positive in 48.1% of the uninfected children born to infected mothers, and in only 7.5% of uninfected (control) children born to uninfected mothers. Areas of skin reactions were also larger in the group born to infected mothers. Both of these differences were statistically significant.There were no significant variations according to age or sex. Only one immediate skin reaction was noted in each group, and Arthus phenomenon was never observed.     

There's no excuse for babies to be born today infected with HIV

Vertical HIV transmission from mother to child is almost entirely preventable with prenatal screening and treatment, but most of the 15,000 infected children in the United States were infected by their mothers. Of those, many will die before they reach the age of 13. Clinicians are calling for universal HIV testing for pregnant women and the administration of antiretroviral treatment either during labor or soon after the baby's birth. Even with universal testing and treatment, there will still be some instances of breakthrough transmission, but the rate of infection for babies would be much lower. A chart shows the percentage of mothers, arranged by states, who discussed HIV testing with their health care provider. Rapid testing in combination with Zidovudine (AZT) treatment has lowered HIV transmission rates by 38 percent in breast-feeding populations and 50 percent in non-breast-feeding populations. The benefits of Nevirapine therapy are discussed.     

Disclosure of the diagnosis of HIV/AIDS to children born of HIV-infected mothers

HIV disease in perinatally infected patients is now treated as a chronic illness of childhood. The effective use of highly active anti-retroviral therapy has contributed to the improvements in the prognosis of this illness. As this population matures, the issue of disclosure of diagnosis becomes more significant and part of their comprehensive medical care. The importance of disclosure relates directly to medication adherence, treatment compliance, sexual exploration, fears associated with premature death, and the child's developing autonomy. disclosure of HIV disease to an infected child poses complex issues, such as transmissibility, maternal guilt, more than one family member with the virus, and the potential for social stigma and isolation, among others. A change in perspectives is currently taking place regarding the process of disclosure, whereby it may be approached as a gradual discussion process over the life of the child. A method of gradual and partial disclosure to the child with consistent support by a multi-disciplinary team of providers has been a successful strategy for many children cared for at the New York Hospital-Cornell University Medical Center. Of 73 perinatally HIV-infected children who are 6 years of age or older, 41% have had complete disclosure and another 19% are partially disclosed. Continuous communication and negotiation among the members of the team, which includes the parents and caregivers, are vital to the gradual process leading to complete disclosure.     

Schistosoma japonicum: susceptibility of neonate mice born to infected and noninfected mothers following subsequent challenge

This study was to investigate the differences between neonate mice born to Schistosoma japonicum‐infected mothers and those born to noninfected mothers in subsequent challenge. The intensity of infection (evidenced by worm burden and liver egg burden) and liver immunopathology (number and size of liver granulomas) were significantly reduced in neonates from infected mothers (I.M.) compared with neonates from noninfected mothers (N.M.). Anti‐soluble worm antigen of S. japonicum (SWA) IgG could be detected in sera of neonates from I.M. (N.N./I.M.) at 1 week after delivery, remained a plateau for 2 weeks and gradually decreased until 8 weeks of age. Parasite‐specific IgM was not detected in sera from N.N./I.M. at any time after delivery. At 6 weeks after infection, the level of anti‐SWA IgG in infected neonates from I.M. (I.N./I.M.) was significantly higher than that of infected neonates from N.M. (I.N./N.M.). In addition, production of IFN‐γ, IL‐12 and TGF‐β by cultured splenocytes from I.N./I.M. was significantly increased, while the level of IL‐4 was significantly decreased when compared to those from I.N./N.M.. These data demonstrate that congenital exposure to schistosomiasis japonica may render neonatal mice born to I.M. less susceptible to subsequent challenge and result in down‐regulation of both infection intensity and immunopathology.     

Evaluation of diagnostic tests for HIV infection in infants born to HIV-infected mothers in Switzerland

Children born to HIV-infected women in Switzerland were tested every 3 months for HIV-reactive serum immunoglobulin (Ig) G, IgM and IgA antibodies by Western blot, viral antigen, virus replicating in T-lymphocyte cultures, and immunologic and clinical parameters. At birth, 27% were isolation-positive, 68% had IgM, 48% IgA and 10% circulating antigen. The proportion of IgM and IgA declined to about 18 and 27%, respectively, during the first 2 years. Detection of circulating antigen was less frequently positive than virus isolation in all age and disease groups. Clinical symptoms were only seen in infants or children who were or had been positive for IgM and/or IgA, but only 39% of children positive for these markers have developed disease so far. Clinical symptoms combined with signs of immunodeficiency were seen only in children who were isolation-positive or had evidence of HIV-reactive IgA or child-produced IgG. Absorption studies showed that Western blot-detected IgM and IgA antibodies were of two types: 42% were directed against various HIV proteins, while the rest represented rheumatoid-factor-like IgM or IgA binding to HIV-specific IgG. HIV-specific IgG antibodies were detected in all samples up to the age of 12 months and were still found in 83% of infants 13-18 months old. We observed weak HIV-specific IgG above the age of 15 months with no other signs of HIV infection, suggesting that the demonstration of antibodies in children beyond this age does not necessarily indicate HIV infection.     

The risk of human immunodeficiency virus-1 infection in twin pairs born to infected mothers in Africa

We examined birth order and delivery route as risk factors for mother-to-child transmission of human immunodeficiency virus (HIV)-1 in 315 twin pairs born in Malawi during 1994-1998. No antiretroviral drugs were administered to these subjects. Infections were detected by polymerase chain reaction and were stratified as having occurred either in utero, perinatally, or postnatally. Risk of in utero infection for 630 infants (39 infections) did not differ by birth order (first born, 6.3%; second born, 6.0%). Similarly, in 260 vaginally delivered infants evaluated for perinatal infection (45 infections), risk did not differ by birth order (first born, 15.9%; second born, 18.7%); risk of perinatal infection was significantly lower in cesarean-delivered infants (odds ratio, 0.19 [95% confidence interval, 0.02-0.78]). There was no effect on postnatal transmission rates. Thus, in contrast to the authors of earlier studies, we did not find birth order to be an important risk factor for infection in twins. These findings indicate that birth-canal exposure is not a major contributor to a newborn's risk of HIV-1 infection.     

Risks to the children born to mothers with autoimmune diseases

This article reviews current information regarding the development and long-term effects on children born to women with connective tissue diseases. There are few data on specific effects attributed to the underlying maternal disease, but fetal growth restriction and preterm birth are relatively common. Antenatal use of prednisone as treatment for these disorders appears to be safe, and most children have developed normally. However, there is growing concern that prolonged fetal exposure to other glucocorticoids such as dexamethasone or betamethasone may lead to decreased growth and abnormal neuronal development. Low birth weight is reportedly associated with long-term medical complications such as adult-onset hypertension. Evidence also suggests that immunosuppressive agents taken during pregnancy might predispose the progeny to autoimmune disorders, malignancies and reproductive problems. Further research is warranted to determine that there are no unrecognized long-term risks to the offspring of these women.     

The heart diseases of children born to alcoholic mothers]

The authors present their experience of heart disease in children with congenital abnormalities of alcoholic origin, of which they have seen 50 cases in 3 years. This syndrome, which was first described by Lemoine in 1968, appears to be fairly common. It shows the teratogenic properties of alcohol. It is characterised by facial abnormalities which are easy to recognise, gross failure to gain in height and weight, psychomotor retardation of varying severity and several other malformations. From amongst these, cardiac malformations are the most commonly encountered. These are usually in the form of septal defects (atrial and ventricular septal defects).     

Guidelines for the screening and follow-up of infants born to anti-HCV positive mothers.

Hepatitis C virus infection in infancy largely depends on vertical transmission. The transfer of hepatitis C virus from mother to child is almost invariably restricted to children whose mother is viremic, and the rate of transmission seems to be influenced by maternal virus load, although, in the single patient, the levels of viremia cannot be used as predictors of pediatric infection. In fact, the flow-chart for screening children at risk for vertically transmitted hepatitis C virus infection takes into account maternal viremia. In children born to anti-hepatitis C virus antibody positive, hepatitis C virus-RNA negative mothers, alanine aminotransferase and anti-hepatitis C virus should be investigated at 18-24 months of life. If alanine aminotransferase values are normal and anti-hepatitis C virus is undetectable, follow-up should be interrupted. In children born to hepatitis C virus-RNA positive mothers, alanine aminotransferase and hepatitis C virus RNA should be investigated at 3 months of age: (1) hepatitis C virus-RNA positive children should be considered infected if viremia is confirmed by a second assay performed within the 12th month; (2) hepatitis C virus-RNA negative children with abnormal alanine aminotransferase should be tested again for viremia at 6-12 months, and for anti-hepatitis C virus at 18 months; (3) hepatitis C virus-RNA negative children with normal alanine aminotransferase should be tested for anti-hepatitis C virus and alanine aminotransferase at 18-24 months, and should be considered non-infected if alanine aminotransferase is normal and anti-hepatitis C virus undetectable; (4) anti-hepatitis C virus seropositivity beyond the 18th month in a never-viremic child with normal alanine aminotransferase is likely consistent with past hepatitis C virus infection.     

Low birth weight infants born to HIV-seropositive mothers and HIV-seronegative mothers in Chiang Rai, Thailand

The low birth weight (LBW) infant has a much higher risk of mortality and morbidity in infancy and early childhood. This study examined the effects of maternal HIV infection and other risk factors for LBW (< 2,500 g). A retrospective study of mothers who delivered at Mae Chan Hospital from 1997 to 2002 was conducted. Logistic regression was used to adjust for confounding factors. There were 266 infants born to HIV-seropositive mothers and 5,872 infants born to HIV-negative mothers. Low birth weight was significantly associated with maternal HIV status, gestational age, antenatal care, maternal age less than 20 years, and > 35 years. Maternal HIV positive status, young maternal age and gestational age were significant factors after adjusting for potential confounders. No significant effect of hilltribe on LBW was found. The results underline the need for nutritional surveillance and dietary counseling. HIV-seropositive women must receive early and continuing antenatal care for good pregnancy outcomes.     

Clinical characteristics of neonatal infants born to mothers with pulmonary tuberculosis

Three hundred and seventy neonatal infants born by mothers with pulmonary tuberculosis were examined. A control group comprised 121 neonatal babies born by apparently healthy women. The infants born by ill mothers weighed less. In the study group, 142 (38.4%) babies with asphyxia were born. In infants born by mothers with active tuberculosis, birth asphyxia was observed 1.5 times as frequently as in those born by healthy mothers. In the control group, only 11 (9.1%) children with mild asphyxia were born. Neonatal compilations were noted in 137 (37.1%) infants of the study group, moreover almost equally frequently in babies born by mothers with both active and inactive tuberculosis, they were in 12 (9.9%) babies in the control group. In the latter group, malformations were detected only in 2 (1.7%) newborn babies, in the study one, they were in 46 (12.4%) infants, the mothers of these 15 (32.6%) infants had received specific therapy for tuberculosis in early pregnancy.     

Transient hypothyroidism or persistent hyperthyrotropinemia in neonates born to mothers with excessive iodine intake.

Perinatal exposure to excess iodine can lead to transient hypothyroidism in the newborn. In Japan, large quantities of iodine-rich seaweed such as kombu (Laminaria japonica) are consumed. However, effects of iodine from food consumed during the perinatal period are unknown. The concentration of iodine in serum, urine, and breast milk in addition to thyrotropin (TSH), free thyroxine (FT(4)), and thyroglobulin was measured in 34 infants who were positive at congenital hypothyroidism screening. Based on the concentration of iodine in the urine, 15 infants were diagnosed with hyperthyrotropinemia caused by the excess ingestion of iodine by their mothers during their pregnancy. According to serum iodine concentrations, these infants were classified into group A (over 17 microg/dL) and group B (under 17 microg/dL) of serum iodine. During their pregnancies these mothers consumed kombu, other seaweeds, and instant kombu soups containing a high level of iodine. It was calculated that the mothers of group A infants ingested approximately 2300-3200 microg of iodine, and the mothers of group B infants approximately 820-1400 microg of iodine per day during their pregnancies. Twelve of 15 infants have required levo-thyroxine (LT(4)) because hypothyroxinemia or persistent hyperthyrotropinemia was present. In addition, consumption of iodine by the postnatal child and susceptibility to the inhibitory effect of iodine may contribute in part to the persistent hyperthyrotropinemia. We propose that hyperthyrotropinemia related to excessive iodine ingestion by the mother during pregnancy in some cases may not be transient.