RESUMO
OBJECTIVE: To evaluate the use of dried blood spot (DBS) specimens and the early diagnostic value of the polymerase chain reaction (PCR) for detection of the human immunodeficiency virus (HIV) in DBS specimens collected at predefined age intervals from a large cohort of U.S. infants at risk of congenital or perinatal HIV infection. DESIGN: We assayed available DBS specimens (n = 272) obtained during the first 4 months of life from 144 infants (41 infected, 103 uninfected) born to HIV-infected mothers enrolled in the Women and Infants Transmission Study. The DBS PCR results were compared with infant HIV infection status, PCR on liquid blood, and viral culture results. Analyses also included sensitivity and specificity of assay as related to the age of the infant when the specimen was obtained. RESULTS: The DBS specimen PCR results were concordant with results from liquid blood specimens and with results from viral culture. The DBS PCR was highly specific for all age groups. Sensitivity in detecting HIV infection status rapidly increased during the first month of life, from 19% (5/26) by 1 week to 96% (25/26) by 1 month of age. Specimens obtained on the day of birth or the next day were the least likely to have detectable HIV DNA. CONCLUSIONS: The PCR assay of DBS specimens is a reliable tool for the early diagnosis of HIV infection and has important advantage over that of liquid blood DNA PCR and viral culture. These advantages include a lower volume of blood required for testing, increased safety, and ease of storage or transport of specimens. Thus DBS PCR is a useful test for clinical and epidemiologic tracking of infants at risk of HIV infection.
Assuntos
DNA Viral/isolamento & purificação , Infecções por HIV/sangue , HIV/isolamento & purificação , Reação em Cadeia da Polimerase/métodos , Preservação de Sangue , Manchas de Sangue , Reações Falso-Positivas , Feminino , HIV/genética , Infecções por HIV/virologia , Humanos , Recém-Nascido , Estudos Prospectivos , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: To determine the sensitivity and specificity of anti-human immunodeficiency virus (HIV) IgA in identifying infected infants at or before 6 months of age among the offspring of HIV-infected mothers. DESIGN: Prospective comparison of anti-HIV IgA measurement performed in 2 different laboratories by 2 different methods with the criterion standard of blood culture. SETTING: Five centers in the United States and Puerto Rico. PATIENTS: Population-based sample of 156 infants of HIV-infected mothers in the Women and Infants Transmission Study. MAIN OUTCOME MEASURES: Results of anti-HIV IgA test in relation to the infection status of the infants as measured by blood culture. RESULTS: Six-month plasma or serum samples were first tested in the 2 laboratories. The sensitivity and specificity of anti-HIV IgA in detecting infected infants at this age by laboratories 1 and 2 were 69% and 63% and 100% and 99%, respectively. A look-back study of samples obtained at birth, 1, 2, and 4 months was then performed on all infected children and a matched set of uninfected children. The performance of the test at birth was unsatisfactory in both laboratories (sensitivity 44% and 33%, specificity 43% and 60%), whether peripheral or cord blood was examined. At 1, 2, and 4 months, the sensitivity of the test was lower than at 6 months, but specificity was high. A modest correlation of absent anti-HIV IgA antibody and low percentage of CD4 cells in peripheral blood was seen at 6 months of age. CONCLUSIONS: The anti-HIV IgA test has moderate sensitivity and high specificity for the diagnosis of HIV infection at 6 months of age in the offspring of infected mothers.
Assuntos
Anticorpos Anti-HIV/sangue , Infecções por HIV/diagnóstico , Infecções por HIV/transmissão , HIV-1/imunologia , Imunoglobulina A/sangue , Transmissão Vertical de Doenças Infecciosas , Feminino , Infecções por HIV/imunologia , Humanos , Lactente , Valor Preditivo dos Testes , Estudos Prospectivos , Porto Rico , Sensibilidade e Especificidade , Estados UnidosRESUMO
PIP: The occurrence of acquired immunodeficiency syndrome (AIDS) in Haitians and Haitian-Americans has remained an enigmatic aspect of the AIDS mystery. Although Haitians are currently classified as a high risk group, this designation has been disputed. The incidence of AIDS in recent Haitian immigrants to the US has been estimated at 84/100,000, which is lower than the 200-240/100,000 figure put forward for other risk groups. To better understand the spread of AIDS within the Haitian population, a serologic study of human T-lymphotropic virus type III (HTLV-III) seropostivity was performed on 88 healthy Haitians and 21 Haitians with AIDS in New York City. 95.2% of Haitian AIDS patients compared with only 1.1% of controls had a positive ELISA for HTLV-III infection. The low rate of seropositivity in health Haitians contrasts sharply with the prevalence of seropositivity noted in other high risk groups. For example, HTLV-III antibodies have been detected in 53% of healthy New York homosexuals and over 60% of drug users in New York and New Jersey. A likely explanation is that only a small segment of Haitian-Americans are really at risk of HTLV-III infection, and that this risk is conferred not by practices widespread in the Haitian community but by homosexuality, drug abuse, blood transfusions, or other as yet unidentified modes of transmission. Support for this thesis is provided by data from Haiti, where AIDS cases have been associated with bisexuality, an extremely high prevalence of veneral diseases, and contact with prostitutes. It is concluded that the designation of the entire Haitian community as a high risk group for AIDS may be inappropriate.^ieng
Assuntos
Síndrome da Imunodeficiência Adquirida/epidemiologia , Anticorpos Antivirais/análise , Síndrome da Imunodeficiência Adquirida/etiologia , Síndrome da Imunodeficiência Adquirida/transmissão , Emigração e Imigração , Feminino , Anticorpos Anti-HIV , Haiti/etnologia , Hemofilia A , Homossexualidade , Humanos , Masculino , Infecções por Retroviridae/epidemiologia , Risco , Comportamento Sexual , Estados UnidosRESUMO
Seven Haitian and one white patient with the acquired immunodeficiency syndrome and Salmonella typhimurium bacteremia were identified over a 28-month period. In three patients bacteremia developed concurrently with an opportunistic infection associated with the acquired immunodeficiency syndrome. The remaining five patients had their initial episodes of bacteremia 3 to 11 months before the diagnosis of the acquired immunodeficiency syndrome. These five patients had signs suggestive of the syndrome, plus evidence of disordered cellular immune function (lymphopenia, anergy, decreased T-helper cells, decreased proliferative responses, and a deficiency in mononuclear-cell alpha interferon production). Salmonella typhimurium bacteremia in the appropriate clinical setting may be an opportunistic pathogen associated with the acquired immunodeficiency syndrome.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Infecções por Salmonella/etiologia , Sepse/etiologia , Adulto , Ampicilina/uso terapêutico , Cloranfenicol/uso terapêutico , Diarreia/etiologia , Combinação de Medicamentos/uso terapêutico , Feminino , Haiti/etnologia , Humanos , Masculino , Cidade de Nova Iorque , Recidiva , Infecções por Salmonella/imunologia , Salmonella typhimurium , Sepse/imunologia , Sulfametoxazol/uso terapêutico , Trimetoprima/uso terapêutico , Combinação Trimetoprima e SulfametoxazolRESUMO
Acquired immune deficiency syndrome (AIDS) is a newly described syndrome in which patients are susceptible to certain malignancies and opportunistic infections (OI) usually found only in immunosuppressed individuals. Patients with AIDS have been found to have deficiencies of virtually all of their host defense systems. In this report, the natural resistance systems have been discussed. Although a deficiency of NK-cell function has been found in many patients with AIDS, this deficiency failed to distinguish patients susceptible to OI or malignancy from male homosexual controls. A deficiency of interferon-alpha generation by mononuclear cells upon exposure to HSV-1 infected fibroblasts was the best correlate with susceptibility to OI in AIDS patients. This deficiency failed to correlate with serum levels of acid-labile interferon-alpha in these patients. Although the interferon generating deficiency may be caused by the infections in these patients, it is more likely that the deficiency lays the groundwork for the establishment of the opportunistic infections.
Assuntos
Síndrome da Imunodeficiência Adquirida/imunologia , Homossexualidade , Interferon Tipo I/imunologia , Células Matadoras Naturais/imunologia , Síndrome da Imunodeficiência Adquirida/etiologia , Suscetibilidade a Doenças/imunologia , Feminino , Haiti/etnologia , Hemofilia A/complicações , Humanos , Imunidade Celular , Interferon Tipo I/sangue , Masculino , Transtornos Relacionados ao Uso de Substâncias/complicações , Linfócitos T/imunologiaRESUMO
Acquired immune deficiency syndrome (AIDS) is a newly recognized disease of unknown etiology, characterized by deregulation of the cell-mediated immune function system and manifested by opportunistic infections, unusual neoplasms (particularly Kaposi's sarcoma) in previously healthy persons. Male homosexuals, drug addicts, Haitian immigrants, and hemophiliacs constitute the group at high risk of having AIDS. The disease is probably caused by an as yet unidentified agent that is transmitted from person to person via sexual contact, blood, or blood products. Available therapy cannot reverse the underlying immune defect. Mortality at two years exceeds 70%. This article reviews the current state of our knowledge about AIDS. Selected aspects of the epidemiology, diagnosis, treatment, immunology, and etiology of the disease are discussed.
Assuntos
Síndrome da Imunodeficiência Adquirida , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/imunologia , Síndrome da Imunodeficiência Adquirida/terapia , Síndrome da Imunodeficiência Adquirida/transmissão , Haiti , Humanos , Infecções/etiologia , Infecções/terapia , Neoplasias/etiologia , Risco , Estados UnidosRESUMO
We describe acquired immune deficiency manifested by opportunistic infections in 10 previously healthy heterosexual Haitian men. The opportunistic pathogens included Toxoplasma gondii (in four patients), Cryptococcus neoformans (in one), Pneumocystis carinii (in four patients), and Candida albicans (in three). Six of the patients also had Mycobacterium tuberculosis. Immunologic studies of three patients showed a decrease in the numbers and activity of helper T cells, with normal or increased populations of suppressor T cells. Serologic markers for previous infections from hepatitis A, cytomegalovirus, and herpes simplex virus were detected in several patients. Six of the patients died despite specific antimicrobial therapy. The clinical and immunologic findings in these 10 Haitians are similar to those reported in drug addicts and homosexuals with the acquired immune-deficiency syndrome.