Elevated CD8(+)DR(+) lymphocytes in HIV-exposed infants with early positive HIV cultures: A possible early marker of intrauterine transmission

The associations among timing of maternal-fetal human immunodeficiency virus (HIV) transmission, infant age at first positive HIV culture, and CD8(+) lymphocyte activation were examined for 74 perinatally infected infants. Nineteen of the infected infants had positive HIV cultures at less than or equal to 7 days of life, and 55 had negative HIV cultures at less than or equal to 7 days but were positive later. Of the infants with early positive HIV-1 cultures, 15 of the 17 tested with DNA polymerase chain reaction methods had concordant results. The percentage of CD8(+) and HLA-DR+ lymphocytes (CD8(+)DR(+)%) during the first week of life was significantly higher in infants with early compared with late positive cultures (median CD8(+)DR(+)% of 5.0% versus 2.0%, p = 0.0006), The CD8(+)DR(+)% was similar between uninfected infants and infants with late positive cultures during the first week of life (median 2%) but increased in infants with late positive cultures to 6% by 1 month. The CD4(+)% during the first 6 months of life was not different between infants with early or with late positive cultures, but infants with the highest CD8(+)DR(+)% at less than or equal to 7 days of life had significantly lower CD4(+)% at less than or equal to 7 days and at 1, 2, and 4 months of age. These data show that early CD8(+) lymphocyte activation is associated with early positive HIV cultures and lower CD4(+) percentages during early infancy and are consistent with the hypothesis that early positive cultures positivity may indicate in utero HIV infection.