The use of viral culture and p24 antigen testing to diagnose human immunodeficiency virus infection in neonates. The HIV Infection in Newborns French Collaborative Study Group.

BACKGROUND: Early diagnosis of human immunodeficiency virus (HIV) infection in infants born to infected mothers is important for the infants' medical care, but the presence of maternal antibodies makes serologic tests uninformative. METHODS: In a cohort study of 181 infants born to HIV-infected mothers, we assessed the diagnostic value of HIV viral culture and testing for the presence of p24 antigen. The infants were tested at birth, again during the first 3 months, then followed and tested at the age of at least 18 months. RESULTS: Of the 181 infants, 3 died of HIV infection and 37 were seropositive after the age of 18 months. Viral cultures at birth were positive in 19 of the 40 infected infants and in none of the uninfected infants, yielding a sensitivity of 48 percent (95 percent confidence interval, 32 to 63 percent) and a specificity of 100 percent (95 percent confidence interval, 97 to 100 percent). By the age of three months, 30 of the 40 infants (75 percent) had positive cultures; again, there were no false positive results among the infants who were tested a second time, of the 141 who remained uninfected. The sensitivity of testing for p24 antigen at birth was only 18 percent, with a specificity of 100 percent. The presence of p24 antigen at birth was associated with the development of early and severe HIV-related disease (P less than 0.04). CONCLUSIONS: Viral culture at birth can correctly identify about half of newborns with HIV infection. The fact that this usually sensitive technique fails to identify about half the ultimately infected neonates suggests that vertical transmission of HIV may occur late in pregnancy or during delivery.

Paternal age and mental functions of progeny in man.

The effects of maternal age on the quality of offspring are well known. Those due to the father's age are less obvious, apart from the role of increasing paternal age in the onset of many dominant autosomal disorders. But an experimental model has demonstrated that, in rats, increasing paternal age, without any other anomalies, might produce a decreased learning capacity in progeny. The object of the epidemiological investigation presented here was to verify whether this effect might also occur in man. The study involved the distribution of scores obtained in psychometric tests by 18-year-old male subjects, according to their father's age at the time of their birth. This distribution indicated not only that increasing paternal age is accompanied by effects similar to those observed in animals, but also that very young paternal age was also related to these effects. Thus, the curve of such scores produced an inverted U-shape, with maximum scores obtained when the father was about thirty years of age. Maternal age did not appear to play a part in this event. These results pose the problem of identifying genetic and/or psychosocial factors which might have an impact on the quality of the conceptus.

A prospective study of infants born to women seropositive for human immunodeficiency virus type 1. HIV Infection in Newborns French Collaborative Study Group.

Assessment of the risks of transmission of infection with human immunodeficiency virus type 1 (HIV-1) from mother to newborn is difficult, partly because of the persistence for up to a year of maternal antibodies transmitted passively to the infant. To determine the frequency of perinatal transmission of HIV infection, we studied from birth 308 infants born to seropositive women, 62 percent of whom were intravenous drug abusers. Of 117 infants evaluated 18 months after birth, 32 (27 percent) were seropositive for HIV or had died of the acquired immunodeficiency syndrome (AIDS) (n = 6); of the 32, only 2 remained asymptomatic. Another 76 infants (65 percent) were seronegative and free of symptoms, whereas 9 (8 percent) were seronegative but had symptoms suggestive of HIV-1 infection. The infants infected with HIV-1 did not differ from the others at birth with respect to weight, height, head circumference, or rate of malformations, but as compared with newborns who were seronegative at 18 months, their serum IgM levels were higher (78 +/- 81 mg per deciliter vs. 38 +/- 39 mg per deciliter; P less than 0.03) and their CD4 lymphocyte counts were lower (2054 +/- 1221 per cubic millimeter vs. 2901 +/- 1195 per cubic millimeter; P less than 0.006). Neither maternal risk factors nor the route of delivery was a predictor of seropositivity at 18 months; however, 5 of the 6 infants who were breast-fed became seropositive, as compared with 25 of 99 who were not (P less than 0.01). We conclude that approximately one third of the infants born to seropositive mothers will have evidence of HIV-1 infection or of AIDS by the age of 18 months, and that about one fifth of this group will have died.

Correlation between defects in chromatin condensation of human spermatozoa stained by aniline blue and semen characteristics.

Human sperm heads which present disturbances of chromatin condensation are stained by acidic aniline, blue. To determine whether the proportion of unstained heads, i.e. with well condensed chromatin, can be considered as an index of sperm quality, a study was undertaken in 157 men during an infertility evaluation. In addition to the usual sperm characteristics, the percentages of unstained heads and of morphologically normal and abnormal forms were concomitantly evaluated. In a total of 15760 spermatozoa, the percentage of unstained heads was much higher in the population of morphologically normal forms than in that of abnormal forms (79.1% and 49.4% respectively, p less than 10(-9]. Among spermatozoa with structural abnormalities, it was much higher in cells with a single anomaly than in those with associated anomalies (53.9% and 40.6% respectively, p less than 10(-9]. When morphology was taken into account, only vitality was found to vary significantly with the percentage of unstained heads.

[Donor artificial insemination. Psychological survey of 830 couples]. / Insémination artificielle avec donneur. Enquête psychologique sur 830 couples.

830 couples who had asked for Artificial Insemination by Donor (AID) were questioned using separate questionnaires for the husband and for the wife. The questions were directed to the reactions that followed in succession to discovery of the sterility, the psychological conditions that led to choosing AID, their attitude as far as secrecy was concerned and finally their contribution to finding donors of sperm. Overall the husband-wife replies corresponded to one another. Frequently the reaction to the news that the man is sterile is a depressive one and to a lesser degree followed by troubles in sexual performance. The choice of AID is usually a decision of both members of the couple. Most couples express themselves as hesitant about adoption. Most of them said that secrecy about the procedure was an essential condition. It appears that, above all, male sterility had to be hidden from the circle in which they associated and from the child. It is this position as far as secrecy is concerned that makes it difficult for the couples to help in recruiting sperm donors.

In-vitro fertilization and embryo transfer: a collaborative study of 1163 pregnancies on the incidence and risk factors of ectopic pregnancies.

In a multi-centric study undertaken on 1163 pregnancies obtained by in-vitro fertilization, a 5% risk of ectopic pregnancies was observed. This figure is certainly higher than that admitted for natural reproduction. After simultaneous adjusting for all variables in our data by means of a multiple logistic regression technique, two factors have specific influence: the therapeutic use of clomiphene citrate which increased the rate of ectopic pregnancies from 3 to 6% and the number of patent Fallopian tubes with a change in ectopic pregnancies rate from 3 or 4% (with 0 or 2 patent tubes) to 13% (with one patent tube). These results suggest various physiologic hypotheses as well as therapeutic considerations.

Abortion rate in A.I.D. and semen characteristics: a study of 1345 pregnancies.

A study undertaken on 1345 pregnancies resulting from artificial insemination with donor showed an 18% risk of abortion. This figure is the same as that admitted for natural reproduction. It does not depend on any of the classically studied semen characteristics and in particular remains invariant whatever the postthaw motility, the factor most strongly linked to conception rate. Two results, well known from the literature, i.e. the increased abortion rate mentioned in natural reproduction when the sperm is of poor quality and the high incidence of repeated abortions when sperm quality is particularly good are discussed. The first of these results cannot be considered as being established in a statistically significant way. The second may result from different sources of bias, some of which are identified. In essence a high frequency of abortions signifies simply a high frequency of pregnancies, it is therefore not surprising that the semen is in this case particularly good.

Lower sperm characteristics in 36 brothers of infertile men, compared with 545 controls.

Among the men who volunteered to become semen donors for artificial insemination at the sperm bank of Centre d'Etude et de Conservation du Sperme Humain, Paris-Bicêtre, some were brothers of the infertile men of couples entering the Artificial Insemination with Donor program. Their sperm characteristics, compared with those of other donor candidates, are clearly lower. The difference is significant for count (78.0 versus 102.8, P less than 0.05) and very significant for the percentage of motile spermatozoa (61.5 versus 66.9, P less than 0.01) and for the percentage of normal forms (51.8 versus 62.7, P less than 0.00001). The differences are even more pronounced when the brothers of azoospermic men are considered. The possibility that some cases of infertility could have a genetic origin is discussed.

Study of sperm morphologic characteristics in a group of 833 fertile men.

For the 13 abnormalities under consideration, the mean percentages were found to be the following: irregular head (15.2), microcephalic (9.8), elongated head (5.9), coiled tail (5.8), bent tail (4.7), thin head (4.6), cytoplasmic remains (3.2), macrocephalic (1.6), short tail (1.1), no tail (0.6), duplicate tail (0.5), duplicate head (0.4), lysis (0.4). In so far as the group studied is representative, the results obtained may be considered as "norms" with the 90th percentiles showing the upper limit of the "normal". The same mean percentages were found by MacLeod and Gold (1951) for the five abnormalities they had identified. The length of abstinence preceding the collection of the ejaculate was found to have no influence on the percentage of abnormal forms.

Semen characteristics as a function of age in 833 fertile men.

The relationship between age and semen characteristics has been studied; any effect due to the influence of the length of abstinence preceding ejaculation was eliminated. There is an improvement in semen characteristics up to 25 years of age, followed by a leveling off and a subsequent decrease. This variation is not significant as far as the sperm count, semen volume, and the total number of spermatozoa are concerned. The variation, although small, is highly significant for the morphologic characteristics and prefreeze and postthaw motility. The values for the older subjects were significantly lower for postthaw motility in the group 36 to 40 years of age, in the group 41 to 45 years of age for morphologic normality, and in the group 46 to 50 years of age for prefreeze motility. The lower values in the group 21 to 25 years of age are particularly noticeable with regard to morphologic characteristics. The same curve is encountered in the variation with age of each abnormal form, but the most marked variation is found in the increased percentage of coiled tails, which first appears in the group 36 to 40 years of age.

Study of a group of 484 fertile men. Part I: distribution of semen characteristics.

The semen characteristics studied were the sperm count, semen volume, morphology and pre-freeze and post-thaw motility. Two categories of fertile men were investigated: semen donor candidates for artificial insemination and pre-vasectomy subjects. Since mean values for each variable in the two series were similar, they could be considered as a single group of 484 fertile men. Only those subjects whose ejaculates were obtained after an abstinence of 5 days or less were retained. The distribution, mean and percentiles were determined for each variable. The 10th and 90th percentiles for sperm count, percentage of motile forms and percentage of normal cells were respectively 25 and 180 million per ml, 60% and 80% and 50% ad 75%. The three variables, sperm count, semen volume and total number of spermatozoa which were dependent on abstinence were analysed in the same manner for 3 days of abstinence. The group studied seemed to be as representative and as well defined as possible.

Study of a group of 484 fertile men. Part II: relation between age (20-59) and semen characteristics.

Commonly measured semen variables as well as post-thaw motility have been studied as a function of age in fertile men. The mean age was 34.6 (SD = 6.6). No significant change with age was found for the sperm count, semen volume or total number of spermatozoa. Conversely, there were significant differences between age groups for the percentage of normal cells (P less than 0.01) and the percentage of motile forms (P less than 0.01) as well as for the after-thaw motility (P less than 0.001). These three variables rise, reach a maximum level at 30 to 35 years of age and then decrease. These changes are not explained by variations in the length of abstinence.