PEDIATRICS Vol. 82 No. 6 December 1988, pp. 919-924
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Persistent Human Immunodeficiency Virus Type 1 Antigenemia in Children Correlates With Disease Progression

Leon G. Epstein MD1, Charles A. B. Boucher MD1, Susan H. Morrison MD1, Edward M. Connor MD1, James M. Oleske MD1, Joep M. A. Lange MD, PhD1, Jan van der Noordaa MD, PhD1, Margreet Bakker 1, John Dekker 1, Henriette Scherpbier MD1, Henk van den Berg MD1, Kees Boer MD, PhD1, and Jaap Goudsmit MD, PhD1

1 From the Human Retrovirus Laboratory, Virology Department, and the Department of Gynecology and Obstetrics, Academic Medical Center, Amsterdam; University of Medicine and Dentistry of New Jersey Medical School and Children's Hospital, AIDS Program, Newark; and the Department of Pediatrics, University Hospital, Leiden, The Netherlands

In a longitudinal study, human immunodeficiency virus type 1 (HIV-1) antigen (HIV-Ag) was measured in serum specimens from 54 children with HIV-1 infection followed for a median duration of 17 months. The persistent detection of free HIV-Ag in a group of 25 children was associated with clinical deterioration in 22 (88%) and a mortality of 52%, whereas the persistent nondetection of free HIV-Ag in a group of 18 children was associated with clinical deterioration in five (28%) and a mortality of 11% during the period of observation. Nine children had transient HIV-1 antigenemia and two children converted from HIV-Ag negative to positive during the study. Free HIV-Ag levels varied inversely with antibody reactivity to viral core proteins p24 and p17 determined by Western immunoblot, suggesting either the formation of immune complexes or a balance between viral expression and the host immune response. Five mother-infant pairs were studied for HIV-Ag expression in the perinatal period. In three of these pairs, both mother and infant were HIV-Ag negative, in one pair the mother had high levels of HIV-Ag and the infant was HIV-Ag negative. In the remaining mother-infant pair, the neonate became HIV-Ag positive but the mother was HIV-Ag negative prepartum and postpartum. These data suggest that HIV-Ag probably does not cross the placenta and that the detection of free HIV-Ag in the offspring of a HIV-1 infected mother most likely indicates viral infection. Two children with persistently high levels of HIV-Ag were treated with the antiviral medication zidovudine and showed a decline in HIV-Ag levels, with a rebound in one when the medication was discontinued, adding further evidence that free HIV-Ag detection is a reliable indicator of viral expression.

Key Words: human immunodeficiency virus type-1 • acquired immunodeficiency syndrome

Submitted on March 23, 1988
Accepted on June 10, 1988




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