Related Experiment Videos
Immunological evaluation in the early diagnosis of prenatal or perinatal HIV infection
D Nadal1, U A Hunziker, J Schüpbach
1Department of Pediatrics, University of Zurich, Switzerland.
Insights
Diagnosing human immunodeficiency virus (HIV) in children requires more than antibody tests. Immunological assessments are crucial for identifying affected children, especially when serology is inconclusive.
Area of Science:
- Pediatrics
- Immunology
- Infectious Diseases
Background:
- Longitudinal study of 34 children born to HIV-infected mothers.
- Mean observation period of 13.4 months, with children aged 6-68 months.
Purpose of the Study:
- To evaluate the clinical, infective, and immunological progress of children born to HIV-infected mothers.
- To determine the utility of serological versus immunological assessments for diagnosing pediatric HIV.
Main Methods:
- Clinical evaluation of symptoms.
- HIV culture for viral detection.
- Immunological assessments including antibody levels, CD4+ cell counts, and cellular responses to antigens.
- Humoral and cellular response analysis to vaccination antigens like tetanus toxoid.
Main Results:
- 11 children developed clinical symptoms; 8 tested positive for HIV via culture.
- Immune abnormalities were prevalent in children with positive HIV cultures, persistent antibodies, or antibody loss.
- Serological diagnosis alone was found to be potentially misleading.
Conclusions:
- Immunological assessment is vital for accurate pediatric HIV diagnosis, complementing serological testing.
- Simple methods like antibody measurement and skin testing for vaccine responses are clinically useful.
- Early and accurate diagnosis aids in managing children exposed to or infected with HIV.
Abstract:
A longitudinal evaluation was carried out of the clinical, infective, and immunological progress of 34 children (who were aged 6 to 68 months--mean 25 months at the time of writing) born to 31 mothers infected with human immunodeficiency virus (HIV), over a mean observation period of 13.4 months. Clinical symptoms, not always clearly related to HIV became apparent in 11 children, and preceding immune abnormalities were documented in two of them. In eight children culture for HIV was positive, and six of these were symptomatic. No cancers were diagnosed and none of the children died. Immune abnormalities including hypergammaglobulinaemia, IgG subclass deficiency, low serum IgA concentration, antibody deficiency, a decrease in the number of CD4+(T helper) cells, and defective cellular responses to antigens, were found in seven of the children in whom culture for HIV was positive; in two of four who had symptoms and in all four who were symptom free and in whom culture was negative for HIV but in whom HIV antibodies persisted and who were older than 15 months; and in three of nine who were symptom free and in whom culture was negative with loss of HIV antibodies. We conclude that serological diagnosis alone may be misleading and that additional immunological assessment may help to identify affected children. Analysis of humoral and cellular responses to antigens used for vaccination such as tetanus toxoid by measurement of specific antibodies and skin testing are simple and helpful in clinical practice.