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In: International Conference on the Implications of AIDS for Mothers and Children: technical statements and selected presentations jointly organized by the Government of France and the World Health Organization, Paris, 27-30 November 1989. Geneva, Switzerland, WHO, Global Programme on AIDS, 1989. 23-4. (WHO/GPA/DIR/89.12)Large gaps exist in knowledge of the clinical, immunologic, and virologic correlates of human immunodeficiency virus (HIV) transmission from infected mothers to their infants. Physiological changes in the immune system of pregnant women as well as maternal antibodies to certain virus-encoded proteins may affect the natural history of HIV infection. Also relevant may be the stage of the mother's infection and the time of HIV transmission to the fetus. There is some evidence that maternal antibodies to the immunodominant hypervariable loop in gag protein 120 may reduce the risk of transmission to the fetus. More basic research in virology and immunology is needed for the development of prophylactic and therapeutic approaches to maternal-infant HIV infection. Research priorities include the following: the impact of pregnancy on clinical outcome and virological and immunologic markers in HIV-infected women; correlates of perinatal transmission such as virus characteristics and load, neutralizing antibodies, and cell-mediated immunity; possible immunologic or chemotherapeutic interventions to decrease perinatal transmission; and the standardization of virologic and immunologic markers for pediatric HIV infection.
ANNALS OF TROPICAL PAEDIATRICS. 1989 Mar; 9(1):1-5.A total of 177 children seen at 2 hospitals in Kampala are described who were strongly suspected of having acquired immunodeficiency syndrome (AIDS), either on clinical grounds or because they fulfilled WHO case- definition criteria for diagnosis of pediatric AIDS. Blood was taken from the 177 children and 154 of their mothers and tested for antibody to human immunodeficiency virus (HIV) by an enzyme-linked immunoassay (ELISA). Altogether, 119 (67%) children were seropositive, but only 85 (71%) fulfilled the WHO case-definition criteria, and they were significantly older than the 34 who did not fulfill the criteria. A further 58 children were seronegative but fulfilled the WHO criteria. Of the 119 seropositive children, only 3 had a history of previous blood transfusion, but 103 (98%) of 105 mothers were HIV seropositive: consequently, their children were considered to have been infected in utero or perinatally. 13 (26%) of 49 mothers of seronegative children were seropositive. 80% of HIV-infected children were under 2 years of age at diagnosis and 23% died within 3 months of diagnosis. None of the parents was known to be an intravenous drug user, a prostitute, or bisexual. The difficulty of accurate diagnosis of AIDS presents a major problem in Africa, as the WHO clinical case-definition criteria alone are clearly not adequate. (author's)