Risk factors for development of symptomatic AIDS in infants remains unclear. Several studies have suggested that although some infected children born to seropositive mothers develop symptoms and die by age two, others have a stable course over several years. Methodologic problems such as the inability to identify infected children at birth due to the presence of maternal antibody, small sample size and complications due to parental IV drug abuse have hampered ascertainment of predictors of poor outcome in children of seropositive mothers. We propose to study the natural history of HIV-1 infection in children infected at or before birth. Children born to seropositive mothers will be followed prospectively and the possible role of risk factors such as maternal symptomatology during pregnancy, mode of delivery, presence of neutralizing antibody and intact delayed-type hypersensitivity will be assessed. We intend to study children born to seropositive mothers in Rwanda, where HIV-1 is endemic; preliminary data indicate 5-15% seropositivity. Infected children will be identified at birth by detection of the viral genome in peripheral blood using polymerase chain reaction (PCR). Children of the first 200 infected women will be followed prospectively for three years; children of 100 non-infected women will be followed in parallel. Clinical and laboratory examinations including assays of viral expression will be performed periodically to assess progression of disease, HIV-1 infection, and immune status (cellular and serologic). Histories of intercurrent infections, injections and immunizations will be collected at each visit. Time to development of symptomatic AIDS/ARC or death will be analyzed as a function of the risk factors discussed above. The identification of factors associated with poor outcome and an improved understanding of the association of viral expression and disease progression should allow better management of pediatric AIDS patients.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD025785-05
Application #
3326965
Study Section
Special Emphasis Panel (ARR (V1))
Project Start
1989-09-30
Project End
1994-06-30
Budget Start
1993-07-01
Budget End
1994-06-30
Support Year
5
Fiscal Year
1993
Total Cost
Indirect Cost
Name
Johns Hopkins University
Department
Type
Schools of Public Health
DUNS #
045911138
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Bulterys, Philip L; Chao, Ann; Dalai, Sudeb C et al. (2011) Placental malaria and mother-to-child transmission of human immunodeficiency virus-1 in rural Rwanda. Am J Trop Med Hyg 85:202-6
Weng, S; Bulterys, M; Chao, A et al. (1998) Perinatal human immunodeficiency virus-1 transmission and intrauterine growth: a cohort study in Butare, Rwanda. Pediatrics 102:e24
Bulterys, M; Chao, A; Dushimimana, A et al. (1996) Fatal complications after Cesarian section in HIV-infected women. AIDS 10:923-4
Semba, R D; Bulterys, M; Munyeshuli, V et al. (1996) Vitamin A deficiency and T-cell subpopulations in children with meningococcal disease. J Trop Pediatr 42:287-90
Bulterys, M; Farzadegan, H; Chao, A et al. (1995) Diagnostic utility of immune-complex-dissociated p24 antigen detection in perinatally acquired HIV-1 infection in Rwanda. J Acquir Immune Defic Syndr Hum Retrovirol 10:186-91
Bulterys, M; Chao, A; Dushimimana, A et al. (1995) HIV-1 seroconversion after 20 months of age in a cohort of breastfed children born to HIV-1-infected women in Rwanda. AIDS 9:93-4
Bulterys, M; Musanganire, F; Chao, A et al. (1994) Traditional mourning customs and the spread of HIV-1 in rural Rwanda: a target for AIDS prevention? AIDS 8:858-9
Chao, A; Bulterys, M; Musanganire, F et al. (1994) Risk factors associated with prevalent HIV-1 infection among pregnant women in Rwanda. National University of Rwanda-Johns Hopkins University AIDS Research Team. Int J Epidemiol 23:371-80
Bulterys, M; Chao, A; Munyemana, S et al. (1994) Maternal human immunodeficiency virus 1 infection and intrauterine growth: a prospective cohort study in Butare, Rwanda. Pediatr Infect Dis J 13:94-100
Bulterys, M; Chao, A; Habimana, P et al. (1994) Incident HIV-1 infection in a cohort of young women in Butare, Rwanda. AIDS 8:1585-91

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