Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound

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Query: UMLS:C0021051 (immunodeficiency)
71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Identification of human immunodeficiency virus (HIV)-positive women during pregnancy provides an opportunity to reduce vertical transmission and optimize the care of HIV-infected mothers and children. However, the effectiveness of prenatal HIV screening depends on the prevalence of HIV in a given population, the capability to predict HIV risk based on demographic and behavioral factors, and the availability of services for HIV-positive pregnant women. This paper reviews the current literature on HIV risk factors in pregnant women in Africa, Asia, Europe, and the US and discusses possible strategies for HIV testing in these populations. Although several HIV risk factors among pregnant women in Africa have been consistently reported (e.g., multiple sex partners, history of other sexually transmitted diseases, positive syphilis serology, low parity), their predictive power is poor. Universal testing would be required, given the high prevalence of HIV, but medical resources to prevent vertical transmission are lacking. A large proportion of HIV-infected women in Asia have no identifiable risk factors, suggesting a need for universal screening; however, the majority of HIV-infected women in Asia do not seek prenatal care and would thus be missed. In Europe, where HIV prevalence is generally low among pregnant women, selective HIV screening in high-risk groups (e.g., intravenous drug users, abortion patients) may be effective. Finally, in the US, HIV seroprevalence among pregnant women and the salient risk factors show wide variation by race and region. As in Asia, the effectiveness of universal HIV screening would be impeded by limited access to prenatal care among high-risk women.
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PMID:Risk factors for HIV in pregnant women. 894 Jun 66

Although Thailand's National Family Planning Program introduced Norplant contraceptive implants in 1986, few women infected with human immunodeficiency virus (HIV) select this method, and its efficacy, clinical effects, and side effects in this population have not been investigated. To address these issues, a prospective cohort study was conducted during 1993-96 of 41 asymptomatic HIV-infected women who presented to the Family Planning Clinic at Ramathibodi Hospital in Bangkok, Thailand, and voluntarily accepted Norplant implants. All implants were inserted within 4 weeks after delivery or abortion. 63.4% of acceptors had not used any contraceptive method prior to pregnancy. At 6 and 12 months after insertion, 26% and 23%, respectively, reported irregular menstrual periods and 24.4% and 36.6%, respectively, reported amenorrhea. Side effects, reported by 3-10% of women, included headache, acne/chloasma, anorexia, and nausea. There were no significant changes in body weight, blood pressure, and hemoglobin between insertion and the 12-month follow-up. No pregnancies occurred during the study period. These findings suggest that Norplant implants are an effective, appropriate contraceptive method for HIV-infected women who want to avoid pregnancy but are not interested in sterilization.
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PMID:Use of Norplant implants in asymptomatic HIV-1 infected women. 917 51

In light of new evidence suggesting that maternal human immunodeficiency virus (HIV) infection produces at least a three-fold increase in the number of early spontaneous abortions, it is important to search for factors that may predispose to fetal wastage. Immunological factors are thought to play an important role in permitting the HLA-disparate fetus to continue to term, despite powerful maternal immune forces capable of rejection. In the context of a heightened incidence of spontaneous abortion in HIV infection, evidence is now accumulating that implicates an imbalance in immune factors in contributing to this fetal loss. Soluble immune factors, such as cytokines, have been suggested as contributing agents to recurrent spontaneous abortions. Inflammatory cytokines-interleukin 1beta, interleukin 6 and tumor necrosis factor alpha-have been measured in isolated placental trophoblastic cells in HIV-infected and non-infected pregnant women in an attempt to explore this hypothesis. These inflammatory cytokines and their messenger RNAs were significantly elevated before and after stimulation in HIV-infected women, supporting the belief that HIV-infected women present their fetuses a milieu of imbalanced immune factors capable of contributing to immunological rejection. In addition, these elevated inflammatory cytokine levels may contribute to HIV disease progression in fetuses by virtue of activation of HIV gene transcription factors similar to what has been demonstrated in in vitro systems. We therefore propose that HIV infection in pregnant women produces an altered state of certain soluble immune factors, which in concert with other immune factor abnormalities, such as loss of immune selection in the fetal thymus, predisposes the fetus to advanced HIV infection and possible spontaneous abortion.
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PMID:Role of placental cytokines and inflammation in vertical transmission of HIV infection. 924 Aug 55

Tuberculosis has re-emerged as a serious health problem throughout the world. In the United States, the human immunodeficiency virus epidemic, increased numbers of foreigners from areas where tuberculosis is endemic, and lack of an adequate infrastructure to deal with the large increase of new cases have led to tuberculosis being a serious problem. Because of the long treatment time required, there is a significant risk of developing drug resistance in partially treated patients. Directly observed therapy is a cornerstone of treatment in both pregnant and nonpregnant patients. We need to think about those at risk for tuberculosis in pregnancy and screen the high-risk population. With the advent of satisfactory drugs to treat tuberculosis, the effects on pregnancy are not as serious as before. However, particularly in low socioeconomic populations, tuberculosis probably increases the prematurity and abortion rate.
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PMID:Tuberculosis in pregnancy. 929 22

Histological lesions occurring in the placenta of human immunodeficiency virus positive women are rare and non specific and opportunistic infections are exceptional. We report the case of a female intravenous drug abuser with AIDS, who had an abortion associated with fever. Histological, immunohistochemical and ultrastructural studies of the placenta allowed the diagnosis of toxoplasmic infection. In comparison of the high frequency of toxoplasmic lesions seen in different organs, we did not find any case in the literature of placenta toxoplasmosis in AIDS.
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PMID:[Placenta toxoplasmosis in the course of AIDS. Immunohistochemical and ultrastructural study of a case]. 947 Nov 49

This review highlights recent studies that investigate causes and treatments for recurrent pregnancy loss. Generally the causes of recurrent pregnancy loss are classified as genetic, endocrinologic, anatomic, immunologic, microbiologic, and environmental. The majority of recent work has focused on potential autoimmune and alloimmune causes; however, controversy still exists over appropriate testing and treatment. Reports have investigated the potential associations between autoimmune factors (antithyroid antibodies and antiphospholipid antibodies) and alloimmune factors (natural killer cells, cytotoxic T cells, and embryotoxic factors) and recurrent pregnancy loss. Increasingly, clinical reports are suggesting intravenous immunoglobulin as a potential treatment for these immunologic problems. Several lines of investigation have suggested certain hypercoagulable states as causative of recurrent pregnancy loss. New studies relating recurrent pregnancy loss to endocrinologic aberrations (hyperprolactinemia and hyperandrogenism) as well as social/environmental factors (stress, caffeine use, tobacco use, human immunodeficiency virus, and history of induced abortion) have been made. A summary of proposed evaluation and treatment options is presented.
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PMID:Recurrent pregnancy loss: an update. 1052 18

Doubtless, the technological advancements achieved in the current century in the area of young women's reproductive health care have also led to the evolution of very important ethical issues that will have to be dealt with in the coming century. Abortion, perhaps the most controversial issue of all, continues to raise a number of ethical issues related to the rights of the women versus the rights of the fetus, which, in addition to the risk of sexually transmitted diseases including the human immunodeficiency virus, emphasize the need for adequate family planning and sexual education. Genetic testing for late-onset diseases, disease susceptibilities, and carrier status may offer medical or psychological benefits; however, several complex ethical, legal, and social issues have been revealed with the advent of this new information. New family structures deviating from the traditional heterosexual couple, consisting of either single or lesbian mothers, have appeared, raising serious disputes regarding the welfare of the child. Important demographic changes are expected in the world population in the 21st century, characterized mainly by a significant increase of the older age groups.
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PMID:Ethical aspects of reproduction in the next century. 1081 25

The objective of this study was to examine the effect of duration of human immunodeficiency virus (HIV) infection on a woman's likelihood of giving birth. Using longitudinal data from the Maryland state Human Immunodeficiency Virus Information System and a retrospective cohort design, the authors compared 1,642 women with acquired immunodeficiency syndrome (AIDS) to 8,443 uninfected women enrolled in the Medicaid program between 1985 and 1995. The decade before AIDS diagnosis was divided into four 2.5-year periods. Proximity to AIDS diagnosis served as a proxy for duration of infection. An extension of the Cox model was used to estimate the relative risk for giving birth, with adjustment for covariates and repeated outcomes. The average number of births per 100 person-years was 6.0 for HIV-infected women and 11.1 for uninfected women (adjusted relative risk = 0.63; 95% confidence interval (CI): 0.57, 0.68). Accounting for duration of infection, the adjusted relative risks for birth among HIV-infected women, as compared with uninfected women, were 0.85 (95% CI: 0.71, 1.03), 0.74 (95% CI: 0.63, 0.86), 0.55 (95% CI: 0.47, 0.64), and 0.45 (95% CI: 0.38, 0.55) for successive 2.5-year periods before AIDS diagnosis. Demographic characteristics, contraception, abortion, fetal loss, or drug use could not fully explain the reductions. These results suggest that HIV-infected women experience a progressive reduction in births years before the onset of AIDS. This may compromise estimation of HIV prevalence and interpretation of time trends from serosurveillance of pregnant women.
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PMID:Duration of human immunodeficiency virus infection and likelihood of giving birth in a Medicaid population in Maryland. 1085 41

Studies in normal, gene-deleted, transgenic and mutant mice have examined apoptotic cell death and its role in B lymphopoiesis in bone marrow. Apoptotic activity has been quantitated among phenotypically defined populations of precursor B cells using flow cytometry of apoptotic cells and an established model of B-cell development. In normal mice, the frequencies of apoptotic cells (apoptotic index) and accumulation of apoptotic cells during short-term culture (apoptotic rate) are maximal at around the pro/pre-B-cell transition and among immature B lymphocytes. The brief period between onset of apoptosis and clearance by macrophages (apoptotic transit time) is similar for most precursor B-cells. Apoptosis-modulating factors produce substantial changes in apoptotic activity among pro-B and pre-B cells, associated with altered expression of bcl-2 family proteins. Pro-B-cell apoptosis, normally extensive, is markedly suppressed in the absence of p53. Complete pro-B-cell abortion in RAG-2 deletion provides an assay for apoptotic fractions in other experimental systems. Pre-B-cell apoptosis is enhanced by deficiencies of interleukin (IL)-7, Abl protooncogene or colony-stimulating factor (CSF)-1 and overexpression of heat-stable antigen, and is inhibited by IL-7 and p190bcr/abl transgenes. CSF-1 and melatonin administration inhibit pre-B-cell apoptosis, probably via stromal cell stimulation. Such apoptotic modulation has implications for B-cell homeostasis, quality control, immunodeficiency and neoplasia.
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PMID:Apoptosis and its modulation during B lymphopoiesis in mouse bone marrow. 1093 1

Interleukin-1 receptor antagonist (IL-1RA) is a naturally occurring competitive inhibitor of interleukin-1 (IL-1)-induced proinflammatory activity. The IL-1RA gene is polymorphic, resulting in quantitative differences in both IL-1RA and IL-1beta production. Persons homozygous for allele 2 of the IL-1RA gene (IL1RN*2) have a more prolonged and more severe proinflammatory immune response than persons with other IL-1RA genotypes. Thus, being IL1RN*2 homozygous might be beneficial when combating infectious agents or malignantly transformed cells, but it might be detrimental for those with chronic inflammatory conditions or who are pregnant. The IL1RN*2 phenotype is associated with ulcerative colitis and Crohn's disease, lupus erythematosus, vulvar vestibulitis, and possibly with osteoporosis and coronary artery disease. IL1RN*2 homozygosity may also be associated with recurrent spontaneous abortion, preterm birth, and severity of preeclampsia. Conversely, there are negative associations between IL1RN*2 homozygosity and vaginal colonization with mycoplasmas, infection with human cytomegalovirus and Epstein-Barr virus, human immunodeficiency virus proliferation, and the occurrence of ovarian cancer.
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PMID:Influence of interleukin-1 receptor antagonist gene polymorphism on disease. 1174 Jul 9


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