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Nic An Ríogh E, McCombe G, Connolly SP, Fawsitt R, McHugh T, O'Connor E, Stewart S, Swan D, Tinago W, Cullen W, Lambert JS. A mixed methods study of attendance and treatment rates among patients with Hepatitis C. Ir Med J 2023; 116:742. [PMID: 37010498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
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Nic An Ríogh E, McCombe G, Connolly SP, Fawsitt R, McHugh T, O'Connor E, Stewart S, Swan D, Tinago W, Cullen W, Lambert JS. A mixed methods study of Attendance and Treatment Rates among Patients with Hepatitis C. Ir Med J 2023; 116:742. [PMID: 36976262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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O'Kelly B, Vidal L, Avramovic G, Broughan J, Cotter AG, Cullen W, McHugh T, O'Gorman T, Woo J, Lambert JS. Predictors and Outcomes for COVID-19 Re-Admissions in the Anticipate Cohort. Ir Med J 2022; 115:599. [PMID: 35696289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Aims To describe readmissions of hospitalised patients with COVID-19, define predictors of readmission and explore the long term outcomes using the SF-12 score compared to patients who were not readmitted and those not hospitalised. Methods A single centre retrospective in North Inner-City Dublin. Recruitment was done through a COVID follow up clinic. Predictors of readmission and SF-12 scores at two timepoints post follow up at median 3 months and 12 months. Results Seventy (45%) participants were admitted, with a median age of 49.5 years (IQR 41.3-56.9), 36(51%) of whom were female. Unscheduled readmissions at ≤30 days in COVID-19 patients were 9(12.9%) and length of stay was four days (IQR 2-5). Readmissions were due to ongoing symptoms(n=9(64.3%)) or new complications(n=5(35.7%)). Mechanical ventilation and having symptoms of nausea and vomiting on index admission were predictive of readmission. (p=0.002). SF-12 scores at one year of readmitted patients were not different to patients who were never admitted at median one year follow up, p=.089. Conclusions Most readmissions were of short duration. Early follow up of patients post MV or who had nausea and vomiting on index admission should be prioritised. Wellbeing of readmitted patients was not different to those never hospitalised, at one year.
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Affiliation(s)
- B O'Kelly
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin 4, Ireland
| | - L Vidal
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - G Avramovic
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - J Broughan
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - A G Cotter
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin 4, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - W Cullen
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - T McHugh
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - T O'Gorman
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - J Woo
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - J S Lambert
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
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Kenny G, McCann K, O’Brien C, Savinelli S, Tinago W, Yousif O, Lambert JS, O’Broin C, Feeney ER, De Barra E, Doran P, Mallon PWG, Cotter A, Muldoon E, Sheehan G, McGinty T, Lambert JS, Green S, Leamy K, Kenny G, McCann K, McCann R, O’Broin C, Waqas S, Savinelli S, Feeney E, Mallon PWG, Garcia Leon A, Miles S, Alalwan D, Negi R, de Barra E, McConkey S, Hurley K, Sulaiman I, Horgan M, Sadlier C, Eustace J, Kelly C, Bracken T, Whelan B, Low J, Yousif O, McNicholas B, Courtney G, Gavin P. Identification of Distinct Long COVID Clinical Phenotypes Through Cluster Analysis of Self-Reported Symptoms. Open Forum Infect Dis 2022; 9:ofac060. [PMID: 35265728 PMCID: PMC8900926 DOI: 10.1093/ofid/ofac060] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/01/2022] [Indexed: 12/14/2022] Open
Abstract
Background We aimed to describe the clinical presentation of individuals presenting with prolonged recovery from coronavirus disease 2019 (COVID-19), known as long COVID. Methods This was an analysis within a multicenter, prospective cohort study of individuals with a confirmed diagnosis of COVID-19 and persistent symptoms >4 weeks from onset of acute symptoms. We performed a multiple correspondence analysis (MCA) on the most common self-reported symptoms and hierarchical clustering on the results of the MCA to identify symptom clusters. Results Two hundred thirty-three individuals were included in the analysis; the median age of the cohort was 43 (interquartile range [IQR], 36–54) years, 74% were women, and 77.3% reported a mild initial illness. MCA and hierarchical clustering revealed 3 clusters. Cluster 1 had predominantly pain symptoms with a higher proportion of joint pain, myalgia, and headache; cluster 2 had a preponderance of cardiovascular symptoms with prominent chest pain, shortness of breath, and palpitations; and cluster 3 had significantly fewer symptoms than the other clusters (2 [IQR, 2–3] symptoms per individual in cluster 3 vs 6 [IQR, 5–7] and 4 [IQR, 3–5] in clusters 1 and 2, respectively; P < .001). Clusters 1 and 2 had greater functional impairment, demonstrated by significantly longer work absence, higher dyspnea scores, and lower scores in SF-36 domains of general health, physical functioning, and role limitation due to physical functioning and social functioning. Conclusions Clusters of symptoms are evident in long COVID patients that are associated with functional impairments and may point to distinct underlying pathophysiologic mechanisms of disease.
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Affiliation(s)
- Grace Kenny
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Kathleen McCann
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Conor O’Brien
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Stefano Savinelli
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Willard Tinago
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
| | - Obada Yousif
- Endocrinology Department, Wexford General Hospital, Carricklawn, Wexford, Ireland
| | - John S Lambert
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Cathal O’Broin
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Eoin R Feeney
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Eoghan De Barra
- Department of Infectious Diseases, Beaumont Hospital, Beaumont, Dublin, Ireland
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Peter Doran
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Patrick W G Mallon
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
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Raben D, Hoekstra M, Combs L, Sullivan AK, Lazarus JV, Lambert JS, Simões D, Streinu‐Cercel A, Rockstroh JK, Streinu‐Cercel A, Amato‐Gauci A, Pop CS, Oprea C, Hedrich D, Gökengin D, Schatz E, Ghita E, Lazarus J, Rockstroh J, Tavochi L, Cosmaro L, Ursan M, Dara M, Dascalu N, Dedes N, Baptista Leite R, Pasanen S, Reic T, Platteau T, Grecu V, Sönnerborg A, Gazzard B, West B, Karpov I, Lundgren JD, de Wit J, Casabona J, Rockstroh J, Cosmaro L, Maistat L, Matičič M, Dedes N, Tsereteli N, Pol S, Platteau T, Delpech V, Zuilhof W, Yazdanpanah Y, Azad Y, Pharris A, Amato‐Gauci A, Noori T, Hedrich D, Mozalevskis A, Vovc E, Dara M, Fenton K, Kakalou C, Klavs I, Wawer I, Casabona J, Hristojeva J, Kivimets K, Cosmaro L, Maffeo M, Kall M, Mommi M, Gasbarrini N, Wysocki P, Delpech V, Koutkias V. A call to action toward integrated testing and earlier care for viral hepatitis, HIV, STIs and TB. HIV Med 2020. [DOI: 10.1111/hiv.12844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- D Raben
- CHIP, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | | | - L Combs
- CHIP, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | | | - JV Lazarus
- Barcelona Institute for Global Health (ISGlobal) Hospital Clínic ‐ University of Barcelona Barcelona Spain
| | - JS Lambert
- Catherine McAuley Education & Research Centre University College Dublin Dublin Ireland
| | - D Simões
- EPIUnit Institute of Public Health University of Porto Porto Portugal
- Grupo de Ativistas em Tratamentos Lisbon Portugal
| | - A Streinu‐Cercel
- Infectious Diseases Department Carol Davila University of Medicine and Pharmacy Bucharest Romania
- National Institute of Infectious Diseases “Prof. Dr Matei Bals” Bucharest Romania
| | - JK Rockstroh
- Department of Medicine I University Hospital Bonn Bonn Germany
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Crowley D, Murtagh R, Cullen W, Lambert JS, McHugh T, Van Hout MC. Hepatitis C virus infection in Irish drug users and prisoners - a scoping review. BMC Infect Dis 2019; 19:702. [PMID: 31395032 PMCID: PMC6686252 DOI: 10.1186/s12879-019-4218-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 06/26/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Hepatitis C infection is a major public health concern globally. In Ireland, like other European countries, people who use drugs (PWUD) and prisoners carry a larger HCV disease burden than the general population. Recent advances in HCV management have made HCV elimination across Europe a realistic goal. Engaging these two marginalised and underserved populations remains a challenge. The aim of this review was to map key findings and identify gaps in the literature (published and unpublished) on HCV infection in Irish PWUD and prisoners. METHODS A scoping review guided by the methodological framework set out by Levac and colleagues (based on previous work by Arksey & O'Malley). RESULTS A total of 58 studies were identified and divided into the following categories; Epidemiology, Guidelines and Policy, Treatment Outcomes, HCV-related Health Issues and qualitative research reporting on Patients' and Health Providers' Experiences. This review identified significantly higher rates of HCV infection among Irish prisoners and PWUD than the general population. There are high levels of undiagnosed and untreated HCV infection in both groups. There is poor engagement by Irish PWUD with HCV services and barriers have been identified. Prison hepatology nurse services have a positive impact on treatment uptake and outcomes. Identified gaps in the literature include; lack of accurate epidemiological data on incident infection, untreated chronic HCV infection particularly in PWUD living outside Dublin and those not engaged with OST. CONCLUSION Ireland like other European countries has high levels of undiagnosed and untreated HCV infection. Collecting, synthesising and identifying gaps in the available literature is timely and will inform national HCV screening, treatment and prevention strategies.
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Affiliation(s)
- D. Crowley
- Irish College of General Practitioners, Dublin, Ireland
| | - R. Murtagh
- School of Medicine, University College, Dublin, Ireland
| | - W. Cullen
- School of Medicine, University College, Dublin, Ireland
| | - J. S. Lambert
- School of Medicine, University College, Dublin, Ireland
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - T. McHugh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - M. C. Van Hout
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
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Crowley D, Van Hout MC, Murphy C, Kelly E, Lambert JS, Cullen W. Hepatitis C virus screening and treatment in Irish prisons from nurse managers' perspectives - a qualitative exploration. BMC Nurs 2019; 18:23. [PMID: 31210751 PMCID: PMC6567378 DOI: 10.1186/s12912-019-0347-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 05/07/2019] [Indexed: 12/29/2022] Open
Abstract
Background Prisoners carry a greater burden of physical, communicable and psychiatric disease compared to the general population. Prison health care structures are complex and provide challenges and opportunities to engage a marginalised and poorly served group with health care including Hepatitis C Virus (HCV) screening, assessment and treatment. Optimising HCV management in prisons is a public health priority. Nurses are the primary healthcare providers in most prisons globally. Understanding the barriers and facilitators to prisoners engaging in HCV care from the perspectives of nurses is the first step in implementing effective strategies to eliminate HCV from prison settings. The aim of this study was to identify the barriers and facilitators to HCV screening and treatment in Irish prisons from a nurse perspective and inform the implementation of a national prison-based HCV screening program. Methods A qualitative study using focus group methodology underpinned by grounded theory for analysis in a national group of nurse managers (n = 12). Results The following themes emerged from the analysis; security and safety requirements impacting patient access, staffing and rostering issues, prison nurses’ skill set and concerns around phlebotomy, conflict between maintaining confidentiality and concerns for personal safety, peer workers, prisoners’ lack of knowledge, fear of treatment and stigma, inter-prison variations in prisoner health needs and health service delivery and priority, linkage to care, timing of screening and stability of prison life. Conclusions Prison nurses are uniquely placed to identify barriers and facilitators to HCV screening and treatment in prisoners and inform changes to health care practice and policy that will optimise the public health opportunity that incarceration provides.
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Affiliation(s)
- D Crowley
- Irish College of General Practitioners, Lincoln Place, Dublin, Ireland
| | - M C Van Hout
- Public Health Institute, Liverpool John Moore's University, Liverpool, UK
| | - C Murphy
- Irish Prison Service, Mountjoy Prison, Dublin 7, Ireland
| | - E Kelly
- Irish Prison Service, Mountjoy Prison, Dublin 7, Ireland
| | - J S Lambert
- Department of Infectious Diseases, School of Medicine, University College Dublin, Mater Misericordiae University Hospital, Dublin, Ireland
| | - W Cullen
- 5School of Medicine, University College Dublin, Dublin, Ireland
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Crowley D, Van Hout MC, Murphy C, Kelly E, Lambert JS, Cullen W. Hepatitis C virus screening and treatment in Irish prisons from a governor and prison officer perspective - a qualitative exploration. Health Justice 2018; 6:23. [PMID: 30569249 PMCID: PMC6755610 DOI: 10.1186/s40352-018-0081-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 12/02/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Prisons are a key location to access Hepatitis C Virus (HCV) infected people who inject drugs (PWID). Prison health care structures are complex and optimising health care delivery to this high need, marginalised and underserved population remains challenging. Despite international guidelines recommending that prisons are a priority location for HCV screening and treatment levels of prisoner engagement in HCV care remain low. Competing priorities between security and healthcare is a key feature of prison health care. A collaborative approach to health care delivery in prisons can maximise the benefits for prisoners, staff and the wider community. AIM To identify the barriers and enablers to HCV screening and treatment in Irish prisons and inform the implementation of a HCV screening program within the Irish Prison Services (IPS). METHODS Qualitative study using focus group methodology underpinned by grounded theory. RESULTS The following themes emerged from the analysis: priority of safety and security, staffing and resources, concerns about personal risk, lack of knowledge, concerns around confidentiality, prisoners' fear of treatment and stigma, timing of screening, use of peer workers, in-reach hepatology and fibroscanning services. The primary role of prison security is to ensure the safety of staff and prisoners with a secondary but important supporting role in health care delivery. Maintaining adequate staffing levels and the provision of training and education were seen as priorities and impacted on prison officers' fear for personal safety and risk of HCV transmission. Opt-out screening and peer support workers had high levels of support among participants. CONCLUSION Upscaling HCV management in prisons requires an in-depth understanding of all barriers and facilitators to HCV screening and treatment. Engaging prison officers in the planning and delivery of health care initiatives is a key strategy to optimising the public health opportunity that prisons provides.
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Affiliation(s)
- D. Crowley
- Irish College of General Practitioners, Lincoln Place, Dublin, Ireland
| | - M. C. Van Hout
- Public Health Institute, Liverpool John Moore’s University, Liverpool, UK
| | - C. Murphy
- Irish Prison Service, Mountjoy Prison, Dublin 7, Ireland
| | - E. Kelly
- Irish Prison Service, Mountjoy Prison, Dublin 7, Ireland
| | - J. S. Lambert
- Department of Infectious Diseases, School of Medicine, University College Dublin, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - W. Cullen
- School of Medicine, University College Dublin, Dublin, Ireland
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Gray E, O'Leary A, Bergin C, Cannon M, Courtney G, Crosbie O, De Gascun CF, Fanning LJ, Feeney E, Houlihan DD, Kelleher B, Lambert JS, Lee J, Mallon P, McConkey S, McCormick A, McKiernan S, McNally C, Murray F, Sheehan G, Stewart S, Walsh C, Norris S. Effectiveness of interferon-free therapy for the treatment of HCV-patients with compensated cirrhosis treated through the Irish early access program. Expert Rev Gastroenterol Hepatol 2017; 11:593-601. [PMID: 28276815 DOI: 10.1080/17474124.2017.1292850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND We investigated the real-world effectiveness of interferon-free regimens for the treatment of patients with compensated cirrhosis infected with hepatitis C virus (HCV). METHOD Using the Irish national HCV treatment registry, the effectiveness and safety of interferon-free regimens for HCV-infected patients treated between April 2015 and August 2016, was determined. RESULTS A SVR12 was achieved in 86% of subjects treated with sofosbuvir/ledipasvir ± ribavirin (SOF/LDV±RBV), 93% treated with paritaprevir, ombitasvir and ritonavir combined with dasabuvir ± ribavirin (3D±RBV) and 89% treated with sofosbuvir/daclatasvir ± ribavirin (SOF/DCV±RBV). The discontinuation rate was 5% and the on-treatment mortality rate was 1%. CONCLUSION The availability of interferon-free regimens represents a significant breakthrough for the treatment of HCV infection. Treatments options, with high SVR12 rates, are now available for patients with compensated cirrhosis who were unsuitable for treatment with interferon-based regimens. Data obtained from studies conducted in real world practice provide robust information fundamental for input into future economic evaluations for agents used for the treatment of HCV infection.
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Affiliation(s)
- E Gray
- a School of Medicine, Trinity College Dublin , Dublin , Ireland
| | - A O'Leary
- b National Centre for Pharmacoeconomics, St. James' Hospital , Dublin , Ireland.,c School of Pharmacy, Royal College of Surgeons of Ireland , Dublin , Ireland
| | - C Bergin
- a School of Medicine, Trinity College Dublin , Dublin , Ireland.,e St James' Hospital , Dublin , Ireland
| | - M Cannon
- f Beaumont Hospital , Dublin , Ireland
| | - G Courtney
- g St. Luke's Hospital , Kilkenny , Ireland
| | - O Crosbie
- h Cork University Hospital , Cork , Ireland
| | - C F De Gascun
- i National Virus Reference Laboratory , University College Dublin , Dublin , Ireland
| | - L J Fanning
- j Molecular Virology Diagnostic & Research Laboratory, Department of Medicine , University College Cork , Cork , Ireland
| | - E Feeney
- k St. Vincent's University Hospital , Dublin , Ireland
| | - D D Houlihan
- k St. Vincent's University Hospital , Dublin , Ireland
| | - B Kelleher
- d Mater Misericordiae University Hospital , Dublin , Ireland
| | - J S Lambert
- d Mater Misericordiae University Hospital , Dublin , Ireland.,n School of Medicine , University College Dublin , Dublin , Ireland
| | - J Lee
- l University College Hospital , Galway , Ireland
| | - Pwg Mallon
- d Mater Misericordiae University Hospital , Dublin , Ireland.,n School of Medicine , University College Dublin , Dublin , Ireland
| | | | - A McCormick
- k St. Vincent's University Hospital , Dublin , Ireland
| | | | - C McNally
- f Beaumont Hospital , Dublin , Ireland
| | - F Murray
- f Beaumont Hospital , Dublin , Ireland
| | - G Sheehan
- d Mater Misericordiae University Hospital , Dublin , Ireland
| | - S Stewart
- d Mater Misericordiae University Hospital , Dublin , Ireland
| | - C Walsh
- m University of Limerick , Limerick , Ireland
| | - S Norris
- a School of Medicine, Trinity College Dublin , Dublin , Ireland.,e St James' Hospital , Dublin , Ireland
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McGettrick P, Ghavami-Kia B, Tinago W, Macken A, O'Halloran J, Lambert JS, Sheehan G, Mallon PWG. The HIV Care Cascade and sub-analysis of those linked to but not retained in care: the experience from a tertiary HIV referral service in Dublin Ireland. HIV Clin Trials 2017; 18:93-99. [PMID: 28290773 DOI: 10.1080/15284336.2017.1298317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The HIV Care Cascade model can be used to measure how clinical services align with United Nations' (UN) HIV treatment targets. Previous models have highlighted sequential losses at each step of the Cascade with a significant proportion being not retained in care (NRIC). OBJECTIVE We aimed to assess the feasibility of meeting the UN targets and assess factors associated with, and calculate the true proportion of those, NRIC. METHODS All people living with HIV who were linked to our service, one of three specialist HIV care providers in Dublin Ireland, from its establishment in 1993 to 1 December 2014, were included in the cohort and were categorized as linked to care, retained in care (RIC), on antiretroviral therapy (on ART), virally suppressed (HIV RNA <40copies/ml), and NRIC. An analysis of those NRIC was performed to categorize their current status through direct/indirect contact. RESULTS Of 1000 patients linked to care, 78.7% (n = 787) were RIC, of whom 91.5% (n = 720) were on ART, with 89.9% (n = 644) virally suppressed. Those RIC were more likely older (p = 0.006) and non-IVDU (p < 0.001). Of 213 (21.3%) NRIC, 56 (26.3%) emigrated, 27 (12.7%) transferred care, 15 (7.0%) stopped attending but were contactable, 38 (17.8%) died, and 77 (36.1%) were lost to follow-up. After revision, 10.5% of the cohort was confirmed as NRIC, with 6 of 15 defined as "stopped attending" re-linked to care following direct contact. CONCLUSIONS Our HIV Care Cascade model demonstrates that the true numbers of patients NRIC may be significantly lower than previously estimated and once RIC, treatment goals approaching the United Nations Programme on HIV and AIDS targets are possible with 91.5% on treatment and almost 90% of those on treatment virally suppressed. That 40% reengaged following direct contact suggests benefit through regular monitoring and direct contact based on the HIV Care Cascade model.
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Affiliation(s)
- P McGettrick
- a HIV Molecular Research Group , School of Medicine, University College Dublin , Dublin , Ireland.,b Department of Infectious Diseases , Mater Misericordae University Hospital , Dublin , Ireland
| | - B Ghavami-Kia
- a HIV Molecular Research Group , School of Medicine, University College Dublin , Dublin , Ireland.,b Department of Infectious Diseases , Mater Misericordae University Hospital , Dublin , Ireland
| | - W Tinago
- a HIV Molecular Research Group , School of Medicine, University College Dublin , Dublin , Ireland
| | - A Macken
- a HIV Molecular Research Group , School of Medicine, University College Dublin , Dublin , Ireland
| | - J O'Halloran
- a HIV Molecular Research Group , School of Medicine, University College Dublin , Dublin , Ireland.,b Department of Infectious Diseases , Mater Misericordae University Hospital , Dublin , Ireland
| | - J S Lambert
- a HIV Molecular Research Group , School of Medicine, University College Dublin , Dublin , Ireland.,b Department of Infectious Diseases , Mater Misericordae University Hospital , Dublin , Ireland
| | - G Sheehan
- a HIV Molecular Research Group , School of Medicine, University College Dublin , Dublin , Ireland.,b Department of Infectious Diseases , Mater Misericordae University Hospital , Dublin , Ireland
| | - P W G Mallon
- a HIV Molecular Research Group , School of Medicine, University College Dublin , Dublin , Ireland.,b Department of Infectious Diseases , Mater Misericordae University Hospital , Dublin , Ireland
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O'Higgins AC, Jackson V, Lawless M, Le Blanc D, Connolly G, Drew R, Eogan M, Lambert JS. Screening for asymptomatic urogenital Chlamydia trachomatis infection at a large Dublin maternity hospital: results of a pilot study. Ir J Med Sci 2016; 186:393-397. [PMID: 26969456 DOI: 10.1007/s11845-016-1429-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 02/21/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND There are currently no Irish guidelines on screening for Chlamydia trachomatis infection in pregnancy. Prevalence rates in the antenatal population are not known which has prevented the development of screening recommendations for this group. AIMS The objective of this study was to determine the prevalence of asymptomatic urogenital C. trachomatis infection in young women attending for care at a large maternity hospital. METHODS All patients aged 25 years and under attending the Hospital between December 2011 and December 2013 were offered screening for urogenital C. trachomatis infection. Nucleic acid amplification testing of the C. trachomatis cryptic plasmid was performed on either endocervical swabs or first void urine samples. RESULTS There were 2687 women tested for C. trachomatis infection, 83.4 % (2241/2687) through the antenatal clinics, 7.1 % (193/2687) through the gynaecology clinic, and 9.4 % (253/2687) through the emergency department. The rate of a positive test result was 5.6 % (151/2687) overall. The rates in women ages 16-18, 19-21 and 22-25 years were 9.1 % (31/340), 6.5 % (50/774) and 4.4 % (69/1561), respectively. A positive test result was more likely in those who were unemployed (p = 0.04), those who were Irish (p = 0.03) and those who were unmarried (p < 0.01). There were no cases of neonatal C. trachomatis infection in babies born to mothers who were screened in early pregnancy. CONCLUSIONS The prevalence rate of detected C. trachomatis infection was 5.6 % in the study population. Screening of antenatal patients may have a role in preventing vertical transmission of infection to the neonate.
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Affiliation(s)
- A C O'Higgins
- Rotunda Hospital, Parnell Square, Dublin 1, Ireland.
| | - V Jackson
- Rotunda Hospital, Parnell Square, Dublin 1, Ireland
| | - M Lawless
- Rotunda Hospital, Parnell Square, Dublin 1, Ireland
| | - D Le Blanc
- Rotunda Hospital, Parnell Square, Dublin 1, Ireland
| | - G Connolly
- Rotunda Hospital, Parnell Square, Dublin 1, Ireland
| | - R Drew
- Rotunda Hospital, Parnell Square, Dublin 1, Ireland
| | - M Eogan
- Rotunda Hospital, Parnell Square, Dublin 1, Ireland
| | - J S Lambert
- Rotunda Hospital, Parnell Square, Dublin 1, Ireland
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12
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O'Halloran JA, Dunne E, Gurwith M, Lambert JS, Sheehan GJ, Feeney ER, Pozniak A, Reiss P, Kenny D, Mallon P. The effect of initiation of antiretroviral therapy on monocyte, endothelial and platelet function in HIV-1 infection. HIV Med 2015; 16:608-19. [PMID: 26111187 DOI: 10.1111/hiv.12270] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Monocyte activation, endothelial dysfunction and platelet activation all potentially contribute to the increased risk of cardiovascular disease (CVD) reported in those with HIV-1 infection. To date, no study has examined how initiation of antiretroviral therapy (ART) affects markers of all three processes. We aimed to compare markers of monocyte, endothelial and platelet function between untreated HIV-positive subjects and HIV-negative controls and to examine the early effects of ART initiation on these markers. METHODS We measured monocyte [soluble CD14 (sCD14) and sCD163], endothelial [von Willebrand factor (vWF), intercellular adhesion molecule-1 (ICAM-1) and vascular adhesion molecule-1 (VCAM-1)] and platelet [soluble P-selectin (sP-selectin), soluble CD40 ligand (sCD40L) and soluble glycoprotein VI (sGPVI)] biomarkers before and at weeks 4 and 12 post ART initiation in HIV-positive and well-matched HIV-negative controls. RESULTS We examined 40 subjects, 25 HIV-positive subjects and 15 controls, with a median age of 34 years [interquartile range (IQR) 31, 40 years], of whom 60% were male and 47.5% Caucasian. Pre-ART, all biomarkers (monocyte, endothelial and platelet) were significantly higher in HIV-positive patients versus controls (all P < 0.05) and decreased with ART initiation, except for sCD14, which remained unchanged [median 1680 (IQR 1489, 1946) ng/mL at week 12 versus 1570 (IQR 1287, 2102) ng/mL at week 0; P = 0.7]. Although platelet activation markers reduced to levels comparable to those in controls, endothelial dysfunction markers remained elevated, as did sCD163 [at week 12, median 1005 (IQR 791, 1577) ng/mL in HIV-positive patients versus 621 (IQR 406, 700) ng/mL in controls; P < 0.0001]. CONCLUSIONS ART initiation resulted in reductions in levels of CVD-associated biomarkers; however, although they improved, markers of endothelial dysfunction and monocyte activation remained elevated. How these persistent abnormalities affect CVD risk in HIV infection remains to be determined.
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Affiliation(s)
- J A O'Halloran
- HIV Molecular Research Group, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - E Dunne
- Cardiovascular Biology Group, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mmp Gurwith
- HIV Molecular Research Group, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - J S Lambert
- HIV Molecular Research Group, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - G J Sheehan
- HIV Molecular Research Group, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - E R Feeney
- HIV Molecular Research Group, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - A Pozniak
- HIV Directorate, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - P Reiss
- Department of Global Health and Stichting HIV Monitoring, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - D Kenny
- Cardiovascular Biology Group, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Pwg Mallon
- HIV Molecular Research Group, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
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13
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Jackson V, Ferguson W, Kelleher TB, Lawless M, Eogan M, Nusgen U, Coughlan S, Connell J, Lambert JS. Lamivudine treatment and outcome in pregnant women with high hepatitis B viral loads. Eur J Clin Microbiol Infect Dis 2014; 34:619-23. [PMID: 25381607 DOI: 10.1007/s10096-014-2270-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 10/20/2014] [Indexed: 01/27/2023]
Abstract
Perinatal transmission is the most common mode of hepatitis B virus (HBV) transmission and is a leading cause of chronic infection worldwide. Maternal treatment with lamivudine (LAM) can result in a rapid and significant reduction in HBV viral load (VL) and, thus, mitigate the risk of mother-to-child transmission (MTCT). The aim of this study was to retrospectively evaluate the safety of LAM treatment administered in the third trimester of pregnancy and determine the influence, if any, on infant outcome. The medical charts of all HBV surface antigen (HBsAg)-positive women eligible for treatment with LAM and who registered for antenatal care between 2007 and 2012 were retrospectively reviewed. During the 6-year period, 45 women met the criteria for LAM treatment. Thirty-six women (80 %) accepted treatment; the remaining women declined treatment (5), defaulted from care (3) or transferred to another maternity unit (1). The median duration of treatment was 11.4 weeks (range 5.3-17.4) and the median baseline VL was 1.4 × 10(8) IU/mL (range 1.8 × 10(7)-1.7 × 10(8)). The median VL at delivery was 2.3 × 10(5) IU/mL and 60 % of women achieved a VL reduction >2 log10 IU/mL before delivery. No cases of perinatal transmission occurred in the infants born to mothers who received treatment; however, one infant, born to a mother who defaulted from care, was HBV-infected at 8 months. The results suggest that LAM therapy in highly viraemic HBV-infected pregnant women could lower the rate of vertical transmission.
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Affiliation(s)
- V Jackson
- Department of Infectious Diseases, The Rotunda Hospital, Dublin, Ireland
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14
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Else LJ, Jackson V, Brennan M, Back DJ, Khoo SH, Coulter-Smith S, Lambert JS. Therapeutic drug monitoring of atazanavir/ritonavir in pregnancy. HIV Med 2014; 15:604-10. [PMID: 24825070 DOI: 10.1111/hiv.12164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Pregnant women experience physiological changes during pregnancy that can have a significant impact on antiretroviral pharmacokinetics. Ensuring optimal plasma concentrations of antiretrovirals is essential for maternal health and to minimize the risk of vertical transmission. Here we describe atazanavir/ritonavir (ATV/r) plasma concentrations in a cohort of pregnant women undergoing routine therapeutic drug monitoring (TDM). METHODS Pregnant HIV-positive women received ATV/r as part of their routine pre-natal care. Demographic and clinical data were collected. ATV plasma concentrations ([ATV]) were determined in the first (T1), second (T2) and third (T3) trimesters and at postpartum (PP) using liquid chromatography-tandem mass spectrometry (LC-MS/MS). RESULTS From January 2007, 44 women (37 black African) were enrolled in the study. All received ATV/r at a dose of 300/100 mg once a day. Twenty-four had received antiretroviral therapy (ART) prior to pregnancy, and 20 initiated ATV/r in pregnancy. At the time nearest to delivery, 36 patients had undetectable plasma viral loads. [ATV] values were determined in 11 (T1), 25 (T2), 34 (T3) and 28 (PP) patients. [ATV] at 24 hours post-dose (C24) values significantly lower at T2/T3 relative to PP. CONCLUSIONS This study was carried out in one of the larger cohorts of women undergoing TDM for ATV in pregnancy. Lower [ATV] values were seen in T2/T3 compared with T1/PP. However, [ATV] were not associated with a lack of virologic suppression at delivery. Nonetheless, careful monitoring of women in pregnancy is required, and dose adjustment of ATV to 400 mg may be an option.
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Affiliation(s)
- L J Else
- Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, UK
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15
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Tinago W, O'Halloran JA, O'Halloran RM, Macken A, Lambert JS, Sheehan GJ, Mallon PWG. Characterization of associations and development of atazanavir resistance after unplanned treatment interruptions. HIV Med 2013; 15:224-32. [DOI: 10.1111/hiv.12107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2013] [Indexed: 12/30/2022]
Affiliation(s)
- W Tinago
- HIV Molecular Research Group; School of Medicine and Medical Science; University College Dublin; Dublin Ireland
- Department of Community Medicine; College of Health Sciences; University of Zimbabwe; Harare Zimbabwe
| | - JA O'Halloran
- Department of Infectious Diseases; Mater Misericordiae University Hospital; Dublin Ireland
| | - RM O'Halloran
- Department of Infectious Diseases; Mater Misericordiae University Hospital; Dublin Ireland
| | - A Macken
- HIV Molecular Research Group; School of Medicine and Medical Science; University College Dublin; Dublin Ireland
| | - JS Lambert
- Department of Infectious Diseases; Mater Misericordiae University Hospital; Dublin Ireland
| | - GJ Sheehan
- Department of Infectious Diseases; Mater Misericordiae University Hospital; Dublin Ireland
| | - PWG Mallon
- HIV Molecular Research Group; School of Medicine and Medical Science; University College Dublin; Dublin Ireland
- Department of Infectious Diseases; Mater Misericordiae University Hospital; Dublin Ireland
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16
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O'Halloran JA, De Gascun CF, Dunford L, Carr MJ, Connell J, Howard R, Hall WW, Lambert JS. Hepatitis B virus vaccine failure resulting in chronic hepatitis B infection. J Clin Virol 2011; 52:151-4. [PMID: 21802353 DOI: 10.1016/j.jcv.2011.06.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 06/19/2011] [Accepted: 06/30/2011] [Indexed: 12/11/2022]
Affiliation(s)
- J A O'Halloran
- Mater Misericordiae University Hospital, Dublin 7, Ireland.
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17
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Caswell RJ, Phillips D, Chaponda M, Khoo SH, Taylor GP, Ghanem M, Poulton M, Welch J, Gibbons S, Jackson V, Lambert JS. Utility of therapeutic drug monitoring in the management of HIV-infected pregnant women in receipt of lopinavir. Int J STD AIDS 2011; 22:11-4. [PMID: 21364060 DOI: 10.1258/ijsa.2009.009184] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The pharmacokinetics of antiretroviral drugs in pregnancy is poorly understood. We reviewed the use of therapeutic drug monitoring (TDM) in clinical settings to document plasma concentrations of lopinavir during pregnancy and investigated how clinicians acted upon TDM results. A retrospective review was carried out of all HIV-infected pregnant women taking boosted lopinavir-based highly active antiretroviral therapy (HAART) at five National Health Service (NHS) centres in the UK between May 2004 and March 2007. Seventy-three women in receipt of lopinavir were identified, of whom 89% had plasma lopinavir concentrations above the suggested minimum recommended for wild-type HIV. Initial TDM results prompted dosage change in 10% and assessment of adherence and/or pharmacist review in 11%. TDM was repeated in 29%. TDM can play an important role in the clinical management of HIV-positive pregnant women, allowing informed dose modification and an alternative measure of adherence.
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Affiliation(s)
- R J Caswell
- Department of GU Medicine and Teaching Primary Care Trust, Coventry PCT, Coventry
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18
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Lambert JS, Else LJ, Jackson V, Breiden J, Gibbons S, Dickinson L, Back DJ, Brennan M, Connor EO, Boyle N, Fleming C, Coulter-Smith S, Khoo SH. Therapeutic drug monitoring of lopinavir/ritonavir in pregnancy. HIV Med 2010; 12:166-73. [DOI: 10.1111/j.1468-1293.2010.00865.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Coulter-Smith S, Lambert JS, Butler K, Brennan M, Cafferkey M. HIV testing and treatment in the antenatal care setting. Ir Med J 2010; 103:14-17. [PMID: 20222387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Routine linked HIV antenatal screening, with "opt-out", was introduced at the Rotunda in January 1998. This paper reviews the screening and subsequent pregnancy management and outcome in HIV positive women from 1998 to 2006. During this time 225 women (280 pregnancies) were HIV positive and 194 women subsequently delivered at the Rotunda, representing 233 liveborn infants. Overall anti-HIV prevalence was 0.42%, increasing from 0.06% in 1998 to 0.57% in 2006. Of 233 livebirths, 111 (48%) were delivered by spontaneous vaginal delivery (SVD). HIV treatment was started pre-pregnancy in 14 (6%) pregnancies and antenatally in 208 (90%). The vertical transmission rate in mothers receiving >4 weeks of treatment was 0%. We conclude that routine antenatal HIV screening is effective and significantly benefits the health of mother and child.
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20
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Machado ES, Hofer CB, Costa TT, Nogueira SA, Oliveira RH, Abreu TF, Evangelista LA, Farias IFA, Mercadante RTC, Garcia MFL, Neves RC, Costa VM, Lambert JS. Pregnancy outcome in women infected with HIV-1 receiving combination antiretroviral therapy before versus after conception. Sex Transm Infect 2008; 85:82-7. [PMID: 18987014 DOI: 10.1136/sti.2008.032300] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The potential adverse effects of antiretroviral drugs during pregnancy are discrepant and few studies, mostly from Europe, have provided information about pregnancy outcomes of those already on treatment at conception. The aim of this study was to investigate the impact of antiretrovirals (ARVs) on pregnancy outcome according to the timing of treatment initiation in a cohort of pregnant women from Brazil infected with HIV. METHODS A prospective cohort of 696 pregnant women followed up in one single centre between 1996 and 2006 was studied. Patients who had ARV treatment before pregnancy were compared with those treated after the first trimester. The outcomes evaluated were preterm delivery (PTD) (<37 weeks), severe PTD (<34 weeks), low birth weight (LBW) (<2500 g) and very LBW (<1500 g). RESULTS Patients who were using ARVs pre-conception had higher rates of LBW (33.3% vs 16.5%; p<0.001) and a similar trend for PTD (26.3% vs 17.7%; p = 0.09). Stratification by type of therapy (dual vs highly active antiretroviral therapy (HAART)) according to timing of initiation of ARVs showed that patients who use HAART pre-conception have a higher rate of PTD (20.2% vs 10.2%; p = 0.03) and LBW (24.2% vs 10.2%; p = 0.002). After adjusting for several factors, HAART used pre-conception was associated with an increased risk for PTD (AOR 5.0; 95% CI 1.5 to 17.0; p = 0.009) and LBW (OR 3.6; 95% CI 1.7 to 7.7; p = 0.001). CONCLUSIONS We identified an increased risk for LBW and PTD in patients who had HAART prior to pregnancy.
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Affiliation(s)
- E S Machado
- Serviço de Doenças Infecciosas e Parasitárias, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
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21
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Scott CJ, Lambert JS, Taylor CB, Poulton MB. Invasive Aspergillus fumigatus associated with liver and bone involvement in a patient with AIDS. Int J Infect Dis 2007; 11:550-3. [PMID: 17383211 DOI: 10.1016/j.ijid.2006.12.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2006] [Accepted: 12/12/2006] [Indexed: 11/30/2022] Open
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22
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Abstract
We report on a patient from a London clinic, (a Jamaican heterosexual man known to have herpes) who has donovanosis and syphilis in a single genital ulcer. The case highlights the importance of careful clinical examination of genital ulcers.
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Affiliation(s)
- M Samuel
- Department of Genitourinary Medicine, Kings College Hospital, Caldecot Centre, 15-22 Caldecot Road, Camberwell, London SE5 9RS, UK.
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McMillan HM, O'Carroll H, Lambert JS, Grundy KB, O'Reilly M, Lennon B, Collins C, Walsh TA, Geary MP, Cafferkey MT. Screening for Chlamydia trachomatis in asymptomatic women attending outpatient clinics in a large maternity hospital in Dublin, Ireland. Sex Transm Infect 2006; 82:503-5. [PMID: 16854994 PMCID: PMC2563860 DOI: 10.1136/sti.2006.020990] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Chlamydia trachomatis can cause a sexually transmitted infection, which, untreated, may result in considerable morbidity. METHODS A prevalence study was conducted for C trachomatis using nucleic acid amplification technology in asymptomatic women, and certain risk factors that may be used to direct future screening strategies were assessed. RESULTS The study population comprised 945 asymptomatic women, of whom 783 were attending antenatal clinics, 91 were attending infertility clinics and 71 were attending family planning clinics. An overall C trachomatis prevalence of 3.7% (35/945) was found, with the highest prevalence of 11.2% (22/196) in Irish single women aged <25 years. Logistic regression analysis showed that single status and age <25 years were independent, statistically significant predictors of C trachomatis infection. CONCLUSION These results support routine screening of asymptomatic women who are sexually active and aged <25 years. An opportunist active screening of all sexually active women independent of age should be additionally considered if resources permit.
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Affiliation(s)
- H M McMillan
- Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland
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24
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Lambert JS, Nogueira SA, Abreu T, Machado ES, Costa TP, Bondarovsky M, Andrade M, Halpern M, Barbosa R, Perez M. A pilot study to evaluate the safety and feasibility of the administration of AZT/3TC fixed dose combination to HIV infected pregnant women and their infants in Rio de Janeiro, Brazil. Sex Transm Infect 2004; 79:448-52. [PMID: 14663118 PMCID: PMC1744786 DOI: 10.1136/sti.79.6.448] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To evaluate the safety and feasibility of zidovudine and lamivudine (AZT/3TC) given to HIV infected pregnant women and their infants in Rio de Janeiro, Brazil. METHODS This open label phase II study enrolled 40 HIV infected antiretroviral naive women >or=20 weeks gestation, CD4 <500 cells x10(6)/l, from two public hospitals. TREATMENT fixed dose AZT 300 mg/3TC 150 mg by mouth every 12 hours until labour; AZT 300 mg by mouth every 3 hours until delivery; infants: AZT 4 mg/kg every 12 hours plus 3TC 2 mg/kg every 12 hours for 6 weeks. Blood haematology and chemistry were monitored; adherence evaluated by pills count; efficacy measured by changes in lymphocyte (CD4) and viral load, and by HIV RNA-PCR tests performed at birth, 6 and 12 weeks, to diagnose infant infection. No women breast fed. RESULTS PATIENT CHARACTERISTICS mean age 24.48 (SD 3.5) years; gestational age 24.5 (4.5) weeks; AZT/3TC duration 14.4 (4.4) weeks; vaginal delivery: 11/39; caesarean section: 28/39. Entry and pre-labour CD4: 310/486 cells x10(6)/l (p<0.001); entry and pre-labour viral load: 53 818/2616 copies/ml (p<0.001). Thirty nine women tolerated treatment with >80% adherence; one was lost to follow up. Five newborns were excluded from 3TC receipt. All 39 babies were uninfected. Haematological toxicity in newborns was common: anaemia in 27; neutropenia in five (two severe); platelets counts <100000 in two. All values recovered on study completion. CONCLUSIONS Fixed dose AZT/3TC is well accepted, gives improvements in CD4 and viral load; no infants were HIV infected. Haematological toxicity in infants needs careful monitoring.
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Affiliation(s)
- J S Lambert
- University of Maryland Institute of Human Virology, Baltimore, Maryland, USA.
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25
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Nogueira SA, Guedes AL, Wanke B, Capella S, Rodrigues K, Abreu TF, Morais JC, Lambert JS. Osteomyelitis caused by Paracoccidioides brasiliensis in a child from the metropolitan area of Rio de Janeiro. J Trop Pediatr 2001; 47:311-5. [PMID: 11695735 DOI: 10.1093/tropej/47.5.311] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The authors describe a case of paracoccidioidomycosis in a 7-year-old girl from the city of Rio de Janeiro who initially presented to her physician with a lesion in her calcaneous which was misdiagnosed and treated as bacterial osteomyelitis. Later, cutaneous manifestations, lymph node enlargement, and hepatosplenomegaly developed and biopsy of the skin and cervical lymph nodes showed the fungus which was also present in the sputum. It is emphasized that Paracoccidioides brasiliensis can be the cause of bone lesions in endemic areas of Latin America and that response to treatment with amphotercin B is good.
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Affiliation(s)
- S A Nogueira
- Hospital Universitário Clementino Fraga Filho, Serviço de Doenças Infecciosas e Parasitárias, University Federal do Rio de Janeiro, Brazil.
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26
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Nogueira SA, Lambert JS, Albuquerque AL, Rodrigues R, Reis S, Bornia R, Dias M, Barbosa R, Sztanjbock D, Santos AL, Blattner W, Constantine NT. Assessment of a rapid HIV test strategy during labor: a pilot study from Rio de Janeiro, Brazil. J Hum Virol 2001; 4:278-82. [PMID: 11907385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
OBJECTIVES To use two rapid human immunodeficiency virus (HIV) tests at labor, measure test acceptance and performance, and measure HIV prevalence in these women. METHODS Between February and October 2000, two rapid tests (Determine; Abbott, Chicago, IL, U.S.A. and Double Check; Orgenics, Yavne, Israel) were used in three public maternities in Rio de Janeiro, Brazil. Enzyme-linked immunosorbent assay (ELISA) and Western blot (WB) analysis confirmed positive and discordant results. RESULTS Of the 858 patients who were enrolled, the mean gestational age was 36 weeks (median = 39, mode = 40) and 17 (2%) refused testing. Of the 841 patients tested, 13 were positive by both tests, which represents a 1.5% prevalence (95% confidence interval: 0.7%-2.3%); all were confirmed by ELISA and WB analysis. Seven samples gave discordant results by the rapid tests; of these, six were ELISA-negative/WB-negative and one was ELISA-negative/WB-indeterminate. The positive predictive value for samples that were positive by both rapid tests simultaneously was 100%. CONCLUSIONS Two rapid HIV tests used at labor were well accepted (98%). When the combined results of the two rapid tests (but not a single rapid test) were analyzed, this strategy was as efficient as the standard ELISA and WB HIV strategy for correctly classifying individuals.
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Affiliation(s)
- S A Nogueira
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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27
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Lambert JS, Keefer M, Mulligan MJ, Schwartz D, Mestecky J, Weinhold K, Smith C, Hsieh R, Moldoveanu Z, Fast P, Forrest B, Koff W. A Phase I safety and immunogenicity trial of UBI microparticulate monovalent HIV-1 MN oral peptide immunogen with parenteral boost in HIV-1 seronegative human subjects. Vaccine 2001; 19:3033-42. [PMID: 11311997 DOI: 10.1016/s0264-410x(01)00051-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Thirty-three HIV-seronegative adults were recruited into a Phase I safety and immunogenicity HIV-1 vaccine trial. The immunogens were as follows: a synthetic, monovalent, octameric HIV-1 MN V3 peptide in aluminum hydroxide (alum) adjuvant administered by intramuscular delivery; and a similar product encapsulated in biodegradable micro-spheres composed of co-polymers of lactic and glycolic acids, administered by the oral route. These were administered in three sequential oral doses, followed by a parenteral boost. No serious adverse experiences were observed. Oral administration of this vaccine, alone or in combination with parenteral boosting, resulted in no significant humoral, cellular, or mucosal immune responses.
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Affiliation(s)
- J S Lambert
- Institute of Human Virology, University of Maryland, 725 West Lombard Street, Baltimore, MD21201, USA.
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Nogueira SA, Abreu T, Oliveira R, Araújo L, Costa T, Andrade M, Garcia Psic MF, Rodrigues K, Mercadante R, Fernandes I, Sapia MC, Lambert JS. Successful prevention of hiv transmission from mother to infant in Brazil using a multidisciplinary team approach. Braz J Infect Dis 2001; 5:78-86. [PMID: 11493413 DOI: 10.1590/s1413-86702001000200006] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To determine the HIV vertical transmission rate (VTR) and associated risk factors by use of zidovudine and infant care education in Brazil. METHODS Since 1995, a prospective cohort of HIV infected pregnant women has been followed at the Federal University of Rio de Janeiro. A multidisciplinary team was established to implement the best available strategy to prevent maternal-infant HIV transmission. Patients with AIDS or low CD(4) and high viral load received anti-retroviral drugs in addition to zidovudine. Children were considered infected if they had 2 positive PCR-RNA tests between 1 and 4 months of age, or were HIV antibody positive after 18 months. Education regarding infant treatment and use of formula instead of breast feeding was provided. RESULTS Between 1995 and August, 2000, HIV status was determined for 145 infants. Compliance with intra-partum treatment, infant treatment and use of formula was 88.2%. Intra-partum zidovudine treatment was completed in 134/145 (92.6%) of patients; 88.1% had rupture of membranes < 4 hours; 85.4% of mothers were asymptomatic. The mean CD(4) count was 428.4 cells and mean viral load 39,050 copies. HIV vertical transmission rate was 4/145 (2.75%; CI: 0.1%-5.4%). The only risk factor significantly associated with transmission was a failure to use zidovudine intra-partum in 2 of the 4 mothers (50% versus 6.4% in non-transmitting mothers). A trend toward low CD(4) and high viral load at entry, and rupture of membranes > 4 hours were associated with increased HIV transmission. CONCLUSION HIV vertical transmission in Brazil was reduced to a level similar to other countries with the most effective prevention programs using a multidisciplinary team approach. A high level of compliance for use of anti-retroviral drugs, the provision of health education to mothers, and use of formula for all exposed infants.
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Villela Nogueira CA, Nogueira SA, Nogueira CN, Coelho HS, Ketema F, Edelman DC, Lambert JS, Constantine NT. The incidence of GB virus C / hepatitis G virus infection in Brazilian patients who received blood transfusion during cardiac surgery. J Med Virol 2001; 63:237-41. [PMID: 11170063 DOI: 10.1002/1096-9071(200103)63:3<237::aid-jmv1006>3.0.co;2-o] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The incidence of GBV-C/hepatitis G virus (GBV-C/HGV) infection after blood transfusion is unknown in Brazil. Many studies have so far addressed its relationship with blood transfusion, but its association with liver disease was not confirmed. A prospective study was carried out between 1996 and 1999 in Rio de Janeiro. Ninety three patients who received blood transfusion during cardiac surgery were followed for six months and blood samples were drawn before and after surgery to determine antibodies to GBV-C/hepatitis G virus (anti-HGenv) using a step sandwich immunoassay and GBV-C/HGV-RNA using reverse transcriptase polymerase chain reaction. The alanine aminotransferase (ALT) levels were serially determined as well as clinical data compiled related to hepatitis. Prior to surgery, anti-HGenv was present in 35.5% (33/93) of patients and 4.3%(4/93) were found to be viremic. Seroconversion following transfusion was observed in 9 patients and 4 additional individuals became viremic for a total incidence of 23% (13/56). Six months after blood transfusion, only 4 of those nine patients previously antibody positive still had anti-HGenv detectable in serum. No patients had clinical or laboratory evidence of acute hepatitis and no correlation was found with GBV-C/HGV infection and number of blood units transfused (p = 0.37). This study highlights the importance of using both HGV-RNA PCR and anti-HGenv to accurately estimate the magnitude of GBV-C/HGV infection. The observed high prevalence and incidence rates show that this infection is common in Brazil; however, no clinical or biochemical evidence of liver disease was demonstrated in the period of study and longer longitudinal observation is needed to define any pathogenic effect.
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Affiliation(s)
- C A Villela Nogueira
- Hospital Universitário Clementino Fraga Filho e Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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Ferreira E, Lucena S, Fonseca G, Barbosa TC, Aquino RB, Lambert JS, Nogueira SA. Visceral leishmaniasis in a Brazilian child infected perinatally with human immunodeficiency virus. Pediatr Infect Dis J 2001; 20:224-6. [PMID: 11224850 DOI: 10.1097/00006454-200102000-00024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This report describes a Brazilian child perinatally infected by HIV who presented visceral leishmaniasis. She showed the classic clinical features, and diagnosis was made by demonstration of amastigote forms of Leishmania in bone marrow aspirate. She responded well to traditional treatment with meglubine.
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Affiliation(s)
- E Ferreira
- Hospital Raphael de Paula Souza, Rio de Janeiro, Brazil
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Gazineo JL, Trope BM, Maceira JP, May SB, Coelho JM, Lambert JS, Nogueira SA. Bacillary angiomatosis: description of 13 cases reported in five reference centers for AIDS treatment in Rio de Janeiro, Brazil. Rev Inst Med Trop Sao Paulo 2001; 43:1-6. [PMID: 11246275 DOI: 10.1590/s0036-46652001000100001] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of this case series was to describe the clinical, laboratory and epidemiological characteristics and the presentation of bacillary angiomatosis cases (and/or parenchymal bacillary peliosis) that were identified in five public hospitals of Rio de Janeiro state between 1990 and 1997; these cases were compared with those previously described in the medical literature. Thirteen case-patients were enrolled in the study; the median age was 39 years and all patients were male. All patients were human immunodeficiency virus type 1 (HIV-1) infected and they had previous or concomitant HIV-associated opportunistic infections or malignancies diagnosed at the time bacillary angiomatosis was diagnosed. Median T4 helper lymphocyte counts of patients was 96 cells per mm(3). Cutaneous involvement was the most common clinical manifestation of bacillary angiomatosis in this study. Clinical remission following appropriate treatment was more common in our case series than that reported in the medical literature, while the incidence of relapse was similar. The frequency of bacillary angiomatosis in HIV patients calculated from two of the hospitals included in our study was 1.42 cases per 1000 patients, similar to the frequencies reported in the medical literature. Bacillary angiomatosis is an unusual opportunistic pathogen in our setting.
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Affiliation(s)
- J L Gazineo
- Serviço de Doenças Infecciosas e Parasitárias, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, RJ, Brasil.
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Lambert JS, Watts DH, Mofenson L, Stiehm ER, Harris DR, Bethel J, Whitehouse J, Jimenez E, Gandia J, Scott G, O'Sullivan MJ, Kovacs A, Stek A, Shearer WT, Hammill H, van Dyke R, Maupin R, Silio M, Fowler MG. Risk factors for preterm birth, low birth weight, and intrauterine growth retardation in infants born to HIV-infected pregnant women receiving zidovudine. Pediatric AIDS Clinical Trials Group 185 Team. AIDS 2000; 14:1389-99. [PMID: 10930154 DOI: 10.1097/00002030-200007070-00012] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate independent contributions of maternal factors to adverse pregnancy outcomes (APO) in HIV-infected women receiving antiretroviral therapy (ART). DESIGN Risk factors for preterm birth (< 37 weeks gestation), low birth weight (LBW) (< 2500 g), and intrauterine growth retardation (IUGR) (birth weight < 10th percentile for gestational age) examined in 497 HIV-infected pregnant women enrolled in PACTG 185, a perinatal clinical trial. METHODS HIV RNA copy number, culture titer, and CD4 lymphocyte counts were measured during pregnancy. Information collected included antenatal use of cigarettes, alcohol, illicit drugs; ART; obstetric history and complications. RESULTS Eighty-six percent were minority race/ethnicity; 86% received antenatal monotherapy, predominantly zidovudine (ZDV), and 14% received combination antiretrovirals. Preterm birth occurred in 17%, LBW in 13%, IUGR in 6%. Risk of preterm birth was independently associated with prior preterm birth [odds ratio (OR) 3.34; P < 0.001], multiple gestation (OR, 6.02; P = 0.011), antenatal alcohol use (OR, 1.91; P = 0.038), and antenatal diagnosis of genital herpes (OR, 0.24; P = 0.022) or pre-eclampsia (OR, 6.36; P = 0.025). LBW was associated with antenatal diagnosis of genital herpes (OR, 0.08; P = 0.014) and pre-eclampsia (OR, 5.25; P = 0.049), and baseline HIV culture titer (OR, 1.41; P = 0.037). IUGR was associated with multiple gestation (OR, 8.20; P = 0.010), antenatal cigarette use (OR, 3.60; P = 0.008), and pre-eclampsia (OR, 12.90; P = 0.007). Maternal immune status and HIV RNA copy number were not associated with APO. CONCLUSIONS Risk factors for APO in antiretroviral treated HIV-infected women are similar to those reported for uninfected women. These data suggest that provision of prenatal care and ART may reduce APO.
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Affiliation(s)
- J S Lambert
- University of Maryland Institute of Human Virology, Baltimore 21201, USA
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Watts DH, Lambert JS, Stiehm ER, Bethel J, Whitehouse J, Fowler MG, Read J. Complications according to mode of delivery among human immunodeficiency virus-infected women with CD4 lymphocyte counts of < or = 500/microL. Am J Obstet Gynecol 2000; 183:100-7. [PMID: 10920316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVE We sought to describe rates of and risk factors for complications by delivery mode among human immunodeficiency virus-infected women with CD4 counts of < or = 500/microL. STUDY DESIGN Complication rates were calculated by delivery mode, as follows: planned cesarean delivery performed without labor or rupture of membranes, other cesarean delivery performed after labor or rupture of membranes, or vaginal delivery. Risk factors were evaluated. RESULTS Major complications in the planned cesarean delivery (n = 37), other cesarean delivery (n = 95), and vaginal delivery (n = 365) groups were amnionitis or endometritis (16%, 27%, and 7%, respectively), wound infection (5%, 8%, and <1%, respectively), and transfusion (8%, 6%, and 3%, respectively). Any peripartum infection occurred among 16 (18%) of those with a CD4 count of <200/microL and 43 (13%) with a CD4 count of > or =200/microL (P =.17). On multivariate analyses, factors associated with amnionitis-endometritis were cesarean delivery and African American race, and a factor associated with transfusion was third-trimester anemia. CONCLUSION Endometritis and wound infection occurred more frequently among human immunodeficiency virus-infected women after cesarean than among women undergoing vaginal delivery; however, complication rates overall were within the range reported in human immunodeficiency virus-negative women. Measures to decrease complications in human immunodeficiency virus-infected women, such as greater use of prophylactic antibiotics, should be assessed.
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Affiliation(s)
- D H Watts
- Pediatric, Adolescent, and Maternal AIDS Branch, National Institute of Child Health and Human Development, Bethesda, MD 20892-7510, USA
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Chuachoowong R, Shaffer N, VanCott TC, Chaisilwattana P, Siriwasin W, Waranawat N, Vanprapar N, Young NL, Mastro TD, Lambert JS, Robb ML. Lack of association between human immunodeficiency virus type 1 antibody in cervicovaginal lavage fluid and plasma and perinatal transmission, in Thailand. J Infect Dis 2000; 181:1957-63. [PMID: 10837175 DOI: 10.1086/315499] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/1999] [Revised: 02/28/2000] [Indexed: 11/03/2022] Open
Abstract
To determine the association between human immunodeficiency virus type 1 (HIV)-specific antibody and RNA levels in cervicovaginal lavage (CVL) samples and plasma, zidovudine treatment, and perinatal transmission, HIV subtype E gp160-specific IgG and IgA were serially measured in a subset of 74 HIV-infected women in a placebo-controlled trial of zidovudine, beginning at 36 weeks of gestation. HIV IgG was detected in 100% of plasma and 97% of CVL samples; HIV IgA was consistently detected in 62% of plasma and 31% of CVL samples. Antibody titers in CVL samples correlated better with the RNA level in CVL samples than with plasma antibody titers. Zidovudine did not affect antibody titers. Perinatal HIV transmission was not associated with antibody in CVL samples or plasma. HIV-specific antibody is present in the cervicovaginal canal of HIV-infected pregnant women; its correlation with the RNA level in CVL fluid suggests local antibody production. However, there was no evidence that these antibodies protected against perinatal HIV transmission.
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Affiliation(s)
- R Chuachoowong
- HIV/AIDS Collaboration, Ministry of Public Health, Nonthaburi 11000, Thailand.
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Abreu T, Plaisance K, Rexroad V, Nogueira S, Oliveira RH, Evangelista LA, Rangel R, Silva IS, Knupp C, Lambert JS. Bioavailability of once- and twice-daily regimens of didanosine in human immunodeficiency virus-infected children. Antimicrob Agents Chemother 2000; 44:1375-6. [PMID: 10770783 PMCID: PMC89876 DOI: 10.1128/aac.44.5.1375-1376.2000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The bioavailability of didanosine at 180 mg/m(2) once daily was compared to that at 90 mg/m(2) twice daily in 24 children with advanced human immunodeficiency virus infection. Children were studied at steady state using optimal sampling and prior pharmacokinetic parameter estimates. Relative bioavailability was 0. 95 +/- 0.49, supporting the potential clinical adequacy of once-daily dosing.
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Affiliation(s)
- T Abreu
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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King JC, Treanor J, Fast PE, Wolff M, Yan L, Iacuzio D, Readmond B, O'Brien D, Mallon K, Highsmith WE, Lambert JS, Belshe RB. Comparison of the safety, vaccine virus shedding, and immunogenicity of influenza virus vaccine, trivalent, types A and B, live cold-adapted, administered to human immunodeficiency virus (HIV)-infected and non-HIV-infected adults. J Infect Dis 2000; 181:725-8. [PMID: 10669363 DOI: 10.1086/315246] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Fifty-seven human immunodeficiency virus (HIV)-infected (CDC class A1-2) and 54 non-HIV-infected adults, not prescreened for influenza susceptibility, were randomized to receive trivalent live attenuated influenza vaccine (LAIV) or placebo intranasally. LAIV was safe and well tolerated with no serious adverse events attributable to vaccine. Reactogenicity rates were similar in LAIV and placebo recipients except that runny nose/nasal congestion was significantly more common in LAIV recipients regardless of HIV status. No prolonged shedding of LAIV was observed in HIV-infected participants. HIV RNA levels were not increased and CD4 counts were not decreased in HIV-infected LAIV recipients compared with placebo recipients after immunization. Shedding of LAIV and increases in antibody titers were infrequent, consistent with prior experience in unscreened adults. The data suggest that inadvertent vaccination with LAIV in relatively asymptomatic HIV-infected adults would not be associated with frequent significant adverse events.
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Affiliation(s)
- J C King
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Wright PF, Lambert JS, Gorse GJ, Hsieh RH, McElrath MJ, Weinhold K, Wara DW, Anderson EL, Keefer MC, Jackson S, Wagner LJ, Francis DP, Fast PE, McNamara J. Immunization with envelope MN rgp120 vaccine in human immunodeficiency virus-infected pregnant women. J Infect Dis 1999; 180:1080-8. [PMID: 10479134 DOI: 10.1086/314985] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Twenty-six human immunodeficiency virus (HIV)-infected pregnant women participated in a placebo-controlled study of immunogenicity and safety of multiple doses of MN rgp120 vaccine over the last half of pregnancy. The women had CD4 lymphocyte counts>400/mm3, no AIDS-defining illness and normal pregnancies. Vaccination was well tolerated, with no significant local or systemic reactions in the women and no adverse outcomes in the infants attributable to the vaccine. Vaccination did not alter plasma RNA reverse transcriptase-polymerase chain reaction copy number; moreover, immunization was not associated with changes in CD4 counts or HIV binding and neutralization antibody titers. Infants were followed up until 18 months of age. Five of 26 infants (19%) were HIV infected, with infection occurring in children of both vaccinated and placebo women. Analysis of factors that influence transmission did not disclose associations with immunization status, viral load, CD4 count, or maternal viral neutralization titers.
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Affiliation(s)
- P F Wright
- Division of Pediatric Infectious Disease, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA. peter.wright@mcmail. vanderbilt.edu
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Mofenson LM, Lambert JS, Stiehm ER, Bethel J, Meyer WA, Whitehouse J, Moye J, Reichelderfer P, Harris DR, Fowler MG, Mathieson BJ, Nemo GJ. Risk factors for perinatal transmission of human immunodeficiency virus type 1 in women treated with zidovudine. Pediatric AIDS Clinical Trials Group Study 185 Team. N Engl J Med 1999; 341:385-93. [PMID: 10432323 DOI: 10.1056/nejm199908053410601] [Citation(s) in RCA: 392] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Maternal, obstetrical, and infant-related factors associated with the risk of perinatal transmission of human immunodeficiency virus type 1 (HIV-1) were identified before the widespread use of zidovudine therapy in pregnant women. The risk factors for transmission when women and infants receive zidovudine are not well characterized. METHODS We examined the effects of maternal, obstetrical, and infant-related characteristics and maternal virologic and immunologic variables on the risk of perinatal transmission of HIV-1 among 480 women and their infants, all of whom received zidovudine. The women and infants were participating in a phase 3 trial of passive immunoprophylaxis for the prevention of perinatal transmission. RESULTS In univariate analyses, the risk of perinatal transmission was associated with each of the following: decreased maternal CD4+ lymphocyte counts at base line; decreased maternal HIV p24 antibody levels at base line and delivery; increased maternal HIV-1 titer at base line and delivery; increased maternal HIV-1 RNA levels at base line and delivery; and the presence of chorioamnionitis at delivery. In multivariate analyses, the only independent risk factor was the maternal HIV-1 RNA level at base line (odds ratio for transmission, 2.4 per log increase in the number of copies; 95 percent confidence interval, 1.2 to 4.7; P=0.02) and at delivery (odds ratio, 3.4; 95 percent confidence interval, 1.7 to 6.8; P=0.001). There was no perinatal transmission of HIV-1 among the 84 women who had HIV-1 levels below the limit of detection (500 copies per milliliter) at base line or the 107 women who had undetectable levels at delivery. CONCLUSIONS Among pregnant women and their infants, all treated with zidovudine, the maternal plasma HIV-1 RNA level was the best predictor of the risk of perinatal transmission of HIV-1. Antiretroviral therapy that reduces the HIV-1 RNA level to below 500 copies per milliliter appears to minimize the risk of perinatal transmission as well as improve the health of the women.
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Affiliation(s)
- L M Mofenson
- Pediatric, Adolescent and Maternal AIDS Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
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Stiehm ER, Lambert JS, Mofenson LM, Bethel J, Whitehouse J, Nugent R, Moye J, Glenn Fowler M, Mathieson BJ, Reichelderfer P, Nemo GJ, Korelitz J, Meyer WA, Sapan CV, Jimenez E, Gandia J, Scott G, O'Sullivan MJ, Kovacs A, Stek A, Shearer WT, Hammill H. Efficacy of zidovudine and human immunodeficiency virus (HIV) hyperimmune immunoglobulin for reducing perinatal HIV transmission from HIV-infected women with advanced disease: results of Pediatric AIDS Clinical Trials Group protocol 185. J Infect Dis 1999; 179:567-75. [PMID: 9952362 DOI: 10.1086/314637] [Citation(s) in RCA: 115] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Pediatric AIDS Clinical Trials Group protocol 185 evaluated whether zidovudine combined with human immunodeficiency virus (HIV) hyperimmune immunoglobulin (HIVIG) infusions administered monthly during pregnancy and to the neonate at birth would significantly lower perinatal HIV transmission compared with treatment with zidovudine and intravenous immunoglobulin (IVIG) without HIV antibody. Subjects had baseline CD4 cell counts </=500/microL (22% had counts <200/microL) and required zidovudine for maternal health (24% received zidovudine before pregnancy). Transmission was associated with lower maternal baseline CD4 cell count (odds ratio, 1.58 per 100-cell decrement; P=.005; 10.0% vs. 3.6% transmission for count <200 vs. >/=200/microL) but not with time of zidovudine initiation (5.6% vs. 4.8% if started before vs. during pregnancy; P=. 75). The Kaplan-Meier transmission rate for HIVIG recipients was 4. 1% (95% confidence interval, 1.5%-6.7%) and for IVIG recipients was 6.0% (2.8%-9.1%) (P=.36). The unexpectedly low transmission confirmed that zidovudine prophylaxis is highly effective, even for women with advanced HIV disease and prior zidovudine therapy, although it limited the study's ability to address whether passive immunization diminishes perinatal transmission.
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Affiliation(s)
- E R Stiehm
- Department of Pediatrics, University of California at Los Angeles Medical Center, Los Angeles, CA 90095-1752, USA.
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Lambert JS, McNamara J, Katz SL, Fenton T, Kang M, VanCott TC, Livingston R, Hawkins E, Moye J, Borkowsky W, Johnson D, Yogev R, Duliege AM, Francis D, Gershon A, Wara D, Martin N, Levin M, McSherry G, Smith G. Safety and immunogenicity of HIV recombinant envelope vaccines in HIV-infected infants and children. National Institutes of Health-sponsored Pediatric AIDS Clinical Trials Group (ACTG-218). J Acquir Immune Defic Syndr Hum Retrovirol 1998; 19:451-61. [PMID: 9859958 DOI: 10.1097/00042560-199812150-00003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Study objectives were to evaluate the safety and immunogenicity of three HIV recombinant glycoproteins in HIV-infected infants and children between 1 month and 18 years of age with asymptomatic (P-1) infection. Using Chiron rgp 120 (SF-2) 15 or 50 microg; MicroGeneSys rgp 160 (IIIB) 40 or 320 microg; Genentech rgp120 (MN) 75 or 300 microg; or adjuvant control (Alum or MF-59), children were randomized to a double-blind, placebo-controlled, dose-escalating study of vaccine administered intramuscularly at entry and 1, 2, 3, 4, and 6 months later. No adverse events were attributed to study vaccines. Between 30% and 56% of volunteers exhibited a lymphoproliferative response as defined in terms of stimulation index (SI) to vaccine antigens; 65% of vaccinees but none of placebo recipients exhibited moderate or strong responses after enzyme immunoassay to HIV specific antigens. CD4 cell counts and quantitative HIV culture did not differ significantly among vaccine and control groups, nor were differences found among groups in HIV disease progression. The rgp160 and gp120 subunit vaccines were safe and immunogenic in this population.
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Affiliation(s)
- J S Lambert
- The Johns Hopkins University, Baltimore, Maryland, USA.
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Funkhouser AW, Katzman PJ, Sickel JZ, Lambert JS. CD30-positive anaplastic large cell lymphoma (ALCL) of T-cell lineage in a 14-month-old infant with perinatally acquired HIV-1 infection. J Pediatr Hematol Oncol 1998; 20:556-9. [PMID: 9856678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
PURPOSE CD30-positive anaplastic large cell lymphoma (ALCL) has been described in adults with HIV-1 infection but is extremely rare in HIV-1-infected infants and children. PATIENT AND METHODS A 14-month-old girl with congenitally acquired HIV-1 infection presented with fever and a tender, erythematous, cystic mass on the right labium majorum. The mass was biopsied. Histologic examination and immunohistochemistry were performed. RESULTS Histologic examination showed Touton-like giant cells resembling histiocytes and focally abundant neutrophils obscuring the lymphoid infiltrate. Immunocytochemistry revealed a CD30-positive ALCL of T-cell lineage. CONCLUSION Although non-Hodgkin's lymphoma is known to be associated with HIV-1 infection in children, large cell lymphomas of T-cell lineage are extremely rare in this population. Early diagnosis should be aggressively pursued in an HIV-1-infected child who presents with a fever and cutaneous mass.
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MESH Headings
- Acquired Immunodeficiency Syndrome/congenital
- Female
- HIV-1
- Humans
- Infant
- Infectious Disease Transmission, Vertical
- Ki-1 Antigen/analysis
- Lymphoma, AIDS-Related/diagnosis
- Lymphoma, AIDS-Related/pathology
- Lymphoma, Large-Cell, Anaplastic/diagnosis
- Lymphoma, Large-Cell, Anaplastic/pathology
- Lymphoma, T-Cell, Cutaneous/diagnosis
- Lymphoma, T-Cell, Cutaneous/pathology
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Affiliation(s)
- A W Funkhouser
- Department of Pediatrics, University of Chicago, Illinois 60637, USA
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Lambert JS, Mofenson LM, Moye J. Reply. J Infect Dis 1998. [DOI: 10.1086/517463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Graham BS, McElrath MJ, Connor RI, Schwartz DH, Gorse GJ, Keefer MC, Mulligan MJ, Matthews TJ, Wolinsky SM, Montefiori DC, Vermund SH, Lambert JS, Corey L, Belshe RB, Dolin R, Wright PF, Korber BT, Wolff MC, Fast PE. Analysis of intercurrent human immunodeficiency virus type 1 infections in phase I and II trials of candidate AIDS vaccines. AIDS Vaccine Evaluation Group, and the Correlates of HIV Immune Protection Group. J Infect Dis 1998; 177:310-9. [PMID: 9466516 DOI: 10.1086/514209] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Among 2099 uninfected subjects in phase I and II trials of candidate AIDS vaccines, 23 were diagnosed with intercurrent human immunodeficiency virus type 1 (HIV-1) infection. High-risk sexual exposures accounted for 17 infections, and intravenous drug use accounted for 6. Four subjects received placebo, 13 received a complete immunization schedule (> or = 3 injections), and 6 were partially immunized (< or = 2 injections). There was no significant difference between vaccine recipients and control groups in incidence of HIV-1 infection, virus load, CD4 lymphocyte count, or V3 loop amino acid sequence. In summary, 19 vaccinated subjects acquired HIV-1 infection during phase I and II trials, indicating that immunization with the products described is < 100% effective in preventing or rapidly clearing infection. Laboratory analysis suggested that vaccine-induced immune responses did not significantly affect the genotypic or phenotypic characteristics of transmitted virus or the early clinical course of HIV-1 infection.
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Affiliation(s)
- B S Graham
- Vanderbilt University School of Medicine, Nashville, Tennessee 37232-2582, USA.
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Nogueira SA, Caiuby MJ, Vasconcelos V, Halpern M, Gouveia C, Thorpe B, Ramparini C, Macieira JM, Lambert JS. Paracoccidioidomycosis and tuberculosis in AIDS patients: report of two cases in Brazil. Int J Infect Dis 1998; 2:168-72. [PMID: 9625612 DOI: 10.1016/s1201-9712(98)90122-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- S A Nogueira
- Infectious Disease Service, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
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Mascola JR, Louder MK, VanCott TC, Sapan CV, Lambert JS, Muenz LR, Bunow B, Birx DL, Robb ML. Potent and synergistic neutralization of human immunodeficiency virus (HIV) type 1 primary isolates by hyperimmune anti-HIV immunoglobulin combined with monoclonal antibodies 2F5 and 2G12. J Virol 1997; 71:7198-206. [PMID: 9311792 PMCID: PMC192059 DOI: 10.1128/jvi.71.10.7198-7206.1997] [Citation(s) in RCA: 104] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Three antibody reagents that neutralize primary human immunodeficiency virus type 1 (HIV-1) isolates were tested for magnitude and breadth of neutralization when used alone or in double or triple combinations. Hyperimmune anti-HIV immunoglobulin (HIVIG) is derived from the plasma of HIV-1-infected donors, and monoclonal antibodies (MAbs) 2F5 and 2G12 bind to distinct regions of the HIV-1 envelope glycoprotein. The antibodies were initially tested against a panel of 15 clade B HIV-1 isolates, using a single concentration that is achievable in vivo (HIVIG, 2,500 microg/ml; MAbs, 25 microg/ml). Individual antibody reagents neutralized many of the viruses tested, but antibody potency varied substantially among the viruses. The virus neutralization produced by double combinations of HIVIG plus 2F5 or 2G12, the two MAbs together, or the triple combination of HIVIG, 2F5, and 2G12 was generally equal to or greater than that predicted by the effect of individual antibodies. Overall, the triple combination displayed the greatest magnitude and breadth of neutralization. Synergistic neutralization was evaluated by analyzing data from dose-response curves of each individual antibody reagent compared to the triple combination and was demonstrated against each of four viruses tested. Therefore, combinations of polyclonal and monoclonal anti-HIV antibodies can produce additive or synergistic neutralization of primary HIV-1 isolates. Passive immunotherapy for treatment or prophylaxis of HIV-1 should consider mixtures of potent neutralizing antibody reagents to expand the magnitude and breadth of virus neutralization.
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Affiliation(s)
- J R Mascola
- Walter Reed Army Institute of Research and Department of Infectious Diseases, Naval Medical Research Institute, Rockville, Maryland 20850, USA.
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Lambert JS, Viscidi R, Walker MC, Clayman B, Winget M, Wolff M, Schwartz DH. Antibody to human immunodeficiency virus type 1 (HIV-1) gp160 in mucosal specimens of asymptomatic HIV-1-infected volunteers parenterally immunized with an experimental recombinant HIV-1 IIIB gp160 vaccine. The National Institute of Allergy and Infectious Diseases-sponsored AIDS Vaccine Evaluation Group. Clin Diagn Lab Immunol 1997; 4:302-8. [PMID: 9144368 PMCID: PMC170523 DOI: 10.1128/cdli.4.3.302-308.1997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Twenty-two human immunodeficiency virus type 1 (HIV-1)-infected, asymptomatic volunteers with CD4 cell counts of >600 cells/mm3 who were enrolled in a phase I immunotherapy trial comparing two schedules of immunization of an HIV-1 IIIB-based recombinant gp160 (rgp160) experimental vaccine were evaluated for rgp160-specific antibodies in parotid saliva, genital secretions, and serum. When the study was unblinded, it was determined that five volunteers had received rgp160 on a month 0, 1, 2, 3, 4, and 5 immunization schedule, seven volunteers had received rgp160 on a month 0, 1, 2, and 5 schedule, five had received alum/deoxycholate placebo, and seven had received a licensed hepatitis B virus vaccine. Five volunteers consented to the donation of parotid saliva but not genital secretions. Prior to immunization, parotid saliva specimens were available for 11 of 22 volunteers, seminal plasma (SP) specimens were available for 7 of 22 volunteers, cervicovaginal lavage (CVL) specimens were available for 5 of 22 volunteers, and serum was available for 22 of 22 volunteers. These baseline specimens and specimens collected at 1 and 7 months after the final immunizations were assessed by enzyme-linked immunosorbent assay for immunoglobulin G (IgG) and IgA antibodies specific for HIV-1 LAI rgp160 or HIV-1 MN rgp160. No augmentation in HIV rgp160-specific IgG or IgA antibody production in either parotid saliva or serum specimens of vaccinees compared to that in controls was observed after immunization. There were insufficient numbers of SP or CVL specimens available for statistical comparisons between vaccinees and controls. Overall, anti-LAI rgp160 IgG antibodies were detected in the parotid saliva specimens of 20 of 22 volunteers, the seminal plasma specimens of 11 of 11 volunteers, and the CVL specimens of 6 of 6 volunteers and in 21 of 22 serum specimens. Fewer volunteers expressed anti-LAI rgp160 IgA antibodies in mucosal or serum specimens: 11 of 22 parotid saliva specimens, 3 of 11 SP specimens, 3 of 5 CVL samples, and 12 of 22 sera.
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Affiliation(s)
- J S Lambert
- The Institute of Human Virology, University of Maryland at Baltimore School of Medicine, 21201, USA.
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Lambert JS, Mofenson LM, Fletcher CV, Moye J, Stiehm ER, Meyer WA, Nemo GJ, Mathieson BJ, Hirsch G, Sapan CV, Cummins LM, Jimenez E, O'Neill E, Kovacs A, Stek A. Safety and pharmacokinetics of hyperimmune anti-human immunodeficiency virus (HIV) immunoglobulin administered to HIV-infected pregnant women and their newborns. Pediatric AIDS Clinical Trials Group Protocol 185 Pharmacokinetic Study Group. J Infect Dis 1997; 175:283-91. [PMID: 9203648 DOI: 10.1093/infdis/175.2.283] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The pharmacokinetics and safety of hyperimmune anti-human immunodeficiency virus (HIV) intravenous immunoglobulin (HIVIG) were evaluated in the first 28 maternal-infant pairs enrolled in a randomized, intravenous immunoglobulin (IVIG)-controlled trial of HIVIG maternal-infant HIV transmission prophylaxis. Using 200 mg/kg, mean half-life and volume of distribution (Vd) in women were 15 days and 72 mL/kg, respectively, after one and 32 days and 154 mL/kg after three monthly infusions, with stable 4 mL/kg/day clearance. Transplacental passage occurred. Newborn single-dose half-life, Vd, and clearance were 30 days, 143 mL/kg, and 4 mL/kg/day, respectively. HIVIG rapidly cleared maternal serum immune complex-dissociated p24 antigen, and plasma HIV-1 RNA levels were stable. Mild to moderate adverse clinical effects occurred in 2 of 103 maternal and 2 of 25 infant infusions. No adverse hematologic, blood chemistry, or immunologic effects were seen. HIVIG is well-tolerated in HIV-infected pregnant women and their newborns, clears antigenemia, crosses the placenta, and exhibits pharmacokinetics similar to those of other immunoglobulin preparations.
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Affiliation(s)
- J S Lambert
- Institute of Human Virology, University of Maryland, Baltimore 21201, USA
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Abstract
Our ability to diagnose, treat, and prevent HIV infection in pregnant women and in children has changed dramatically over the last few years. Recent developments include "early diagnostic" techniques such as polymerase chain reaction, quantitative viral load measurements to assist in estimating disease status and prognosis, newer antiretroviral therapies (including combinations) and effective antibiotic prophylaxis for HIV-infected children, and a better understanding of maternal-fetal factors that may mediate transmission of HIV. As children with long-term immunosuppression live longer, we are diagnosing new diseases and unusual clinical manifestations of common diseases. Children are living into their teenage years with perinatally acquired HIV infection, and we now find ourselves dealing with many of the complex medical and psychosocial issues that have confronted clients with other chronic diseases (e.g., diabetes, cancer): issues of growth failure; nutrition; depression' disclosure of illness to school, friends, and family; and death and dying. What separates HIV from other chronic diseases is its ability to infect and affect so many other family members, not just the child.
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Affiliation(s)
- J S Lambert
- University of Maryland, Baltimore School of Medicine, Institute of Human Virology 21201-1192, USA
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Lambert JS. The prevention of maternal-fetal HIV-1 infection through passive antibody products (HIVIG) and active immunization (AIDS vaccines). Pediatr AIDS HIV Infect 1995; 6:300-2. [PMID: 11361396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Affiliation(s)
- J S Lambert
- Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Affiliation(s)
- J S Lambert
- Department of Medicine, University of Rochester School of Medicine and Dentistry, New York 14642
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