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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

There has been reluctance by the medical establishment and government to promote extensive human immunodeficiency virus (HIV) testing, even though it can be done economically and accurately. There are good arguments for more testing of 1 of the most serious epidemics of a infectious diseases in history. In 1987 there was estimated to be over 1 million people infected with HIV and most of them are unaware of the infection. The current methods to make people with HIV infection aware of the disease are not effective. Many people do not realize that early detection of HIV is important and that it is treatable. Where increased testing has been done there is evidence that unsafe sexual practices have been reduced by those with HIV. Another benefit of early detection of HIV is the identification of candidates for experimental therapies. There are reports that zidovudine is effective immediately after exposure to HIV, and hospitals should offer this treatment free to personnel exposed to blood or body fluids of an infected person. The effectiveness of hospital precautions should be evaluated and routine screening of patients can then be decided. Testing for HIV in the health care system could drive away those infected or who fear they are. Another argument against wider testing is false positive test results, but use of screening with sequential enzyme immunoassays followed by Western blot should rarely produce false positive results. It is a minimum requirement to test all patients that acknowledge sexual contact with homosexual men, any needle sharing, and any multiple unsafe heterosexual contacts. Also, testing of prenatal patients is strongly recommended, since early detection can allow abortion decision to be made, and also further pregnancies can be prevented.
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PMID:The case for wider use of testing for HIV infection. 279 90

Pregnant women who were seen in 3 hospitals in Amsterdam were tested for antibodies to HIV, after informed consent. Out of 2,308 eligible pregnant women, 2,094 (90.7%) participated by name and 21 (0.9%) anonymously; 193 (8.4%) refused to participate. Among refusers there were significantly more women with a non-Dutch nationality or born in other countries. Of 2,115 pregnant women, 6 were found to be HIV-infected (0.28%, 95% confidence interval (0.05-0.51). Among women who at their first prenatal visit reported no AIDS-risk factor either for themselves or their partner(s), the HIV prevalence was 1/1,893 (0.05%) and among women with such risk factor the prevalence was 5/180 (2.78%). Three of the seropositive pregnant women knew before they were tested that they were HIV-infected. Of the 6 HIV-infected women one had a spontaneous abortion and the 4 women who were tested within the period when therapeutic abortion was still possible, decided to continue their pregnancy.
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PMID:[The prevalence of HIV in pregnant women at 3 outpatient clinics in Amsterdam]. 273 68

During the period between 1977 and the first quarter of 1988, 35 countries liberalized their abortion laws and four countries limited grounds for the procedure. Most legislation has extended abortion eligibility through traditional indications such as danger to maternal health or fetal handicap, but a number of other indications have been created such as adolescence, advanced maternal age, family circumstances, and AIDS or HIV infection. A number of countries have redesigned their abortion laws as part of a comprehensive package to facilitate access to and delivery of contraception, voluntary sterilization, and abortion services. Abortion litigation has increased and stimulated the liberalization of abortion provisions and the support of women's autonomous choice within the law. In Canada, the entire criminal prohibition of abortion was held unconstitutional for violating women's integrity and security. In contrast, Latin American and other constitutional developments may limit legal abortion to instances of danger to women's lives.
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PMID:International developments in abortion laws: 1977-88. 304 26

With screening of the blood supply and effective heat and chemical treatment of blood product derivatives, the overwhelming majority of newly acquired adult HIV infections will result from consensual acts, through the exchange of blood or sexual secretions. Societal relaxation about discussion of sex, death, homosexuality, drugs, and abortion is essential to prevent further deaths. Careful partner selection, use of condoms in conjunction with nonoxynol-9 (a viricidal spermicide), and selected confidential HIV antibody testing could help decrease the number of infected persons. Efforts directed toward IV drug users to decrease initiation of drugs, make drug treatment more accessible, provide simple techniques for cleaning needles such as a quick rinsing with bleach and water, and emphasizing the risks of sharing needles could decrease the exponential rise of HIV infection in IV drug users. A substantial percentage of women infected with both HIV and hepatitis B are unaware of their infection. Information, counseling, and antibody testing of men and women prenatally with informed options could reduce infection in children. Health care providers must work through their own valid issues of fear and possible discomfort with various lifestyles to function effectively in the health professions.
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PMID:Prevention of HIV transmission. 306 May 18

Doses of 150 and 450 mg RU-486 (mifepristone) were compared in a randomized double-blind trial for 2nd or 3rd trimester termination of pregnancy. The 35 women averaged 22.5 weeks gestation (range 15-34); indications were maternal (HIV infection or psychiatric), and fetal, including major genetic, chromosomal or fetal abnormalities not compatible with life. RU-486 was given orally in 9 50 mg tablets or placebos 48 hours before hospitalization. The evening upon entering the hospital they received 1.5 mg PGE2 in a vaginal suppository. Labor had ensued in 3 women before receiving PG. 150 mg of RU-486 improved cervical softening score from 0.73 to 3.3, and a cervical dilatation, judging by Hegar dilators, from 7.1 to 12.75. The 450 mg dose improved cervical score from 0.72 to 3.12, and cervical dilatation from 6.3 to 11.9 (mean n.s.). The mean interval to abortion in women 20 weeks gestation or more was 19.54 hours in the 150 mg group and 8.6 hours in the 450 mg group (n.s.). Those less than 20 weeks gestation were terminated by dilation and evacuation under general anesthesia. There were no clinical or hematological side effects. 5 patients have subsequently had normal full-term deliveries. This drug may be useful to help dilate the cervix, shorten the abortion time, and reduce the dose of prostaglandin needed. No side effects have been reported with these doses of RU-486 combined with prostaglandin for midtrimester abortion.
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PMID:Mifepristone (RU486) and therapeutic late pregnancy termination: a double-blind study of two different doses. 306 55

Details are presented on the outcome of pregnancy in a group of Edinburgh women identified as positive for antibodies to HIV and in women who had a history of drug abuse or a partner known to be seropositive but who were themselves negative for HIV antibody. Pregnant women who had been tested for HIV up to June 1987 were identified. HIV state was known for 205 pregnant women. Most cases were determined during pregnancy, but in 23 (9 seropositive patients) it was determined retrospectively. Seropositivity was only found in women who had been intravenous drug users or whose partner was known seropositive. Of 50 women who were seropositive, 46 were intravenous drug users and 4 had seropositive partners. In 64 cases who were seronegative, 45 had used intravenous drugs since 1983, and 19 had a seropositive partner. These women tended to be young, unmarried, and smoked heavily. They usually lived in areas of Edinburgh with multiple deprivation. Both they and their partners were usually unemployed. In the seropositive group, spontaneous abortion showed an apparent increase, but this may be due to differences in ascertainment as the incidence in the seronegative group was low. Premature delivery, intrauterine growth retardation, and low birth weight were common compared with the total population, but seropositive and seronegative women did not differ from each other in these variables. Compared with rates in the total population of Edinburgh, the rates of prematurity and intrauterine growth retardation were increased more than 2-fold and the rate of low birthweight babies was increased nearly 4-fold, though the 1 twin pregnancy contributed to this. Adverse outcome was equally distributed between the seropositive and seronegative women, and there was no suggestion that infection with HIV itself had any effect. Although no evidence from this study shows that infection with HIV per se affects the outcome of pregnancy, none of these women showed symptomatic illness.
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PMID:Does infection with HIV affect the outcome of pregnancy? 312 65

Ethical issues imposed on the United States by the maturing AIDS epidemic are discussed. In the 2 years since the U.S. Public Health Service predicted that 220,000 new cases of AIDS will appear by 1991, 5 times the number reported in the 1st 7 years, the projections appear to be remarkably on target. The sheer burden of these numbers, and their distribution, will affect the nation's social climate. The "ghettoization" of the disease will subject the voluntary education, counseling and testing policy to elements of coercion. A radical transformation of the culture regarding sexual behavior, childbearing and drug use will be required of the AIDS education campaign. The crippling moralism that inhibits education on sexual matters must be confronted. Efforts to prevent perinatal transmission of HIV will affect women's rights, the nature of counseling, the privacy of the abortion decision, and perhaps elements of coercion. Another serious issue is how to institutionalize and hospitalize poor and minority AIDS victims without turning the wards and hospitals into pariah institutions. Anxiety still persists among health care workers about their risk of contracting AIDS from their patients. A final ethical dilemma is how to allocate research, vaccine and drug testing, and treatment between wealthy and developing nations. The history of earlier epidemics teaches us that an objective, asocial response to disease is impossible: controversies between conflicting values will introduce numerous ethical dilemmas.
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PMID:AIDS and the ethics of public health: challenges posed by a maturing epidemic. 314 73

In an editorial comment on an article entitled Induced Abortions in Teenagers, it is pointed out that Norway has the highest abortion rate in Scandinavia for women between 15-19 and that the rate has been rising in Norway while decreasing in Denmark, Finland, and Sweden. Abortion is a preventable threat to health. Teenagers should be encouraged to postpone intercourse and the use of oral contraceptives, and this advice should be coupled with discussions on sexuality in general. Pregnancy among teenagers is often the result of a transitory relationship, and teenagers should be encouraged to learn the techniques of self control to gain enough confidence to say no to sex they do not desire. 1 study showed that 61% of women seeking abortion had not used any contraceptive at the time of conception. A marketing approach is needed to make use of condoms obligatory in sexual relationships among teenagers. Although condoms are an imperfect contraceptive, improper use is possible the most important cause of failure both for pregnancies and HIV infection. Condoms should be made easily available from machines installed in suitable places and instruction in proper use of condoms should be made a part of normal sex education. School authorities in cooperation with teachers and parents have clear responsibility to improve guidance and instruction in contraception.
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PMID:[Induced abortions in teenagers]. 320 28

AIDS has unique effects for women and children. Women at risk are: intravenous drug users, sexual partners of HIV positive men or women, and women receiving semen for artificial insemination. General practitioners are in the best position to provide counseling about HIV testing, safer drug use and safer sexual practices. HIV positive women need particular medical and emotional support. Discrimination is a real possibility so confidentiality and discretion should be exercised. Pregnancy exposes the fetus to the risk of contracting HIV and must be considered by any HIV positive women. Safer sex and contraception should be encouraged including abortion although it should never be forced on an HIV positive women. The care providers of HIV infected women must be informed of all the special needs and precautions that must be met. Children contract HIV form their HIV positive mothers or from transfusions because of hemophilia. It currently takes 15 months to determine whether a child is HIV positive. The added stress of guilt experienced by HIV infected mothers who infect their new born children needs special attention. Most of these children develop AIDS by age 2.
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PMID:How AIDS affects women and children. 324 26

Since the 1st cases of a new acquired immunodeficiency syndrome (AIDS) described by Oleske et al. and Rubinstein et al. in children in 1983, the authors have witnessed an ever-increasing number of such situations. As serology is not being performed on all pregnant women in many European countries, obstetricians must try to identify those belonging to risk groups: intravenous drug abusers, natives of affected regions, or women having travelled to these areas, women having numerous sexual partners, presenting with other sexually transmitted diseases or living with infected individuals, prostitutes, transfused women. If the woman belongs to a risk group, HIV antibody testing is to be done at the beginning of the pregnancy. The risks for the mother remain ill-defined, due in part to the difficulties inherent in keeping track of heroin abusers. Aggravation is certain if the mother is affected with AIDS or an associated syndrome called AIDS-related complex (ARC). It is debatable and at least more rare if the mother presents no clinical symptoms. Infant risk is becoming better known. The existence of materno-fetal contamination by the transplacental route is undebatable. However, contamination during delivery or during the passage through the genital tract cannot be excluded. The proportion of contaminated infants is about 40%. According to data which is known, obstetricians generally adopt the following procedures: abortion if recommended during the 1st trimester, free choice is given to the woman during the 2nd trimester, and during the 3rd trimester, delivery is carried out naturally. Cesarean section is done only when there are obstetrical indications. Breastfeeding is not advised. Infants do not receive live vaccinations and pediatricians are kept informed. The hope for the furture is that there will be an efficient vaccination and perhaps a prenatal diagnosis. Patients must insist on information and ways to help in the prevention process.
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PMID:Pregnancy and AIDS. 328 69


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