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Abstract
TORCH infections classically comprise toxoplasmosis, Treponema pallidum, rubella, cytomegalovirus, herpesvirus, hepatitis viruses, human immunodeficiency virus, and other infections, such as varicella, parvovirus B19, and enteroviruses. The epidemiology of these infections varies; in low-income and middle-income countries, TORCH infections are major contributors to prenatal, perinatal, and postnatal morbidity and mortality. Evidence of infection may be seen at birth, in infancy, or years later. For many of these pathogens, treatment or prevention strategies are available. Early recognition, including prenatal screening, is key. This article covers toxoplasmosis, parvovirus B19, syphilis, rubella, hepatitis B virus, hepatitis C virus, and human immunodeficiency virus.
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Affiliation(s)
- Natalie Neu
- Division of Pediatric Infectious Disease, Columbia University Medical Center, 622 West 168th Street, PH-468, New York, NY 10032, USA.
| | - Jennifer Duchon
- Division of Pediatric Infectious Disease, New York-Presbyterian Morgan Stanley Children's Hospital, 622 West 168th Street, PH-471, New York, NY 10032, USA
| | - Philip Zachariah
- Division of Pediatric Infectious Disease, New York-Presbyterian Morgan Stanley Children's Hospital, 622 West 168th Street, PH-471, New York, NY 10032, USA
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Antiretroviral adherence interventions in Southern Africa: implications for using HIV treatments for prevention. Curr HIV/AIDS Rep 2014; 11:63-71. [PMID: 24390683 DOI: 10.1007/s11904-013-0193-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
There is concern that the expansion of ART (antiretroviral treatment) programmes to incorporate the use of treatment as prevention (TasP) may be associated with low levels of adherence and retention in care, resulting in the increased spread of drug-resistant HIV. We review research published over the past year that reports on interventions to improve adherence and retention in care in Southern Africa, and discuss these in terms of their potential to support the expansion of ART programmes for TasP. We found eight articles published since January 2012, seven of which were from South Africa. The papers describe innovative models for ART care and adherence support, some of which have the potential to facilitate the ongoing scale- up of treatment programmes for increased coverage and TasP. The extent to which interventions from South Africa can be effectively implemented in other, lower-resource Southern African countries is unclear.
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Park JW, Yang TW, Kim YK, Choi BM, Kim HJ, Park DW. Ten years of experience in the prevention of mother-to-child human immunodeficiency virus transmission in a university teaching hospital. KOREAN JOURNAL OF PEDIATRICS 2014; 57:117-24. [PMID: 24778693 PMCID: PMC4000757 DOI: 10.3345/kjp.2014.57.3.117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 10/24/2013] [Accepted: 11/15/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE Administration of antiretroviral drugs to mothers and infants significantly decreases mother-to-child human immunodeficiency virus (HIV) transmission; cesarean sections and discouraging breastfeeding further decreases this risk. The present study confirmed the HIV status of babies born to mothers infected with HIV and describes the characteristics of babies and mothers who received preventive treatment. METHODS This study retrospectively analyzed medical records of nine infants and their mothers positive for HIV who gave birth at Korea University Ansan Hospital, between June 1, 2003, and May 31, 2013. Maternal parameters, including HIV diagnosis date, CD4+ count, and HIV ribonucleic acid (RNA) copy number, were analyzed. Infant growth and development, HIV RNA copy number, and HIV antigen/antibody test results were analyzed. RESULTS Eight HIV-positive mothers delivered nine babies; all the infants received antiretroviral therapy. Three (37.5%) and five mothers (62.5%) were administered single- and multidrug therapy, respectively. Intravenous zidovudine was administered to four infants (50%) at birth. Breastfeeding was discouraged for all the infants. All the infants were negative for HIV, although two were lost to follow-up. Third trimester maternal viral copy numbers were less than 1,000 copies/mL with a median CD4+ count of 325/µL (92-729/µL). Among the nine infants, two were preterm (22.2%) and three had low birth weights (33.3%). CONCLUSION This study concludes that prophylactic antiretroviral therapy, scheduled cesarean section, and prohibition of breastfeeding considerably decrease mother-to-child HIV transmission. Because the number of infants infected via mother-to-child transmission may be increasing, studies in additional regions using more variables are necessary.
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Affiliation(s)
- Jung-Weon Park
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Tae-Whan Yang
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Yun-Kyung Kim
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Byung-Min Choi
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Hai-Joong Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Dae-Won Park
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
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Abdel-Latif ME, Oei J, Craig F, Lui K. Profile of infants born to drug-using mothers: a state-wide audit. J Paediatr Child Health 2013; 49:E80-6. [PMID: 22530812 DOI: 10.1111/j.1440-1754.2012.02471.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIMS To ascertain the characteristics and short-term outcomes of infants born to illicit drug-using mothers in public hospitals in the state of New South Wales and the Australian Capital Territory during 2004. METHODS Patients were identified retrospectively by hospital records searches using ICD-10 morbidity codes and records of local Drug and Alcohol Services. Records were reviewed on site. All public hospitals (n= 101) with obstetric services were included. RESULTS A total of 879 (1.4%, 95% confidence interval: 1.3-1.5%) drug-using mothers were identified from 62,682 confinements. Opiates (46.8%), amphetamines (23.0%) and polydrug (16.4%) exposure were most common. There were eight stillbirths. Among these 871 infants, prematurity (23.6%) and low birthweight (27.1%) were common and 51.1% were admitted to nurseries for further care. Two infants died. Major congenital anomalies were detected in 15 infants. Pharmacological treatment for withdrawal was required for 202 (23.2%), and 143 (70.8%) infants were discharged home on medication. Infants who completed inpatient pharmacological treatment were hospitalised longer (median 26.0 vs. 12.0 days) and were more likely to be premature (37.3 vs. 14.0%). Child-at-risk notifications affected 40.6% of the infants, and 7.6% were fostered prior to discharge. A total of 333 (38.2%) infants were breastfed at discharge. CONCLUSIONS Our regional study highlights a substantial prevalence of drug use in pregnancy with considerable adverse perinatal and hospital outcomes in infants born to these mothers. Coordinated health care and resources are needed to support these mother-infant pairs because of their social, medical and mental-health issues.
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Affiliation(s)
- Mohamed E Abdel-Latif
- Department of Neonatology, The Canberra Hospital, Garran, Australian Capital Territory, Australia
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Abstract
Prematurity and HIV present a complex challenge, with biologic underpinnings that are often confounded by a myriad of other factors that coexist in this high-risk population. Furthermore, many of the current management options designed to reduce mother-to-infant transmission, including antiretroviral therapy and cesarean birth, may each have an independent effect on prematurity. These issues notwithstanding, knowledge gained from randomized controlled trials and epidemiologic studies has made a significant impact on the approach to this challenging public health problem worldwide. This article discusses the significance, contribution, and management of perinatal transmission of HIV in prematurity.
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Affiliation(s)
- Julie Mirpuri
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA, USA.
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Divi RL, Einem TL, Leonard Fletcher SL, Shockley ME, Kuo MM, St Claire MC, Cook A, Nagashima K, Harbaugh SW, Harbaugh JW, Poirier MC. Progressive mitochondrial compromise in brains and livers of primates exposed in utero to nucleoside reverse transcriptase inhibitors (NRTIs). Toxicol Sci 2010; 118:191-201. [PMID: 20702595 PMCID: PMC2955212 DOI: 10.1093/toxsci/kfq235] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 07/26/2010] [Indexed: 11/13/2022] Open
Abstract
Mitochondrial compromise has been documented in infants born to women infected with the human immunodeficiency virus (HIV-1) who received nucleoside reverse transcriptase inhibitor (NRTI) therapy during pregnancy. To model these human exposures, we examined mitochondrial integrity at birth and 1 year in brain cortex and liver from offspring of retroviral-free Erythrocebus patas dams-administered human-equivalent NRTI doses for the last half (10 weeks) of gestation. Additional infants, followed for 1 year, were given the same drugs as their mothers for the first 6 weeks of life. Exposures included: no drug, Zidovudine (AZT), Lamivudine (3TC), AZT/3TC, AZT/Didanosine (ddI), and Stavudine (d4T)/3TC. In brain and liver, oxidative phosphorylation (OXPHOS) enzyme activities (complexes I, II, and IV) showed minimal differences between unexposed and NRTI-exposed offspring at both times. Brain and liver mitochondria from most NRTI-exposed patas, both at birth and 1 year of age, contained significant (p < 0.05) morphological damage observed by electron microscopy (EM), based on scoring of coded photomicrographs. Brain and liver mitochondrial DNA (mtDNA) levels in NRTI-exposed patas were depleted significantly in the 3TC and d4T/3TC groups at birth and were depleted significantly (p < 0.05) at 1 year in all NRTI-exposed groups. In 1-year-old infants exposed in utero to NRTIs, mtDNA depletion was 28.8-51.8% in brain and 37.4-56.5% in liver. These investigations suggest that some NRTI-exposed human infants may sustain similar mitochondrial compromise in brain and liver and should be followed long term for cognitive integrity and liver function.
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Affiliation(s)
- Rao L. Divi
- Carcinogen-DNA Interactions Section, Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-4255
| | - Tracey L. Einem
- Carcinogen-DNA Interactions Section, Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-4255
| | - Sarah L. Leonard Fletcher
- Carcinogen-DNA Interactions Section, Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-4255
| | - Marie E. Shockley
- Carcinogen-DNA Interactions Section, Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-4255
| | - Maryanne M. Kuo
- Carcinogen-DNA Interactions Section, Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-4255
| | - Marisa C. St Claire
- Division of Clinical Research, National Institute of Allergy and Infectious Disease, National Institutes of Health, Ft Detrick, Frederick, Maryland 21702
| | | | - Kunio Nagashima
- Electron Microscope Laboratory, National Cancer Institute—Frederick, Advance Technology Program, Science Applications International Corporation-Frederick, Frederick Maryland 21702
| | | | | | - Miriam C. Poirier
- Carcinogen-DNA Interactions Section, Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-4255
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Haeri S, Shauer M, Dale M, Leslie J, Baker AM, Saddlemire S, Boggess K. Obstetric and newborn infant outcomes in human immunodeficiency virus-infected women who receive highly active antiretroviral therapy. Am J Obstet Gynecol 2009; 201:315.e1-5. [PMID: 19733286 DOI: 10.1016/j.ajog.2009.06.017] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Revised: 04/28/2009] [Accepted: 06/05/2009] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Our aim was to examine perinatal outcomes in women who are infected with human immunodeficiency virus (HIV) and who receive highly active antiretroviral therapy compared with the general population. STUDY DESIGN In this retrospective cohort study, we compared 151 HIV-positive and 302 HIV-negative women. We defined highly active antiretroviral therapy as concomitant use of at least 3 antiretroviral drugs. We calculated frequencies and odds ratios for adverse pregnancy outcomes. RESULTS Compared with control subjects, smoking (odds ratio, 4.62; 95% confidence interval [CI], 2.58-8.27), drug abuse (odds ratio, 5.48; 95% CI, 2.21-13.59), and spontaneous preterm birth (adjusted odds ratio, 2.27; 95% CI, 1.22-4.25) were more common among HIV-positive women. HIV-positive women were more likely to deliver a small-for-gestational-age infant, but this was due to higher tobacco and cocaine use. Neonatal outcomes were otherwise similar. CONCLUSION HIV-positive women are at increased risk for preterm birth and lower birthweight infants; therefore, antenatal surveillance should include fetal growth assessment. Highly active antiretroviral therapy use does not increase maternal complications.
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Affiliation(s)
- Sina Haeri
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599-7516, USA
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Mehta N, Trzmielina S, Nonyane BAS, Eliot MN, Lin R, Foulkes AS, McNeal K, Ammann A, Eulalievyolo V, Sullivan JL, Luzuriaga K, Somasundaran M. Low-cost HIV-1 diagnosis and quantification in dried blood spots by real time PCR. PLoS One 2009; 4:e5819. [PMID: 19503790 PMCID: PMC2688035 DOI: 10.1371/journal.pone.0005819] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 05/04/2009] [Indexed: 02/07/2023] Open
Abstract
Background Rapid and cost-effective methods for HIV-1 diagnosis and viral load monitoring would greatly enhance the clinical management of HIV-1 infected adults and children in limited-resource settings. Recent recommendations to treat perinatally infected infants within the first year of life are feasible only if early diagnosis is routinely available. Dried blood spots (DBS) on filter paper are an easy and convenient way to collect and transport blood samples. A rapid and cost effective method to diagnose and quantify HIV-1 from DBS is urgently needed to facilitate early diagnosis of HIV-1 infection and monitoring of antiretroviral therapy. Methods and Findings We have developed a real-time LightCycler (rtLC) PCR assay to detect and quantify HIV-1 from DBS. HIV-1 RNA extracted from DBS was amplified in a one-step, single-tube system using primers specific for long-terminal repeat sequences that are conserved across all HIV-1 clades. SYBR Green dye was used to quantify PCR amplicons and HIV-1 RNA copy numbers were determined from a standard curve generated using serially diluted known copies of HIV-1 RNA. This assay detected samples across clades, has a dynamic range of 5 log10, and %CV <8% up to 4 log10 dilution. Plasma HIV-1 RNA copy numbers obtained using this method correlated well with the Roche Ultrasensitive (r = 0.91) and branched DNA (r = 0.89) assays. The lower limit of detection (95%) was estimated to be 136 copies. The rtLC DBS assay was 2.5 fold rapid as well as 40-fold cheaper when compared to commercial assays. Adaptation of the assay into other real-time systems demonstrated similar performance. Conclusions The accuracy, reliability, genotype inclusivity and affordability, along with the small volumes of blood required for the assay suggest that the rtLC DBS assay will be useful for early diagnosis and monitoring of pediatric HIV-1 infection in resource-limited settings.
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Affiliation(s)
- Nishaki Mehta
- Department of Pediatrics and Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Sonia Trzmielina
- Department of Pediatrics and Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Bareng A. S. Nonyane
- School of Public Health and Health Sciences, University of Massachusetts at Amherst, Amherst, Massachusetts, United States of America
| | - Melissa N. Eliot
- School of Public Health and Health Sciences, University of Massachusetts at Amherst, Amherst, Massachusetts, United States of America
| | - Rongheng Lin
- School of Public Health and Health Sciences, University of Massachusetts at Amherst, Amherst, Massachusetts, United States of America
| | - Andrea S. Foulkes
- School of Public Health and Health Sciences, University of Massachusetts at Amherst, Amherst, Massachusetts, United States of America
| | - Kristina McNeal
- Department of Pediatrics and Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Arthur Ammann
- Global Strategies for HIV Prevention, San Rafael, California, United States of America
| | | | - John L. Sullivan
- Department of Pediatrics and Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Katherine Luzuriaga
- Department of Pediatrics and Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Mohan Somasundaran
- Department of Pediatrics and Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
- * E-mail:
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Abstract
In the neonatal intensive care unit, critical care nurses who are not advanced practice nurses cannot make the medical diagnosis of infection/sepsis in the neonate. Even so, the critical care nurse has a critical role in dealing with sepsis infection. The nurse must (1) have a high index of suspicion about the risk of infection, (2) be able to recognize septic/infected newborns, (3) report related concerns to the physician or advanced practice nurse, and (4) advocate on behalf of the infant to ensure a timely diagnostic workup and empiric antibiotics. This article is a guide for understanding issues related to sepsis in the neonatal intensive care unit.
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10
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Abstract
Universal HIV testing of pregnant women in the United States is the key to prevention of mother-to-child transmission of HIV. Repeat testing in the third trimester and rapid HIV testing at labor and delivery are additional strategies to further reduce the rate of perinatal HIV transmission. Prevention of mother-to-child transmission of HIV is most effective when antiretroviral drugs are received by the mother during her pregnancy and continued through delivery and then administered to the infant after birth. Antiretroviral drugs are effective in reducing the risk of mother-to-child transmission of HIV even when prophylaxis is started for the infant soon after birth. New rapid testing methods allow identification of HIV-infected women or HIV-exposed infants in 20 to 60 minutes. The American Academy of Pediatrics recommends documented, routine HIV testing for all pregnant women in the United States after notifying the patient that testing will be performed, unless the patient declines HIV testing ("opt-out" consent or "right of refusal"). For women in labor with undocumented HIV-infection status during the current pregnancy, immediate maternal HIV testing with opt-out consent, using a rapid HIV antibody test, is recommended. Positive HIV antibody screening test results should be confirmed with immunofluorescent antibody or Western blot assay. For women with a positive rapid HIV antibody test result, antiretroviral prophylaxis should be administered promptly to the mother and newborn infant on the basis of the positive result of the rapid antibody test without waiting for results of confirmatory HIV testing. If the confirmatory test result is negative, then prophylaxis should be discontinued. For a newborn infant whose mother's HIV serostatus is unknown, the health care professional should perform rapid HIV antibody testing on the mother or on the newborn infant, with results reported to the health care professional no later than 12 hours after the infant's birth. If the rapid HIV antibody test result is positive, antiretroviral prophylaxis should be instituted as soon as possible after birth but certainly by 12 hours after delivery, pending completion of confirmatory HIV testing. The mother should be counseled not to breastfeed the infant. Assistance with immediate initiation of hand and pump expression to stimulate milk production should be offered to the mother, given the possibility that the confirmatory test result may be negative. If the confirmatory test result is negative, then prophylaxis should be stopped and breastfeeding may be initiated. If the confirmatory test result is positive, infants should receive antiretroviral prophylaxis for 6 weeks after birth, and the mother should not breastfeed the infant.
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Affiliation(s)
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- Centers for Disease Control and Prevention
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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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Spencer JD, Tibbits D, Tippet C, Mead C, Kaldor JM, Dore GJ. Review of antenatal testing policies and practice for HIV and hepatitis C infection. Aust N Z J Public Health 2007; 27:614-9. [PMID: 14723409 DOI: 10.1111/j.1467-842x.2003.tb00608.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To investigate antenatal HIV and HCV testing policy and practice in Australia. METHODS A survey of private obstetricians and general practitioners (GPs) affiliated with the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and directors of obstetric units in public hospitals was undertaken. Surveys were mailed to 40% and 20% random samples of private obstetricians and GPs, respectively, and all public hospital obstetric units. The questionnaires included information on type of antenatal policy, proportion of women tested for HIV and HCV, and number of HIV and HCV-positive women receiving antenatal care. RESULTS Of the 995 surveys distributed, 847 (85%) were returned. Of these 847, 277 (33%) were returned from practitioners or hospitals no longer involved in antenatal care. The response rates from the remaining practitioners (n=570) included 87% from private obstetricians, 78% from GPs, and 71% from public hospitals. The proportion of private obstetricians, GPs and public hospitals with an antenatal testing policy for HIV was 62%, 42% and 44%, and for HCV 65%, 41% and 39%, respectively. Universal offer of antenatal testing among private obstetricians, GPs and public hospitals was 47%, 62% and 23% for HIV and 54%, 46% and 23% for HCV, respectively. During 1999, an estimated 33% of pregnant women were tested for HIV and 37% for HCV. Based on reported numbers of women in antenatal care, prevalence rates were estimated at 0.23 per 1,000 and 13 per 1,000, for HIV and HCV, respectively. CONCLUSIONS Antenatal testing policy and practice varies widely in Australia. The lack of uniformity may reflect differing policies among clinical and public health bodies.
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Affiliation(s)
- Jenean D Spencer
- Surveillance and Epidemiology Section, Population Health Division, Commonwealth Department of Health and Ageing, Australian Capital Territory
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13
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Gray L, Fiscus S, Shugars D. HIV-1 variants from a perinatal transmission pair demonstrate similar genetic and replicative properties in tonsillar tissues and peripheral blood mononuclear cells. AIDS Res Hum Retroviruses 2007; 23:1095-104. [PMID: 17919104 DOI: 10.1089/aid.2006.0247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Human immunodeficiency virus type 1 (HIV-1) can be acquired through oropharyngeal tissues in breastfeeding infants. Efforts to better understand the determinants of breast milk transmission are hampered by the lack of a relevant oral human mucosa model and well-defined breast milk-derived viruses. This study used human ex vivo palatine tonsil tissues and peripheral blood mononuclear cells (PBMCs) to characterize the genetic, biological, and replicative properties of HIV-1 variants obtained from a perinatal transmission pair. Unique viral populations from maternal breast milk and infant blood were identified by gp120 V1-V2- and V3-specific heteroduplex tracking assays (HTAs). Full-length infectious recombinant viruses, containing a common HIV-1 NL4-3 genetic background, were generated with V1-V3 gp120 fragments from maternal and infant isolates representing the major viral populations identified in the HTAs. The resulting recombinant viruses used the CCR5 coreceptor, were nonsyncytium forming, and demonstrated replication properties similar to those of parental and control viruses in PBMCs and tonsillar explants. These findings indicate that viruses from breast milk cells and infant blood can infect PBMCs and tonsil tissues. The maternal and infant HIV-1 viruses detailed here will provide useful tools for defining the viral and host factors that contribute to HIV breastfeeding transmission.
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Affiliation(s)
- Laurie Gray
- Dental Research Center, University of North Carolina School of Dentistry, Chapel Hill, North Carolina
| | - Susan Fiscus
- UNC Retrovirology Laboratory, Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Diane Shugars
- Dental Ecology, University of North Carolina School of Dentistry, Chapel Hill, North Carolina
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Thurstone C, Riggs PD, Klein C, Mikulich-Gilbertson SK. A one-session human immunodeficiency virus risk-reduction intervention in adolescents with psychiatric and substance use disorders. J Am Acad Child Adolesc Psychiatry 2007; 46:1179-1186. [PMID: 17712241 DOI: 10.1097/chi.0b013e31809fe774] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To explore change in human immunodeficiency virus (HIV) risk among teens in outpatient treatment for substance use disorders (SUDs). METHOD From December 2002 to August 2004, 50 adolescents (13-19 years) with major depressive disorder, conduct disorder, and one or more non-nicotine SUD completed the Teen Health Survey (THS) at the beginning and end of 16 weeks of outpatient cognitive behavioral SUD treatment, which included a one-session HIV intervention. Changes in THS scale scores and specific item responses targeted by the intervention were assessed with paired t tests and Wilcoxon signed rank tests. RESULTS Pre/post mean THS scores significantly improved for two subscales: Measures of HIV Information (14.8-17.6; p < .001) and Beliefs about Condom Use (17.6-18.5; p < .05). Analyses of specific items showed trends for improvement in intentions to carry condoms and in the number of teens who obtained condoms. Not all of the risks targeted by the intervention showed significant change, but no change was observed in any area that was not specifically targeted. CONCLUSIONS Results from this preliminary study are consistent with the need for specific assessment and targeted intervention to reduce HIV risk in outpatient adolescent SUD treatment.
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Affiliation(s)
- Christian Thurstone
- Dr. Thurstone is affiliated with Denver Health and Hospital Authority and the University of Colorado at Denver and Health Sciences Center. All of the other authors are affiliated with the University of Colorado at Denver and Health Sciences Center..
| | - Paula D Riggs
- Dr. Thurstone is affiliated with Denver Health and Hospital Authority and the University of Colorado at Denver and Health Sciences Center. All of the other authors are affiliated with the University of Colorado at Denver and Health Sciences Center
| | - Constance Klein
- Dr. Thurstone is affiliated with Denver Health and Hospital Authority and the University of Colorado at Denver and Health Sciences Center. All of the other authors are affiliated with the University of Colorado at Denver and Health Sciences Center
| | - Susan K Mikulich-Gilbertson
- Dr. Thurstone is affiliated with Denver Health and Hospital Authority and the University of Colorado at Denver and Health Sciences Center. All of the other authors are affiliated with the University of Colorado at Denver and Health Sciences Center
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Bryant Borders AE, Eary RL, Olszewski Y, Statton A, Handler A, Cohen MH, Garcia PM. Ready or not--intrapartum prevention of perinatal HIV transmission in Illinois. Matern Child Health J 2007; 11:485-93. [PMID: 17508276 DOI: 10.1007/s10995-007-0192-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Accepted: 02/06/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The overall readiness of Illinois birthing hospitals to comply with the 2003 Illinois HIV Perinatal Prevention Act and prevent perinatal HIV transmission, and the hospital characteristics that predict readiness were examined. METHODS Nurse Managers of all 137 Illinois birthing hospitals were surveyed regarding current labor and delivery (L&D) practices for HIV status identification, documentation, testing and zidovudine (AZT) availability in March 2004. Bivariate and multivariable regression analysis was performed. RESULTS All 137 hospitals returned the surveys. Almost forty seven percent of Illinois birthing hospitals had adequate maternal HIV status documentation on arrival in L&D, 72.3% documented prenatal HIV results in the L&D chart, 65.7% documented prenatal HIV in the newborn chart, 38.7% ordered HIV tests on L&D if no prenatal HIV status was available, and 61.3% had AZT available. Only 17 hospitals (12.4%) met requirements for overall readiness to prevent perinatal HIV transmission. Sixteen hospitals (11.6%) met a minimal level of readiness (prenatal HIV status documentation and AZT availability). CONCLUSIONS Despite passage of legislation to increase perinatal HIV testing and reduce transmission, Illinois birthing hospitals had an overall low level of readiness to implement the intrapartum interventions that are an essential part of eradicating pediatric HIV infection. Perinatal reduction protocols and implementation guidelines would improve the overall readiness of Illinois birthing hospitals to prevent perinatal HIV transmission.
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Affiliation(s)
- Ann E Bryant Borders
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Abstract
Mother-to-child transmission of the human immunodeficiency virus continues to be a major global health problem. The pediatric HIV-1 epidemic is fueled by HIV-1 infection in women of childbearing age with vertical transmission in utero or at the time of birth. In resource-rich countries, the birth of an infected child is a sentinel health event signaling a chain of missed opportunities and barriers to prevention. Because the fate and ultimate HIV-infection status of the baby is inextricably linked to the infection status of the mother and her general state of well-being, we provide in this review: 1) background and state-of-the-art management guidelines for optimum maternal care; 2) strategies to minimize the risk of vertical transmission of HIV; and 3) recommendations for managing infants born to HIV-infected women. These are discussed under four case scenarios that obstetric and pediatric providers frequently encounter in their practices.
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Affiliation(s)
- Elijah Paintsil
- Department of Pharmacology, Yale University School of Medicine, New Haven, CT 06520-8064, USA
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Abstract
The pathogenesis of HIV infection and the general principles of therapy are the same for HIV-infected adults, adolescents, children and infants. However, antiretroviral treatment of HIV infection in pediatrics requires the consideration of a number of factors specific to its population, including differences in drug pharmacokinetics and the use of virologic and immunologic markers, as well as age-related adherence issues. This review summarizes the text of the Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection, which was updated in October 2006. The guidelines are the work of the Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children, a group of the Office of AIDS Research Advisory Council of the National Institutes of Health, which reviews new data on an ongoing basis and provides regular updates to the guidelines. As these guidelines were developed for the US, they may not be applicable in other countries. This summary does not attempt to place the Working Group guidelines in the context of international guidelines, nor does it attempt to detail the use of antiretroviral medication in the prevention of perinatal transmission of HIV, such as addressing the use of zidovudine versus single-dose nevirapine.
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Affiliation(s)
- Takehisa Ikeda
- Division of Infectious Diseases, Department of Pediatrics, University of Medicine and Dentistry of New Jersey, 185 South Orange Avenue, Room F570-A, Newark, New Jersey 07103, USA
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Eary RL, Borders AEB, Handler A, Cohen MH, Garcia PM. AZT Availability in Illinois birthing hospitals: is the perinatal HIV prevention safety net in place? Matern Child Health J 2007; 11:313-8. [PMID: 17243021 DOI: 10.1007/s10995-006-0175-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2006] [Accepted: 12/28/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To prevent perinatal HIV transmission, providers must identify HIV status for all women in labor and newborns, and provide timely antiretroviral therapy if necessary. The objective of this study is to evaluate the availability and accessibility of zidovudine (AZT) in Illinois birthing hospitals. METHODS We surveyed all Illinois birthing hospital pharmacies by telephone in February 2005 regarding availability, accessibility, and protocols surrounding AZT use in the perinatal period. RESULTS All 137 pharmacies participated. Only 43.1% reported having syrup and IV AZT available and only 37.2% indicated the ability to have AZT available on labor and delivery within 30 min during off hours. Protocols for treating HIV positive women in labor and exposed newborns were available in only 37.2% of pharmacies while 72.4% had protocols for antiretroviral therapy for occupational post-exposure prophylaxis. Variables associated with pharmacies having AZT available included being a major academic hospital and serving a predominately (greater than 96%) white patient population. Timely provision of AZT was more likely to occur in urban, major academic hospitals serving a predominately white population. CONCLUSIONS In order to further reduce perinatal HIV transmission, availability and timely access to both syrup and IV AZT must be improved in Illinois birthing hospitals.
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Affiliation(s)
- Rebecca L Eary
- University of Illinois School of Public Health, Community Health Sciences, Maternal and Child Health Division, Chicago, IL, USA
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Baumann RJ, Espinosa PS. Neuroepidemiology of HIV/AIDS. HANDBOOK OF CLINICAL NEUROLOGY 2007; 85:3-31. [PMID: 18808973 DOI: 10.1016/s0072-9752(07)85002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Kang MW. Prevention of HIV/AIDS. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2007. [DOI: 10.5124/jkma.2007.50.4.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Moon Won Kang
- Department of Internal Medicine, The Catholic University College of Medicine, Korea.
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Affiliation(s)
- Ronald H Goldschmidt
- National Perinatal HIV Consultation and Referral Service (Perinatal Hotline), National Clinicians' Consultation Center, University of California, San Francisco General Hospital, San Francisco, California, 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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Kropp RY, Montgomery ET, Hill DW, Ruiz JD, Maldonado YA. Unique challenges to preventing perinatal HIV transmission among Hispanic women in California: results of a needs assessment. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2005; 17:22-40. [PMID: 15843108 DOI: 10.1521/aeap.17.1.22.58687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
To identify rates and factors associated with timely prenatal care (PNC) initiation, HIV test counseling, test offering, and test offer acceptance, we conducted a semistructured survey of a convenience sample of pregnant/recently delivered Hispanic women (n=453, 418 with analyzable data) in four California counties in 2000. Only 68.4% and 43.5% of Hispanic women reported receiving an HIV test offer and counseling, respectively, though 88.8% of those offered a test accepted. After controlling for the effects of age, education, years lived in the United States, health insurance coverage, delivery status, and parity, Hispanic women who initiated prenatal care in the first trimester were 1.7 times more likely to be offered an HIV test and almost 3 times more likely to receive counseling than women with a later prenatal care start or no prenatal care. Factors associated with timely PNC initiation on multivariate analysis were private/HMO insurance (OR=10.7, p < .001), Medi-Cal insurance (OR = 4.32, p < .001), being 25-30 years old (OR = 3.0, p = .008), and completion of high school (OR = 2.07, p = .01). Key opportunities to prevent perinatal HIV transmission are being lost for Hispanic women in California. Interventions to increase timely PNC initiation, and to improve test offering by health care providers, may help to improve counseling and testing rates for this population.
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Affiliation(s)
- Rhonda Y Kropp
- University of California, School of Public Health, Berkeley, USA
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Abstract
OBJECTIVE The risk of vertical HIV transmission from mother to child has been shown to be markedly decreased through HIV education, counseling, testing, and zidovudine (ZDV) use. The US Public Health Service published guidelines in 1994 for the use of ZDV on the basis of results of the AIDS Clinical Trials Group Protocol, a multicenter clinical trial of ZDV. The Public Health Service followed these guidelines with recommendations for routine HIV counseling and testing with informed consent for all pregnant women. New Jersey adopted these guidelines as the standard of care and created a program implementing the standard in all hospitals with maternity units. The purpose of this report was to study the trends in the rate of HIV infection in childbearing women over the past decade and to follow patterns of use of ZDV in the HIV-positive women, as a marker for the success of New Jersey's policy and program to reduce mother-to-child transmission. METHODS Since 1988 in New Jersey, blood from heel-stick filter papers has been tested for the presence of HIV antibody through anonymous, unlinked surveys. Excess blood from screening for inborn errors of metabolism for all infants who were born in the state from July through September of each year was tested using a Food and Drug Administration-approved HIV-1 and Western blot test. Age, race, and ethnicity were recorded, as well as the results from the HIV-1 and Western blot tests. Since 1994, specimens confirmed to be HIV-1 positive by Western blot test were tested for the presence of ZDV, and the results were recorded. RESULTS The number of New Jersey women included in the study for the period 1990 through 2002 numbered 372305. The percentage of childbearing women who tested positive for HIV declined by 55% during the period, although the declines were not uniform in all subgroups. In the early 1990s, women who were <30 years old had higher infection rates than older women, but this has not been a consistent pattern during the period. Younger women again had a higher rate in 2002. When HIV-positive rates are examined by 5-year age groups, the declines are dramatic for younger women. The rate per 100 women 20 through 24 years decreased from 0.46 per 100 tested women in 1990 to 0.29 in 2002 and for women 25 through 29 years from 0.51 per 100 in 1990 to 0.25 in 2002. The rate for women 30 through 34 years of age declined from 0.54 in 1990 to 0.13 in 2002. During the same time period, the rate per 100 tested women 35 though 39 years of age increased from 0.23 to 0.33. Black non-Hispanic women who give birth to live infants have the highest HIV-positive rates, followed by Hispanic women and white non-Hispanic women. In 2002, this rate was 0.74 per 100 in black non-Hispanic women, 0.22 per 100 in Hispanic women, and 0.08 in white non-Hispanic women. Although major disparities continue, the infection rate in black non-Hispanic women demonstrated the greatest decrease during the period, followed by the decline among Hispanic women. The use of ZDV in HIV-positive women increased dramatically during the period, from 13.3% in 1994, when it was first tested in New Jersey, to an all-time high of 88.5% in 2002. CONCLUSIONS Reducing perinatal HIV transmission is a priority for the New Jersey Department of Health and Senior Services. Reducing perinatal transmission can be accomplished by reducing the number of infants who are exposed perinatally or decreasing the percentage of exposed infants for whom transmission occurs or both. The decrease in prevalence of HIV-positive status in childbearing women is in opposition to an overall increasing trend in prevalence rates. This decrease is thought to be attributable in part to the positive impact of numerous education and prevention programs but may also be the result of a voluntary decision on the part of HIV-infected women not to become pregnant or not to carry to term. In addition, the cohort of women who became infected in the early years of the epidemic may be aging out of their childbearing years, may have more advanced disease with a concomitant difficulty with fertility and carrying to term, or may have died. In New Jersey, a greater proportion of women with newly diagnosed HIV disease are past their childbearing years as compared with earlier years. Increased use of ZDV is thought to be attributable to several factors: dissemination of information to health care providers via continuing medical education activities; dissemination of information to the public, in particular to women; outreach via community-based organizations; and New Jersey Department of Health and Senior Service regulations and policies for mandatory counseling and voluntary testing of all pregnant women. A recent addition to New Jersey's comprehensive program to decrease perinatal transmission occurred in 2002 with dissemination to hospitals of the department's standard of care for women who present in labor with unknown HIV status. Physicians, nurses, and hospitals play vital roles in preventing vertical transmission of HIV by providing preconception and postconception counseling, testing with consent of pregnant women, and treatment for HIV-positive mothers, including administration of ZDV. This study not only provides an estimate of the prevalence of HIV infection in the population of childbearing women but also provides a means of examining the vertical transmission of HIV infection from mother to child. Continued research on this subpopulation as well as on other groups will provide additional knowledge to help in the overall goal of reducing HIV prevalence.
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Affiliation(s)
- Jasmine Sia
- Department of Medicine, University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey, USA.
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Sweat MD, O'Reilly KR, Schmid GP, Denison J, de Zoysa I. Cost-effectiveness of nevirapine to prevent mother-to-child HIV transmission in eight African countries. AIDS 2004; 18:1661-71. [PMID: 15280777 DOI: 10.1097/01.aids.0000131353.06784.8f] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A comprehensive approach to preventing HIV infection in infants has been recommended, including: (a) preventing HIV in young women, (b) reducing unintended pregnancies among HIV-infected women, (c) preventing vertical transmission (PMTCT), and (d) providing care, treatment, and support to HIV-infected women and their families. Most attention has been given to preventing vertical transmission based on analysis showing nevirapine to be inexpensive and cost-effective. METHODS The following were determined using data from eight African countries: national program costs and impact on infant infections; reductions in adult HIV prevalence and unintended pregnancies among HIV-infected women that would have equivalent impact on infant HIV infections averted as the nevirapine intervention; and the cost threshold for drugs with greater efficacy than nevirapine yielding an equivalent cost per DALY saved. RESULTS Average national annual program cost was 4.8 million dollars. There was, per country, an average of 1898 averted infant HIV infections (2517 US dollars per HIV infection and 84 US dollars per DALY averted). Lowering HIV prevalence among women by 1.25% or reducing unintended pregnancy among HIV-infected women by 16% yielded an equivalent reduction in infant cases. An antiretroviral drug with 70% efficacy could cost 152 US dollars and have the same cost per DALY averted as nevirapine at 47% efficacy. CONCLUSIONS Cost-effectiveness of nevirapine prophylaxis is influenced by health system costs, low client uptake, and poor effectiveness of nevirapine. Small reductions in maternal HIV prevalence or unintended pregnancy by HIV-infected women have equivalent impacts on infant HIV incidence and should be part of an overall strategy to lessen numbers of infant infections.
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Affiliation(s)
- Michael D Sweat
- Department of International Health, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland 21205, USA
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27
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Abstract
In developed countries, care and treatment are available for pregnant women and infants that can decrease the rate of perinatal human immunodeficiency virus type 1 (HIV-1) infection to 2% or less. The pediatrician has a key role in prevention of mother-to-child transmission of HIV-1 by identifying HIV-exposed infants whose mothers' HIV infection was not diagnosed before delivery, prescribing antiretroviral prophylaxis for these infants to decrease the risk of acquiring HIV-1 infection, and promoting avoidance of HIV-1 transmission through human milk. In addition, the pediatrician can provide care for HIV-exposed infants by monitoring them for early determination of HIV-1 infection status and for possible short- and long-term toxicities of antiretroviral exposure, providing chemoprophylaxis for Pneumocystis pneumonia, and supporting families living with HIV-1 infection by providing counseling to parents or caregivers.
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Evaluation and treatment of the human immunodeficiency virus-1-exposed infant. Paediatr Child Health 2004; 9:409-28. [PMID: 19657433 PMCID: PMC2721159 DOI: 10.1093/pch/9.6.409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2024] Open
Abstract
In developed countries, care and treatment are available for pregnant women and infants that can decrease the rate of perinatal human immunodeficiency virus type 1 (HIV-1) infection to 2% or less. The paediatrician has a key role in the prevention of mother-to-child transmission of HIV-1 by identifying HIV-exposed infants whose mothers' HIV infection was not diagnosed before delivery, prescribing antiretroviral prophylaxis for these infants to decrease the risk of acquiring HIV-1 infection, and promoting avoidance of HIV-1 transmission through human milk. In addition, the paediatrician can provide care for HIV-exposed infants by monitoring them for early determination of HIV-1 infection status and for possible short- and long-term toxicities of antiretroviral exposure, providing chemoprophylaxis for Pneumocystis pneumonia, and supporting families living with HIV-1 infection by providing counselling to parents or caregivers.
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L'évaluation et le traitement du nourrisson exposé au virus d'immunodéficience humaine de type 1. Paediatr Child Health 2004. [DOI: 10.1093/pch/9.6.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Divi RL, Walker VE, Wade NA, Nagashima K, Seilkop SK, Adams ME, Nesel CJ, O'Neill JP, Abrams EJ, Poirier MC. Mitochondrial damage and DNA depletion in cord blood and umbilical cord from infants exposed in utero to Combivir. AIDS 2004; 18:1013-21. [PMID: 15096804 DOI: 10.1097/00002030-200404300-00009] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Although most uninfected infants born to women infected with HIV-1 show no clinical evidence of mitochondrial compromise, mitochondrial dysfunction has been reported in children born to women receiving zidovudine and/or lamivudine during pregnancy. In this pilot study we examined mitochondrial integrity in HIV-1-uninfected infants born to HIV-1-infected women receiving Combivir during pregnancy. DESIGN : Samples of umbilical cord and cord blood were obtained from HIV-1-uninfected infants born to either HIV-1-infected women receiving Combivir therapy during pregnancy (n = 10) or HIV-1-uninfected women (n = 9). METHODS Mitochondrial morphological integrity was examined in umbilical cords (n = 16) by electron microscopy and mtDNA quantity was determined in DNA from cord blood (n = 18) and umbilical cord (n = 18) by PCR-chemiluminescence immunoassay detection. RESULTS In umbilical cords from six of nine infants born to HIV-1-infected mothers taking Combivir moderate to severe mitochondrial morphological damage was observed (P = 0.011), while none of seven unexposed infants showed similar damage. Compared to unexposed infants, statistically significant mtDNA depletion was observed in umbilical cord (P = 0.006) and cord blood (P = 0.003) from drug-exposed infants. CONCLUSIONS A cohort of HIV-1-uninfected Combivir-exposed infants with no clinical symptoms showed morphological and molecular evidence of mitochondrial damage.
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Affiliation(s)
- Rao L Divi
- CDI Section, National Cancer Institute, NIH, Bethesda, Maryland 20892, USA
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Mofenson LM. Advances in the prevention of vertical transmission of human immunodeficiency virus. ACTA ACUST UNITED AC 2004; 14:295-308. [PMID: 14724794 DOI: 10.1053/j.spid.2003.09.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The major mode of acquisition of human immunodeficiency virus (HIV) for children is through mother-to-child transmission, which can occur during pregnancy or labor and delivery, or postnatally through breastfeeding. In resource-rich countries, mother-to-child HIV transmission has decreased to less than 2 percent after recommendations for universal prenatal HIV counseling and testing, antiretroviral prophylaxis and elective cesarean delivery, and avoidance of breastfeeding were implemented. In resource-limited settings, effective, shorter, and less expensive antiretroviral prophylaxis interventions also have been identified, but implementation has been slower, and continued transmission through breastfeeding remains a significant problem. This review summarizes recent advances made in prevention of mother-to-child transmission of HIV in the United States and other resource-rich countries, as well as progress in resource-limited countries.
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Affiliation(s)
- Lynne M Mofenson
- Center for Research for Mothers and Children, National Institute of Child Health and Human Development, National Institutes of health, Rockville, MD 20852, USA.
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Gerschenson M, Nguyen V, Ewings EL, Ceresa A, Shaw JA, St Claire MC, Nagashima K, Harbaugh SW, Harbaugh JW, Olivero OA, Divi RL, Albert PS, Poirier MC. Mitochondrial toxicity in fetal Erythrocebus patas monkeys exposed transplacentally to zidovudine plus lamivudine. AIDS Res Hum Retroviruses 2004; 20:91-100. [PMID: 15000702 DOI: 10.1089/088922204322749530] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study was designed to investigate fetal mitochondrial toxicity in Erythrocebus patas monkeys exposed in utero to zidovudine (AZT) and lamivudine (3TC), and taken at term. Pregnant patas monkeys were given a daily dose of 40 mg AZT (86% of the human daily dose, based on body weight), for the last 10 weeks (50%) of gestation, and a daily dose of 24 mg 3TC (84% of the human daily dose, based on body weight) for the last 4 weeks of gestation. At term, AZT was found to be incorporated into fetal mitochondrial DNA from skeletal muscle, liver, kidney, and placenta. By transmission electron microscopy (EM) drug-exposed fetal cardiac and skeletal muscle cells showed mitochondrial membrane compromise, mitochondrial proliferation, and damaged sarcomeres, while mitochondria in brain cerebrum and cerebellum were morphologically normal. Substantial depletion of oxidative phosphorylation (OXPHOS) Complex I specific activities was observed in heart (87% reduction in mean, p = 0.02) and skeletal muscle (98% reduction in mean, p = 0.002) from drug-exposed fetuses, compared to unexposed fetuses. In addition Complex IV activity was highly depleted (85% reduction in mean, p = 0.004) in skeletal muscle from the drug-exposed fetuses (p = 0.004). Brain cerebrum and cerebellum showed no statistically significant OXPHOS changes with drug exposure. Mitochondrial DNA quantity was substantially depleted (>50%) in heart, skeletal muscle, cerebellum, and cerebrum from drug-exposed fetuses compared to unexposed controls. Overall, the data indicate that significant mitochondrial damage was observed at birth in monkey fetuses exposed in utero to AZT plus 3TC in a human-equivalent dosing protocol.
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Affiliation(s)
- Mariana Gerschenson
- Division of Heart and Vascular Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 6701 Rockledge Drive, Bethesda, MD 20892, USA
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Kline MW, O'Connor KG. Disparity between pediatricians' knowledge and practices regarding perinatal human immunodeficiency virus counseling and testing. Pediatrics 2003; 112:e367. [PMID: 14595078 DOI: 10.1542/peds.112.5.e367] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This survey of members of the American Academy of Pediatrics (AAP) was initiated by the AAP Committee on Pediatric AIDS to assess the knowledge, attitudes, and behaviors of pediatricians regarding prenatal and neonatal screening as a means to reduce mother-to-child transmission of human immunodeficiency virus (HIV). METHODS The survey consisted of a 4-page, self-administered questionnaire, which was mailed to a random sample of 1647 active US members of the AAP. The original and 5 subsequent mailings to nonresponders were conducted from July to November 2001. RESULTS Completed questionnaires were received from 982 pediatricians, for a response rate of 59.6%. Nearly all pediatricians (96.6%) agree on the importance of knowing the HIV status of pregnant women, and more than three-fourths (78.5%) do not think that HIV screening during pregnancy or postpartum should be limited to women with perceived risk for infection. Approximately 6 (58.5%) of 10 pediatricians indicate that they counsel or provide education on HIV screening to pregnant women or mothers of newborns whose HIV status is unknown; 41.5% do not. Pediatricians reported evaluating an average of 56 newborns each during the 3 months before the survey. The HIV infection status of the mother was unknown for 40.6% of these cases. During the same time period, pediatricians said that they discussed a newborn or maternal HIV screening test with only 10.4% of the mothers whose HIV infection status was unknown. Reasons given for not counseling mothers with unknown HIV infection status about maternal and/or newborn screening for HIV included low prevalence of HIV in the pediatrician's practice area (65.4%), assessment by the pediatrician that the parents did not fit the profile of those "at risk" for HIV infection (56.1%), fear of offending the parents (50.2%), parental lack of understanding regarding the importance of screening (50.1%), and lack of sufficient time for counseling (44.4%). CONCLUSIONS Pediatricians exhibit a high degree of understanding of the importance of HIV screening as a means to reduce mother-to-child transmission of HIV, but this does not always translate into their clinical practices.
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Affiliation(s)
- Mark W Kline
- Committee on Pediatric AIDS, American Academy of Pediatrics, Elk Grove Village, Illinois, USA.
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Fowler MG, Mofenson L, McConnell M. The Interface of Perinatal HIV Prevention, Antiretroviral Drug Resistance, and Antiretroviral Treatment: What Do We Really Know? J Acquir Immune Defic Syndr 2003; 34:308-11. [PMID: 14600577 DOI: 10.1097/00126334-200311010-00009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Poirier MC, Divi RL, Al-Harthi L, Olivero OA, Nguyen V, Walker B, Landay AL, Walker VE, Charurat M, Blattner WA. Long-term mitochondrial toxicity in HIV-uninfected infants born to HIV-infected mothers. J Acquir Immune Defic Syndr 2003; 33:175-83. [PMID: 12794551 DOI: 10.1097/00126334-200306010-00010] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although children born to HIV-infected (HIV+) women receiving antiretroviral therapy during pregnancy show virtually no adverse clinical effects at birth, the antiretroviral nucleoside analog drugs are known to damage nuclear and mitochondrial DNA. In this study, biomarkers of mitochondrial toxicity and genotoxicity have been examined in a well-characterized sample set consisting of infants born to HIV-uninfected (HIV-) mothers (n = 30), and HIV- infants (n = 20) born to HIV-infected (HIV+) mothers who received either no antiretroviral therapy (n = 10) or zidovudine (3'-azido-3'-deoxythymidine [AZT]) during pregnancy (n = 10). DNA from cord blood leukocytes and peripheral blood leukocytes taken at 1 and 2 years of age was examined for loss of mitochondrial DNA (mtDNA) and telomere integrity. Telomere length, a measure of nuclear DNA damage, was the same in all infants at birth and at age 1 year. The quantity of mtDNA was assessed relative to nuclear DNA using a polymerase chain reaction-based chemiluminescence detection (PCR-CID) method that determined mitochondrial D Loop gene copies relative to nuclear 18S RNA gene copies by comparison with a standard curve. MtDNA quantity was expressed as a ratio of gene copy numbers. In infants of uninfected mothers (AZT-/HIV-) at the three time points, the ratios were 442 to 515, whereas in infants of untreated AZT-/HIV+ mothers the ratios were 261 to 297, and in infants of AZT-treated (AZT+/HIV+) mothers the ratios were 146 to 203. At all three time points, differences between the AZT-/HIV- group and the two HIV+ groups were statistically significant (p <.05), and differences between the AZT-/HIV+ and AZT+/HIV+ groups were also statistically significant (p <.05), demonstrating that AZT exposure causes a persistent depletion of mtDNA. The study shows that children of HIV+ mothers are at risk for mitochondrial damage that is further increased in infants of mothers receiving AZT during pregnancy.
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MESH Headings
- Adult
- Child, Preschool
- DNA, Mitochondrial/analysis
- DNA, Mitochondrial/drug effects
- Female
- Fetal Blood/immunology
- Genetic Markers
- HIV Infections/blood
- HIV Infections/drug therapy
- HIV Infections/genetics
- Humans
- Infant
- Infant, Newborn
- Leukocytes, Mononuclear/chemistry
- Leukocytes, Mononuclear/drug effects
- Pilot Projects
- Pregnancy
- Pregnancy Complications, Infectious/drug therapy
- Prenatal Exposure Delayed Effects
- Prospective Studies
- RNA, Ribosomal, 18S/analysis
- RNA, Ribosomal, 18S/drug effects
- Reverse Transcriptase Inhibitors/adverse effects
- Telomere/drug effects
- Telomere/ultrastructure
- Zidovudine/adverse effects
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Affiliation(s)
- Miriam C Poirier
- Carcinogen-DNA Interactions Section, National Cancer Institute, National Institutes of Health, Building 37, Room 4032, 37 Convent Drive, Bethesda, MD 20892-4255, USA.
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36
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Luján-Zilbermann J, Bitar W, Knapp K, Flynn P. Human immunodeficiency virus type 1 RNA polymerase chain reaction reasonably excludes infection in exposed infants. Pediatr Infect Dis J 2003; 22:97-9. [PMID: 12553306 DOI: 10.1097/00006454-200301000-00027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A nucleic acid sequence-based amplification (NASBA) assay that detects HIV RNA may be helpful in excluding perinatal HIV infection. We reviewed the records of 190 infants born to HIV-infected mothers. The sensitivity and specificity of the NASBA assay were 100% when measured at two time periods in the first 9 months of life. The HIV RNA NASBA assay should be considered a valid diagnostic test in this population.
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Affiliation(s)
- Jorge Luján-Zilbermann
- Department of Inectious Diseases, St Jude Children's Research Hospital, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, USA
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37
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Kline NE, Schwarzwald H, Kline MW. False negative DNA polymerase chain reaction in an infant with subtype C human immunodeficiency virus 1 infection. Pediatr Infect Dis J 2002; 21:885-6. [PMID: 12380591 DOI: 10.1097/00006454-200209000-00023] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Diagnosis of HIV infection in early infancy generally relies on detection of HIV proviral DNA by PCR. However, many of the HIV DNA PCR assays currently in use are either not optimized or have not been validated for diagnosis of infection with non-subtype B HIV. We report the case of an HIV-infected African American immigrant infant with subtype C HIV infection who tested negative repeatedly by HIV DNA PCR. Clinicians should be aware of this particular limitation of HIV DNA PCR assays, because it is likely that an increasing proportion of the HIV-infected infants seen in US centers will be infected with non-subtype B HIV.
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Affiliation(s)
- Nancy E Kline
- Section of Retrovirology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA
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