How frequent and how early does the neurological involvement in HIV-positive children occur? Preliminary results of a prospective study.

To study the natural history of the neurological involvement in pediatric human immunodeficiency virus (HIV) infection, 77 children born to seropositive mothers have been followed up since birth. The median follow-up time has been 17.5 months. Fourteen children were classified as infected, 34 as not infected, and 21 as indeterminable. Only two children with full-blown acute immune deficiency syndrome had severe neurological manifestations. "Soft" neurological signs were found in six infected, and ten non-infected children (chi 2, P < 0.05). The mean development quotient and IQ scores in the infected and the non-infected children were 82.22, and 93.15, respectively (Mann-Whitney test, P > 0.05). These data suggest that neurological and developmental abnormalities do not occur early in the course of vertical HIV infection and that they are associated with severe immunodeficiency.

Congenital human immunodeficiency virus (HIV) infection in the Bahamas.

In the 13-month period between June 1985 and July 1986, 27 children were found to be HIV positive in the Princess Margaret Hospital in Nassau. Nineteen of the children had clinical AIDS, four were in the prodromal phase and four were symptom free. The clinical course of these infants is presented. Of the 18 mothers 16 were screened and were all seropositive and asymptomatic. They remained healthy in spite of subsequent pregnancies in nine of them (56%) during a follow-up period of between 13 and 65 months (mean 40 months). Fifteen of the 18 mothers were Haitian but only three had other risk factors, throwing doubt on the value of selective screening in Afro-Caribbean countries.

PIP: From June 1985 through July 1986, HIV screening (ELISA/Abbott) was performed on all donated blood, on family members of those found to be HIV positive, and those who were thought to be infected on clinical groups alone at the Princess Margaret Hospital in Nassau. Positive cases were confirmed in Miami, Florida, using the Western blot method. Laboratory confirmation of infections was made whenever possible. Selection of the 27 children for testing was based on clinical suspicion in 19, because of seropositive siblings in 4, and as the result of screening paternal blood donations in 4. The 27 children were born to 18 mothers. 19 of the HIV-positive children were classified as having Acquired Immune Deficiency Syndrome (AIDS), 4 had AIDS-related complex (ARC), and 4 were HIV positive but asymptomatic. The 19 children with AIDS exhibited clinical signs and symptoms of their disease within the 1st 18 months of life (range 2-18 months). They were hospitalized on 79 occasions and seen frequently as outpatients because of bacterial infections. Children with ARC became symptomatic later in general than those with AIDS (range 3 months to 6 years). The course of the disease was variable. Of the 27 HIV-positive children, 14 were less than 15 months of age when tested initially. 9 of these children developed AIDS (5 have died), 2 have ARC, and 3 were symptom-free at the end of the period, although 1 is known to have developed AIDS subsequently. 15 of the 18 mothers were Haitian, but only 3 had other risk factors, raising doubt about the value of selective screening in Afro-Caribbean countries.

Congenital human immunodeficiency virus (HIV) infection in the Bahamas

In the 13 month period between June 1985 and July 1986, 27 children were found to be HIV positive in the Princess Margaret Hospital in Nassau. Nineteen of the children had clinical AIDS, four were in the prodromal phase and four were symptom free. The clinical course of these infants is presented. Of the 18 mothers 16 were screened and were all seropositive and asymptomatic. They remained healthy in spite of subsequent pregnancies in nine of them (56 percent during a follow-up period of between 13 and 65 months (mean 40 months). Fifteen of the 18 mothers were Haitian but only three had other risk factors, throwing doubt on the valur of selective screening in Afro-Caribbean countries. (AU)

[HIV infection caused by maternal transmission in children born in French Guyana. Apropos of 15 cases]. / L'infection à HIV par transmission maternelle chez l'enfant né en Guyane française. A propos de 15 observations.

From 1980 to 1987, 15 children infected by HIV were born in Guyana from seropositive Haitian mothers. All these children presented the classical picture of HIV infection associated with a chronic extensive prurigo (7/15). There were 8 AIDS and 7 ARC cases. Five infants (4 AIDS, 1 ARC) died during the first year of life. There were 2 different clinical forms: 1) a severe form with cryptosporidium diarrhea and severe neurologic disturbance (one infant who died from neonatal AIDS at 3 months of age); 2) a prolonged form lasting several years complicated with infections, mainly localised to the lung.

More on human immunodeficiency virus embryopathy.

Eight patients with acquired immunodeficiency syndrome (AIDS) or AIDS-related complex, ranging in age from 4 to 33 months, were evaluated for the presence of dysmorphic features recently described as human immunodeficiency virus embryopathy. Birth data and growth charts were available. Growth failure, a prominent box-like head, large wide eyes, and a well-formed philtrum were seen in the majority of patients. The significance of hypertelorism, obliquity of eyes, long palpebral fissures, blue scleras, depressed bridge of nose, and prominent upper vermilion border is discussed.

Infants born to mothers seropositive for human immunodeficiency virus. Preliminary findings from a multicentre European study.

As part of a project within the European Community research activities on acquired immunodeficiency syndrome (AIDS), infants born to human-immunodeficiency-virus-seropositive mothers are being followed up from birth. By October, 1986, 71 infants from Padua, Berlin, and Edinburgh had been followed up to a median age of 6 months (range 1-15 months). Symptoms of AIDS or AIDS-related complex (ARC) had developed in 5, 3 of whom had died. The median age at antibody loss was during the 10th month. An estimated 75% will have lost maternal antibody by 12 months, but loss of antibody did not exclude infection confirmed by virus culture. Numbers were too small to draw conclusions about the risk of AIDS/ARC and mode of delivery or breast-feeding. The study suggested that the risk of AIDS/ARC is higher in infants born to mothers who have AIDS symptoms during pregnancy.

Pregnancies resulting in infants with acquired immunodeficiency syndrome or AIDS-related complex.

Thirty-four children have been cared for at SUNY-Health Science Center at Brooklyn with diagnoses of either acquired immunodeficiency syndrome (AIDS) or AIDS-related complex. Reported here are descriptions of pregnancies resulting in these children. Few of the mothers (four of 32) were symptomatic; however, low birth weight (11 of 34), preterm birth (11 of 34), and premature rupture of membranes (ten of 32) were common. Of 33 patients whose mode of delivery was known, cesarean section was used in ten cases, including one elective repeat. Among mothers who had children before their affected offspring, the average birth weight of the older children significantly exceeded that of the affected (3241 +/- 508 versus 2712 +/- 722 g, P less than .05). The affected child's age at onset of symptoms did not correlate with birth weight, mode of delivery, or status of membranes at the onset of labor.

Pregnancies resulting in infants with acquired immunodeficiency syndrome or AIDS-related complex: follow-up of mothers, children, and subsequently born siblings.

Although several hundred cases of acquired immunodeficiency syndrome (AIDS) and AIDS-related complex (ARC) in infants have been reported, there is little information available concerning the follow-up of mothers and these children or subsequently born children. Thirty-four children with perinatally acquired AIDS and ARC (19 AIDS; 15 ARC) have been followed at the Downstate Medical Center. Although no mother had AIDS or ARC during her pregnancy, after an average follow-up (+/- SD) of 27.8 +/- 21.6 months, five had AIDS and ten had ARC. For 22 of the mothers, T4/T8 ratios were obtained; 15 of these were less than 1, and five were between 1 and 1.5. Among 11 subsequently born siblings for whom HTLV-III antibody status was known, four were positive; of these, two had ARC and one had AIDS. We conclude that the diagnosis of AIDS or ARC in a child indicates a risk for the development of illness in the mother and subsequently born siblings.