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Nankabirwa V, Tumwine JK, Namugga O, Tylleskär T, Ndeezi G, Robberstad B, Netea MG, Sommerfelt H. Early versus late BCG vaccination in HIV-1-exposed infants in Uganda: study protocol for a randomized controlled trial. Trials 2017; 18:152. [PMID: 28359325 PMCID: PMC5374628 DOI: 10.1186/s13063-017-1881-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 03/07/2017] [Indexed: 12/21/2022] Open
Abstract
Background Bacillus Calmette-Guérin (BCG) vaccination may have nonspecific effects, i.e., effects on childhood morbidity and mortality that go beyond its effect on the risk of childhood tuberculosis (TB). Though the available scientific literature is mostly from observational studies, and is fraught with controversy, BCG vaccination at birth may protect infants in high-mortality populations against serious infections other than TB. Yet, other studies indicate that giving BCG later in infancy may modify immune responses to non-TB antigens and potentially enhance immunity, potentially also against tuberculosis (TB). It is unclear whether BCG vaccination very early in life offers adequate protection against TB and other infections among HIV-1-exposed children because even those who remain uninfected with HIV-1 show signs of impaired immunocompetence early in infancy. This study will compare BCG vaccination at birth with BCG vaccination at 14 weeks of age in HIV-1-exposed infants. Methods This is an individually randomized controlled trial in 2200 HIV-1-exposed infants. The intervention is BCG vaccination within 24 h of birth while the comparator is BCG given at 14 weeks of age. The study co-primary outcomes are severe illness in the first 14 weeks of life, and production of tumor necrosis factor, interleukin (IL)-1β, IL-6 and interferon-γ in response to mycobacterial and nonmycobacterial antigens. The study is being conducted in three health centers in Uganda. Discussion A well-timed BCG vaccination could have important nonspecific effects in HIV-1-exposed infants. This trial could inform the development of appropriate timing of BCG vaccination for HIV-1-exposed infants. Trial registration ClinicalTrials.gov, identifier: NCT02606526. Registered on 12 November 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1881-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Victoria Nankabirwa
- Department of Epidemiology and Biostatics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda. .,Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, .
| | - James K Tumwine
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Olive Namugga
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen
| | - Thorkild Tylleskär
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Bjarne Robberstad
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Halvor Sommerfelt
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen.,Global Women and Children's Health, Norwegian Institute of Public Health, Oslo, Norway
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Grieb SMD, Davey-Rothwell M, Latkin CA. Housing stability, residential transience, and HIV testing among low-income urban African Americans. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2013; 25:430-44. [PMID: 24059880 PMCID: PMC4116750 DOI: 10.1521/aeap.2013.25.5.430] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The association between housing and HIV has been widely demonstrated, although inquiry into HIV testing has been largely limited to the homeless. This study examines correlates of HIV testing within the past 6 months with housing stability and residential transience (moving two or more times in the past 6 months) among 620 low-income urban African Americans. Unstably housed and transient participants were more likely to participate in high-risk sex behaviors than stably housed participants and non-transient participants, respectively. In multivariate analyses, residential transience was positively associated with recent HIV testing; however, persons unstably housed were not more likely to have recently been tested for HIV despite their increased vulnerability and risk. While structural interventions are necessary to address the HIV disparities related to housing, increased community-based and mobile testing centers may be able to improve access to HIV testing among unstably housed.
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Thomas MR, Wara D, Saxton K, Truskier M, Chesney MA, Boyce WT. Family adversity and autonomic reactivity association with immune changes in HIV-affected school children. Psychosom Med 2013; 75:557-65. [PMID: 23766380 PMCID: PMC3830556 DOI: 10.1097/psy.0b013e31829807fb] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To explore whether primary school entry is associated with changes in immune system parameters in HIV-affected children. HIV-affected children are vulnerable to psychosocial stressors, regardless of their own HIV serological status. METHODS Data from 38 HIV-positive and 29 HIV-negative children born to seropositive women were obtained. Measures included family adversity questionnaires, autonomic nervous system (ANS) reactivity, and enumerative and functional changes in peripheral blood immune parameters. RESULTS In comparison with children who were HIV-negative, children who were HIV-positive at baseline had fewer CD4(+) T lymphocytes (mean [M] = 916 versus 1206 cells/mm(3) × 10(3); F = 7.8, p = .007), more CD8(+) cells (M = 1046 versus 720 cells/mm(3) × 10(3); F = 7.98, p = .006), and diminished natural killer cell cytotoxicity (M = -0.29 versus 0.41; F = 8.87, p = .004). School entry was associated with changes in immune parameters, but HIV status was not associated with the magnitude of changes. Changes in immune parameters after school entry were associated with family stress and preschool entry ANS reactivity. Highly ANS reactive children had either the greatest increase in CD8(+) cells after school entry or the greatest decrease, depending on reported levels of family adversity (B = 215.35; t = 3.74, p < .001). Changes in functional immune assays were significantly associated with the interactions between HIV status and ANS reactivity. CONCLUSIONS These results suggest that autonomic reactivity is associated with increased immunological sensitivity to adverse or challenging social contexts among children affected by HIV.
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Affiliation(s)
- Melanie R Thomas
- University of California, San Francisco, San Francisco, CA, USA.
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Ladner J, Besson MH, Rodrigues M, Sams K, Audureau E, Saba J. Prevention of mother-to-child HIV transmission in resource-limited settings: assessment of 99 Viramune Donation Programmes in 34 countries, 2000-2011. BMC Public Health 2013; 13:470. [PMID: 23672811 PMCID: PMC3660172 DOI: 10.1186/1471-2458-13-470] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 04/26/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transmission of HIV from mother-to-child during pregnancy, labor, or breastfeeding is the primary cause of pediatric HIV infection in sub-Saharan Africa. A regimen of single-dose nevirapine administered to both HIV-positive pregnant women and their infants has been shown to lower the risk of mother-to-child transmission (MTCT) of HIV. In an effort to facilitate scale-up of PMTCT programs in low-income countries, Boehringer Ingelheim, the manufacturer of Viramune (branded nevirapine), initiated the Viramune Donation Programme (VDP) in 2000. The aim of this study was to evaluate the impact of the VDP on participating institutions. METHODS A total of 164 institutions in 60 countries were included in the VDP over its 11-year duration. An online quantitative and qualitative questionnaire was submitted to all program managers. The questionnaire collected data on the impact of the VDP on initiation and scale-up of PMTCT services, operational capacity, national PMTCT policies, access to funding, and national and international partnerships. Participants were asked for their opinion of how VDP was perceived by different stakeholders (medical community, patients, government authorities, communities). RESULTS Ninety-nine managers (60.4%) in 34 countries responded to the online questionnaire; 89 of institutions (89.9%) were located in Africa The most positive aspects of the VDP identified were: helped to expand PMTCT services (85.9% of program managers), reduced stigma against HIV-positive pregnant women, increased social support mechanisms (78.8%), fostered partnerships with national and international organizations (69.0%), and encouraged access to donor funding (63.0%). Implementation of the VDP triggered improvements in training hospitals and logistical capacity and was associated with changes in policy strategies at the national level. CONCLUSION A drug donation program such as the VDP can act as a catalyst for systemic changes at the institutional and national levels. The VDP provides a model for how private initiatives can have a significant impact on public health issues and foster diverse public-private partnerships among governments, commercial organizations, local institutions, and international NGOs.
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Affiliation(s)
- Joël Ladner
- Rouen University Hospital, Epidemiology and Public Health Department, Rouen University Hospital, Hôpital Charles Nicolle. 1, rue de Germont, Rouen cedex, 76 031, France
| | | | - Mariana Rodrigues
- Axios International, 7 boulevard de la Madeleine, Paris, 75001, France
| | - Kelley Sams
- Axios International, 7 boulevard de la Madeleine, Paris, 75001, France
| | - Etienne Audureau
- Biostatistics and Epidemiology Unit, Hôtel Dieu, Assistance Publique Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Joseph Saba
- Axios International, 7 boulevard de la Madeleine, Paris, 75001, France
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Transplacental exposure to AZT induces adverse neurochemical and behavioral effects in a mouse model: protection by L-acetylcarnitine. PLoS One 2013; 8:e55753. [PMID: 23409035 PMCID: PMC3567094 DOI: 10.1371/journal.pone.0055753] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 12/31/2012] [Indexed: 11/19/2022] Open
Abstract
Maternal-fetal HIV-1 transmission can be prevented by administration of AZT, alone or in combination with other antiretroviral drugs to pregnant HIV-1-infected women and their newborns. In spite of the benefits deriving from this life-saving prophylactic therapy, there is still considerable uncertainty on the potential long-term adverse effects of antiretroviral drugs on exposed children. Clinical and experimental studies have consistently shown the occurrence of mitochondrial dysfunction and increased oxidative stress following prenatal treatment with antiretroviral drugs, and clinical evidence suggests that the developing brain is one of the targets of the toxic action of these compounds possibly resulting in behavioral problems. We intended to verify the effects on brain and behavior of mice exposed during gestation to AZT, the backbone of antiretroviral therapy during human pregnancy. We hypothesized that glutamate, a neurotransmitter involved in excitotoxicity and behavioral plasticity, could be one of the major actors in AZT-induced neurochemical and behavioral alterations. We also assessed the antioxidant and neuroprotective effect of L-acetylcarnitine, a compound that improves mitochondrial function and is successfully used to treat antiretroviral-induced polyneuropathy in HIV-1 patients. We found that transplacental exposure to AZT given per os to pregnant mice from day 10 of pregnancy to delivery impaired in the adult offspring spatial learning and memory, enhanced corticosterone release in response to acute stress, increased brain oxidative stress also at birth and markedly reduced expression of mGluR1 and mGluR5 subtypes and GluR1 subunit of AMPA receptors in the hippocampus. Notably, administration during the entire pregnancy of L-acetylcarnitine was effective in preventing/ameliorating the neurochemical, neuroendocrine and behavioral adverse effects induced by AZT in the offspring. The present preclinical findings provide a mechanistic hypothesis for the neurobehavioral effects of AZT and strongly suggest that preventive administration of L-acetylcarnitine might be effective in reducing the neurological side-effects of antiretroviral therapy in fetus/newborn.
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Antibodies with high avidity to the gp120 envelope protein in protection from simian immunodeficiency virus SIV(mac251) acquisition in an immunization regimen that mimics the RV-144 Thai trial. J Virol 2012; 87:1708-19. [PMID: 23175374 DOI: 10.1128/jvi.02544-12] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The recombinant canarypox vector, ALVAC-HIV, together with human immunodeficiency virus (HIV) gp120 envelope glycoprotein, has protected 31.2% of Thai individuals from HIV acquisition in the RV144 HIV vaccine trial. This outcome was unexpected, given the limited ability of the vaccine components to induce CD8(+) T-cell responses or broadly neutralizing antibodies. We vaccinated macaques with an immunization regimen intended to mimic the RV144 trial and exposed them intrarectally to a dose of the simian immunodeficiency virus SIV(mac251) that transmits few virus variants, similar to HIV transmission to humans. Vaccination induced anti-envelope antibodies in all vaccinees and CD4(+) and CD8(+) T-cell responses. Three of the 11 macaques vaccinated with ALVAC-SIV/gp120 were protected from SIV(mac251) acquisition, but the result was not significant. The remaining vaccinees were infected and progressed to disease. The magnitudes of vaccine-induced SIV(mac251)-specific T-cell responses and binding antibodies were not significantly different between protected and infected animals. However, sera from protected animals had higher avidity antibodies to gp120, recognized the variable envelope regions V1/V2, and reduced SIV(mac251) infectivity in cells that express high levels of α(4)β(7) integrins, suggesting a functional role of antibodies to V2. The current results emphasize the utility of determining the titer of repeated mucosal challenge in the preclinical evaluation of HIV vaccines.
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Amoran OE, Salami OF, Oluwole FA. A comparative analysis of teenagers and older pregnant women in the utilization of prevention of mother to child transmission [PMTCT] services in, Western Nigeria. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2012; 12:13. [PMID: 22883969 PMCID: PMC3492029 DOI: 10.1186/1472-698x-12-13] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Accepted: 07/31/2012] [Indexed: 11/26/2022]
Abstract
UNLABELLED INTRODUCTION Most HIV/AIDS infections in women occur at a younger age, during the first few years after sexual debut. This study was therefore designed to assess factors associated with the knowledge and utilization of the prevention of mother-to-child transmission (PMTCT) services by the teenage pregnant women when compared to mature pregnant women in Ogun state, Nigeria. METHODS This study is an analytical cross-sectional study. A total sample of all pregnant women [52 teenagers and 148 adults] attending the primary health care centres in Sagamu local government area, Ogun State, Nigeria within a 2 months period were recruited into the study. RESULTS A total of 225 respondents were recruited into the study. The overall point prevalence of HIV/AIDS infection among those that had been tested and disclosed their result was 4 [2.8%]. The prevalence of HIV among the teenagers was 2 [7.4%] compared with 2 [1.8%] among older women. Only 85 [37.8%] of all respondents were tested through the Voluntary counseling and testing (VCCT) programme and 53 (23.7%) were aware of antiretroviral therapy while 35 (15.6%) have ever used the PMTCT services before.There was no statistically significant difference in the knowledge of the teenage pregnant women when compared with the older women about mother to child transmission (MTCT) [OR = 1.47, C.I = 0.57-3.95] and its prevention [OR = 0.83, C.I = 0.38-1.84]. The teenagers were 3 times less likely to use the services when compared with the older women. [OR = 0.34, C.I = 0.10-1.00]. Those from the low socio-economic background were about 6 times more likely to utilize PMTCT facilities when compared to those from high socioeconomic background [OR = 6.01, C.I = 1.91-19.19]. CONCLUSION The study concludes that the teenage pregnant women who were more vulnerable to HIV/AIDS infection did not utilize PMTCT services as much as the older pregnant women. Special consideration should be given to teenagers and those from high socioeconomic group in the design of scale up programmes to improve the uptake of PMTCT services in Nigeria and other low income countries.
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Affiliation(s)
- Olorunfemi E Amoran
- Department of Community Medicine and Primary Care, College of Health Sciences, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
| | - Omotayo F Salami
- Department of Community Medicine and Primary Care, College of Health Sciences, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
| | - Francis A Oluwole
- Department of Community Medicine and Primary Care, College of Health Sciences, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
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Kalembo FW, Zgambo M. Loss to Followup: A Major Challenge to Successful Implementation of Prevention of Mother-to-Child Transmission of HIV-1 Programs in Sub-Saharan Africa. ISRN AIDS 2012; 2012:589817. [PMID: 24052879 PMCID: PMC3767368 DOI: 10.5402/2012/589817] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 06/18/2012] [Indexed: 12/13/2022]
Abstract
Purpose. The purpose of this paper was to explore how loss to followup (LFTU) has affected the successful implementation of prevention of mother to child transmission of HIV-1 (PMTCT) programs in sub-Saharan Africa. Methods. We conducted an electronic search from the following databases PubMed, ScienceDirect, Directory of Open Access Journals (DOAJs), and PyscINFO. Additional searches were made in WHO, UNAIDS, UNICEF, Google, and Google scholar websites for (1) peer-reviewed published research, (2) scientific and technical reports, and (3) papers presented on scientific conferences. Results. A total of 678 articles, published from 1990 to 2011, were retrieved. Only 44 articles met our inclusion criteria and were included in the study. The rates of LTFU of mother-child pairs ranged from 19% to 89.4 in the reviewed articles. Health facility factors, fear of HIV-1 test, stigma and discrimination, home deliveries and socioeconomic factors were identified as reasons for LTFU. Conclusion. There is a great loss of mother-child pairs to follow up in PMTCT programs in sub-Saharan Africa. There is need for more research studies to develop public health models of care that can help to improve followup of mother-child pairs in PMTCT programs in Sub-Saharan Africa.
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Affiliation(s)
- Fatch W. Kalembo
- Maternal and Child Health Department, Tongji Medical College, Huazhong University of Science and Technology, Hang Kong Lu, Wuhan 430030, China
- Faculty of Health Sciences, Mzuzu University, Mzuzu, Malawi
| | - Maggie Zgambo
- University of North Carolina Project, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
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Ibeziako NS, Ubesie AC, Emodi IJ, Ayuk AC, Iloh KK, Ikefuna AN. Mother-to-child transmission of HIV: the pre-rapid advice experience of the university of Nigeria teaching hospital Ituku/Ozalla, Enugu, South-east Nigeria. BMC Res Notes 2012; 5:305. [PMID: 22713282 PMCID: PMC3434106 DOI: 10.1186/1756-0500-5-305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 06/19/2012] [Indexed: 11/13/2022] Open
Abstract
Background Mother-to-child transmission of human immune deficiency virus (HIV) is the most common route of HIV transmission in the pediatric age group. A number of risk factors contribute to the rate of this transmission. Such risk factors include advance maternal HIV disease, lack of anti-viral prophylaxis in the mother and child, mixing of maternal and infant blood during delivery and breastfeeding. This study aims to determine the cumulative HIV infection rate by 18 months and the associated risk factors at the University of Nigeria Teaching Hospital, Enugu. Results A retrospective study, involving HIV exposed infants seen at the pediatric HIV clinic of UNTH between March 2006 and September 2008. Relevant data were retrieved from their medical records. The overall rate of mother to child transmission of HIV in this study was 3.9% (95% CI 1.1%- 6.7%). However, in children breastfed for 3 months or less, the rate of transmission was 10% (95% CI −2.5%-22.5%), compared to 3.5% (95% CI 0.5%-6.5%) in children that had exclusive replacement feeding. Conclusions This retrospective observational study shows a 3.9% cumulative rate of mother-to-child transmission of HIV by 18 months of age in Enugu. Holistic but cost effective preventive interventions help in reducing the rate of mother-to-child transmission of HIV even in economically-developing settings like Nigeria.
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Affiliation(s)
- Ngozi S Ibeziako
- Department of Pediatrics, Faculty of Medical Sciences, University of Nigeria, Enugu, Nigeria
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Abstract
The HIV epidemic in higher-income nations is driven by receptive anal intercourse, injection drug use through needle/syringe sharing, and, less efficiently, vaginal intercourse. Alcohol and noninjecting drug use increase sexual HIV vulnerability. Appropriate diagnostic screening has nearly eliminated blood/blood product-related transmissions and, with antiretroviral therapy, has reduced mother-to-child transmission radically. Affected subgroups have changed over time (e.g., increasing numbers of Black and minority ethnic men who have sex with men). Molecular phylogenetic approaches have established historical links between HIV strains from central Africa to those in the United States and thence to Europe. However, Europe did not just receive virus from the United States, as it was also imported from Africa directly. Initial introductions led to epidemics in different risk groups in Western Europe distinguished by viral clades/sequences, and likewise, more recent explosive epidemics linked to injection drug use in Eastern Europe are associated with specific strains. Recent developments in phylodynamic approaches have made it possible to obtain estimates of sequence evolution rates and network parameters for epidemics.
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Affiliation(s)
- Sten H Vermund
- Institute for Global Health and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
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Whitmore SK, Taylor AW, Espinoza L, Shouse RL, Lampe MA, Nesheim S. Correlates of mother-to-child transmission of HIV in the United States and Puerto Rico. Pediatrics 2012; 129:e74-81. [PMID: 22144694 DOI: 10.1542/peds.2010-3691] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal of this study was to examine associations between demographic, behavioral, and clinical variables and mother-to-child HIV transmission in 15 US jurisdictions for birth years 2005 through 2008. METHODS The study used Enhanced Perinatal Surveillance system data for HIV-infected women who gave birth to live infants. Multivariable logistic regression was used to assess variables associated with mother-to-child transmission. RESULTS Among 8054 births, 179 infants (2.2%) were diagnosed with HIV infection. Half of the births had at least 1 missed prevention opportunity: 74.3% of infected infants, 52.1% of uninfected infants. Among 7757 mother-infant pairs with sufficient data for analysis, the odds of having an HIV-infected infant were higher for women who received late testing or no prenatal antiretroviral medications (odds ratio: 2.5 [95% confidence interval (CI): 1.5-4.0] and 3.5 [95% CI: 2.0-6.4], respectively). The odds for mothers who breastfed were 4.6 times (95% CI: 2.2-9.8) the odds for those who did not breastfeed. The adjusted odds for women with CD4 counts <200 cells per microliter were 2.4 times (95% CI: 1.4-4.2) those for women with CD4 counts ≥500 cells per microliter. The odds for women who abused substances were twice (95% CI: 1.4-2.9) those for women who did not. CONCLUSIONS The odds of having an HIV-infected infant were higher among HIV-infected women who were tested late, had no antiretroviral medications, abused substances, breastfed, or had lower CD4 cell counts. Increases in earlier HIV diagnosis, substance abuse treatment, avoidance of breastfeeding, and use of prenatal antiretroviral medications are critical in eliminating perinatal HIV infections in the United States.
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Affiliation(s)
- Suzanne K Whitmore
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Sun Y, Hewan-Lowe K, Wu Q, Yu J, Guo Z, Han Y, Fan Y, Qin X, Xu P, Bolatihan J, Hoshaerbai M, Yuan L, Hong H. HIV Screening and Awareness Survey for Pregnant Women in a Remote Area in Xinjiang Uyghur Autonomous Region of China. Open AIDS J 2011; 5:96-101. [PMID: 22207891 PMCID: PMC3242400 DOI: 10.2174/1874613601105010096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 08/11/2011] [Accepted: 08/25/2011] [Indexed: 11/22/2022] Open
Abstract
Objective: The number of people infected with human immunodeficiency virus (HIV) in China has increased in recent years. HIV screening for pregnant women was performed in a remote area in Xinjiang, as an effort to promote universal HIV screening in pregnant women and to help prevention of mother-to-child transmission. Methods: Pregnant women in Burqin and Jeminay Counties in Xinjiang were offered free voluntary HIV screening. Local mid-level medical workers were trained to use Determine® HIV-1/2 kit for HIV screening. All the tested pregnant women signed a consent form, received HIV education material, and participated in an HIV knowledge survey. Results: All the 890 pregnant women receiving HIV test had negative result. Among these women, 67.6% were Kazakh and 40.9% were farmers. Survey of HIV knowledge showed that these women's awareness about mother-to-child transmission was limited. The levels of HIV knowledge were related with ethnic background, age, education and profession of the pregnant women. Conclusion: The results suggested that HIV infection had not become a significant problem among the pregnant women in this remote area of Xinjiang, but continued efforts to improve the awareness of HIV, especially the knowledge about mother-to-child transmission of HIV, in pregnant women were needed.
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Affiliation(s)
- Yuping Sun
- Department of Microbiology, Xinjiang Medical University, Urumoqi, China
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Friedman RK, Bastos FI, Leite IC, Veloso VG, Moreira RI, Cardoso SW, Andrade ACVD, Sampaio MC, Currier J, Grinsztejn B. Pregnancy rates and predictors in women with HIV/AIDS in Rio de Janeiro, Southeastern Brazil. Rev Saude Publica 2011; 45:373-81. [PMID: 21412574 DOI: 10.1590/s0034-89102011000200016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 10/18/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess incidence and predictors of first pregnancy among women with HIV/AIDS. METHODS Prospective cohort study was conducted in Rio de Janeiro, southeastern Brazil, between 1996 and 2003. This study comprised 225 women with HIV/AIDS followed up until their first pregnancy or first censored event (hysterectomy, tubal ligation, menopause, 50 years of age, loss to follow-up, death or the end of December 2003). Pregnancy and abortion rates were estimated, and Cox proportional hazards models were used to identify baseline characteristics associated with pregnancy risk. RESULTS The women were followed up for 565 person/years with a median follow-up of 3 years per women. The mean age was 32 years (SD: 7), and 54.7% were white. There were 60 pregnancies in 39 women, and 18 were terminated (induced abortions), accounting for a rate of 6.9% and 2.1% women/year, respectively. Repeated pregnancies occurred in 33.3% of the women (13/39). Higher pregnancy risk was seen among younger women (HR=3.42; 95%CI: 1.69;6.95) and those living with their partners (HR=1.89; 95%CI: 1.00;3.57). Lower pregnancy risk was associated with higher education level (HR=0.43; 95%CI: 0.19;0.99) and use of antiretroviral therapy (HR=061; 95%CI: 0.31;1.17). CONCLUSIONS Lower pregnancy rates were found in our cohort than in the general population. Sociodemographic characteristics should be taken into consideration in the management of reproductive health in HIV-positive childbearing age women. Reproductive and family planning counseling must be incorporated into HIV/AIDS programs for women to help preventing HIV transmission to their partners and offspring.
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Affiliation(s)
- Ruth Khalili Friedman
- Laboratório de Pesquisa em DST/Aids, Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4, Rio de Janeiro, RJ, Brazil. ruthkf@fi ocruz.br
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Breastfeeding in HIV Exposed Infants Significantly Improves Child Health: A Prospective Study. Matern Child Health J 2011; 16:632-40. [DOI: 10.1007/s10995-011-0795-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chenine AL, Siddappa NB, Kramer VG, Sciaranghella G, Rasmussen RA, Lee SJ, Santosuosso M, Poznansky MC, Velu V, Amara RR, Souder C, Anderson DC, Villinger F, Else JG, Novembre FJ, Strobert E, O'Neil SP, Secor WE, Ruprecht RM. Relative transmissibility of an R5 clade C simian-human immunodeficiency virus across different mucosae in macaques parallels the relative risks of sexual HIV-1 transmission in humans via different routes. J Infect Dis 2010; 201:1155-63. [PMID: 20214475 DOI: 10.1086/651274] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Worldwide, approximately 90% of all human immunodeficiency virus (HIV) transmissions occur mucosally; almost all involve R5 strains. Risks of sexual HIV acquisition are highest for rectal, then vaginal, and finally oral exposures. METHODS Mucosal lacerations may affect the rank order of susceptibility to HIV but cannot be assessed in humans. We measured relative virus transmissibility across intact mucosae in macaques using a single stock of SHIV-1157ipd3N4, a simian-human immunodeficiency virus encoding a primary R5 HIV clade C env (SHIV-C). RESULTS The penetrability of rhesus macaque mucosae differed significantly, with rectal challenge requiring the least virus, followed by vaginal and then oral routes (P = .031, oral vs vaginal; P < .001 rectal vs vaginal). These findings imply that intrinsic mucosal properties are responsible for the differential mucosal permeability. The latter paralleled the rank order reported for humans, with relative risk estimates within the range of epidemiological human studies. To test whether inflammation facilitates virus transmission--as predicted from human studies--we established a macaque model of localized buccal inflammation. Systemic infection occurred across inflamed but not normal buccal mucosa. CONCLUSION Our primate data recapitulate virus transmission risks observed in humans, thus establishing R5 SHIV-1157ipd3N4 in macaques as a robust model system to study cofactors involved in human mucosal HIV transmission and its prevention.
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Affiliation(s)
- Agnès L Chenine
- Dana-Farber Cancer Institute, Massachusetts General Hospital, Boston, Massachusetts 02115-6084, USA
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16
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Koenig S, Ivers L, Pace S, Destine R, Leandre F, Grandpierre R, Mukherjee J, Farmer P, Pape J. Successes and challenges of HIV treatment programs in Haiti: aftermath of the earthquake. ACTA ACUST UNITED AC 2010; 4:145-160. [PMID: 21197385 DOI: 10.2217/hiv.10.6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Haiti's HIV/AIDS program is one of the most successful in the world, with a declining HIV prevalence, and treatment outcomes that rival those of industrialized nations. It is now on the way to providing universal treatment for HIV/AIDS nationwide. This success is tied to a strong foundation for HIV care that was in place before external funding became available that includes national guidelines prepared by the Ministry of Health, political commitment at the highest levels of government, non-governmental organizations that had been providing high quality care in Haiti for decades, and the assistance of the Global Fund to Fight AIDS, TB, and Malaria, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and other private donors.While the challenges of human resource shortages, widespread poverty, and limited infrastructure cannot be overstated, these are being addressed through the provision of integrated, comprehensive services. Haiti's successful treatment models are being duplicated around the world.
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Affiliation(s)
- S Koenig
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA; Partners In Health, Boston, MA; the Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti; and the Department of Medicine of Weill Cornell Medical College, New York, NY
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Msellati P. Improving mothers' access to PMTCT programs in West Africa: a public health perspective. Soc Sci Med 2009; 69:807-12. [PMID: 19539413 DOI: 10.1016/j.socscimed.2009.05.034] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2008] [Indexed: 11/17/2022]
Abstract
Despite technical means and apparent political will, the percentage of pregnant women involved in preventing mother-to-child transmission (PMTCT) interventions is not increasing as fast as public health authorities would expect. This is even more striking when compared to the scaling up of access to antiretroviral treatment. It seems important to analyze the successes and failures of the programs and the "scaling-up" of PMTCT programs. This is a major issue for women at two levels: women are very concerned about the health of their children, and they are the ones who implement prevention in collaboration with health services. A review of achievements and failures described from a public health perspective may lead to greater understanding of the social aspects involved in PMTCT program achievements and failures. This paper is based on the combination of a literature review and empirical evidence collected during 15 years of PMTCT implementation, childcare research and treatment programs in West Africa. The analysis aims to identify the social issues that explain the gap between PMTCT program aims and achievements in order to encourage research in the social sciences regarding relationships between mothers and the care system. We find it is possible to build programs at the national level that have a high degree of acceptance of testing and intervention, with a progressive decline in HIV infection among children. However, many obstacles remain, highlighting the necessity to broaden access to HIV screening, develop mass campaigns on testing for couples and improve HIV care and training for caregivers. Because HIV-infected pregnant women are experiencing great psychological distress, healthcare providers must use an approach that is as friendly as possible.
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Affiliation(s)
- Philippe Msellati
- IRD, UMR 145, IRD-Université de Montpellier/CreCSS, MMSH, 5 Rue du Chateau de l'Horloge, 13094 Aix en Provence cedex 2, France.
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Immunogenicity of 23-valent pneumococcal polysaccharide vaccine in HIV-infected pregnant women and kinetics of passively acquired antibodies in young infants. Vaccine 2009; 27:3856-61. [PMID: 19443091 DOI: 10.1016/j.vaccine.2009.04.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2008] [Revised: 04/02/2009] [Accepted: 04/03/2009] [Indexed: 11/22/2022]
Abstract
Whether gestational immunization of HIV-infected mothers with the 23-valent pneumococcal polysaccharide vaccine (PPV) confers maternal and infant early life, passive protection is not known. We evaluated safety, immunogenicity and placental transfer of antibodies in 44 HIV-infected women. Pneumococcal IgG antibodies against serotypes 1, 3, 5, 6B, 9V, and 14 were measured in mothers (pre-vaccination and at delivery), and infants (at birth, 1, 2, 3, and 6 months). PPV was safe and immunogenic in mothers. Newborns received 46-72% of maternal antibody titers. Overall, infants had antibody levels lower than protective by 2 months of age. Alternative pneumococcal vaccination of HIV-infected pregnant women should be explored with the aim of prolonging passive protection in their infants.
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Zhang H, Wu X, Chung F, Naraharisetti SB, Whittington D, Mirfazaelian A, Unadkat JD. As in humans, pregnancy increases the clearance of the protease inhibitor nelfinavir in the nonhuman primate Macaca nemestrina. J Pharmacol Exp Ther 2009; 329:1016-22. [PMID: 19293388 DOI: 10.1124/jpet.109.151746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The apparent oral clearance of protease inhibitors (PIs) is increased in pregnant women. Although this phenomenon is reproduced in the mouse, because of the multiplicity of mouse cytochrome P450 isoforms, lack of information on their substrate and inhibitor selectivity, and lack of reagents (e.g., antibodies, purified protein), it is difficult to study the mechanistic basis of this phenomenon in this animal model. To investigate the mechanistic basis of this phenomenon in a more representative model, the nonhuman primate, we first determined whether this phenomenon could be reproduced in Macaca nemestrina, using nelfinavir as a model PI. Consistent with the human and mouse studies, we found that the apparent oral clearance of nelfinavir (NFV) in the macaques was significantly increased (3.14-fold) antepartum (n = 3) versus postpartum (n = 4). This increased apparent oral clearance was a result of an increased systemic clearance (1.9-fold) and a decreased bioavailability (approximately 45%) during pregnancy. In vitro, pregnancy significantly enhanced the rate of NFV depletion in hepatic, but not intestinal S-9 fractions. Human CYP3A inhibitors erythromycin (0.5 mM), ketoconazole (0.5 microM), and troleandomycin (0.01-1 mM), but not the CYP2C inhibitor, sulfaphenazole (3 microM), significantly inhibited the depletion of NFV in hepatic S-9 fractions and expressed rhesus CYP3A64 enzyme. Based on these data, we conclude that increased hepatic activity of NFV-metabolizing enzymes (perhaps CYP3A enzymes) results in increased clearance of PIs during pregnancy in the macaques. The M. nemestrina should be further investigated as a model to study the mechanisms by which the clearance of PIs is increased during pregnancy.
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Affiliation(s)
- Huixia Zhang
- Department of Pharmaceutics, University of Washington, Box 357610, Seattle, WA 98195, USA
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Zorrilla CD, Tamayo-Agrait V. Pharmacologic and nonpharmacologic options for the management of HIV infection during pregnancy. HIV AIDS (Auckl) 2009; 1:41-53. [PMID: 22096378 PMCID: PMC3218681 DOI: 10.2147/hiv.s6326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Over the past decade, significant advances have been made in the treatment of HIV-1 infection using both pharmacologic and nonpharmacologic strategies to prevent mother-to-child transmission (MTCT). Optimal prevention of the MTCT of HIV requires antiretroviral drugs (ARV) during pregnancy, during labor, and to the infant. ARVs reduce viral replication, lowering maternal plasma viral load and thus the likelihood of MTCT. Postexposure prophylaxis of ARV agents in newborns protect against infection following potential exposure to maternal HIV during birth. In general, the choice of an ARV for treatment of HIV-infected women during pregnancy is complicated by the need to consider the effectiveness of the therapy for the maternal disease as well as the teratogenic or teratotoxic potential of these drugs. Clinicians managing HIV in pregnancy need to discuss the potential risks and benefits of available therapy options so that mothers can make informed decisions in choosing the best treatment regimen for themselves and for their children.
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Affiliation(s)
- Carmen D Zorrilla
- Department of Obstetrics and Gynecology, University of Puerto Rico School of Medicine, Maternal Infant Studies Center (CEMI), San Juan, Puerto Rico
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Msuya SE, Mbizvo EM, Hussain A, Uriyo J, Sam NE, Stray-Pedersen B. Low male partner participation in antenatal HIV counselling and testing in northern Tanzania: implications for preventive programs. AIDS Care 2008; 20:700-9. [PMID: 18576172 DOI: 10.1080/09540120701687059] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aimed to describe the prevalence and predictors for male partner participation in HIV voluntary counselling and testing (VCT) at two primary healthcare clinics in Moshi urban, Tanzania as well as the effect of partner participation on uptake of HIV perinatal interventions. Pregnant women (n = 2654) in their third trimester, participating in a prevention of mother to child tranmission (PMTCT) program between June 2002 and March 2004 were encouraged to inform and invite their partners for HIV-VCT. Trained nurses conducted pre-test counselling, interviews, clinical examinations and blood sampling from the participating women and their partners. Test results were presented and post-test counselling was conducted individually or in couples, depending on the wishes of the participants. Three-hundred-and-thirty-two male partners (12.5%) came for HIV-VCT. A high proportion (131; 40%) came after the woman had delivered. HIV-seropositive women whose partners attended were three times more likely to use Nevirapine prophylaxis, four times more likely to avoid breastfeeding and six times more likely to adhere to the infant feeding method selected than those whose partners didn't attend. Women were more likely to bring their partner for VCT if they collected their own test results, were living with their partner, had a high monthly income and had expressed at enrolment the intention to share HIV results with their partner. Although PMTCT programs are presumably a good entry point for male involvement in prevention of sexual and perinatal HIV transmission, this traditional clinic-based approach reaches few men. Given the positive influence male participation has on the acceptance of perinatal interventions, a different approach for promoting male participation in VCT is urgently required. Within PMTCT programs, counseling should emphasize the advantages of partner participation to encourage women to inform and convince male partners to come for VCT. Also, promotion of couple VCT outside antenatal settings in male friendly and accessible settings should be given priority.
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Affiliation(s)
- S E Msuya
- Department of International Health, University of Oslo, Norway.
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22
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Castro ACD, Borges LGDA, Souza RDSD, Grudzinski M, D'Azevedo PA. Evaluation of the human immunodeficiency virus type 1 and 2 antibodies detection in dried whole blood spots (DBS) samples. Rev Inst Med Trop Sao Paulo 2008; 50:151-6. [PMID: 18604415 DOI: 10.1590/s0036-46652008000300004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2006] [Accepted: 04/04/2008] [Indexed: 11/21/2022] Open
Abstract
Human Immunodeficiency Virus Type 1 and 2 antibodies detection was performed in 457 dried whole blood spots samples (S&S 903). Q-Preven HIV 1+2 was the screening test used. The results were compared with the gold standard serum tests by ELISA (Cobas Core e Axsym HIV1/2 gO) and immunofluorescence was the definitive confirmatory test. The samples were obtained from the Hospital Nossa Senhora da Conceição in Porto Alegre, RS - Brazil, through whole blood transfer to filter paper card and sent to Caxias do Sul, RS-Brazil where the tests were performed. The dried whole blood spot stability was evaluated with two different panels. The first one was composed of five negative and five positive samples stored at room temperature, 4 degrees C, -20 degrees C and -70 degrees C, while the second was composed of two negative and three positive samples stored at 37 degrees C (humidity <50%). Each sample was screened every week for six weeks. These measurement results didn't show variation during the study period. The detected sensibility was 100%, specificity was 99.6%, the positive predictive value was 99.5% and negative predictive values were 100%. The results demonstrated high performance characteristics, opening a new perspective of dried whole blood spot utilization in HIV screening diagnosis.
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Affiliation(s)
- Andréa Cauduro de Castro
- Programa de Pós-graduação em Patologia, Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, Rua Visconde do Herval 472, Porto Alegre, RS, Brazil.
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Abstract
PURPOSE To study the morphologic changes and cytotoxicity in corneal fibroblasts after mitomycin C (MMC) treatment, ultraviolet B (UVB) irradiation, or in combination. METHODS Primary porcine corneal fibroblasts, passages 3-5, were treated with MMC (0.1 or 0.2 mg/mL, ie, 0.01% or 0.02%, for 5 minutes), UVB irradiation (2, 5, or 10 mJ/cm2), or in combination. Control cells were treated with culture medium as a sham procedure. Alterations in cell morphology were documented by phase-contrast microscopy; cellular apoptosis was evaluated by Annexin V/propidium iodide staining and analyzed by flow cytometry; cytotoxicity was evaluated by lactate dehydrogenase assay; and cell growth was studied by genomic DNA quantification with the PicoGreen assay. RESULTS UV irradiation induced significant dose-dependent corneal fibroblast rounding and detachment and cytotoxicity. MMC at 0.1 or 0.2 mg/mL induced considerable cell elongation and retarded cell proliferation at similar rates. MMC treatment alone did not cause significant apoptosis or cytotoxicity. However, MMC treatment before UV irradiation potentiated UV-related cytotoxicity proportional to the UV radiation dose. CONCLUSIONS UV irradiation causes dose-dependent cytotoxicity in porcine corneal fibroblasts. MMC pretreatment potentiates UV-related cytotoxicity.
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Zhang H, Wu X, Wang H, Mikheev AM, Mao Q, Unadkat JD. Effect of pregnancy on cytochrome P450 3a and P-glycoprotein expression and activity in the mouse: mechanisms, tissue specificity, and time course. Mol Pharmacol 2008; 74:714-23. [PMID: 18509067 DOI: 10.1124/mol.107.043851] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The plasma concentrations of orally administered anti-human immunodeficiency virus protease inhibitors are significantly reduced during human and mouse pregnancy. We have shown that in the mouse, at gestational day 19, this reduction is due to increased hepatic cytochrome P450 3a (Cyp3a) protein expression and activity. In the current study, we investigated the mechanisms by which Cyp3a activity is increased by pregnancy and the time course of change in expression of Cyp3a and P-glycoprotein (P-gp) in various tissues. We found that hepatic transcripts of Cyp3a16, Cyp3a41, and Cyp3a44 were significantly increased during pregnancy, whereas those of Cyp3a11 and Cyp3a25 were significantly decreased. This resulted in a net increase in Cyp3a protein expression and activity in the liver during pregnancy. The increase in Cyp3a41 and Cyp3a44 transcripts was positively correlated (p < 0.05) with hepatocyte nuclear factor 6 and estrogen receptor-alpha transcripts. The pregnancy-related factors that transcriptionally activated mouse Cyp3a isoforms also activated the human CYP3A4 promoter in pregnant CYP3A4-promoter-luciferase transgenic (CYP3A4-tg) mice. In contrast, intestinal Cyp3a protein expression was not significantly affected by pregnancy. No change in P-gp protein expression was observed in the liver or kidney during pregnancy, although a significant decrease was observed in the placenta. Because hepatic CYP3A activity also seems to be induced during human pregnancy, the mouse (including CYP3A4-tg mouse) seems to be an excellent animal model to determine the molecular mechanisms for such an induction.
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Affiliation(s)
- Huixia Zhang
- Department of Pharmaceutics, University of Washington, Seattle, WA 98195, USA
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Fernández-Ibieta M, Ramos Amador JT, Guillén Martín S, González-Tomé MI, Navarro Gómez M, Iglesias González-Nicolás E, Rubio Gribble B, de José Gómez MI, Beceiro Mosquera J, Regidor J, De Santos Butragueño MJ, Martínez Guardia N, Roa Francia MA. [Why are HIV-infected infants still being born in Spain?]. An Pediatr (Barc) 2007; 67:109-15. [PMID: 17692255 DOI: 10.1016/s1695-4033(07)70570-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Despite the success of preventive measures against mother-to-child transmission (MTCT) of human immunodeficiency virus-1 and -2 (HIV-1 and -2) in developed countries, HIV-infected infants continue to be born. The aim of this study was to evaluate failures in the prevention of MTCT and the clinical characteristics of infected infants. METHODS The Foundation for the Investigation and Prevention of AIDS in Spain (FIPSE) Cohort in Madrid prospectively follows up children at risk of MTCT HIV born in eight public hospitals in Madrid. From May 2000 to December 2005, 632 children born to HIV-infected mothers were evaluated. Data from pregnancy follow-up, antiretroviral therapy (ART), and symptoms at diagnosis in infected infants were analyzed. RESULTS Nine infants were infected. The rate of vertical transmission was 1.42 (95% CI 0.7-2.68). Of the nine mothers, seven had not received ART during pregnancy (and five had not received ART at delivery). Of the mothers who received ART, one had only done so for the last month of pregnancy. Two infants were given three drugs as prevention of MTCT, one received bitherapy and six received monotherapy. The median age at diagnosis was 2.4 months (range 7 days-2 years). The mean plasma viral load at diagnosis was 276,000 copies/ml (range: 11,900-1,000,000). Five of the infants were symptomatic at diagnosis (P. jirovaci pneumonia in two, sepsis in one, recurrent bacterial infections in one, hepatosplenomegaly in one). Four of the nine infants had been admitted to hospital prior to HIV diagnosis. DISCUSSION Missed opportunities for the prevention of MTCT were identified in eight of the nine HIV-infected infants (89%). Administration of AZT during labor in HIV-infected mothers and triple therapy for the prevention of MTCT in high risk infants is not universal. Hospital admission in young infants at risk might lead to suspicion of infection in infants born to HIV-infected mothers. Improved implementation of all the preventive measures for MTCT should be encouraged.
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Affiliation(s)
- M Fernández-Ibieta
- Servicio de Pediatría, Hospital Universitario de Getafe, Madrid, España.
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Ojesina AI, Mullins C, Imade G, Samuels J, Sankalé JL, Pam S, Sagay S, Idoko J, Kanki PJ. Characterization of HIV type 1 reverse transcriptase mutations in infants infected by mothers who received peripartum nevirapine prophylaxis in Jos, Nigeria. AIDS Res Hum Retroviruses 2007; 23:1587-92. [PMID: 18160018 DOI: 10.1089/aid.2007.0064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study was carried out to characterize HIV-1 reverse transcriptase (RT) mutations in vertically infected infants in Jos, Nigeria. DNA was extracted from peripheral blood mononuclear cells of 102 infants, aged 0 to 6 months, born to HIV-1-infected mothers who had received peripartum single-dose nevirapine prophylaxis. PCR-based diagnosis revealed that 14 infants (13.7%) were infected with HIV-1. Phylogenetic analyses of RT revealed wide viral diversity, with CRF02_AG, subtype G, subsubtype A3, CRF06_cpx, and a subtype D recombinant present in the population. Four of 13 (31%) infants had NNRTI resistance mutations--V179I (2 infants), Y181C, and V179E. Intriguingly, subtype G sequences did not have NNRTI mutations but rather carried a Q207N mutation, which may undergo negative selection under drug pressure. Our data suggest wide diversity for vertically transmitted HIV-1 viruses in Nigeria and highlight the potential significance of transmitting rare mutations in subtype G.
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Affiliation(s)
- Akinyemi I. Ojesina
- Harvard School of Public Health, Department of Immunology and Infectious Diseases, Boston, Massachusetts 02115
| | - Christopher Mullins
- Harvard School of Public Health, Department of Immunology and Infectious Diseases, Boston, Massachusetts 02115
| | - Godwin Imade
- Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Jay Samuels
- Harvard School of Public Health, Department of Immunology and Infectious Diseases, Boston, Massachusetts 02115
| | - Jean-Louis Sankalé
- Harvard School of Public Health, Department of Immunology and Infectious Diseases, Boston, Massachusetts 02115
| | - Sunday Pam
- Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Solomon Sagay
- Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - John Idoko
- Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Phyllis J. Kanki
- Harvard School of Public Health, Department of Immunology and Infectious Diseases, Boston, Massachusetts 02115
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Chandisarewa W, Stranix-Chibanda L, Chirapa E, Miller A, Simoyi M, Mahomva A, Maldonado Y, Shetty AK. Routine offer of antenatal HIV testing ("opt-out" approach) to prevent mother-to-child transmission of HIV in urban Zimbabwe. Bull World Health Organ 2007; 85:843-50. [PMID: 18038074 PMCID: PMC2636259 DOI: 10.2471/blt.06.035188] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Accepted: 03/02/2007] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To assess the impact of routine antenatal HIV testing for preventing mother-to-child transmission of HIV (PMTCT) in urban Zimbabwe. METHODS Community counsellors were trained in routine HIV testing policy using a specific training module from June 2005 through November 2005. Key outcomes during the first 6 months of routine testing were compared with the prior 6-month "opt-in" period, and clients were interviewed. FINDINGS Of the 4551 women presenting for antenatal care during the first 6 months of routine HIV testing, 4547 (99.9%) were tested for HIV compared with 3058 (65%) of 4700 women during the last 6 months of the opt-in testing (P < 0.001), with a corresponding increase in the numbers of HIV-infected women identified antenatally (926 compared with 513, P < 0.001). During routine testing, more HIV-infected women collected results compared to the opt-in testing (908 compared with 487, P < 0.001) resulting in a significant increase in deliveries by HIV-infected women (256 compared with 186, P = 0.001); more mother/infant pairs received antiretroviral prophylaxis (n = 256) compared to the opt-in testing (n = 185); and more mother/infant pairs followed up at clinics (105 compared with 49, P = 0.002). Women were satisfied with counselling services and most (89%) stated that offering routine testing is helpful. HIV-infected women reported low levels of spousal abuse and other adverse social consequences. CONCLUSION Routine antenatal HIV testing should be implemented at all sites in Zimbabwe to maximize the public health impact of PMTCT.
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Affiliation(s)
| | | | - Elizabeth Chirapa
- Zimbabwe AIDS Prevention Project, University of Zimbabwe, Harare, Zimbabwe
| | - Anna Miller
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA
| | - Micah Simoyi
- Chitungwiza Health Department, Chitungwiza, Zimbabwe
| | - Agnes Mahomva
- Ministry of Health and Child Welfare, Harare, Zimbabwe
| | - Yvonne Maldonado
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Avinash K Shetty
- Department of Pediatrics, Wake Forest University Health Sciences, Winston-Salem, NC, USA
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Coovadia H. Breastfeeding in HIV-positive women: do the benefits outweigh the risks? ACTA ACUST UNITED AC 2007. [DOI: 10.2217/17455111.1.1.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Hoosen Coovadia
- University of Kwazulu-Natal, Doris Duke Medical Research Institute, Nelson Mandela School of Medicine, 719 Umbilo Road, Congella 4013, South Africa
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Cowburn C, Hatherill M, Eley B, Nuttall J, Hussey G, Reynolds L, Waggie Z, Vivian L, Argent A. Short-term mortality and implementation of antiretroviral treatment for critically ill HIV-infected children in a developing country. Arch Dis Child 2007; 92:234-41. [PMID: 16670122 PMCID: PMC2083402 DOI: 10.1136/adc.2005.074856] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe the short-term outcome of critically ill HIV-infected children with access to highly active antiretroviral therapy (HAART) in a developing region. METHODS Prospective observational study conducted in a paediatric teaching hospital in Cape Town, South Africa. All children admitted to the paediatric intensive care unit (PICU) with suspected HIV infection were screened. Data are n (%) with 95% confidence intervals. RESULTS Sixty eight of 96 HIV antibody-positive children, median age 3 months, were confirmed HIV-infected. Predicted PICU mortality was 0.42. Fifty one children (75%; 95% CI 65 to 85%) survived to PICU discharge, but hospital survival was only 51% (95% CI 40 to 63%). Limitation of intervention (LOI) decisions were a factor in the majority of PICU and ward deaths. Twenty one PICU survivors (31%; 95% CI 20 to 42%) commenced HAART, and two children were already on treatment. Nineteen children (28%) were considered to be established on HAART after 1 month. Thirteen HIV-infected children (19%; 95% CI 10 to 28%), representing 25% (95% CI 14 to 37%) of all PICU survivors, and 68% (95% CI 48 to 89%) of those PICU survivors who were established on HAART remain well on treatment after median 350 days. CONCLUSION The majority of HIV-infected children survived to discharge from PICU, but only half survived to hospital discharge. LOI decisions, usually made in PICU, directly influenced short-term survival and the opportunity to commence HAART. Although few critically ill HIV-infected children survived to become established on HAART, the long-term outcome of children on HAART is encouraging and warrants further investigation.
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Affiliation(s)
- C Cowburn
- Infectious Diseases Clinic, Red Cross Children's Hospital and University of Cape Town, Cape Town, South Africa.
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Mussi-Pinhata MM, Freimanis L, Yamamoto AY, Korelitz J, Pinto JA, Cruz MLS, Losso MH, Read JS. Infectious disease morbidity among young HIV-1-exposed but uninfected infants in Latin American and Caribbean countries: the National Institute of Child Health and Human Development International Site Development Initiative Perinatal Study. Pediatrics 2007; 119:e694-704. [PMID: 17296782 DOI: 10.1542/peds.2006-1856] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal was to describe the frequency, characteristics, and correlates of infectious disease morbidity during the first 6 months of life among HIV-1-exposed but uninfected infants. METHODS The study population consisted of infants enrolled in the National Institute of Child Health and Human Development International Site Development Initiative Perinatal Study who were HIV-1 uninfected and had follow-up data through the 6-month study visit. Definitive and presumed infections were recorded at study visits (birth, 6-12 weeks, and 6 months). RESULTS Of 462 HIV-1-uninfected infants with 11,644 child-weeks of observation, 283 experienced > or = 1 infection. These 283 infants experienced 522 infections (1.8 infections per infant). The overall incidence rate of infections was 4.5 cases per 100 child-weeks of observation. Overall, the most common infections were skin or mucous membrane infections (1.9 cases per 100 child-weeks) and respiratory tract infections (1.7 cases per 100 child-weeks). Thirty-six percent of infants had > 1 respiratory tract infection (1.8 cases per 100 child-weeks). Incidence rates of upper and lower respiratory tract infections were similar (0.89 cases per 100 child-weeks and 0.9 cases per 100 child-weeks, respectively). Cutaneous and/or oral candidiasis occurred in 48 neonates (10.3%) and 92 older infants (19.3%). Early neonatal sepsis was diagnosed in 12 infants (26.0 cases per 1000 infants). Overall, 81 of 462 (17.5%) infants were hospitalized with an infection. Infants with lower respiratory tract infections were hospitalized frequently (40.7%). The occurrence of > or = 1 neonatal infection was associated with more-advanced maternal HIV-1 disease, tobacco use during pregnancy, infant anemia, and crowding. Lower maternal CD4+ cell counts, receipt of intrapartum antibiotic treatment, and country of residence were associated with postneonatal infections. CONCLUSIONS Close monitoring of HIV-1-exposed infants, especially those who are anemic at birth or whose mothers have more-advanced HIV-1 disease or who smoked during pregnancy, remains important.
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Heard I, Sitta R, Lert F. Reproductive choice in men and women living with HIV: evidence from a large representative sample of outpatients attending French hospitals (ANRS-EN12-VESPA Study). AIDS 2007; 21 Suppl 1:S77-82. [PMID: 17159592 DOI: 10.1097/01.aids.0000255089.44297.6f] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In France, the third decade of the HIV epidemic is characterized by a lower age among women who have been recently infected with HIV. This study analysed factors associated with the desire for a child in a sample of heterosexual women and men of reproductive age living with HIV. METHODS Individuals of reproductive age within the VESPA study were included in the analysis. Desire for a child was analysed according to reproductive potential, cultural aspects and HIV-related health condition (CD4 cell count, plasma HIV load and being on treatment). RESULTS A total of 555 women and 699 men who self-identified as heterosexual and did not report a medical diagnosis of infertility, were included in the analysis. Among them, 33% of the women and 20% of the men stated that they expected to have children in the future. In multivariate analysis, significant predictors of the desire for a child included factors associated with reproductive potential (younger age, already being a parent, regular relationship), the HIV status of the regular partner and ethnicity (African origin). HIV-related health status did not affect reproductive intentions among men and women. CONCLUSIONS For both men and women, reproductive potential, ethnicity and partner's HIV status influenced the desire for a child, whereas the person's own clinical condition in relation to HIV had low impact. Reproductive counselling integrated into HIV care should take into account cultural aspects in order to help people living with HIV examine issues of parenthood.
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Affiliation(s)
- Isabelle Heard
- Service d'immunologie Clinique, Hôpital Européen Georges Pompidou, Paris, France.
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McDonald C, Lambert J, Nayagam D, Welz T, Poulton M, Aleksin D, Welch J. Why are children still being infected with HIV? Experiences in the prevention of mother-to-child transmission of HIV in south London. Sex Transm Infect 2006; 83:59-63. [PMID: 17005542 PMCID: PMC2598578 DOI: 10.1136/sti.2006.021535] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of interventions to prevent mother-to-child transmission of HIV at a large teaching hospital in South East London, and to assess reasons for the small numbers of transmissions that continue to occur. DESIGN A database of all pregnant women diagnosed as HIV positive between 1993 and 2005 was reviewed, with detailed (retrospective) case-note review of all mother-infant pairs where HIV transmission occurred. SETTING King's College Hospital, London, UK, a teaching hospital serving an ethnically diverse and socially deprived population. RESULTS 296 pregnancies to 274 women were recorded. 9 of 296 (3.0%) women were lost to follow-up before the end of the pregnancy. Of 287 pregnancies followed up until after delivery, 6 (2.1%) resulted in HIV infection in the infant. More recently, between 2000 and 2004, this transmission rate was even lower, at 3 in 231 (1.3%). Each of these six women had complications, including late presentation to services and defaulting follow-up appointments, which were likely to increase the risk of HIV transmission. Four of the six transmissions occurred in utero. CONCLUSION The overall transmission rate of 2% attests to the efforts of the multidisciplinary care team in managing this population which is often hard to reach. Clearly, good systems are needed to trace those women who default. Further data are needed regarding in utero transmissions.
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Affiliation(s)
- C McDonald
- Department of Sexual Health, Caldecot Clinic, King's College Hospital, Caldecot Road, Denmark Hill, London SE5 9RS, UK.
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Luzuriaga K, Newell ML, Dabis F, Excler JL, Sullivan JL. Vaccines to prevent transmission of HIV-1 via breastmilk: scientific and logistical priorities. Lancet 2006; 368:511-21. [PMID: 16890838 DOI: 10.1016/s0140-6736(06)69159-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Mother-to-child transmission (MTCT) of HIV-1 is the major mode of paediatric infection. The rapidly increasing incidence of MTCT worldwide has resulted in an urgent need for preventive strategies. Antiretroviral regimens can prevent intrapartum HIV transmission; however, these regimens do not prevent HIV transmission through breastfeeding. Furthermore, children who escape MTCT are again at risk of infection when they become sexually active as adolescents. An infant vaccine regimen, begun at birth, would hence be a more attractive strategy and might also provide the basis for lifetime protection. Unique features of MTCT and paediatric HIV disease could be helpful in understanding correlates of immune protection and could facilitate rapid assessment of vaccine efficacy. Thus, there is compelling rationale to develop safe, effective HIV vaccines for use in infants and children. Here, we discuss the scientific and logistical challenges for the development of paediatric HIV vaccines; available vaccines and completed or planned paediatric vaccine trials are also discussed.
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Affiliation(s)
- Katherine Luzuriaga
- University of Massachusetts Medical School, Program in Molecular Medicine, 373 Plantation Street, Suite 318, Worcester, MA 01605, USA.
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Sherr L, Fox Z, Lipton M, Whyte P, Jones P, Harrison U. Sustaining HIV testing in pregnancy- evaluation of routine offer of HIV testing in three London hospitals over 2 years. AIDS Care 2006; 18:183-8. [PMID: 16615201 DOI: 10.1080/09540120500456599] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study sets out to examine how routine offers of HIV testing for pregnant women in ante-natal (prenatal) clinics are managed over time. Data was collected over two time periods (2002, 2004) from all women booking clinics at three London hospitals. Data from 3,560 women, comprising 2,710 in 2002 (time 1) and 850 in 2004 (time 2) were gathered. Uptake of HIV testing, demographic variables, HIV-associated risks, pregnancy variables and uptake of other ante-natal tests were monitored. In the later study, details of partner testing and time spent discussing HIV was monitored. HIV test uptake with routine offer (RCT) was high. There was a significant increase in HIV testing over time from 85 to 91% (p<0.0001). In 2004, significantly more women had been previously tested for HIV (25 versus 41%, p<0.0001), more women refused all other ante-natal tests (rubella [0 versus 4% p<0.0001], syphilis [1 versus 5%, p<0.0001], Haemoglobin [1 versus 3%, p<0.0001], Down's syndrome [0 versus 13%, p<0.0001] and hepatitis B [1 versus 5%, p<0.0001]). Significantly less women refused HIV test (15 versus 9%, p<0.0001). Initially, HIV was the most frequently refused test (15%), whereas at time 2 Down's syndrome tests were most frequently declined. At time 1, 2% declined any test. By time 2, 14% of the sample declined any test (p<0.0001). Three percent of women had an established HIV risk at time 1 and 6% at time 2. Women with risk factors were significantly less likely to accept testing at time 2, but not at time 1 or not overall. Multivariable analysis was carried out to look at predictors of opting in and opting out of testing. At time 2 HIV test uptake was more likely if less than 3 min was spent discussing it (chi2=9.3, p=0.002). This information was not available at time 1. HIV testing in ante-natal care can be sustained over time. Challenges for the future relate to complex cases, test declining, ensuring that women with risk factors do not systematically decline and providing skills for midwives or referral pathways to deal with more demanding cases. It has been possible to normalise HIV testing. Women have responded with high HIV test uptake, but are also questioning other tests which were previously routinely offered.
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Affiliation(s)
- Lorraine Sherr
- Royal Free and University College Medical School, UCL, London, UK.
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Abstract
Vertical exposure to HIV occurs at a time when functional capacity of the infant's immune system is attenuated through immaturity. Immune response capability is rooted in host genetic makeup, and the broad and fine specificity of innate and adaptive immune responses, respectively, shape the outcomes of HIV encounter in some instances and imprint viral changes through selective immune pressure in others. Findings from recent studies have profound implications for understanding immune pathogenesis of pediatric HIV infection and, in particular, highlight the importance of host genetics of both mother and child in determining whether an exposed child acquires HIV infection or not and, if infected, the rate of disease progression. This review focuses on the key host molecules, the CC chemokine CCL3 and HLA, which have taken center stage in these new developments.
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Affiliation(s)
- CAROLINE T. TIEMESSEN
- C.T. Tiemessen, AIDS Virus Research Unit, National Institute for Communicable Diseases and University of the Witwatersand, Private Bag X4, Sandringham, 2131, South Africa. Phone: (+27-11) 386-6366/6400; Fax: (+27-11) 386-6465 E-mail:
| | - LOUISE KUHN
- L. Kuhn, Gertrude H. Sergievsky Centre, College of Physicians and Surgeons; and Department of Epidemiology, Mailman School of Public Health, Columbia University, 630 West 168 Street, New York, NY 10032. Phone: (212) 305-2398; Fax: (212) 305-2426 E-mail;
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England K, Thorne C, Newell ML. Vertically acquired paediatric coinfection with HIV and hepatitis C virus. THE LANCET. INFECTIOUS DISEASES 2006; 6:83-90. [PMID: 16439328 DOI: 10.1016/s1473-3099(06)70381-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Both HIV and hepatitis C virus (HCV) can be transmitted from mother to child during pregnancy and delivery. Vertical transmission of HIV and HCV separately is most likely from HIV/HCV-coinfected mothers; however, transmission of both infections is less frequent. The effect of HCV coinfection on HIV-related disease remains unclear; whereas most studies indicate no effect, recent results suggest HCV in adults accelerates HIV progression. Little is known about how HIV coinfection affects HCV progression in children and the information available is based on small numbers of patients. Paediatric HIV treatment is extremely successful and it is vital to determine if HCV coinfection alters the effectiveness of this treatment. The hepatotoxicity of many HIV therapies and the possible negative impact of HCV on this treatment, alongside the interactions and contraindications of many HIV and HCV therapies, further limits the choice of paediatric treatments for coinfected children. Future research must therefore focus on vertically acquired HIV/HCV coinfection to inform treatment trials addressing coinfection management.
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Affiliation(s)
- Kirsty England
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, London, UK
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Mathias AA, Maggio-Price L, Lai Y, Gupta A, Unadkat JD. Changes in pharmacokinetics of anti-HIV protease inhibitors during pregnancy: the role of CYP3A and P-glycoprotein. J Pharmacol Exp Ther 2005; 316:1202-9. [PMID: 16293714 DOI: 10.1124/jpet.105.095406] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Human immunodeficiency virus (HIV)-infected women have reduced exposure [area under the curve (AUC)] to anti-HIV protease inhibitors [e.g., nelfinavir (NFV)] during pregnancy. To determine the mechanistic basis of this phenomenon, we administered NFV mesylate orally (2.5 mg) or intravenously (0.625 mg) to timed pregnant (gestational age: 18-19 days) and non-pregnant FVB mice. After oral but not after i.v. administration, the plasma clearance of NFV was higher (by 134%, p < 0.05) and bioavailability was lower (by 32%, p < 0.05) in pregnant (n = 3) versus nonpregnant mice (n = 3). These effects of pregnancy were not due to changes in plasma protein binding of NFV. The half-life of NFV depletion in hepatic S-9 fractions of pregnant mice (n = 8) was 2.2-fold faster (p < 0.05) than that in nonpregnant mice (n = 7). Hepatic CYP3A activity (testosterone 6beta-hydroxylation, n = 4) and expression (n = 8) were significantly higher (by 138 and 49%, p < 0.05) in pregnant mice than that in nonpregnant mice. In the intestine, no CYP3A activity was detected and CYP3A protein expression (n = 6, p > 0.05) was not significantly different between the two groups. P-glycoprotein expression (n = 6) in hepatic and intestinal tissue of pregnant mice was not significantly different from that in nonpregnant mice. These changes in disposition of NFV during pregnancy are predominately due to a change in its bioavailability. An increase in hepatic CYP3A can explain the reduced bioavailability of NFV during pregnancy. If such upregulation of hepatic CYP3A activity occurs in pregnant women, it has important implications for dose adjustment of a variety of drugs ingested by pregnant women and cleared predominately via CYP3A metabolism.
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Affiliation(s)
- Anita A Mathias
- Department of Pharmaceutics, University of Washington, Box 357610, Seattle, WA 98195, USA
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Shetty AK. Perinatally Acquired HIV-1 Infection: Prevention and Evaluation of HIV-Exposed Infants. ACTA ACUST UNITED AC 2005; 16:282-95. [PMID: 16210108 DOI: 10.1053/j.spid.2005.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Perinatal transmission of human immunodeficiency virus type 1 (HIV-1) is the primary cause of pediatric HIV infections. In recent years, perinatal HIV-1 transmission rates in the United States have declined markedly because of several factors that include enhanced voluntary counseling and HIV-1 testing (VCT) for pregnant women, widespread use of antiretroviral prophylaxis or combination antiretroviral therapy, avoidance of breastfeeding, and elective cesarean delivery. However, perinatal transmission of HIV-1 still occurs, and 300 to 400 infected infants are born annually, primarily because of missed prevention opportunities. The pediatrician plays a vital role in the prevention of perinatal transmission of HIV-1 by identifying newborns born to infected mothers who were not tested during pregnancy, administering antiretroviral prophylaxis, and ensuring follow-up to confirm or exclude the diagnosis of HIV-1 infection in early infancy. This article reviews recent advances in the prevention of perinatal transmission of HIV-1, discusses evaluation and treatment of infants exposed to HIV-1, and highlights certain unique features of HIV-1 infections in infants, with a focus on early diagnosis, clinical manifestations, treatment, and prognosis.
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Affiliation(s)
- Avinash K Shetty
- Department of Pediatrics, Wake Forest University Health Sciences and Brenner Children's Hospital, Winston-Salem, NC, USA.
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Abstract
OBJECTIVE To review predisposition to sepsis in children infected with human immunodeficiency virus (HIV) in the era of highly active antiretroviral therapy (HAART). DESIGN Summary of the literature with review by experts in the field. RESULTS In industrialized regions, new diagnoses of vertically acquired HIV infection are falling due to perinatal interventions. Provision of HAART has resulted in an enlarging cohort of clinically stable HIV-infected children, with low viral loads and normal CD4 T-lymphocyte counts. Access to HAART in "developed" countries has markedly decreased the rate of progression to acquired immunodeficiency syndrome, the prevalence of organ-specific complications of HIV, the risk of recurrent sepsis, and the high early childhood mortality from HIV infection. There are currently no data on whether initiation of HAART during acute sepsis reduces short-term morbidity or mortality. Undiagnosed, antiretroviral-naive, HIV-infected infants still present sporadically with opportunistic infections such as Pneumocystis jiroveci and cytomegalovirus pneumonia. HIV-infected children have a greater burden of disease due to viral, bacterial, and fungal sepsis, and the case fatality rate for nonopportunistic infections may be greater than in non-HIV-infected children. In "developing" countries, with limited access to HAART, the natural history of HIV infection has altered very little, with the majority of infected children dying from either opportunistic or nonopportunistic disease before 3 yrs of age. CONCLUSION Pediatric HIV infection is not a homogeneous condition in the era of HAART. Susceptibility to sepsis, morbidity, and mortality differ according to stage of disease, access to HAART, and virologic and immunologic response to treatment. These issues should be considered if HIV-infected children are to be enrolled and stratified in clinical trials.
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Affiliation(s)
- Mark Hatherill
- Paediatric Intensive Care Unit, School of Child and Adolescent Health, University of Cape Town, South Africa
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Rawal BD, Pretorius AM. “Nanobacterium sanguineum” – Is it a new life-form in search of human ailment or commensal: Overview of its transmissibility and chemical means of intervention. Med Hypotheses 2005; 65:1062-6. [PMID: 16122881 DOI: 10.1016/j.mehy.2005.06.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2005] [Revised: 06/23/2005] [Accepted: 06/29/2005] [Indexed: 12/29/2022]
Abstract
Morphological, cultural, and immuno-histochemical characteristics of "Nanobacterium sanguineum" (NB) described in the literature are reviewed. NB is reported to be a motile, Gram negative organism that divides by binary fission within a calcium-coated slimy shell; this yeast-like shell replicates by budding. It measures between 20 and 200 nm with a unique structure containing 16S ribosomal RNA. NB has been observed by electron microscopy in coronary artery plaques (CAD) and in kidney stones (KS) found in renal diseases. On the basis of supportive literature, we suggest that NB is not only present in the human body but also has auxiliary association with human ailments without a specific etiological role; anti-NB antibody has been detected in subjects with calcified lesions and inflammation in diverse ailments including choriodecidual inflammation in pregnancy, ovarian cancers, arthritis and even Alzheimer's disease. More recent report on the detection and vertical transmission of NB antigen and anti-NB antibody in HIV-infected mothers supports the view that NB might be an important opportunistic infective agent contributing to HIV pathology; we note that the presence of viable and transmitting NB was not studied and suggest further studies to establish vertical transmission of NB in HIV-infected persons. On the basis of the foregoing we suggest that NB possibly exacerbates human ailments and raise the question: Is NB a new life-form in search of human ailment or a commensal organism? Recognizing the presence of NB in the human body, we discuss clinical trials, reported in the literature relevant to its eradication, with a rectal suppository containing very high amounts of disodium EDTA and tetracycline. We suggest that tetracycline in this formulation acted in combination with EDTA, more as a chelating agent than an antibiotic; oxytetracycline- a non-chelating form of tetracycline-does not inhibit or kill NB. Evaluation of anti-NB effect of orally administrable and potentially safer as well as therapeutically more acceptable chelating agent -ascorbic acid, acting alone or in combination with antibiotics-that eradicates another slime forming bacterium - Pseudomonas aeruginosa - in children with cystic fibrosis, is suggested.
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Affiliation(s)
- Bhupat D Rawal
- Human Ailments Research Independent Services (HARIS), San Diego, CA 92129, USA.
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Noguera A, Fortuny C, Muñoz-Almagro C, Sanchez E, Vilaseca MA, Artuch R, Pou J, Jimenez R. Hyperlactatemia in human immunodeficiency virus-uninfected infants who are exposed to antiretrovirals. Pediatrics 2004; 114:e598-603. [PMID: 15492359 DOI: 10.1542/peds.2004-0955] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Exposure to nucleoside analogues in fetal or early life has been associated with rare clinically significant mitochondrial toxic effects, mainly neurologic symptoms. Lactate (LA) measurements have been used to monitor nucleoside-related mitochondrial toxicity. Our aim was to determine the prevalence, clinical evolution, and risk factors for hyperlactatemia in our cohort of human immunodeficiency virus (HIV)-uninfected children who were exposed to antiretrovirals. METHODS We conducted a prospective observational study of 127 HIV-uninfected infants who were born to HIV-infected women. Clinical symptoms suggesting mitochondrial dysfunction were analyzed in routine follow-up, and LA and alanine plasma levels were obtained at 6 weeks, 3 months, 6 months, and 12 months in all patients. Elevated alanine levels, together with hyperlactatemia, suggest chronic mitochondrial injury. RESULTS Most (85%) women received highly active antiretroviral therapy (HAART) during pregnancy (mean duration: 31 weeks) and zidovudine during labor (93%). Most (96%) children received zidovudine alone. Hyperlactatemia with hyperalaninemia was detected in 63 children in at least 1 of the measurements. Mean LA levels were significantly higher in children who were exposed to nucleoside analogue reverse transcriptase inhibitors than in control subjects (2.88 vs 1.61 at 6 weeks, 2.78 vs 1.49 at 3 months, 1.89 vs 1.39 at 6 months, and 1.71 vs 1.24 at 12 months; peak levels: 8.06, 10.1, 7.28, and 4.48 mmol/L, respectively). In 44 patients, LA levels progressed spontaneously to normality within the first year of life. Three girls presented a slight and self-limited delay in psychomotor development, with LA peak levels of 7.3, 4.0, and 4.6 mmol/L. Only the gestational use of didanosine was associated with a higher risk of hyperlactatemia. CONCLUSIONS In our series, almost half of the children (63 of 127) who were exposed to nucleoside analogues developed benign and self-limited hyperlactatemia. When symptomatic, nucleoside analogue-induced toxicity affected neurologic development.
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Affiliation(s)
- Antoni Noguera
- Infectious Diseases Unit, Pediatrics Department, Integrated Unit Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
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