Assuntos
Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Pentamidina/uso terapêutico , Pneumonia por Pneumocystis/prevenção & controle , Administração por Inalação , Aerossóis , Pré-Escolar , Dapsona/administração & dosagem , Dapsona/uso terapêutico , Esquema de Medicação , Humanos , Injeções Intravenosas , Pentamidina/administração & dosagem , Estudos Retrospectivos , Fatores de Tempo , Falha de Tratamento , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoRESUMO
To assess the risk of transmission of hepatitis C virus from mother to infant during pregnancy or at delivery, we measured the antibody to hepatitis C virus (anti-HCV) by an enzyme-linked immunosorbent assay (ELISA) and a recombinant immunoblot assay (RIBA) in serum from 43 infants whose mothers took illicit drugs intravenously. Passively transmitted maternal anti-HCV was detected in 17 (40%) of the 43 infants tested with the ELISA during the first 4 postnatal months. Ten of these initially seropositive infants were followed to 15 months of age or beyond; anti-HCV cleared from nine infants and persisted in one. Among 24 initially seronegative infants, three (12.5%) showed persistent anti-HCV at 6, 11, and 18 months of age, respectively. The remaining two infants were initially tested with ELISA at 6 and 15 months of age; both were transiently seropositive, but anti-HCV disappeared by 12 and 24 months of age, respectively. Among the 17 infants with maternal antibody, nine with ELISA reactions greater than 2.5 optical density units were reactive by RIBA: the eight with weaker reactivity by ELISA were nonreactive by RIBA. When serum samples from the four infants who showed persistent reactivity by ELISA were tested with RIBA, one reacted to both antigens displayed by RIBA (C-100 and 5-1-1), one reacted to the 5-1-1 antigen only, and two were nonreactive. Serum transaminase values were elevated in three of these four infants; all four were also infected with human immunodeficiency virus. The results indicate that vertically transmitted hepatitis C virus may be a cause of hepatitis in infants, especially those coinfected with human immunodeficiency virus. Neonates at risk of hepatitis C virus infection should be monitored beyond 12 months of age. The interpretation of tests for anti-HCV antibody during infancy requires further investigation.
Assuntos
Hepatite C/diagnóstico , Hepatite C/transmissão , Pré-Escolar , Ensaio de Imunoadsorção Enzimática , Feminino , Hepacivirus/isolamento & purificação , Humanos , Immunoblotting/métodos , Lactente , Masculino , Gravidez , Complicações na Gravidez , Estudos Prospectivos , Testes Sorológicos/métodos , Abuso de Substâncias por Via Intravenosa/complicaçõesRESUMO
To diagnose infection with the human immunodeficiency virus (HIV) soon after birth in infants born to HIV type 1-infected women, we developed antiviral IgA Western blot and dot blot assays with recombinant HIV-1 proteins. Thirty-three infants born to HIV-1-seropositive mothers and nine infants born to HIV-1-seronegative intravenous drug-abusing mothers were followed prospectively. Infection was documented by positive virus culture. Results with the polymerase chain reaction were used for comparison. Twelve infants were found infected with HIV-1; the earliest age at which cultures became positive ranged from birth to 31 weeks of age. Of the 12 culture-positive infants, 10 had anti-HIV IgA antibodies detectable initially between birth (cord blood) and 27 weeks of age. Anti-HIV IgA was not present in the uninfected infants or in the control subjects, either by Western blot or dot blot assays. Testing for anti-HIV IgA antibodies with recombinant HIV-1 proteins is an effective method for detecting viral infection in newborn and young infants.
Assuntos
Síndrome da Imunodeficiência Adquirida/diagnóstico , Anticorpos Anti-HIV/análise , HIV-1 , Imunoglobulina G/análise , Western Blotting , Seguimentos , Produtos do Gene env/análise , Produtos do Gene gag/análise , Antígenos HIV/análise , Proteína do Núcleo p24 do HIV , Proteína gp160 do Envelope de HIV , HIV-1/imunologia , HIV-1/isolamento & purificação , Humanos , Immunoblotting , Lactente , Recém-Nascido , Reação em Cadeia da Polimerase , Precursores de Proteínas/análise , DNA Polimerase Dirigida por RNA/análise , Proteínas Recombinantes , Sensibilidade e Especificidade , Fatores de Tempo , Proteínas do Core Viral/análiseRESUMO
To determine the usefulness of DNA amplification by polymerase chain reaction for the early identification of human immunodeficiency virus type 1 (HIV-1) infection in infants and children, we compared the polymerase chain reaction and concurrent viral cultures of peripheral blood mononuclear cells from 25 high-risk subjects aged 5 weeks to 8 years. In two separate primer pairs, HIV-1 proviral DNA gag sequences were successfully identified in cell lysates from seven patients, including two infants with previously indeterminate HIV-1 status on the basis of serologic and culture results. In the remaining 18 patients the polymerase chain reaction was negative for HIV-1. Simultaneously grown HIV-1 cultures concurred with polymerase chain reaction results for all patients. In an 18-month-old infant who had had a single HIV-1 positive culture at 1 month of age with four subsequent negative cultures, both polymerase chain reaction and HIV-1 culture were negative. Our data demonstrate the clinical applicability of polymerase chain reaction on crude cell lysates for the rapid, early, definitive detection of HIV-1 infection in high-risk infants and children.
Assuntos
Síndrome da Imunodeficiência Adquirida/microbiologia , DNA Viral/análise , Amplificação de Genes , HIV-1/isolamento & purificação , Criança , Pré-Escolar , DNA Polimerase Dirigida por DNA , Feminino , Genes Virais , HIV-1/genética , Humanos , Lactente , Troca Materno-Fetal , GravidezAssuntos
Anemia Falciforme/complicações , Vacinas Bacterianas/administração & dosagem , Imunização Secundária , Infecções Pneumocócicas/prevenção & controle , Polissacarídeos Bacterianos/administração & dosagem , Streptococcus pneumoniae , Adolescente , Anticorpos Antibacterianos/análise , Criança , Pré-Escolar , Seguimentos , Humanos , Estudos Longitudinais , Infecções Pneumocócicas/imunologia , Talassemia/complicaçõesRESUMO
To assess the immunologic status of healthy persons with hemophilia A, we performed studies of T cell immunity in 21 patients, 10 given only cryoprecipitate and 11 given factor VIII concentrate. Patients in the factor VIII group had significantly decreased helper/suppressor T cell ratios. Both groups had diminished mononuclear cell response to phytohemagglutinin and normal mixed lymphocyte culture, compared with controls. Abnormalities in T cell number or function did not correlate with the presence of antibody to cytomegalovirus, Epstein-Barr virus, or hepatitis B. Physicians caring for patients with hemophilia A should realize that asymptomatic individuals may have early evidence of immunodeficiency.