CORRELATION OF PERINATAL TRANSMISSION OF HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1 WITH MATERNAL VIREMIA AND LYMPHOCYTE PHENOTYPES

Objective: To determine whether maternal transmission of human immunodeficiency virus (HIV) is correlated with increased quantities of HIV, decreased frequencies of CD4(+) T cells, or increased levels of CD8+ T cells in the transmitting mother. Methods: Peripheral blood obtained from HIV-infected women at different times during pregnancy was used to measure quantitative cell-associated HIV-1 and CD3(+)CD4(+) and CD3(+)CD8(+) proportions; the plasma was used to perform measurements of quantitative viremia by culture and subsequently to measure quantitative HIV-1 ribonucleic acid levels. These measurements were analyzed with respect to their association with HIV transmission to the baby, which occurred in one fourth of the cases. The children were also studied to determine whether HIV-1 was detected near birth or not until 1 to 8 weeks of life. Results: Increased clonal frequencies of H1V-1-infected peripheral blood mononuclear cells were found in mothers of infected children; fivefold fewer cells were required for a positive culture result (median cell numbers of 10(4.5) vs 10(5.2); p = 0.008). Higher frequencies of infected cells were seen in mothers af babies with evidence of infection at birth than in mothers of infected babies without evidence of Infection at birth (p < 0.05). Plasma viremia was measured in 10% of cultures without regard to whether the mothers transmitted virus to their babies. Increased levels of ribonucleic acid as detected by the branched-chain DNA method were measurable more often (45% vs 17%) in the mothers of infected children than in mothers of uninfected children. Proportions of CD4(+) and CD8(+) T cells were indistinguishable in these two groups of women. Conclusions: Increased viremia was present in mothers who transmitted HIV to their offspring. This variable could be used to select women of highest risk of transmitting HIV to their offspring for treatment to decrease the HIV burden five-fold.