This 5 year prospective study of 1752 pregnant women at risk for HIV infection and their offspring will help define the epidemiology and clinical spectrum of perinatally acquired HIV infection. We will establish an HIV testing and counselling service at Boston City Hospital where high risk women seek either methadone maintenance or antenatal care. Each consenting women will be tested for HIV antibody and antigen upon entrance to the study and at 36 weeks gestation. Amniotic fluid will also be cultured and examined for HIV antigen in women who are having a clinically indicated amniocentesis, a caesarian section, or who have not ruptured the amniotic membranes prior to delivery. Blood from the estimated 126 liveborn infants who will be born to HIV positive women during the three years of patient enrollment will be tested for HIV antibody, antigen and cultured for HIV within the first week of life. Blood from 252 matched control infants who are born of mothers from the same high risk groups but are HIV antibody negative will only be tested for HIV antibody. HIV antibody positive infants will also be retested for HIV antibody and antigen at 2, 4, 6, 8, 12, and 24 months of age. HIV negative controls will be retested for HIV antibody at 6 months of age. All HIV antibody positive children will have HIV cultures at 6 and 12 months of age. We will conduct physical examination and sequential neurobehavioral tests on all infants of HIV positive mothers and control infants of HIV negative mothers from the same high risk groups for AIDS. Infants with symptoms of AIDS infection will have more extensive neurologic testing. Antibody response to immunization will be studied in case and control infants. The pregnancy of some HIV positive women will terminate in abortion and we will culture the fetus for HIV should this occur. This study will increase understanding of the transmission of HIV from mothers to infants and define the spectrum and developmental sequelae of HIV induced disease in infants and young children. A critical evaluation of antigen detection methods in relation to HIV culture and antibody may provide a better method for longitudinal studies in this population. Furthermore, the data gathered from this study should provide a sound basis for future management, immunization practices, and prevention of perinatal HIV infection.
