Perinatal transmission of human immunodeficiency virus (HIV) will become a major mode of transmission in the next decade. It is currently estimated that, in coastal cities in the United States, greater than 0.1% of childbearing women are HIV infected. The rate of development of new cases of AIDS is greatest in the pediatric population. Critical for the development of methods to prevent perinatal transmission of HIV is an understanding of the observation that only one-half of children born to seropositive women are infected. Evidence exists that antiviral antibody in the mother decreases perinatal transmission for other congenital infections. This protocol will test the hypotheses that there is an inverse relationship between anti-HIV antibody in mothers and vertical transmission to their offspring. The University of Maryland has an ideal population of pregnant HIV infected women to study factors affecting perinatal transmission of HIV. Detailed histories of at risk behavior before and during pregnancy will be obtained. The serum and secretory (cervicovaginal) antibody response to HIV will be documented during pregnancy. At time of delivery, maternal and infant blood and maternal cervicovaginal secretions will be cultured for HIV virus. Neonates will be assayed for salivary and serum antibodies at delivery, 2, 4 months and 6 months of age and every 6 months thereafter. Children will be followed for 2 to 5 years so that the maternal and infant anti-HIV antibody response may be related to long term pediatric outcome. In this fashion, we will test the following hypotheses: 1) higher titers of anti-HIV antibody is associated with decreased vertical transmission of HIV, 2) the type and titer of antibody response in the infants is both an identifier of infection and a predictor of disease, and 3) the ongoing risk factors for HIV infection affect the type and titer of antibody response.
