Use of the polymerase chain reaction for early detection of the proviral sequences of human immunodeficiency virus in infants born to seropositive mothers.

The early diagnosis of infection with human immunodeficiency virus (HIV) in infants born to infected mothers is essential for early treatment but current tests cannot detect HIV infection in newborns because of the presence of maternal antibodies. The authors used the polymerase chain reaction a new technique which amplifies proviral sequences of HIV within DNA to detect HIV infection in peripheral-blood mononuclear cells obtained from infants from seropositive women during the neonatal (less than 28 days) and postneonatal periods. In blood obtained during the neonatal period the polymerase chain reaction was positive in 5 of 7 infants in whom the acquired immunodeficiency syndrome (AIDS) later developed (a mean of 9.8 months after the tests). The test was also positive in 1 of 8 newborns who later had nonspecific signs and symptoms suggestive of HIV infection (mean followup 12 months). No proviral sequences were detected in neonatal samples from 9 infants who remained well (mean follow-up 16 months). HIV proviral sequences were detected in samples obtained during the postneonatal period (median age 5 months) in all of 6 infants tested who later had AIDS and in 4 of 14 infants with nonspecific findings suggestive of HIV infection. No proviral sequences were detected in 25 infants who remained well (mean follow-up 17 months) after being born to HIV-seropositive mothers or in 15 infants born to HIV-seronegative mothers. The authors conclude that the polymerase chain reaction will be a useful technique to diagnose HIV infection in newborns and to predict the subsequent development of AIDS. However larger studies will be required to determine the sensitivity and specificity of the test. (authors)