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Bhandari HM, Mitchell T, Duffy J, Mania A, Konsta N, Sarris I, Boyer P, Calhaz-Jorge C, Matik S, Ma Q, Ma F, Siristatidis C, Bosco L, Pomeroy KO, von Byern J, Mocanu E, Drakeley A, Kupka MS, Lara-Molina EE, Le Clef N, Ombelet W, Patrat C, Pennings G, Semprini AE, Tilleman K, Tognon M, Tonch N, Woodward B. ESHRE guideline: medically assisted reproduction in patients with a viral infection/disease. Hum Reprod Open 2021; 2021:hoab037. [PMID: 36733615 PMCID: PMC9887941 DOI: 10.1093/hropen/hoab037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Indexed: 02/05/2023] Open
Abstract
STUDY QUESTION What is the recommended management for medically assisted reproduction (MAR) in patients with a viral infection or disease, based on the best available evidence in the literature? SUMMARY ANSWER The ESHRE guideline on MAR in patients with a viral infection/disease makes 78 recommendations on prevention of horizontal and vertical transmission before, during and after MAR, and the impact on its outcomes, and these also include recommendations regarding laboratory safety on the processing and storage of gametes and embryos testing positive for viral infections. WHAT IS KNOWN ALREADY The development of new and improved anti-viral medications has resulted in improved life expectancy and quality of life for patients with viral infections/diseases. Patients of reproductive age are increasingly exploring their options for family creation. STUDY DESIGN SIZE DURATION The guideline was developed according to the structured methodology for the development of ESHRE guidelines. After the formulation of nine key questions for six viruses (hepatitis B virus, hepatitis C virus, human immunodeficiency virus, human papilloma virus, human T-lymphotropic virus I/II and Zika virus) by a group of experts, literature searches and assessments were performed. Papers published up to 2 November 2020 and written in English were included in the review. Evidence was analyzed by female, male or couple testing positive for the virus. PARTICIPANTS/MATERIALS SETTING METHODS Based on the collected evidence, recommendations were formulated and discussed until consensus was reached within the guideline group. There were 61 key questions to be answered by the guideline development group (GDG), of which 12 were answered as narrative questions and 49 as PICO (Patient, Intervention, Comparison, Outcome) questions. A stakeholder review was organized after the finalization of the draft. The final version was approved by the GDG and the ESHRE Executive Committee. MAIN RESULTS AND THE ROLE OF CHANCE This guideline aims to help providers meet a growing demand for guidance on the management of patients with a viral infection/disease presenting in the fertility clinic.The guideline makes 78 recommendations on prevention of viral transmission before and during MAR, and interventions to reduce/avoid vertical transmission to the newborn. Preferred MAR treatments and interventions are described together with the effect of viral infections on outcomes. The GDG formulated 44 evidence-based recommendations-of which 37 were formulated as strong recommendations and 7 as weak-33 good practice points (GPP) and one research only recommendation. Of the evidence-based recommendations, none were supported by high-quality evidence, two by moderate-quality evidence, 15 by low-quality evidence and 27 by very low-quality evidence. To support future research in the field of MAR in patients with a viral infection/disease, a list of research recommendations is provided. LIMITATIONS REASONS FOR CAUTION Most interventions included are not well-studied in patients with a viral infection/disease. For a large proportion of interventions, evidence was very limited and of very low quality. More evidence is required for these interventions, especially in the field of human papilloma virus (HPV). Such future studies may require the current recommendations to be revised. WIDER IMPLICATIONS OF THE FINDINGS The guideline provides clinicians with clear advice on best practice in MAR for patients with a viral infection/disease, based on the best evidence currently available. In addition, a list of research recommendations is provided to stimulate further studies in the field. STUDY FUNDING/COMPETING INTERESTS The guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, with the literature searches and with the dissemination of the guideline. The guideline group members did not receive any financial incentives, all work was provided voluntarily. A.D. reports research fees from Ferring and Merck, consulting fees from Ferring, outside the submitted work. C.P. reports speakers fees from Merck and MSD outside the submitted work. K.T. reports speakers fees from Cooper Surgical and Ferring and consultancy fees as member of the advisory board BioTeam of Ferring, outside the submitted work. The other authors have no conflicts of interest to declare. DISCLAIMER This guideline represents the views of ESHRE, which were achieved after careful consideration of the scientific evidence available at the time of preparation. In the absence of scientific evidence on certain aspects, a consensus between the relevant ESHRE stakeholders has been obtained. Adherence to these clinical practice guidelines does not guarantee a successful or specific outcome, nor does it establish a standard of care. Clinical practice guidelines do not replace the need for application of clinical judgment to each individual presentation, nor variations based on locality and facility type. ESHRE makes no warranty, express or implied, regarding the clinical practice guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. (Full disclaimer available at www.eshre.eu/guidelines.).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Edgar Mocanu
- Department of Reproductive Medicine, Rotunda Hospital, Royal College of Surgeons in Ireland , Dublin, Ireland
| | - Andrew Drakeley
- Department of Reproductive Medicine, Liverpool Women’s Hospital , Liverpool, UK
| | - Markus S Kupka
- Department Gynaecology and Obstetrics, Gynaekologicum Hamburg , Hamburg, Germany
| | | | - Nathalie Le Clef
- European Society of Human Reproduction and Embryology , Grimbergen, Belgium
| | - Willem Ombelet
- Genk Institute for Fertility Technology, ZOL Hospitals, Genk Faculty of Medicine and Life Sciences, Hasselt University , Hasselt, Belgium
| | - Catherine Patrat
- APHP Centre—University of Paris, Cochin, Service de Biologie de la Reproduction—CECOS , Paris, France
| | - Guido Pennings
- Department of Philosophy and Moral Science, Bioethics Institute Ghent (BIG) Ghent University , Gent, Belgium
| | | | - Kelly Tilleman
- Department for Reproductive Medicine, Ghent University Hospital , Gent, Belgium
| | - Mauro Tognon
- Department of Medical Sciences, University of Ferrara School of Medicine , Ferrara, Italy
| | - Nino Tonch
- Department of Reproductive Medicine, Amsterdam University Medical Centre, Location AMC , Amsterdam, The Netherlands
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Semprini AE, Macaluso M, Hollander L, Vucetich A, Duerr A, Mor G, Ravizza M, Jamieson DJ. Safe conception for HIV-discordant couples: insemination with processed semen from the HIV-infected partner. Am J Obstet Gynecol 2013; 208:402.e1-9. [PMID: 23395921 DOI: 10.1016/j.ajog.2013.02.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 01/15/2013] [Accepted: 02/04/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate the safety of semen washing with intrauterine insemination (SW-IUI) for achieving pregnancy when the man is human immunodeficiency virus (HIV) infected and the woman is HIV negative. STUDY DESIGN We conducted a retrospective analysis of 635 HIV-discordant couples enrolled in a SW-IUI program and followed up 367 Italian women. We computed pregnancy, live birth, and multiple delivery rates and assessed the women's postinsemination HIV status. RESULTS The retrospective analysis included 635 couples (2113 SW-IUI cycles): 41% of the women (95% confidence interval [CI], 37-45%) had a live birth (per-cycle live birth rate 13%; 95% CI, 11-14%). HIV status after SW-IUI was negative when available but unknown for 26% of the women: missing HIV status was not associated with correlates of HIV risk. The follow-up study included 367 couples (1365 cycles): 47% of the women (95% CI, 42-52%) had a live birth (per-cycle rate 14%; 95% CI, 12-16%). Ascertainment of postinsemination HIV status was complete and confirmed no HIV transmission attributable to SW-IUI. The upper 95% confidence limit of the HIV transmission rate was 1.8 per 1000 cycles in the retrospective analysis and 2.7 per 1000 cycles in the follow-up study. CONCLUSION SW-IUI appears to be a safe and effective method for achieving pregnancy in HIV-discordant couples in which the man is HIV infected.
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Abstract
Free foetal DNA in maternal blood during early pregnancy is an ideal source of foetal genetic material for non-invasive prenatal diagnosis. The aim of this study was to evaluate the use of free foetal DNA analysis at early gestational age as pretest for the detection of specific Y-chromosome sequences in maternal plasma of women who are carriers of X-linked disorders, such as haemophilia. Real-time quantitative PCR analysis of maternal plasma was performed for the detection of the SRY or DYS14 sequence. A group of 208 pregnant women, at different gestational periods from 4 to 12 weeks, were tested to identify the optimal period to obtain an adequate amount of foetal DNA for prenatal diagnosis. Foetal gender was determined in 181 pregnant women sampled throughout pregnancy. Pregnancy outcome and foetal gender were confirmed using karyotyping, ultrasonography or after birth. The sensitivity, which was low between 4th and 7th week (mean 73%), increased significantly after 7+1th weeks of gestation (mean 94%). The latter sensitivity after 7+1th week of gestation is associated to a high specificity (100%), with an overall accuracy of 96% for foetal gender determination. This analysis demonstrates that foetal gender determination in maternal plasma is reliable after the 9th week of gestation and it can be used, in association with ultrasonography, for screening to determine the need for chorionic villus sampling for prenatal diagnosis of X-linked disorders, such as haemophilia.
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Affiliation(s)
- M Mortarino
- UOS Dipartimentale per la Diagnosi e la Terapia delle Coagulopatie, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan and Luigi Villa Foundation, Milan, Italy
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Abstract
Thanks to antiretroviral combination therapy, HIV-infected individuals live longer, healthier lives and may wish to have children. Women with HIV can attempt to conceive naturally or through simple self-insemination to minimize the risk of horizontal HIV transmission. Assisted reproduction technology is necessary in couples with infertility, which can either be independent of HIV infection and its treatment or be associated with it. This article summarizes the latest evidence regarding the desire for a child in HIV-positive women and how HIV infection and its treatment may impact female fertility. Current data regarding access to and outcomes of assisted conception programs in HIV-positive women wishing to conceive in both high- and low-income countries is also reviewed.
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Affiliation(s)
- Augusto Enrico Semprini
- ESMAN Medical Consulting, Via Carlo Crivelli, 20 20122 Milano, Italy, Tel.: +39 025 843 0703; Fax: +39 025 830 4466
| | - Lital Hannah Hollander
- ESMAN Medical Consulting, Via Carlo Crivelli, 20 20122 Milano, Italy, Tel.: +39 025 843 0703; Fax: +39 025 830 4466
- Tel.: +39 024 549 1134; Fax: +39 024 549 1135
| | - Alessandra Vucetich
- ESMAN Medical Consulting, Via Carlo Crivelli, 20 20122 Milano, Italy, Tel.: +39 025 843 0703; Fax: +39 025 830 4466
- Tel.: +39 025 843 0703; Fax: +39 02 5830 4466
| | - Carole Gilling-Smith
- Chelsea & Westminster Hospital, Assisted Conception Unit, London SW10 9NH, UK, Tel.: +44 172 8746 8000; Fax: +44 172 8746 8921
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Sunderam S, Hollander L, Macaluso M, Vucetich A, Jamieson DJ, Osimo F, Duerr A, Semprini AE. Safe Conception for HIV Discordant Couples through Sperm-Washing: Experience and Perceptions of Patients in Milan, Italy. Reproductive Health Matters 2008; 16:211-9. [DOI: 10.1016/s0968-8080(08)31342-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Semprini AE, Bujan L, Englert Y, Smith CG, Guibert J, Hollander L, Ohl J, Vernazza P. Establishing the safety profile of sperm washing followed by ART for the treatment of HIV discordant couples wishing to conceive. Hum Reprod 2007; 22:2793-4; author reply 2794-5. [PMID: 17609245 DOI: 10.1093/humrep/dem197] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
In developed countries, antiretroviral treatment has increased life quality and expectancy of HIV-infected individuals and led to a drop in mother-to-child transmission (MCT) risk to below 1%. Fertility has been shown to be reduced in both men and women with HIV. As a result of these factors, the demand for reproductive care in this population is rising. In discordant couples where the man is positive, sperm washing significantly reduces viral transmission risk to the uninfected female partner over unprotected intercourse. Positive women do not necessarily need specialised fertility treatment but should be monitored closely during pregnancy to minimise MCT risk.
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Affiliation(s)
- C Gilling-Smith
- Assisted Conception Unit, Chelsea & Westminster Hospital, London, UK.
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Persico T, Savasi V, Ferrazzi E, Oneta M, Semprini AE, Simoni G. Detection of human immunodeficiency virus-1 RNA and DNA by extractive and in situ PCR in unprocessed semen and seminal fractions isolated by semen-washing procedure. Hum Reprod 2006; 21:1525-30. [PMID: 16476677 DOI: 10.1093/humrep/del004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [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: 11/14/2022] Open
Abstract
BACKGROUND To determine the presence of human immunodeficiency virus-1 (HIV-1) viral RNA/DNA in whole semen, in properly isolated seminal fractions and in spermatozoa after swim-up, by extractive nested PCR and to compare the detection of HIV DNA by in situ PCR (IS-PCR) with the results of nested PCR. METHODS We tested HIV-1 RNA and DNA by nested PCR in semen and in seminal fractions from 55 patients. Non-spermatic cells and spermatozoa pellet fractions from 10 HIV-1-positive and five HIV-1-negative men were tested for proviral DNA by IS-PCR. RESULTS All samples of spermatozoa recovered after sperm washing were free of HIV RNA. HIV RNA tested positive in seven (13%) seminal plasma samples and only in two (4.2%) whole semen of these same samples. Of the seven seminal plasma samples testing positive for HIV RNA, four men had elevated blood viral load and three an undetectable viraemia. HIV DNA by IS-PCR turned positive in three of five samples in semen of HIV-noninfected men. CONCLUSION HIV RNA/DNA detection in the semen of HIV-infected men proves the efficacy of sperm washing with swim-up of spermatozoa. It is recommended that nested PCR be conducted on purified seminal compartments. IS-PCR is inadequate for detecting HIV in semen.
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Affiliation(s)
- Tiziana Persico
- Department of Obstetrics and Gynaecology, Sacco Clinical Sciences Institute, University of Milan Medical School, Milan, Italy
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Freeman K, Oakley L, Pollak A, Buffolano W, Petersen E, Semprini AE, Salt A, Gilbert R. Association between congenital toxoplasmosis and preterm birth, low birthweight and small for gestational age birth. BJOG 2005; 112:31-7. [PMID: 15663394 DOI: 10.1111/j.1471-0528.2004.00299.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [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: 11/28/2022]
Abstract
OBJECTIVE To determine the association between congenital toxoplasmosis and preterm birth, low birthweight and small for gestational age birth. DESIGN Multicentre prospective cohort study. SETTING Ten European centres offering prenatal screening for toxoplasmosis. POPULATION Deliveries after 23 weeks of gestation in 386 women with singleton pregnancies who seroconverted to toxoplasma infection before 20 weeks of gestation. Deliveries after 36 weeks in 234 women who seroconverted at 20 weeks or later, and tested positive before 37 weeks. METHODS Comparison of infected and uninfected births, adjusted for parity and country of birth. MAIN OUTCOME MEASURES Differences in gestational age at birth, birthweight and birthweight centile. RESULTS Infected babies were born or delivered earlier than uninfected babies: the mean difference for seroconverters before 20 weeks was -5.4 days (95% CI: -1.4, -9.4), and at 20 weeks or more, -2.6 days (95% CI: -0.5, -4.7). Congenital infection was associated with an increased risk of preterm delivery when seroconversion occurred before 20 weeks (OR 4.71; 95% CI: 2.03, 10.9). No significant differences were detected for birthweight or birthweight centile. CONCLUSION Babies with congenital toxoplasmosis were born earlier than uninfected babies but the mechanism leading to shorter length of gestation is unknown. Congenital infection could precipitate early delivery or prompt caesarean section or induction of delivery. We found no evidence for a significant association between congenital toxoplasmosis and reduced birthweight or small for gestational age birth.
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Affiliation(s)
- K Freeman
- Albert Einstein College of Medicine, Bronx, NY, USA
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Affiliation(s)
- S Sharma
- Department of Gynaecology, Chelsea and Westminster Hospital, London, UK
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Gilling-Smith C, Smith JR, Semprini AE. HIV and infertility: time to treat. There's no justification for denying treatment to parents who are HIV positive. BMJ 2001; 322:566-7. [PMID: 11238138 PMCID: PMC1119773 DOI: 10.1136/bmj.322.7286.566] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fiore S, Semprini AE, Ravizza M, Bucceri A, Muggiasca ML, Guerra B, Spinillo A, Pardi G. The changing HIV epidemic in Italian pregnant women. Eur J Obstet Gynecol Reprod Biol 2000; 91:149-53. [PMID: 10869787 DOI: 10.1016/s0301-2115(99)00268-7] [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: 11/18/2022]
Abstract
OBJECTIVE To describe changes in the characteristics of HIV-pregnant women in Italy and the impact of strategies for prevention of HIV vertical transmission. STUDY DESIGN Since 1985, HIV-infected women and their children are followed in 23 European centres in the European Collaborative Study (ECS), according to a standard protocol. Eight Italian Obstetric units participating in the ECS enrolled 815 patients. RESULTS Overall use of zidovudine to reduce HIV vertical transmission has increased significantly since 1994 and between 1995 and 1997, 57% of Italian women were treated. However, 27% of babies received the infant component of the 076 regimen. Over the years, age at delivery has increased and their CD4 count at delivery decreased, most likely reflecting heterosexually infected women with a longer duration of infection. The increasing rate of elective caesarean section (42%) is not related to maternal, foetal or obstetrical indications, but its use as an intervention to reduce HIV vertical transmission. CONCLUSIONS The identification of HIV-infected women during pregnancy or before delivery ensures the appropriate management of the woman and her child, and clinicians should be aware of the increasing number of women with heterosexual acquisition of HIV-infection who may be less easily identified.
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Affiliation(s)
- S Fiore
- Department of Obstetrics and Gynecology, Ospedale San Paolo, Milan, Italy.
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Cook AJ, Gilbert RE, Buffolano W, Zufferey J, Petersen E, Jenum PA, Foulon W, Semprini AE, Dunn DT. Sources of toxoplasma infection in pregnant women: European multicentre case-control study. European Research Network on Congenital Toxoplasmosis. BMJ 2000; 321:142-7. [PMID: 10894691 PMCID: PMC27431 DOI: 10.1136/bmj.321.7254.142] [Citation(s) in RCA: 601] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/30/2000] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the odds ratio and population attributable fraction associated with food and environmental risk factors for acute toxoplasmosis in pregnancy. DESIGN Case-control study. SETTING Six large European cities. PARTICIPANTS Pregnant women with acute infection (cases) detected by seroconversion or positive for anti-Toxoplasma gondii IgM were compared with pregnant women seronegative for toxoplasma (controls). MAIN OUTCOME MEASURES Odds ratios for acute infection adjusted for confounding variables; the population attributable fraction for risk factors. RESULTS Risk factors most strongly predictive of acute infection in pregnant women were eating undercooked lamb, beef, or game, contact with soil, and travel outside Europe and the United States and Canada. Contact with cats was not a risk factor. Between 30% and 63% of infections in different centres were attributed to consumption of undercooked or cured meat products and 6% to 17% to soil contact. CONCLUSIONS Inadequately cooked or cured meat is the main risk factor for infection with toxoplasma in all centres. Preventive strategies should aim to reduce prevalence of infection in meat, improve labelling of meat according to farming and processing methods, and improve the quality and consistency of health information given to pregnant women.
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Affiliation(s)
- A J Cook
- Department of Farm Animal and Equine Medicine and Surgery, Royal Veterinary College, University of London, North Mimms, Hertfordshire AL9 7TA
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Semprini AE, De Andreis C, Fiore S, Garagiola I, Sirchia SM, Savasi V, Newell ML, Simoni G. Detection of maternal DNA in cord blood at birth after elective caesarean section or vaginal delivery. AIDS 2000; 14:623-5. [PMID: 10780730 DOI: 10.1097/00002030-200003310-00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Semprini AE, Persico T, Thiers V, Oneta M, Tuveri R, Serafini P, Boschini A, Giuntelli S, Pardi G, Brechot C. Absence of hepatitis C virus and detection of hepatitis G virus/GB virus C RNA sequences in the semen of infected men. J Infect Dis 1998; 177:848-54. [PMID: 9534955 DOI: 10.1086/515257] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.5] [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
The identification of hepatitis C virus (HCV) in semen remains controversial and that of hepatitis G virus (HGV) or GB virus C (GBV-C) has never been investigated. Serum and semen from 90 anti-HCV-positive drug users were tested (27 infected with HIV) for HCV and HGV/GBV-C RNAs by polymerase chain reaction (PCR) assay, hybridization, and sequence analysis. Semen was processed into round cells, seminal plasma, and spermatozoa. Fifty-six patients were HCV-viremic, but HCV-RNA was not identified in their seminal fractions. However, PCR inhibitors were found in the semen of 34 of these men. Twenty-eight patients had HGV/GBV-C RNA in their blood and for 24 of them, ejaculates were available for analysis. HGV/GBV-C RNA was found in the seminal plasma of 6 of 12 samples free from PCR inhibitors. These results agree with the low risk of sexual transfer of HCV and provide preliminary evidence for the presence of HGV/GBV-C in semen.
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Affiliation(s)
- A E Semprini
- Department of Obstetrics and Gynecology, San Paolo Biomedical Institute, University of Milan Medical School, Italy.
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Perino A, Vassiliadis A, Vucetich A, Colacurci N, Menato G, Cignitti M, Semprini AE. Short-term therapy for recurrent abortion using intravenous immunoglobulins: results of a double-blind placebo-controlled Italian study. Hum Reprod 1997; 12:2388-92. [PMID: 9436670 DOI: 10.1093/humrep/12.11.2388] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.6] [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
It is still unclear whether i.v. immunoglobulins (Ig) can facilitate the reproductive prognosis of women who have suffered recurrent pregnancy loss. We report the results of a multicentre placebo-controlled study on the effect of Ig administration on pregnancy outcome in 46 women who had suffered at least three recurrent miscarriages. All were screened to exclude chromosomal or Müllerian abnormalities, the presence of antinuclear antibodies, lupus anticoagulant (LA) or elevated titres of anticardiolipin antibodies which may have revealed an underlying autoimmune problem. To avoid a selection bias towards ongoing pregnancies, i.v. Ig or placebo were administered between weeks 5 and 7 of gestation for 2 consecutive days as soon as each woman knew she was pregnant and before embryonic heart activity could be detected. A further infusion was administered at week 8 when ultrasonography confirmed an ongoing embryonic development. In all, 68% of the women who received Ig went to term versus 79% of those who received a placebo (not significant), with no significant differences in the pregnancy course or the perinatal outcome. These results suggest either that women with recurrent miscarriages who have no recognized cause of pregnancy loss have a good reproductive prognosis without any treatment or that the emotional care associated with the administration of a placebo can indirectly facilitate the progression of pregnancy.
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Affiliation(s)
- A Perino
- Department of Obstetrics and Gynaecology, University of Palermo, Italy
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De Andreis C, Simoni G, Castagna C, Sacchi L, Sirchia SM, Garagiola I, Persico T, Serafini P, Pardi G, Semprini AE. Absence of detectable maternal DNA and identification of proviral HIV in the cord blood of two infants who became HIV-infected. AIDS 1997; 11:840-1. [PMID: 9223754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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De Andreis C, Simoni G, Castagna C, Sacchi L, Sirchia SM, Garagiola I, Persico T, Serafini P, Pardi G, Semprini AE. Absence of detectable maternal DNA and identification of proviral HIV in the cord blood of two infants who became HIV-infected. AIDS 1997; 11:840-1. [PMID: 9143631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Newell ML, Dunn DT, Peckham CS, Semprini AE, Pardi G. Vertical transmission of HIV-1: maternal immune status and obstetric factors. The European Collaborative Study. AIDS 1996; 10:1675-81. [PMID: 8970688] [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: 02/03/2023]
Abstract
OBJECTIVE To estimate the effect of maternal factors and events around the time of delivery on HIV-1 vertical transmission risk. DESIGN Prospective study. SETTING Twenty-two obstetric and paediatric clinics in seven European countries. PATIENTS OR OTHER PARTICIPANTS Mothers identified as HIV-infected before or at delivery and their children. MAIN OUTCOME MEASURE Paediatric HIV infection. RESULTS By November 1995, 1846 mothers with 1945 children had been enrolled. The vertical transmission rate was 16.4% (95% confidence interval, 14.5-18.3). Parity, maternal age, race, mode of HIV acquisition, injecting drug use and sex of infant were not statistically significantly associated with risk of transmission. Children delivered vaginally were more likely to be infected than those delivered by Caesarean section. However, in vaginal deliveries the procedures used, duration of ruptured membranes or length of second-stage labour were not related to transmission. Transmission increased almost linearly with decreasing CD4 cell count, but there was no such trend for CD8 cell count. Women with CD4 cell counts below 200 x 10(6)/l were significantly more likely to deliver early (chi 2 for trend, 14.02; P < 0.001). Very premature infants were at increased risk of infection, but after about 35 weeks gestation the transmission rate remained stable, with no increase in late pregnancy. This trend was confirmed after allowing for maternal CD4 cell count. CONCLUSIONS The rate of vertical transmission increases linearly with decreasing maternal CD4 cell count. Women with fewer than 200 x 10(6) CD4 cells/l have an increased risk of premature delivery, which would affect timing of interventions. The stable transmission rate after 35 weeks gestation suggests little acquisition of infection during late pregnancy.
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Affiliation(s)
- M L Newell
- Department of Epidemiology, Institute of Child Health, London, UK
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De Andreis C, Simoni G, Rossella F, Castagna C, Pesenti E, Porta G, Colucci G, Giuntelli S, Pardi G, Semprini AE. HIV-1 proviral DNA polymerase chain reaction detection in chorionic villi after exclusion of maternal contamination by variable number of tandem repeats analysis. AIDS 1996; 10:711-5. [PMID: 8805861 DOI: 10.1097/00002030-199606001-00004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [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: 02/02/2023]
Abstract
OBJECTIVE The study of the placental HIV infection in cases of seropositive pregnant women after exclusion of maternal contamination of chorionic villi samples by variable number of tandem repeats (VNTR) analysis. METHODS We studied 30 HIV-positive women: 17 terminated their pregnancy (11 in the first trimester and six in the second) and 13 delivered at term (one was a twin gestation). We selected chorionic villi and ruled out maternal contamination by VNTR analysis. DNA from chorionic villi and cord and maternal blood were tested for HIV by PCR. All infants underwent a paediatric follow-up. RESULTS All maternal blood samples tested positive for HIV-1 by polymerase chain reaction. No maternal contamination was revealed and HIV was found in six out of 11 first trimester placentas, in all second trimester samples, and in 10 out of 14 at term. Cord blood tested positive in all second trimester cases and in seven out of 14 liveborns. In no case was HIV found in cord blood without infection of the corresponding placenta; conversely, three placentas tested positive but cord blood was negative. Two infants were HIV-positive, 11 were uninfected (one case was lost to follow-up). CONCLUSION Our study indicates that HIV-1 can infect the placenta from first trimester onwards. HIV was found in two-thirds of our cord blood samples but it is possible that some viral DNA in cord blood may have come from infected placental cells. Additional studies are needed to assess the source of HIV in cord blood and the possible contribution of placental or maternal cells infected with HIV to vertical transmission of the virus.
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Affiliation(s)
- C De Andreis
- Department of Obstetrics and Gynaecology, University of Milan Medical School, Italy
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25
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Semprini AE, Castagna C, Ravizza M, Fiore S, Savasi V, Muggiasca ML, Grossi E, Guerra B, Tibaldi C, Scaravelli G. The incidence of complications after caesarean section in 156 HIV-positive women. AIDS 1995; 9:913-7. [PMID: 7576327 DOI: 10.1097/00002030-199508000-00013] [Citation(s) in RCA: 114] [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: 01/26/2023]
Abstract
OBJECTIVE To investigate the risks of post-operative complications in HIV-positive mothers who undergo a caesarean section (CS) because the delivery cannot be safely accomplished by the vaginal route or to protect the infant from viral infection. DESIGN In a multicentre study, we reviewed the incidence and type of post-operative complications in 156 HIV-positive women who underwent a CS. These results were compared with those observed in an equal number of HIV-uninfected women who matched for the indication requiring a caesarean delivery, the stage of labour, the integrity or rupture of membranes, and the use of antibiotic prophylaxis. SETTING Seven teaching hospitals providing obstetrical care for mothers infected with HIV. RESULTS We found that six HIV-infected mothers suffered a major complication (two cases of pneumonia, one pleural effusion, two severe anaemia and one sepsis) compared with only one HIV-negative woman who required blood transfusion after surgery. Minor complications like post-operative fever, endometritis, wound and urinary tract infections were significantly more frequent in HIV-positive women than controls. Multivariate analysis revealed that in HIV-infected women the only factor associated with a significant increase in the rate of complications was a CD4 lymphocyte count < 200 x 10(6)/l. CONCLUSIONS The results of our study indicate that HIV-positive mothers are at an increased risk of post-operative complications when delivered by CS. The risk of post-operative complications is higher in HIV-infected women who are severely immunodepressed.
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Affiliation(s)
- A E Semprini
- Department of Obstetrics and Gynaecology, San Paolo Biomedical Institute, Milan, Italy
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26
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Affiliation(s)
- A E Semprini
- Department of Obstetrics and Gynaecology, San Paolo Biomedical Institute, University of Milan Medical School, Italy
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27
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Semprini AE, Stillo A, Marcozzi S, Castagna C, Fiore S, Radaelli U. Treatment with interferon for genital HPV in HIV-positive and HIV-negative women. Eur J Obstet Gynecol Reprod Biol 1994; 53:135-7. [PMID: 7910799 DOI: 10.1016/0028-2243(94)90221-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [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: 01/27/2023]
Abstract
The administration of interferons can be resorted to, either on its own or in combination with physical destruction methods, when the extent of genital HPV is widespread. Extensive genital HPV involvement is often seen in HIV-positive patients as a consequence of their immunodeficiency. The extension of these lesions may invalidate treatment by physical destruction, while an underlying immunodeficiency renders interferon therapy less efficacious. We studied HIV-positive and HIV-negative patients with a similar HPV involvement of their genital tract and compared the effectiveness of systemically administered alpha 2b and beta interferons in clearing HPV. Our results confirm that interferon therapy will cure most patients with extensive genital HPV when they are HIV-negative. HIV-positive patients with CD4 counts over 400 lymphocytes/mm3 may expect a similar cure rate, but this halves when this critical threshold is crossed. In these severely immunodeficient patients repeated courses of interferon therapy alone or in combination with physical destruction methods may be required to cure HPV infection.
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Affiliation(s)
- A E Semprini
- Department of Obstetrics and Gynecology, San Paolo Biomedical Institute, University of Milan Medical School, Italy
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Colucci G, Pesenti E, Molteni E, Lobbiani A, De Andreis C, Pariani S, Rossella F, Semprini AE, Simoni G. Applicability of DNA isolated from syncytiotrophoblast vesicles to gene amplification and molecular analysis. Prenat Diagn 1993; 13:335-40. [PMID: 8341630 DOI: 10.1002/pd.1970130504] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Maternal contamination of fetal DNA represents a major problem when highly sensitive molecular techniques are used in the prenatal diagnosis of genetic diseases. For this reason, we have studied the possibility of using DNA isolated from syncytiotrophoblast vesicles as a target of gene amplification (PCR). Three PCR systems were selected which included a repetitive 149 bp fragment of the Y chromosome, the VNTR locus D1S80, and a portion of the beta-globin gene. The results of these experiments indicate that DNA isolated from syncytiotrophoblast vesicles is free of maternal contamination and is suitable for gene amplification and DNA analysis.
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Affiliation(s)
- G Colucci
- Fondazione Centro Studi di Patologia Molecolare applicata alla clinica, Milano, Italy
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30
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Semprini AE, Levi-Setti P, Bozzo M, Ravizza M, Taglioretti A, Sulpizio P, Albani E, Oneta M, Pardi G. Insemination of HIV-negative women with processed semen of HIV-positive partners. Lancet 1992; 340:1317-9. [PMID: 1360037 DOI: 10.1016/0140-6736(92)92495-2] [Citation(s) in RCA: 205] [Impact Index Per Article: 6.4] [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: 10/27/2022]
Abstract
Many HIV-discordant couples want to have children so much that they are willing to abandon condom-protected sexual intercourse irrespective of the risks. Previous testing in our laboratory showed that gradient centrifugation followed by a swim-up procedure effectively removed HIV-1-infected cells from the semen of HIV-seropositive men. 85 HIV-discordant couples were screened for fertility; 29 women were found suitable for a timed insemination course with the processed semen of their HIV-seropositive partner. None of the inseminated women seroconverted, and 17 pregnancies were achieved in 15 women. All 10 babies born to these mothers remain HIV seronegative. The findings may help in the counselling of such couples and also give them hope of having healthy babies.
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Affiliation(s)
- A E Semprini
- Department of Obstetrics and Gynecology, San Paolo Biomedical Institute, University of Milan Medical School, Italy
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Abstract
We have observed 74 HIV-seropositive and 48 HIV-seronegative drug-addicted women and 22 HIV-seropositive nondrug-addicted pregnant women during pregnancy and we report their perinatal outcome. 8 out of 96 HIV-seropositive patients had hematological signs of immunodeficiency and 2 of these patients were symptomatic belonging to CDC class III. We recorded 2 early and 3 late spontaneous abortions, no intrauterine fetal death and 3 neonatal deaths. Seropositive patients had 3 malformed babies, seronegative patients had 1. All these women had a high incidence of premature delivery and intrauterine fetal growth retardation: seropositive patients had a higher incidence of fetuses small for gestational age and a lower incidence of preterm delivery compared to seronegative patients, but the difference was not statistically significant. The incidence of malformation was comparable to the general population: 3 malformed babies were born to HIV-positive drug-addicted mothers, and 1 to a seronegative drug-addicted mother. These findings do not support the hypothesis of a direct detrimental effect of HIV on perinatal outcome. Consequences of fetal exposure to maternal HIV infection involve mostly postnatal life and development of acquired immunodeficiency.
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Affiliation(s)
- A E Semprini
- Department of Obstetrics and Gynecology, University of Milano Medical School, Ospedale S. Paolo, Italy
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Plebani A, Biolchini A, Bucceri A, Buscaglia M, Pardi G, Semprini AE. Prenatal immune status of fetuses of HIV-seropositive mothers. Gynecol Obstet Invest 1990; 29:108-11. [PMID: 2335309 DOI: 10.1159/000293313] [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: 12/31/2022]
Abstract
Human immunodeficiency virus (HIV) has been isolated from fetal tissues as early as 13 weeks and later from fetal blood. These findings have raised the possibility of prenatal diagnosis of infected fetuses by identification of the virus in the fetal compartment. Study of the fetal immune status has proved reliable in prenatal diagnosis of congenital immunodeficiency, and we have tested the possibility to diagnose acquired immunodeficiency in utero by this approach. We studied T lymphocyte subsets and their mitogenic response in fetal blood obtained after elective termination at midgestation in 8 cases and at delivery in 26 cases of maternal HIV infection. Results have been compared to appropriate normal controls. No significant difference was found in terms of total lymphocytes, CD4 and CD8 populations and phytohemagglutinin responses. This indicates either that immunological parameters currently used to assess postnatal immunodeficiency are not reliable during intrauterine life or that the intrauterine environment and the transplacental passage of maternal antibodies interfere with development of prenatal immunodeficiency.
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Affiliation(s)
- A Plebani
- First Department of Pediatrics, University of Milan, Medical School, Italy
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Semprini AE, Vucetich A, Garbo S, Agostoni G, Pardi G. Effect of prednisone and heparin treatment in 14 patients with poor reproductive efficiency related to lupus anticoagulant. Fetal Ther 1989; 4 Suppl 1:73-6. [PMID: 2518672 DOI: 10.1159/000263469] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In women with a previous intrauterine fetal death related to lupus anticoagulant (LAC), we studied the effect of prednisone and calcieparine treatment to enable longer intrauterine life, increased fetal growth and increased survival rate. LAC was determined by the kaolin clotting time and was associated with elevated levels of antinuclear and anticardiolipin antibody in 42% and 21% of the cases, respectively. 14 women entered the study; they had a past history of 27 pregnancies, with only 1 small-for-gestational age (SGA) liveborn. The mean gestational age at the time of fetal death was 30 +/- 4 weeks. During index pregnancies, we observed 2 miscarriage, 9 liveborns (6 of appropriated gestational weight, 3 SGA) and a mean gestational age of 35 +/- 3 weeks. The mean decrease in fetal weight from the 50th percentile in previous pregnancies was 44%, and with treatment this was reduced to 12%. All these differences were statistically significant. We conclude that prednisone and heparin treatment can improve reproductive prognosis in fertile patients with LAC.
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Affiliation(s)
- A E Semprini
- 6th Department of Obstetrics and Gynecology, University of Milan Medical School, San Paolo Hospital, Italy
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Bucceri A, Ravizza M, Ferraris G, Lodi I, Brescianini C, Canestrari A, Semprini AE, Taglioretti A, Pardi G. [Pregnancy and drug dependence: assistance and perinatal outcome in 223 cases (1980-86)]. Ann Ostet Ginecol Med Perinat 1987; 108:367-74. [PMID: 3448978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Semprini AE, Vucetich A, Pardi G, Cossu MM. HIV infection and AIDS in newborn babies of mothers positive for HIV antibody. Br Med J (Clin Res Ed) 1987; 294:610. [PMID: 3103824 PMCID: PMC1245649 DOI: 10.1136/bmj.294.6572.610] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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36
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Macchi B, Federico M, Orecchia A, Verani P, Rossi GB, Lazzarin A, Moroni M, Pardi G, Semprini AE. Transplacental transmission of HTLV-III virus. AIDS Res 1986; 2:267-9. [PMID: 3643796 DOI: 10.1089/aid.1.1986.2.267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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37
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Semprini AE, Marconi AM, Pardi G. [Cholestasis in pregnancy]. Ann Ostet Ginecol Med Perinat 1983; 104:368-75. [PMID: 6675497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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D'Incalci M, Sessa C, Colombo N, de Palo G, Semprini AE, Pardi G. Transplacental passage of cyclophosphamide. Cancer Treat Rep 1982; 66:1681-2. [PMID: 7105061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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