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 7,134 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We present the baseline results of a prospective cohort study on the perinatal transmission of HIV-1 in Kigali, Rwanda. HIV-1-antibody testing was offered to all women of urban origin delivering a live newborn at the maternity ward of the Centre Hospitalier de Kigali from November 1988 to June 1989; 218 newborns of 215 HIV-positive mothers were matched to 218 newborns of 216 HIV-negative mothers. The matching criteria were maternal age and parity. No differences in socioeconomic characteristics were observed between HIV-positive and HIV-negative women. HIV-positive mothers more frequently reported a history of at least one death of a previously born child (P less than 0.01) and a history of abortion (P less than 0.001). Most of the HIV-positive women were asymptomatic, but 72.4% of them had a CD4; CD8 ratio less than 1 versus 10.1% in the HIV-negative group (P less than 0.001). The frequency of signs and symptoms was not statistically different in the two groups, except for a history of herpes zoster or chronic cough, which was more frequent among HIV-positive women. The rates of prematurity, low birth weight, congenital malformations and neonatal mortality were comparable in the two groups. However, infants of HIV-positive mothers had a mean birth weight 130 g lower than the infants of HIV-negative mothers (P less than 0.01). The impact of maternal HIV-1 infection on the infant seems limited during the neonatal period.
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PMID:Perinatal transmission of HIV-1: lack of impact of maternal HIV infection on characteristics of livebirths and on neonatal mortality in Kigali, Rwanda. 205 69

In a national multicentre study, 229 pregnancies in 219 HIV-positive women were prospectively followed up between January 1, 1990, and October 30, 1993. 69.8% were infected by intravenous drug abuse and 91.5% were asymptomatic (CDC classes II and III) in early pregnancy. 48 (21.0%) were first discovered to be HIV-infected during the index pregnancy: 46 of these had risk factors. The present epidemiologic development does not seem to warrant a general HIV-screening in pregnancy at this time. 71 pregnancies (31%) were terminated; 158 children were born, 17 (23.3%) of the 73 definitely classified are HIV-infected. An asymptomatic HIV infection with a sufficiently high (> 200/microliters) CD4 cell count has no proven influence on the pregnancy. Otherwise, however, maternal infectious diseases can lead to prematurity. For mothers with i.v. drug abuse, there is a significantly higher incidence of prematurity and fetal growth retardation. The maternal HIV infection can be transmitted to the child either during pregnancy or at delivery. The incidence of vertical transmission in our study was 23.3%; the most predictive parameter for a prenatal HIV transmission is a low anti-p24 antibody titre. The risk of intrapartum transmission seems to be somewhat, but not significantly, reduced for primary Caesarean sections. Recently, prophylaxis with Zidovudin during pregnancy, beginning after the 14th GW, was found to reduce vertical HIV-transmission by 66%. Since the virus can also be transmitted through mothers' milk, HIV-positive mothers should not nurse their babies. Maternal infections are significantly more frequent in HIV-positive women, and are a risk factor for prematurity.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Pregnancies in HIV infected women in Switzerland]. 755 20

HIV infection in children is mainly the result of a mother-to-child transmission. The contamination during pregnancy is well known but intrapartum vertical transmission may also occur through ascending infection, blood exchange between mother and child, or direct contact with vaginal or cervical secretions. In addition HIV can be transmitted via breast milk. The reported rates of vertical transmission are highly variable: 14.4% in a European study, 18.3% in a French survey, 20 to 25% in the USA, 35 to 50% in Africa. It is unclear whether such a large variation of the rate of transmission is due to methodological differences or to different distributions of risk factors in the populations. There are some known predictive factors of HIV transmission such as low CD4 cells count, positive p24 antigenaemia and elevated concentrations of virus. The role of other factors is still debated: prematurity, virus (CMV, HTLV-1, HVB, HVC), C section prior labour, rupture of membranes. The prevention of HIV infection in infants is mainly based on contra-indication of pregnancy in infected women, desinfection of the vagina at the beginning of labour, early protection of the newborn by avoiding skin lesions and immediate washing, preventive treatment by zidovudin during pregnancy.
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PMID:[Maternal-fetal transmission of HIV]. 773 51

In the Swiss Study "HIV and pregnancy" we observed 153 singleton pregnancies of HIV-positive women. 23 (15%) of those ended with a premature delivery. For drug addicts (n = 100), the incidence of prematurity, 20%, significantly higher than in those free of drugs (n = 53) with 5.6%. The most frequent cause of prematurity was premature labor or rupture of the membranes (n = 13), followed by maternal illness (n = 8) and fetal complications (n = 2). Women with premature delivery tended to have lower CD4 cell counts than those with term delivery (29.4% vs 12.0% with < 200 CD4 cells/microliters). Low CD4 cell counts and drug consumption are two independent but cumulative risks for severe infections. 16 of the 153 women (12 with, 4 without drug consumption) had severe infections during pregnancy; in 4 cases (25%), this led to prematurity. The most common infection was pneumonia (14/16), further one case of pyelonephritis and one of cerebral toxoplasmosis. Two of these 16 infants (12.5%) were HIV-positive. We could not confirm a relationship between prematurity and vertical HIV transmission. Of the HIV-classified children, 3/18 (16.7%) premature infants and 16/74 (21.6%) term infants were infected.
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PMID:[Premature labor in HIV infected women. Swiss "HIV and Pregnancy" Study Group]. 778 79

Infection with HIV may significantly affect the human immune response. Depletion of CD4 T cells directly or indirectly results in global immune dysfunction, including both cellular and humoral components of the immune system. Ongoing viral replication leads to progressive immune destruction despite apparent clinical latency. The end result, if left untreated, is CD4 T-cell depletion, severe immune compromise, opportunistic infection, and eventual death. Pregnancy has been purported to induce an altered immune state to protect the fetus from immune rejection that may leave the mother with impaired immunity. This theoretical risk has been overemphasized, and, in fact, only limited data suggest that certain infections may have worse presentations and outcomes during pregnancy. The mother maintains immunocompetence throughout gestation and is not overwhelmed with opportunistic infection. Women infected with HIV may experience some decline in CD4 T-cell percentages and possibly in function. It is not clear whether any of the effects will significantly affect long-term outcome. Infection with HIV may predispose pregnant women to a variety of adverse pregnancy outcomes, including preterm labor, prematurity, low-birth-weight infants, postpartum endometritis, and other infectious morbidity. Larger controlled studies are necessary to determine the frequency of these adverse outcomes and whether they will predominantly affect the severely immunocompromised HIV-infected pregnant women.
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PMID:Immunology of HIV and pregnancy. The effects of each on the other. 943 Jan 69

HIV load and CD4 cell numbers were measured among 95 HIV infected women during pregnancy in order to determine their value as prognostic markers for transmission of virus from mother to infant. Among the 94 live births, 13 children were infected with HIV, 69 were uninfected and 12 were of unknown infection status. HIV RNA levels, as measured by nucleic acid sequence based amplification, were significantly higher (P < 0.001) in women who transmitted virus than among those who did not transmit and maternal viral load was a stronger predictor of transmission than CD4 cell number. The predicted rate of transmission relative to maternal HIV RNA was 2% at 1,000 copies, 11% at 10,000 copies and 40% at 100,000 copies/ml. Little variation in viral load occurred during pregnancy and there was an association between viral load and prematurity, the mean gestation at delivery decreasing by 1.3 weeks for every 10-fold increase in maternal HIV RNA (P = 0.007). This study demonstrates that a high level of maternal HIV RNA is a risk factor for transmission of virus to the infant and maternal viral load is of more value as a prognostic marker for transmission risk than CD4 cell number. High viral load is also associated with premature delivery. Maternal viral load is therefore a useful marker on which to base management decisions during pregnancy.
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PMID:Maternal viral load, CD4 cell count and vertical transmission of HIV-1. 949 69

The patient M.S, 24 years old has been admitted to the Department of Obstetrics and Perinatology of University School of Medicine in Lublin with diagnosis: V pregnancy, bronchial asthma. History taken from the patient revealed four recurrent pregnancy losses. The patient has taken prednisone in the dose 10 mg per day for several weeks. After performing immunological phenotyping of lymphocytes we have found some alterations in the patient's immune status: increased T CD4:TCD8 ratio, increased percentage of B CD19+ and B CD19+5+ lymphocytes, increased percentage of Natural Killer cells CD3(-)16/56+, deficiency of T CD8+ suppressor lymphocytes and increased expression of CD25 and HLA-DR antigens on T CD4+ lymphocytes. According to the obtained results we have increased prednisone dose to 20 mg per day. After forty days of prednisone therapy in the dose mentioned above patient's immunological status has evolution favorably: T CD4:TCD8 ratio decreased, percentage of B CD19+ and B CD19+5+ lymphocytes decreased, percentage of Natural Killer cells CD3(-)16/56+ decreased, the expression of CD25 and HLA-DR antigens on T CD4+ lymphocytes decreased. Due to the PROM (premature rupture of membranes), and obstetric anamnesis the patient was qualified for caesarean section (21st of September 1998). Male baby was born in good general condition (weight 1180 g, Apgar score 8 pts.). The baby was discharged from Prematurity Department 10th of November 1998 in good general status (weight 2180 g). The child was observed for one year after being discharged from the ward, psycho-physical development is normal.
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PMID:[Pregnancy after four recurrent pregnancy losses: a case report]. 1100 58

Tuberculosis is the commonest HIV-1-related disease and the most frequent cause of mortality in young women in endemic regions. Tuberculosis and HIV-1 are independent risk factors for maternal mortality and adverse perinatal outcomes, and in combination have a greater impact on these parameters than their individual effects. In referral health centres in southern Africa around one-sixth of all maternal deaths are due to tuberculosis/HIV-1 coinfection. One-third (37%) of HIV-1-infected mothers with tuberculosis are severely immunocompromised, with CD4 counts of fewer than 200 cells/microL compared with 14-19% in mothers recruited into major mother-to-child intervention trials in Europe. Babies born to mothers with tuberculosis/HIV-1 also have higher rates of prematurity, low birthweight, and intrauterine growth restriction. Transmission rates of HIV-1 from mother to infant are around 25-45% in resource-limited settings, while that for mother-to-child-transmission of tuberculosis is 15% within 3 weeks of birth. We highlight this emergent problem, and discuss the dilemmas associated with diagnosis and management of pregnant HIV-1-infected mothers with tuberculosis, and their newborn babies.
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PMID:Perinatal tuberculosis and HIV-1: considerations for resource-limited settings. 1499 1

Transmission of the Human Immunodeficiency Virus type 1 (HIV-1) from mother to child has been associated with maternal plasma viral load and CD4 lymphocyte count, prematurity, the mode of infant delivery, length of rupture of membranes and breast feeding. Without intervention, the transmission of HIV-1 occurs in a quarter to a third of infants born to infected mothers. During the last decade, mother-to-child transmission of HIV-1 has been reduced to less than 1%, through formula feeding, prelabour Caesarean section (PLCS) and antiretroviral therapy. With such an impressive reduction in the transmission of HIV-1, attention is turning towards the minimisation of possible drug side effects both in mothers and their infants. HIV-1-infected women are increasingly choosing to conceive on combination antiretroviral therapy, hence, infants are exposed to increasing numbers, combinations and classes of drugs, often from conception. Current guidelines on the prevention of mother to child transmission of HIV-1 are discussed.
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PMID:Current guidelines for the management of UK Infants born to HIV-1 infected mothers. 1570 21

Prior to the introduction of interventions reducing mother-to-child transmission of HIV-1 natural history data reports vertical transmission rates in the order of 25%. The risk of transmission from mother-to-child has been associated with advanced maternal HIV disease, maternal plasma HIV viral load and CD4 lymphocyte count, mode of delivery, length of rupture of membranes, prematurity and breast feeding. During the last 10-15 years the introduction of prelabour cesarean section, formula feeding and antiretroviral therapy has reduced transmission to less than 1% for pregnant women in the UK who are aware of their HIV status. Attention is now turning to the minimization of possible drug side effects for both mother and infant as women are increasingly conceiving on combination antiretroviral therapy. The evolution of current UK guidelines on the prevention of mother-to-child transmission of HIV-1 are discussed.
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PMID:HIV in pregnancy: evolution of clinical practice in the UK. 1705 34


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