Frequent detection of escape from cytotoxic T-lymphocyte recognition in perinatal human immunodeficiency virus (HIV) type 1 transmission: the ariel project for the prevention of transmission of HIV from mother to infant.

Host immunologic factors, including human immunodeficiency virus (HIV)-specific cytotoxic T lymphocytes (CTL), are thought to contribute to the control of HIV type 1 (HIV-1) replication and thus delay disease progression in infected individuals. Host immunologic factors are also likely to influence perinatal transmission of HIV-1 from infected mother to infant. In this study, the potential role of CTL in modulating HIV-1 transmission from mother to infant was examined in 11 HIV-1-infected mothers, 3 of whom transmitted virus to their offspring. Frequencies of HIV-1-specific human leukocyte antigen class I-restricted CTL responses and viral epitope amino acid sequence variation were determined in the mothers and their infected infants. Maternal HIV-1-specific CTL clones were derived from each of the HIV-1-infected pregnant women. Amino acid substitutions within the targeted CTL epitopes were more frequently identified in transmitting mothers than in nontransmitting mothers, and immune escape from CTL recognition was detected in all three transmitting mothers but in only one of eight nontransmitting mothers. The majority of viral sequences obtained from the HIV-1-infected infant blood samples were susceptible to maternal CTL. These findings demonstrate that epitope amino acid sequence variation and escape from CTL recognition occur more frequently in mothers that transmit HIV-1 to their infants than in those who do not. However, the transmitted virus can be a CTL susceptible form, suggesting inadequate in vivo immune control.

The Ariel Project: A prospective cohort study of maternal-child transmission of human immunodeficiency virus type 1 in the era of maternal antiretroviral therapy.

In a prospective cohort study, clinical and biologic factors that contribute to maternal-child transmission of human immunodeficiency virus type 1 (HIV-1) were studied. HIV-infected pregnant women and their infants were evaluated prospectively according to a standardized protocol. Of 204 evaluable women, 81% received zidovudine during their pregnancy. The infection rate among the 209 evaluable infants was 9.1%. By univariate analysis, histologic chorioamnionitis, prolonged rupture of membranes, and a history of genital warts were significantly associated with transmission. Additional factors associated with transmission that approached significance included a higher maternal virus load at delivery and the presence of cocaine in the urine. In a logistic regression model, histologic chorioamnionitis was the only independent predictor of transmission. Despite a significantly higher transmission rate at one site, no unique viral genotype was found at any site. Thus, chorioamnionitis was found to be the major risk factor for transmission among women receiving zidovudine.

Predictors of Haitian-American infant development at twelve months.

Perinatal and early childhood influences on the development of 66 Haitian-American children were examined as part of an ongoing home visiting program. Although all participants were impoverished, approximately two-thirds lived in an urban setting with some access to social and health services, while one-third lived in a rural farmworkers' community where housing and services were sharply substandard. Measures used to examine the development of infants in these 2 settings included birthweight, household crowding, parental contributions to the child-rearing environment (the HOME), and developmental progress at 12 months on the Bayley Scales of Infant Development. Results showed that the urban sample was advanced on the Mental Development Index of the Bayley Scales. Regression analyses showed birthweight and the HOME score measuring child-rearing environment to be significant predictors of mental development, while psychomotor development was related to birthweight and household crowding. The results indicate that even within this disadvantaged Haitian entrant population, environmental differences exist that influence infant development in subtle but significant ways.

Effects of Brazelton demonstrations for mothers on the development of preterm infants.

Thirty healthy preterm infants were randomly assigned either to a control group or to one of two experimental groups. The mothers of the first experimental group were present during an administration of the Brazelton Neonatal Behavioral Assessment Scale and were asked to complete the Mother's Assessment of the Behavior of Her Infant Scale (MABI) at birth and weekly for four weeks after the discharge of their infants. The mothers of the second experimental group were not present during the administration of the Brazelton scale, but were asked to complete the MABI scale at birth and weekly for the first month after discharge. The mothers of the control infants did not observe administration of the Brazelton scale or complete the MABI scale, but were asked to complete a questionnaire on the developmental milestones of their infants. At 1, 4, and 12 months of age these infants were visited in their homes by teams of researchers blind to the hypothesis of the study and to the group assignment of the infants. The results at 1 month demonstrated that the experimental groups performed more optimally on the Brazelton scale interactive process items. These infants also received superior ratings on the video-taped feeding and face-to-face play sequences. At 4 months the experimental group infants showed better fine motor-adaptive abilities on the Denver Developmental Screening Test than did the control group. In addition, the face-to-face interaction ratings of the two experimental groups were significantly better that were those of the control group. The Bayley Scales of Infant Development were administered when the infants were 12 months corrected age. The infants of the experimental groups received significantly higher scores on the Mental Development Scale. This study suggests that teaching mothers the amazing skills of their newborns on the Brazelton and MABI scales may facilitate early interactions which, in turn, may contribute to early cognitive development.

Teenage, lower-class, black mothers and their preterm infants: an intervention and developmental follow-up.

To assess the combined risks of being born preterm and to a teenage mother, and to evaluate the effects of an early intervention, preterm infants born to lower-class, black, teenage mothers were provided a home-based, parent-training intervention, and their development was then compared with that of nonintervention controls, of term infants of teenage mothers, and of term and preterm infants of adult mothers. Despite equivalence on prenatal care, factors which placed the preterm infant of the teenage mother at greater risk at birth were the small-for-date size of the infant and the less realistic developmental milestones and child rearing attitudes expressed by the mother. The preterm infants of teenage mothers who received intervention showed more optimal growth, Denver scores, and face-to-face interactions at 4 months. Their mothers rated their infants' temperaments more optimally, expressed more realistic developmental milestones and child-rearing attitudes, and received higher ratings on face-to-face interactions. At 8 months, the intervention group received superior Bayley mental, Caldwell, and infant temperament scores.