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Objective: To evaluate immunologic and virologic correlates of vertical transmission of human immunodeficiency virus type 1 (HIV-1).

Design: Case-control study.

Patients: Women who were prospectively enrolled in a natural history study of HIV-1 infection in women and infants. Sixteen HIV-1-infected women whose infants became infected were matched by CD4 sup cell percentage and use of zidovudine during pregnancy with women whose infants did not become infected.

Measurements: Maternal autologous neutralizing antibody, virus load determined by RNA-polymerase chain reaction (RNA-PCR), and virus phenotype.

Results: Most women in both groups had low titers of autologous neutralizing antibody, and no difference in neutralizing titers was observed (range, less than 4 to 181 in both groups). The HIV-1 copy number in maternal plasma was not significantly different in the two groups but was inversely correlated with maternal CD4 sup cell percentage (p less than 0.005). Five women in the transmitting group and four in the nontransmitting group had syncytium-inducing (SI) phenotype virus. Two infected infants had SI phenotype virus. The SI phenotype virus was associated with a greater HIV-1 copy number in maternal plasma (p less than 0.05) and an increase in the mortality rate for the infants (p less than 0.01).

Conclusions: In women matched for CD4 sup cell percentage, low titers of autologous neutralizing antibody, high virus load, and SI phenotype virus were not associated with an increased risk of transmission of HIV-1 to their infants. (J Pediatr 1995;126:865-71)

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