NATURAL HISTORY OF VERTICALLY TRANSMITTED HIV INFECTION

婴儿中仍有症状的艾滋病的危险因素 不清楚。多项研究表明，尽管一些人感染了 血清阳性母亲所生的孩子会出现症状，并在两岁时死亡， 其他人则有几年的稳定航向。方法学问题，如 因为在出生时无法识别受感染的儿童 母源抗体、样本量小和父母引起的并发症 静脉注射药物滥用阻碍了对不良结局预测因素的确定 母亲血清阳性的孩子。 我们建议研究儿童感染HIV-1的自然历史。 在出生时或出生前感染的。母亲血清阳性所生的孩子将是 随之而来的前瞻性和风险因素的可能作用，如 怀孕期间的产妇症状、分娩方式、是否存在 中和抗体和完整的迟发型超敏反应 评估过了。 我们打算研究卢旺达血清阳性母亲所生的孩子，在那里 HIV-1是地方性的；初步数据显示血清阳性率为5-15%。受感染的 儿童出生时将通过检测病毒基因组来确定身份 外周血采用聚合酶链式反应(PCR)。世界上的孩子 最初200名受感染的妇女将被前瞻性地跟踪三年； 100名未感染病毒的妇女的孩子将同时接受跟踪调查。临床 包括病毒表达分析在内的实验室检查将是 定期进行以评估疾病进展、HIV-1感染、 和免疫状态(细胞和血清)。并行史 每次就诊时将收集感染、注射和免疫接种。 出现有症状的艾滋病/ARC或死亡的时间将作为 以上讨论的风险因素的作用。身份的鉴定 与不良结局相关的因素和对 病毒表达和疾病进展的关联应该允许更好的 儿科艾滋病患者的管理。

Risk factors for development of symptomatic AIDS in infants remains unclear. Several studies have suggested that although some infected children born to seropositive mothers develop symptoms and die by age two, others have a stable course over several years. Methodologic problems such as the inability to identify infected children at birth due to the presence of maternal antibody, small sample size and complications due to parental IV drug abuse have hampered ascertainment of predictors of poor outcome in children of seropositive mothers. We propose to study the natural history of HIV-1 infection in children infected at or before birth. Children born to seropositive mothers will be followed prospectively and the possible role of risk factors such as maternal symptomatology during pregnancy, mode of delivery, presence of neutralizing antibody and intact delayed-type hypersensitivity will be assessed. We intend to study children born to seropositive mothers in Rwanda, where HIV-1 is endemic; preliminary data indicate 5-15% seropositivity. Infected children will be identified at birth by detection of the viral genome in peripheral blood using polymerase chain reaction (PCR). Children of the first 200 infected women will be followed prospectively for three years; children of 100 non-infected women will be followed in parallel. Clinical and laboratory examinations including assays of viral expression will be performed periodically to assess progression of disease, HIV-1 infection, and immune status (cellular and serologic). Histories of intercurrent infections, injections and immunizations will be collected at each visit. Time to development of symptomatic AIDS/ARC or death will be analyzed as a function of the risk factors discussed above. The identification of factors associated with poor outcome and an improved understanding of the association of viral expression and disease progression should allow better management of pediatric AIDS patients.