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

Worldwide, perinatal (i.e., mother to infant) transmission accounts for most human immunodeficiency virus (HIV) infections among children; in the United States, of the approximately 7000 infants born to HIV-infected mothers each year, 1000-2000 are HIV-infected. Strategies for reducing perinatally acquired HIV infection have included preventing HIV infection among women and, for HIV-infected women, avoiding pregnancy or refraining from breastfeeding their infants. On February 21, 1994, the National Institutes of Health's National Institute of Allergy and Infectious Diseases (NIAID) and National Institute of Child Health and Human Development (NICHD) announced preliminary results from a randomized, multicenter, double-blinded clinical trial of zidovudine (ZDV) to prevent HIV transmission from mothers to their infants (AIDS Clinical Trials Group [ACTG] protocol 076). This report summarizes the interim results of that trial, which indicate effectiveness of ZDV for prevention of perinatal transmission.
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PMID:Zidovudine for the prevention of HIV transmission from mother to infant. 815 53

To determine the effect of zidovudine on functional status and well-being in patients with early symptomatic human immunodeficiency virus (HIV) infection, 70 subjects in a randomized, placebo-controlled trial (ACTG Protocol 016) were observed for 1 year using a brief quality-of-life questionnaire. Thirty-four subjects were assigned to placebo and 36 subjects to zidovudine, 200 mg orally every 4 h (1,200 mg daily). Functional status and well-being were measured every 3 months using a 30-item self-administered questionnaire derived from health ratings from the Medical Outcomes Study. The mean changes from baseline for zidovudine versus placebo groups were compared using paired and two-sample t tests. Subjects receiving a placebo reported better quality of life compared to baseline than subjects receiving zidovudine at 24 weeks for all dimensions of well-being, including overall health, energy, mental health, health distress, pain, and quality of life. The difference between the two groups' changes from baseline for overall health was 11.5 points on a 100-point scale (p = 0.02), and 11.1 points for energy (0.002). There were no differences between changes from baseline along various dimensions of functional status (physical, social, role, and cognitive function). At 52 weeks both groups reported worse overall health than at baseline, and changes in scores were more similar for the two groups. Although zidovudine has previously been demonstrated to delay progression of disease for patients with mildly symptomatic HIV infection, early in treatment the net effect of a 1,200 mg daily dose of zidovudine may diminish patients' subjective well-being.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Functional status and well-being in a placebo-controlled trial of zidovudine in early symptomatic HIV infection. 848 9

Saquinavir is a peptide derivative which inhibits the HIV protease enzyme, preventing post-translational processing of viral polyproteins. It was the first agent of its class to become available for the treatment of HIV infection. Well controlled studies have assessed the effects of saquinavir, when used alone or in combination with reverse transcriptase inhibitors, in patients with advanced HIV infection. Analysis of CD4+ cell counts and measures of viral load in the ACTG 229 study suggest that triple therapy with saquinavir, zidovudine and zalcitabine is more effective than double therapy with saquinavir plus zidovudine or zidovudine plus zalcitabine in patients who have previously received long term treatment with zidovudine. Similar assessments from a small study in previously untreated patients suggest that double therapy with saquinavir plus zidovudine is more effective than monotherapy with either agent. Combination therapy with saquinavir and zalcitabine significantly reduced the time to the first AIDS-defining event or death, and the time to death, compared with zalcitabine alone, according to data from a large, long term study (NV 14256) in patients with advanced HIV infection who had previously received zidovudine. Saquinavir is generally well tolerated, either as monotherapy or in combination with reverse transcriptase inhibitors; no change in tolerability profile was reported when saquinavir was added to treatment with nucleoside analogues. In vitro and clinical studies have documented the emergence of saquinavir-resistant HIV strains. Although the possible impact of resistance on the clinical efficacy of saquinavir has yet to be fully characterised, genotypic and phenotypic resistance appear to develop slowly during treatment with saquinavir, and the drug does not appear to have a significant effect on the incidence of mutations associated with cross-resistance to other protease inhibitors. Thus, laboratory and clinical results suggest that saquinavir in combination with reverse transcriptase inhibitors is effective in the treatment of advanced HIV infection. Initial data on the effects of saquinavir on disease progression and mortality are promising, and the apparent absence of mutations conferring cross-resistance to other protease inhibitors is a potentially valuable clinical feature. Additional data on disease progression, mortality and viral resistance, together with information on relative efficacy (in comparison with other protease inhibitors), will need to be assessed before the clinical value of saquinavir can be fully determined. Nevertheless, saquinavir represents a valuable new pharmacological option for the treatment of HIV infection and is likely to be a useful component of combined therapy with reverse transcriptase inhibitors and/or other protease inhibitors.
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PMID:Saquinavir. A review of its pharmacology and clinical potential in the management of HIV infection. 879 87

The termination of the perinatal HIV transmission trial, ACTG 076, by the Data Safety and Monitoring Board in February 1994 because of the efficacy of zidovudine (ZDV) in substantially reducing maternal-infant HIV transmission has created a considerable need for efficacious patient education approaches and materials for women with and at risk of HIV infection. Complexities surrounding patients' decisions to use ZDV in accordance with the treatment arm protocol of this study must be communicated to women, especially the consequences for both themselves and their potential children. In March 1994, a public-private partnership was formed to develop and test the impact of patient education information on 076 and to explore cultural differences in decision-making surrounding ZDV use during pregnancy. Objectives were (1) to develop an efficacious patient informational booklet on the results of ACTG 076 and (2) to determine the differential attitudes and behavioral intentions of women toward taking AZT during pregnancy. A multi-disciplinary group of providers and researchers developed the patient education booklet and field-tested it in five New York City area sites. Subjects were a multiethnic group of women of childbearing age who were predominantly HIV-positive or at risk of HIV infection (n = 120). This 076 education resulted in a substantial increase in intention to use ZDV to reduce perinatal transmission despite full disclosure of the unknowns (P < .001). There were differences in knowledge acquired between racial/ethnic groups, which must be viewed cautiously since the study did not assess socioeconomic status adequately. Attitudes toward ZDV (P < .05), trust in health care providers (P < .03), and opinions on whether testing should be voluntary (P < .02) also varied by race/ethnicity. Medical Subject Headings (MeSH): perinatal transmission, AIDS education, pregnancy, HIV, ACTG 076.
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PMID:The impact of patient education about the effect of zidovudine on HIV perinatal transmission: knowledge gain, attitudes, and behavioral intent among women with and at risk of HIV. 887 4

With the results from the Delta and ACTG 175 clinical trials clearly showing an increased benefit of two drugs over monotherapy, combination nucleoside analog therapy looks set to play a major role in the battle against HIV. It is therefore essential that suitable combinations of drugs are used in clinical trials. We investigated the intracellular activation of zidovudine (ZDV), zalcitabine (ddC), and lamivudine (3TC) in MOLT-4 cells in two- and three-drug combinations at clinically achieved concentrations. The phosphorylation of ZDV and 3TC to their active triphosphate anabolites was not affected by the presence of the other drugs studied. However, the phosphorylation of ddC was significantly inhibited when incubated with 3TC, resulting in levels of ddC triphosphate (ddC-TP) less than 50% of control values. This can be explained by the requirement of both nucleoside analogs for the enzyme deoxycytidine kinase to carry out the initial step in their phosphorylation pathways, and by the comparatively low plasma concentrations of ddC achieved in vivo. These results suggest that regimens containing nucleoside analogs should be designed taking into account potential interactions affecting phosphorylation.
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PMID:In vitro screening of nucleoside analog combinations for potential use in anti-HIV therapy. 910 Sep 89

In the USA, the AIDS epidemic has shown dramatic increases among women and children in the past decade with more than 70,000 cases in women and 7000 cases in children reported. Acquired immunodeficiency syndrome is the seventh leading cause of death in children aged 1-4 years and the fourth leading cause of death among women aged 25-44 years. Data from the National Survey of Childbearing Women, a blinded serosurvey of blood specimens left over from routine metabolic screening of most infants born in the USA, indicate that approximately 7000 HIV-infected women have given birth each year for the past several years. Human immunodeficiency virus infection disproportionately affects African-Americans and women of Hispanic ethnicity. Most cases in women and children have come from states along the east coast and large urban areas. Pneumocystis carinii pneumonia (PCP) continues to be the most commonly reported opportunistic infection in children with AIDS. As of 31 December, 1995, 2383 cases of PCP had been reported to the Centers for Disease Control and Prevention. Revised guidelines for PCP prophylaxis published in 1995 will hopefully provide a better means for preventing this deadly infection in children with AIDS. In 1994, a clinical trial (ACTG 076) found that the risk of perinatal transmission could be reduced by two-thirds with the use of a zidovudine regimen given antenatally, during labor and delivery, and postnatally to the infant. The US Public Health Service published guidelines based on these results, recommending voluntary HIV counseling and testing for all pregnant women in the USA and zidovudine therapy for those women found to be HIV-infected. Since implementation of these guidelines, cases of perinatally acquired AIDS in children have begun to decrease. Adequate resources for provision of care, outreach to women who do not receive prenatal care, training of healthcare personnel and attention to the many social and psychological needs of HIV-infected women and their children are key factors for further reduction of HIV infection in children.
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PMID:Epidemiology of HIV/AIDS in women and children in the USA. 924 Aug 51

Mother to child transmission (MCT) of Human Immunodeficiency Virus (HIV) is the main cause of the spread of the HIV epidemic in the pediatric population. It is estimated that to date, three million children worldwide have been infected by HIV. The epidemic burden in developing countries is dramatic. Ninety-five percent of the world's HIV-infected women are living in developing countries. In industrialized countries, antiretroviral treatment of pregnant women and newborns with azidothymidine (AZT, ACTG 076 regimen) and discouraging breast feeding by HIV-infected mothers are effectively reducing MCT of HIV. However, there are three major obstacles to the systematic application of these strategies in developing countries: (a) difficulties in implementing the complex AZT administration and its corollary the avoidance of breast feeding; (b) the complexity of the logistics of the ACTG 076 regimen; (c) cost. Indeed, in developing countries the socioeconomic situation of the populations are precarious and health structures and services are underdeveloped. In addition, the anxiety and the reluctance of general population in the face of the HIV problem and the high prevalence of maternal anemia reduce the acceptability and safety of AZT treatment for pregnant women in developing regions. Only interventions that are applicable, acceptable, safe, affordable, of low cost and integrated into health system will be able to reduce HIV MCT. We now know that MCT occurs mostly during the perinatal period and the maternal viral load in blood, in cervical secretions and in breast milk appears to be the main determinant of transmission. Maternal vitamin A deficiency may also favor MCT of HIV. It is however possible that this association is confounded by the relationship between advanced maternal HIV disease (a known risk factor for transmission) and vitamin A deficiency. In spite of these uncertainties concerning determinants of MCT of HIV, several interventions have been designed. The first involves treating the mother with antiretroviral drugs for the perinatal period. The second is vaginal disinfection by application of virucidal antiseptics during the perinatal period. The third is to give vitamin A supplements to pregnant women and children. Finally, passive immunotherapy with anti-HIV antibodies applied to pregnant women and/or new born, may be beneficial. The feasibility, safety and efficacy of these potential interventions have not yet been demonstrated in developing countries. In view of the dramatic spread of HIV infection in these countries, the evaluation of these interventions is of utmost priority. These trials are necessary because of the public health emergency but should be performed in strict respect of human rights and medical ethics.
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PMID:[The reduction of mother-child transmission of HIV infection in developing countries: potential intervention strategies, obstacles to implementation and perspectives. The Reduction of Mother-Child Transmission of HIV Infection in Africa Group]. 927 18

It was published almost 3 years ago that zidovudine administered orally to HIV-infected pregnant women, intravenously during labor, and later administered to newborn infants reduces the incidence of HIV infection in infants by two-thirds. This regimen, known as the ACTG 076 regimen and capable of saving the life of one of every seven infants born to HIV-infected women, subsequently became the standard of care in the US. However, the high cost of zidovudine and the ACTG 076 regimen impedes their use in developing countries. A regimen as effective but less expensive than ACTG 076 is therefore highly desirable in countries worldwide, but especially in developing countries. The authors oppose the use of placebo-controlled trials as unethical in the search for alternative antiretroviral drug regimens to prevent the perinatal transmission of HIV. 15 trials in developing countries are identified in which some or all of the participants are not being provided with antiretroviral drugs. Those studies violate recent guidelines designed specifically to address ethical issues regarding studies in developing countries. An urgent need exists to develop and adhere to a universally recognized code of ethics for medical research upon human subjects.
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PMID:Unethical trials of interventions to reduce perinatal transmission of the human immunodeficiency virus in developing countries. 984 1

The findings of ACTG 076 have already resulted in local, state, and federal legislative initiatives targeted at pregnant and post-partum women and their newborns. This article advises clinicians and administrations on setting up successful voluntary prenatal HIV counseling and testing programs for early detection of HIV infection, and complying with the burgeoning array of legislative directives. Over the past several years their have been attempts to optimize and evaluate testing programs--perinatal ZDV counseling and administration of ZDV--and to link HIV-infected women with care in academic, community, and municipal hospitals. The suggestions are, therefore, broad enough to be applicable to a full array of clinical practices, from a private single provider office to a large hospital-based prenatal clinic. It is hoped that the models presented in this article can be replicated in diverse settings, and that readers can avoid the pitfalls and barriers sometimes encountered.
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PMID:Establishing a successful HIV counseling and testing service. A blueprint for preventing pediatric HIV infections and translating research into clinical practice. 943 Jan 72

HIV-1 infected pregnant woman with minor HIV-related symptoms insisted on her pregnancy. Having been on zidovudine prophylaxis (ACTG 076) she delivered a healthy girl and DNA PCR test indicated the lack of her infection. Principles of counselling, care and obstetric management of HIV infected pregnant women are also summarised.
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PMID:[Principles of counseling and care of HIV-1 seropositive pregnant women in the light of a Hungarian case]. 943 49


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