1
|
Abstract
Supplemental Digital Content is available in the text Objective and design: To inform WHO guidelines, we conducted a systematic review and meta-analysis to assess maternal and perinatal outcomes comparing cesarean section (c-section) before labor and rupture of membranes [elective c-section (ECS)] with other modes of delivery for women living with HIV. Methods: We searched PubMed, CINAHL, Embase, CENTRAL, and previous reviews to identify published trials and observational studies through October 2015. Results were synthesized using random-effects meta-analysis, stratifying for combination antiretroviral therapy (cART), CD4+/viral load (VL), delivery at term, and low-income/middle-income countries. Results: From 2567 citations identified, 36 articles met inclusion criteria. The single randomized trial, published in 1999, reported minimal maternal morbidity and significantly fewer infant HIV infections with ECS [odds ratio (OR) 0.2, 95% confidence interval (CI) 0.0–0.5]. Across observational studies, ECS was associated with increased maternal morbidity compared with vaginal delivery (OR 3.12, 95% CI 2.21–4.41). ECS was also associated with decreased infant HIV infection overall (OR 0.43, 95% CI 0.30–0.63) and in low-income/middle-income countries (OR 0.27, 95% CI 0.16–0.45), but not among women on cART (OR 0.82, 95% CI 0.47–1.43) or with CD4+ cell count more than 200/VL less than 400/term delivery (OR 0.59, 95% CI 0.21–1.63). Infant morbidity moderately increased with ECS. Conclusion: Although ECS may reduce infant HIV infection, this effect was not statistically significant in the context of cART and viral suppression. As ECS poses other risks, routine ECS for all women living with HIV may not be appropriate. Risks and benefits will differ across settings, depending on underlying risks of ECS complications and vertical transmission during delivery. Understanding individual client risks and benefits and respecting women's autonomy remain important.
Collapse
|
2
|
[Human immunodeficiency virus: position of Blood Working Group of the Federal Ministry of Health]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 58:1351-70. [PMID: 26487384 DOI: 10.1007/s00103-015-2255-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
3
|
Human Immunodeficiency Virus (HIV). Transfus Med Hemother 2016; 43:203-22. [PMID: 27403093 PMCID: PMC4924471 DOI: 10.1159/000445852] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 02/22/2016] [Indexed: 12/13/2022] Open
|
4
|
Briand N, Warszawski J, Mandelbrot L, Dollfus C, Pannier E, Cravello L, Nguyen R, Matheron I, Winer N, Tubiana R, Rouzioux C, Faye A, Blanche S. Is intrapartum intravenous zidovudine for prevention of mother-to-child HIV-1 transmission still useful in the combination antiretroviral therapy era? Clin Infect Dis 2013; 57:903-14. [PMID: 23728147 DOI: 10.1093/cid/cit374] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Intrapartum intravenous zidovudine (ZDV) prophylaxis is a long-standing component of prevention of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) in high-resource countries. In some recent guidelines, intravenous ZDV is no longer systematically recommended for mothers receiving combination antiretroviral therapy (cART) with low viral load. We evaluated the impact of intravenous ZDV according to viral load and obstetrical conditions. METHODS All HIV-1-infected women delivering between 1 January 1997 and 31 December 2010 in the French Perinatal Cohort (ANRS-EPF) were analyzed if they received ART during pregnancy and did not breastfeed. We identified maternal and obstetrical characteristics related to lack of intravenous ZDV and compared its association with MTCT rate and other infant parameters, according to various risk factors. RESULTS Intravenous ZDV was used in 95.2% of the 11 538 deliveries. Older age, multiparity, and preterm and vaginal delivery were associated with lack of intravenous ZDV (n = 554). In women who delivered with viral load ≥1000 copies/mL, the overall MTCT rate was higher without than with intravenous ZDV (7.5% vs 2.9%; P = .01); however, there was no such difference when the neonate received postnatal intensification therapy. Among them, 77% of women who had viral load <400 copies/mL, there was no difference in MTCT rate (0% without intravenous ZDV vs 0.6% with intravenous ZDV; P = .17). Intravenous ZDV was not associated with increased short-term hematological toxicity or lactate level. CONCLUSIONS Intravenous ZDV remains an effective tool to reduce transmission in cases of virological failure, even in cART-treated women. However, for the vast majority of women with low viral loads at delivery, in the absence of obstetrical risk factors, systematic intravenous ZDV appears to be unnecessary.
Collapse
Affiliation(s)
- Nelly Briand
- INSERM U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Sud, Paris, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Neubert J, Pfeffer M, Borkhardt A, Niehues T, Adams O, Bolten M, Reuter S, Stannigel H, Laws HJ. Risk adapted transmission prophylaxis to prevent vertical HIV-1 transmission: effectiveness and safety of an abbreviated regimen of postnatal oral zidovudine. BMC Pregnancy Childbirth 2013; 13:22. [PMID: 23347580 PMCID: PMC3568057 DOI: 10.1186/1471-2393-13-22] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 01/17/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Antiretroviral drugs including zidovudine (ZDV) are effective in reducing HIV mother to child transmission (MTCT), however safety concern remains. The optimal duration of postnatal ZDV has not been established in clinical studies and there is a lack of consensus regarding optimal management. The objective of this study was to investigate the effectiveness and safety of a risk adapted two week course of oral postnatal ZDV as part of a combined intervention to reduce MTCT. METHODS 118 mother infant pairs were treated according to the German-Austrian recommendations for HIV therapy in pregnancy and in HIV exposed newborns between 2000-2010. In the absence of factors associated with an increased HIV-1 transmission risk, children were assigned to the low risk group and treated with an abbreviated postnatal regimen with oral ZDV for 2 weeks. In the presence of risk factors, postnatal ZDV was escalated accordingly. RESULTS Of 118 mother-infant pairs 79 were stratified to the low risk group, 27 to the high risk group and 11 to the very high risk group for HIV-1 MTCT. 4 children were lost to follow up. Overall Transmission risk in the group regardless of risk factors and completion of prophylaxis was 1.8% (95% confidence interval (CI) 0.09-6.6). If transmission prophylaxis was complete, transmission risk was 0.9% (95% CI 0.01-5.7). In the low risk group receiving two week oral ZDV transmission risk was 1.4% (95% CI 0.01-8.4) CONCLUSION These data demonstrate the effectiveness of a short neonatal ZDV regimen in infants of women on stable ART and effective HIV-1 suppression. Further evaluation is needed in larger studies.
Collapse
Affiliation(s)
- Jennifer Neubert
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Center for Child and Adolescent Health, medical faculty, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Maren Pfeffer
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Center for Child and Adolescent Health, medical faculty, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Arndt Borkhardt
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Center for Child and Adolescent Health, medical faculty, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Tim Niehues
- Department of Pediatrics, Helios Clinic Krefeld, Lutherplatz 40, 47805, Krefeld, Germany
| | - Ortwin Adams
- Institut of Virology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Mareike Bolten
- Department of Obstetrics and Gynaecology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Stefan Reuter
- Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Hans Stannigel
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Center for Child and Adolescent Health, medical faculty, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Hans-Juergen Laws
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Center for Child and Adolescent Health, medical faculty, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| |
Collapse
|
6
|
Buchholz B, Beichert M, Marcus U, Grubert T, Gingelmaier A, Haberl A, Schmied B. German-Austrian recommendations for HIV1-therapy in pregnancy and in HIV1-exposed newborn, update 2008. Eur J Med Res 2009; 14:461-79. [PMID: 19948442 PMCID: PMC3352287 DOI: 10.1186/2047-783x-14-11-461] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In Germany during the last years about 200-250 HIV1-infected pregnant women delivered a baby each year, a number that is currently increasing. To determine the HIV-status early in pregnancy voluntary HIV-testing of all pregnant women is recommended in Germany and Austria as part of prenatal care. In those cases, where HIV1-infection was known during pregnancy, since 1995 the rate of vertical transmission of HIV1 was reduced to 1-2%. - This low transmission rate has been achieved by the combination of anti-retroviral therapy of pregnant women, caesarean section scheduled before onset of labour, anti-retroviral post exposition prophylaxis in the newborn and refraining from breast-feeding by the HIV1-infected mother. To keep pace with new results in research, approval of new anti-retroviral drugs and changes in the general treatment recommendations for HIV1-infected adults, in 1998, 2001, 2003 and 2005 an interdisciplinary consensus meeting was held. Gynaecologists, infectious disease specialists, paediatricians, pharmacologists, virologists and members of the German AIDS Hilfe (NGO) were participating in this conference to update the prevention strategies. A fifth update became necessary in 2008. The updating process was started in January 2008 and was terminated in September 2008. The guidelines provide new recommendations on the indication and the starting point for HIV-therapy in pregnancies without complications, drugs and drug combinations to be used preferably in these pregnancies and updated information on adverse effects of anti-retroviral drugs. Also the procedures for different scenarios and risk constellations in pregnancy have been specified again. - With these current guidelines in Germany and Austria the low rate of vertical HIV1-transmission should be further maintained.
Collapse
Affiliation(s)
- Bernd Buchholz
- University Medical Centre Mannheim, Pediatric Clinic, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
| | | | | | | | | | | | | |
Collapse
|
7
|
Grosch-Woerner I, Puch K, Maier RF, Niehues T, Notheis G, Patel D, Casteleyn S, Feiterna-Sperling C, Groeger S, Zaknun D. Increased rate of prematurity associated with antenatal antiretroviral therapy in a German/Austrian cohort of HIV-1-infected women. HIV Med 2008; 9:6-13. [PMID: 18199167 DOI: 10.1111/j.1468-1293.2008.00520.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of the study was to assess the risk of adverse pregnancy outcomes after antenatal antiretroviral therapy in a well-defined prospective cohort of nontransmitting HIV-infected women. METHODS Prospective monitoring of 183 mother-child pairs from 13 centres in Germany and Austria, delivering between 1995 and 2001, was carried out. Following German-Austrian guidelines recommending an elective Caesarean section (CS) at 36 weeks, prematurity was defined as <36 weeks' gestation for these analyses. RESULTS Of 183 mother-child pairs, 42% were exposed to antenatal monotherapy and 17% to dual therapy. Of the 75 women exposed to highly active antiretroviral therapy (HAART), 21 (28%) received protease inhibitor (PI)-based HAART and the remaining 54 received nonnucleoside reverse transcriptase inhibitor-based HAART. In multivariable analysis (176 pregnancies), PI-based HAART exposure during pregnancy was associated with an increased risk of premature delivery [adjusted odds ratio 3.40; 95% confidence interval (CI) 1.13-10.2; P=0.029, compared with monotherapy]. Congenital abnormalities affected 3.3% infants. Perinatally, 18.9% of children (34 of 179) had respiratory problems requiring interventions, which were associated with prematurity but not with type of treatment exposure. From adjusted regression analysis, the mean birth weight z-score for children exposed to HAART with PI (+0.46; 95% CI 0.01-0.92; P=0.047) or dual therapy (+0.43; 95% CI 0.03-0.82; P=0.034) was slightly but significantly higher than that for those exposed to monotherapy; head circumference was appropriate for gestational age and there were no significant differences between treatment groups. CONCLUSIONS Use of antenatal PI-based HAART initiated before or during pregnancy was associated with a significantly increased risk of premature delivery at <36 weeks' gestation. The overall crude prematurity rate was 34% (63 of 183; 95% CI 28-42).
Collapse
Affiliation(s)
- I Grosch-Woerner
- Department of General Paediatrics, Charité Universitaetsmedizin Berlin, Berlin, Germany.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Feiterna-Sperling C, Weizsaecker K, Bührer C, Casteleyn S, Loui A, Schmitz T, Wahn V, Obladen M. Hematologic Effects of Maternal Antiretroviral Therapy and Transmission Prophylaxis in HIV-1-Exposed Uninfected Newborn Infants. J Acquir Immune Defic Syndr 2007; 45:43-51. [PMID: 17356471 DOI: 10.1097/qai.0b013e318042d5e3] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE A prospective observational study to investigate hematologic alterations during the first 3 months of life in HIV-exposed uninfected infants subjected to antiretroviral medication before and after birth. METHODS Two hundred twenty-one consecutive uninfected infants born to HIV-positive mothers on antiretroviral medication during pregnancy were included. Perinatal transmission prophylaxis comprised zidovudine (ZDV) administered intravenously intrapartum and 10 days after birth. Blood counts and differentials were determined at birth and at 2, 4, 6, and 12 weeks of age, and hematologic toxicity was graded according to pediatric toxicity scales. Data were analyzed according to the kind of prenatal medication (ZDV alone or with another nucleoside reverse transcriptase inhibitor [NRTI] vs. highly active antiretroviral therapy [HAART]). RESULTS Median hemoglobin was significantly lower in HAART-exposed newborns from birth (P = 0.004) until day 28. During follow-up, 119 (53.8%) infants had anemia grade 2 or higher on at least 1 occasion; 16 (7.2%) received red blood cell transfusion at 23 (range: 1-56) days of age. Neutropenia grade 2 or higher occurred in 106 (48.0%) infants at least once; 8 infants had staphylococcal infections, and 2 infections were severe. After adjustment for possible confounders (prematurity, birth weight, ethnicity, gender, duration of maternal antiretroviral therapy, maternal Centers for Disease Control and Prevention stage, and maternal illicit drug use), HAART exposure was the only independent risk factor for anemia (odds ratio [OR] = 2.22, 95% confidence interval [CI]: 1.06 to 4.64; P = 0.034) and neutropenia (OR = 2.15, CI: 1.02 to 4.55; P = 0.045). CONCLUSIONS Antiretroviral transmission prophylaxis is associated with significant anemia and neutropenia in HIV-uninfected infants during the first 3 months of life. Anemia was more profound in HAART-exposed infants.
Collapse
Affiliation(s)
- Cornelia Feiterna-Sperling
- Charité, Department of Pediatric Pneumology and Immunology, University Medicine Berlin, Berlin, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Abstract
Human immunodeficiency virus infection profoundly affects the medical community and is spreading rapidly in women of childbearing age worldwide. Transmission of HIV from mother to child can occur in utero, during labor, or after delivery through breast-feeding. Most of the infants are infected during delivery. We focus on the factors affecting the transmission of HIV, diagnostic and resistance tests, strategies to prevent mother-to-child transmission with special reference to mode of delivery, infant feeding, and use of antiretroviral therapy. The risk of infection for the infant can be decreased by reducing maternal viral load, by elective cesarean delivery, and by avoidance of breast-feeding. The efficacy of antiretroviral treatment should be balanced against the possibility of embryonic or fetal toxicity. The choice of therapy should be based on the woman's treatment history, the clinical status, and the available prognostic markers, which are related to the progression of disease in the mother and the risk of mother-to-child transmission HIV transmission.
Collapse
Affiliation(s)
- Haritini Petropoulou
- Department of Dermatology, Andreas Sygros Hospital for Skin and Venereal Diseases, University of Athens School of Medicine, Kesariani 161 21, Athens, Greece
| | | | | |
Collapse
|
10
|
Schmitz T, Weizsaecker K, Feiterna-Sperling C, Eilers E, Obladen M. Exposure to HIV and antiretroviral medication as a potential cause of necrotizing enterocolitis in term neonates. AIDS 2006; 20:1082-3. [PMID: 16603869 DOI: 10.1097/01.aids.0000222089.74905.0f] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
11
|
Read JS, Newell MK. Efficacy and safety of cesarean delivery for prevention of mother-to-child transmission of HIV-1. Cochrane Database Syst Rev 2005:CD005479. [PMID: 16235405 DOI: 10.1002/14651858.cd005479] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cesarean section before labor and before ruptured membranes ("elective cesarean section", or ECS) has been introduced as an intervention for the prevention of mother-to-child transmission (MTCT) of HIV-1. The role of mode of delivery in the management of HIV-1-infected women should be assessed in light of risks as well as benefits, since HIV-1-infected pregnant women must be provided with available information with which to make informed decisions regarding cesarean section and other options to prevent transmission of infection to their children. OBJECTIVES Our objectives were to assess the efficacy (for prevention of MTCT of HIV-1) and the safety of ECS among HIV-1-infected women. SEARCH STRATEGY Electronic searches were undertaken using MEDLINE and other databases. Hand searches of reference lists of pertinent reviews and studies, as well as abstracts from relevant conferences, were also conducted. Experts in the field were contacted to locate any other studies. The search strategy was iterative. SELECTION CRITERIA Randomized clinical trials assessing the efficacy and safety of ECS for prevention of MTCT of HIV-1 were included in the analysis, as were observational studies with relevant data. DATA COLLECTION AND ANALYSIS Data regarding HIV-1 infection status of infants born to HIV-1-infected women according to mode of delivery were extracted from the reports of the studies. Similarly, data regarding postpartum morbidity (PPM) (including minor (e.g., febrile morbidity, urinary tract infection) and major (e.g., endometritis, thromboembolism) morbidity) of the HIV-1-infected women, and infant morbidity, according to mode of delivery were extracted. MAIN RESULTS One randomized clinical trial of the efficacy of ECS for prevention of MTCT of HIV-1 was identified. No data regarding infant morbidity according to the HIV-1-infected mother's mode of delivery were available. Data regarding PPM according to mode of delivery were available from this clinical trial as well as from five observational studies. Among HIV-1-infected women not taking antiretrovirals (ARVs) during pregnancy or taking only zidovudine, ECS was found to be efficacious for prevention of MTCT of HIV-1. PPM is generally higher among HIV-1-infected women who undergo cesarean as compared to vaginal delivery, with the risk with ECS being intermediate between that of vaginal delivery and NECS (including emergency procedures). Other factors associated with the risk of PPM among HIV-1-infected women include HIV-1 disease stage (more advanced disease, as manifested by lower CD4 counts and higher viral loads, being associated with a greater risk of PPM) and co-morbid conditions (e.g., diabetes). AUTHORS' CONCLUSIONS ECS is an efficacious intervention for the prevention of MTCT among HIV-1-infected women not taking ARVs or taking only zidovudine. The risk of PPM with ECS is higher than that associated with vaginal delivery, yet lower than with NECS. Among HIV-1-infected women, more advanced maternal HIV-1 disease stage and concomitant medical conditions (e.g., diabetes) are independent risk factors for PPM. The risk of MTCT of HIV-1 according to mode of delivery among HIV-1-infected women with low viral loads (low either because the woman's HIV-1 disease is not advanced, or because her HIV-1 disease is well-controlled with ARVs) is unclear. Therefore, an important issue to be addressed in one or more large studies (individual studies or an individual patient data meta-analysis combining data from more than one study) is assessment of the effectiveness of ECS for prevention of MTCT of HIV-1 among HIV-1-infected women with undetectable viral loads (with or without receipt of highly active ARV therapy (HAART)).
Collapse
Affiliation(s)
- J S Read
- Center for Research for Mothers and Children, Pediatric, Adolescent, and Maternal AIDS Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510, USA.
| | | |
Collapse
|
12
|
Li D, Xu DZ, Choi BCK, Men K, Zhang JX, Lei XY, Yan YP. Preliminary study on the efficacy and safety of lamivudine and interferon alpha therapy in decreasing serum HBV DNA level in HBV positive transgenic mice during pregnancy. J Med Virol 2005; 76:203-7. [PMID: 15834875 DOI: 10.1002/jmv.20353] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Previous studies reported that the HBV DNA level in maternal serum is an important risk factor for intrauterine infection. Two antiviral drugs, lamivudine (3TC) and interferon alpha (IFNalpha), are used extensively clinically to reduce maternal HBV DNA level, However, because of a lack of evidence on the efficacy and safety of these drugs during pregnancy, they are categorized as grade C which prevents their use during pregnancy. This study provides new data on the efficacy and safety of lamivudine and IFNalpha in HBV positive transgenic pregnant mice. In this study, transgenic mice with high titers of hepatitis B virus (HBV) were employed to study the antiviral effects of 3TC and IFNalpha during different gestation periods. The study also examined changes in several serological HBV markers, the effects of perinatal exposure to antiviral drugs on the mother and offspring, drug efficacy in reducing the level of HBV DNA in maternal blood, and the safety to both the mother and offspring. The main conclusion of the study is that a significant decrease in HBV DNA level can be obtained after treatment with lamivudine but not with IFNalpha. No adverse effects were observed in the maternal mice and the offsprings. This finding may provide a rationale for the potential use of lamivudine for the treatment of pregnant women as a safe and effective measure to reduce the level of maternal viremia.
Collapse
Affiliation(s)
- Duan Li
- Department of Epidemiology, Fourth Military Medical University, Xian, China
| | | | | | | | | | | | | |
Collapse
|
13
|
|
14
|
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.
Collapse
Affiliation(s)
- Bhupat D Rawal
- Human Ailments Research Independent Services (HARIS), San Diego, CA 92129, USA.
| | | |
Collapse
|
15
|
Exposure to antiretroviral therapy in utero or early life: the health of uninfected children born to HIV-infected women. J Acquir Immune Defic Syndr 2003; 32:380-7. [PMID: 12640195 DOI: 10.1097/00126334-200304010-00006] [Citation(s) in RCA: 170] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Concerns have been raised over possible adverse effects of prophylactic antiretroviral therapy (ART) on the fetus and newborn. We analyzed data relating to uninfected children enrolled in the European Collaborative Study and investigated the association between ART exposure, perinatal problems, and major adverse health events later in life. Median length of follow-up was 2.2 (0-15.9) years. Of the 2414 uninfected children, 687 (28%) were exposed to ART in all three periods (antenatal, intrapartum, and neonatal). Of the 1008 infants exposed to ART at any time, 906 (90%) were exposed antenatally, 840 (83%) neonatally, and 750 (74%) both antenatally and neonatally. ART exposure was not significantly associated with pattern or prevalence of congenital abnormalities or low birth weight. In multivariate analysis, prematurity was associated with exposure to combination therapy without a protease inhibitor (PI) (OR = 2.66; 95% CI: 1.52-4.67) and with a PI (OR = 4.14; 95% CI: 2.36-7.23). ART exposure was associated with anemia in early life ( <.001). There was no evidence of an association with clinical manifestations suggestive of mitochondrial abnormalities. The absence of serious adverse events in this large cohort of uninfected children exposed to prophylactic ART in the short to medium term is reassuring.
Collapse
|
16
|
Bhana N, Ormrod D, Perry CM, Figgitt DP. Zidovudine: a review of its use in the management of vertically-acquired pediatric HIV infection. Paediatr Drugs 2003; 4:515-53. [PMID: 12126455 DOI: 10.2165/00128072-200204080-00004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
UNLABELLED Zidovudine is a thymidine analog that, after intracellular phosphorylation to zidovudine triphosphate metabolite, inhibits HIV-specific reverse transcriptase and terminates proviral DNA. Zidovudine administered to mildly symptomatic women with HIV infection in the antepartum (100mg orally 5 times/day), intrapartum (2 mg/kg intravenously over 1 hour then 1 mg/kg/h) and then to the neonate for 6 weeks (2 mg/kg), significantly reduced the rate of vertical HIV transmission by about two thirds, in the absence of breast-feeding (The Pediatric AIDS Clinical Trials Group 076 trial, standard protocol). Shorter zidovudine regimens, reduced the risk of transmission of HIV by 50% in a non-breast-feeding population and by about 37% in breast-feeding populations. Zidovudine (standard protocol) in combination with lamivudine was superior to zidovudine alone. A short oral zidovudine regimen was not as effective as a two-dose oral nevirapine regime, although the combination of short-course zidovudine plus lamivudine was as effective. Suppression of viral replication in neonates, infants and children has been achieved with zidovudine when used in triple-therapy regimens that include other antiviral drugs. Results from a trial of treatment-naive children indicate that the antiviral efficacy of combinations of zidovudine and lamivudine or abacavir, given with the protease inhibitor nelfinavir, is superior to treatment with this combination minus nelfinavir. When zidovudine was used in other highly active antiretroviral therapy regimens significant improvements in surrogate markers were consistently seen. Changing to ritonavir-containing regimens was superior to changing to treatment with two new nucleoside reverse transcriptase inhibitors. Short- and long-term (up to 5.6 years) outcomes from clinical trials showed that prenatal and neonatal exposure to zidovudine was generally well tolerated with the exception of mild anemia that resolved spontaneously after treatment cessation. Zidovudine was generally well tolerated as monotherapy in clinical trials of pediatric patients with HIV infection, and adverse events were similar to those reported in adults, with anemia and neutropenia being the most common. CONCLUSION Zidovudine, as monotherapy or in combination with other antiretroviral agents, remains a first-choice therapy for the prophylaxis of mother-to-child HIV transmission as shown by substantial reductions in transmission rates. Where feasible, the optimal strategy to prevent vertical transmission is to combine drug therapy with Cesarean section delivery and no breast-feeding. In addition, zidovudine in combination with another nucleoside analogue and a protease inhibitor is a first- or second-choice therapy for the treatment of pediatric HIV infection as significant and sustained reductions in viral load have been shown in both plasma and cerebrospinal fluid.
Collapse
Affiliation(s)
- Nila Bhana
- Adis International Inc, 860 Town Center Drive, Langhorne, PA 19047, USA.
| | | | | | | |
Collapse
|
17
|
Fiscus SA, Adimora AA, Funk ML, Schoenbach VJ, Tristram D, Lim W, McKinney R, Rupar D, Woods C, Wilfert C. Trends in interventions to reduce perinatal human immunodeficiency virus type 1 transmission in North Carolina. Pediatr Infect Dis J 2002; 21:664-8. [PMID: 12237600 DOI: 10.1097/00006454-200207000-00012] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mother-to-child transmission of HIV has decreased in industrialized countries because of widespread use of antiretroviral therapy (ART) by HIV-infected pregnant women and perhaps to increased use of elective cesarean section. We evaluated changes in the use of ART and mode of delivery among HIV positive pregnant women in North Carolina. METHODS We reviewed the medical records of HIV-exposed infants born in North Carolina between January 1, 1998, and December 31, 1999, who were tested for HIV DNA. These results were compared with data collected on HIV-exposed infants born from 1993 through 1997. RESULTS The use of combination ART increased from 1.5% in 1996 to 73% in 1999. The most common ART was zidovudine/lamivudine (39%) followed by zidovudine-lamivudine-nelfinavir (34%), although 34 combinations were used. Elective cesarean sections in the state increased significantly from 16.5% in the first half of 1998 to 49.4% in the second half of 1999. Overall transmission rates declined from 24.5% in 1993 to an average of 10.6% in 1994 to 1996 (41 of 385) and to 3.5% in 1997 to 1999 (15 of 428). CONCLUSIONS Increased use of combination ART and elective cesarean section was accompanied by consistently low rates of perinatal transmission. However, because perinatal transmission rates were also low among women who used combination therapy and had vaginal deliveries, it is difficult to determine how much additional benefit cesarean section affords. Most HIV transmission occurred among women who lacked prenatal care and did not receive or adhere to ART.
Collapse
Affiliation(s)
- Susan A Fiscus
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, 27599-7140, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
|
19
|
|