Beta 2-microglobulin, HIV-1 p24 antibody and acid-dissociated HIV-1 p24 antigen levels: predictive markers for vertical transmission of HIV-1 in pregnant Ugandan women.

1993 
This study sought to evaluate the clinical utility of plasma beta2-microglobulin (beta2M) levels acid-dissociated HIV-1 p24 antigen and HIV-1 p24-antibody titers in predicting HIV-1 vertical transmission in 227 HIV-1-infected Ugandan pregnant women. Plasma beta2M levels acid-dissociated HIV-1 p24-antigen positivity and HIV-1 p24-antibody titers were determined using commercial enzyme immunoassays (EIA) in a Ugandan cohort of 52 HIV-1-seropositive transmitting mothers 175 HIV-1-seropositive non-transmitting mothers and 52 seronegative mothers within 6 weeks prior to delivery. Transmitter mothers had significantly higher plasma concentrations of beta2M (1.80 + or - 1.13 mg/1) than non-transmitter seropositive mothers (1.32 + or - 0.81 mg/1; P = 0.0013). Similarly a significantly higher proportion of transmitter mothers had detectable p24 antigen than non-transmitter mothers [6 out of 51 (11.8%) vs. 6 out of 173 (3.5%); P = 0.03]. Compared with the vertical transmission rate of 23% in the seropositive group the positive predictive values of a beta2M level > 1.5 mg/1 or detectable HIV-1 p24 antigen for vertical transmission were 34 and 50% respectively. 5 of 6 (83.3%) seropositive mothers with both a beta2M level > 1.5 mg/1 and detectable p24 antigenemia transmitted HIV-1 infection to their infants compared with 25 of 124 (20.2%) seropositive mothers with values below the cut-off values for both tests (P = 0.00249). However beta2M was not found to be a significant independent predictor of vertical transmission when analyzed in a multivariate model with p24 antigenemia. There was no significant difference in HIV-1 p24-antibody titers in transmitter mothers vs. non-transmitter mothers (P = 0.299). Beta2M levels and acid-dissociated HIV-1 p24-antigen assays may be used to predict which HIV-1 infected pregnant women are at greatest risk for vertical transmission. However only the p24-antigen test was independently predictive of vertical transmission and its clinical utility is limited. (authors)
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