Early diagnosis and immunologic changes in HIV-1 infected pregnant women and their children

The diagnosis of HIV infection in pregnant women is usually based on the detection of HIV-specific antibodies. These tests become positive a few weeks to months after infection. In the United States, it is recommended that tests be offered to all women and encouraged where the rate of infection is > or = 1/1,000 or the woman is at increased risk for infection. The great majority of infected pregnant women are asymptomatic, and questioning patients about risk behavior will identify only about one-half of the infected women. In Washington, D.C. about 1.5% of the pregnant women who reside in the city are HIV positive. The diagnosis of HIV in the child in the first month of life is difficult and requires the use of polymerase chain reaction tests and/or culture. Other tests become positive later. Immunological tests in most HIV-infected mothers in the USA are normal; however, about 12% of patients are symptomatic and show decreased CD4 T cell counts and 6% have AIDS. These patients may have other evidence of decreased T cell responses and are at increased risk for opportunistic infections. At birth, almost all children of HIV-infected mothers have normal immunological findings. However, about 50 of these children become ill by 1 year of age and many develop decreased T cell counts and other immunological changes.