1401
the discrepancies between our experience and that of Soriano’s and other groups;23 the seronegative individuals were recruited as being at high risk of HIV infection in an area (Paris) with a high prevalence of HI V infection.4 Horsburgh et aP detected HIV DNA before seroconversion in seronegative at-risk individuals, but PCR was positive only in the seronegative sample taken closest to the time of seroconversion. No seroconversion was observed during the study period in at-risk individuals in our study. Before concluding, as Soriano et al do, that DNA tests may be required to estimate the true prevalence of HIV infection, the methods and results of different PCR laboratories should be compared. An international quality control system is needed before the PCR assay can be used as a diagnostic tool for HIV infection.
explain
identifying pregnant women who are seropositive.s A trend towards heterosexual transmission would increase the proportion of HIVinfected women who are not identified as belonging to a risk group. Our findings suggest that public health campaigns should stress the risk of heterosexual transmission and its prevention and that broad screening programmes should be considered, to limit vertical transmission.
Clinique Universitaire
Port
Royal,
and inserm-U 149, 75014 Paris, France
R. HENRION E. HENRION-GEANT L. MANDELBROT C. DU MAZAUBRUN J. PARIS-LLADO G. BREART
JEAN-JACQUES LEFRERE Institut National de Transfusion Sanguine, 75015 Paris, France
MARTINE MARIOTTI ANNE-MARIE COUROUCE PHILIPPE ROUGER CHARLES SALMON
Immunology Service, Hôpital Necker, Paris
DANIEL VITTECOQ
Clinical
1. Anon. Situation du SIDA en France au 30 septembre 1989. Bull Epidemiol Hebd 1989;
46: 189-95. 2. Smith DG. Women and AIDS. Lancet
4. 5.
1. Loche M, Mach B. Identification of HIV-infected seronegative individuals
diagnostic
test
based
on
hybridisation
to
amplified
by a direct viral DNA. Lancet 1988; ii:
1990; 335: 281 Collaborating Centre on AIDS. AIDS surveillance in Europe: quarterly report (vol XXIII) 1989: 14-16 Davidson CF, Hudson CN, Ades AE, Peckham CS. Antenatal testing for human immunodeficiency virus. Lancet 1989; ii: 1442-44. Krasinski K, Borkowsky W, Bebenroth D, Moore T. Failure of voluntary testing for human immunodeficiency virus to identify infected parturient women in a high-risk population. N Engl J Med 1988; 318: 185.
3. WHO
418-21. 2. Ameisen
JC, Guy B, Lecoq JP, et al Persistent antibody response to the HIV-1 negative regulatory facfactorn in HIV-1 infected seronegative persons N Engl J Med 1989; 320: 251-52. 3. Horsburgh C, Ou CY, Jason J, et al. Duration of human immunodeficiency virus infection before detection of antibody. Lancet 1989; ii: 637-41. 4. Lefrère JJ, Richard D, Couroucé AM, et al. Risk factors of HIV-seropositive subjects detected through blood donation in France, 1985-1988. Transfusion 1989; 29: 84-86.
Trends in HIV transmission in pregnancy SiR,—Infection with HIV seems to be spreading among women in Europe, especially in France.’ We have recorded the route of HIV transmission in 200 seropositive women attending antenatal clinics at the Port Royal maternity hospital from Jan 1, 1984, to September 30, 1989. 88% of these women had been referred to us because of their seropositivity. The remainder were found to be HIV seropositive at first-trimester screening, which is done here for all consenting clinic attenders. Risk factors were recorded on a confidential questionnaire completed by a midwife or obstetrician. The probable route of transmission was noted as intravenous, sexual, both, or unknown. The intravenous transmission group (97 patients) were all drug abusers except for 1 woman who had had a transfusion with contaminated blood. The frequency of sexual transmission rose from 14% to 58% between 1984 and 1989 while the intravenous route (p
the discrepancies between our experience and that of Soriano’s and other groups;23 the seronegative individuals were recruited as being at high risk of HIV infection in an area (Paris) with a high prevalence of HI V infection.4 Horsburgh et aP detected HIV DNA before seroconversion in seronegative at-risk individuals, but PCR was positive only in the seronegative sample taken closest to the time of seroconversion. No seroconversion was observed during the study period in at-risk individuals in our study. Before concluding, as Soriano et al do, that DNA tests may be required to estimate the true prevalence of HIV infection, the methods and results of different PCR laboratories should be compared. An international quality control system is needed before the PCR assay can be used as a diagnostic tool for HIV infection.
explain
identifying pregnant women who are seropositive.s A trend towards heterosexual transmission would increase the proportion of HIVinfected women who are not identified as belonging to a risk group. Our findings suggest that public health campaigns should stress the risk of heterosexual transmission and its prevention and that broad screening programmes should be considered, to limit vertical transmission.
Clinique Universitaire
Port
Royal,
and inserm-U 149, 75014 Paris, France
R. HENRION E. HENRION-GEANT L. MANDELBROT C. DU MAZAUBRUN J. PARIS-LLADO G. BREART
JEAN-JACQUES LEFRERE Institut National de Transfusion Sanguine, 75015 Paris, France
MARTINE MARIOTTI ANNE-MARIE COUROUCE PHILIPPE ROUGER CHARLES SALMON
Immunology Service, Hôpital Necker, Paris
DANIEL VITTECOQ
Clinical
1. Anon. Situation du SIDA en France au 30 septembre 1989. Bull Epidemiol Hebd 1989;
46: 189-95. 2. Smith DG. Women and AIDS. Lancet
4. 5.
1. Loche M, Mach B. Identification of HIV-infected seronegative individuals
diagnostic
test
based
on
hybridisation
to
amplified
by a direct viral DNA. Lancet 1988; ii:
1990; 335: 281 Collaborating Centre on AIDS. AIDS surveillance in Europe: quarterly report (vol XXIII) 1989: 14-16 Davidson CF, Hudson CN, Ades AE, Peckham CS. Antenatal testing for human immunodeficiency virus. Lancet 1989; ii: 1442-44. Krasinski K, Borkowsky W, Bebenroth D, Moore T. Failure of voluntary testing for human immunodeficiency virus to identify infected parturient women in a high-risk population. N Engl J Med 1988; 318: 185.
3. WHO
418-21. 2. Ameisen
JC, Guy B, Lecoq JP, et al Persistent antibody response to the HIV-1 negative regulatory facfactorn in HIV-1 infected seronegative persons N Engl J Med 1989; 320: 251-52. 3. Horsburgh C, Ou CY, Jason J, et al. Duration of human immunodeficiency virus infection before detection of antibody. Lancet 1989; ii: 637-41. 4. Lefrère JJ, Richard D, Couroucé AM, et al. Risk factors of HIV-seropositive subjects detected through blood donation in France, 1985-1988. Transfusion 1989; 29: 84-86.
Trends in HIV transmission in pregnancy SiR,—Infection with HIV seems to be spreading among women in Europe, especially in France.’ We have recorded the route of HIV transmission in 200 seropositive women attending antenatal clinics at the Port Royal maternity hospital from Jan 1, 1984, to September 30, 1989. 88% of these women had been referred to us because of their seropositivity. The remainder were found to be HIV seropositive at first-trimester screening, which is done here for all consenting clinic attenders. Risk factors were recorded on a confidential questionnaire completed by a midwife or obstetrician. The probable route of transmission was noted as intravenous, sexual, both, or unknown. The intravenous transmission group (97 patients) were all drug abusers except for 1 woman who had had a transfusion with contaminated blood. The frequency of sexual transmission rose from 14% to 58% between 1984 and 1989 while the intravenous route (p
