OBJECTIVE: Our purpose was to describe the lymphocyte subpopulations in genital tract samples from human immunodeficiency virus–infected women and the clinical correlates associated with lymphocyte ...shedding. STUDY DESIGN: Genital tract samples of women infected with human immunodeficiency virus-1 were processed for immunophenotyping analysis with a FACScan flow cytometer. Immunologic and virologic characteristics of women with and without lymphocyte shedding were compared with t test, Wilcoxon rank test, or Fisher's exact test. RESULTS: The rate of genital lymphocyte shedding among human immunodeficiency virus-1–infected women was 39%. Genital shedding was not related to age, race, use of antiretroviral therapy, or positive human immunodeficiency virus-1 culture. A negative rank correlation (r = −0.71, p = 0.047) between CD3+CD4+ counts in peripheral blood and genital tract was observed. The majority of the lymphocyte cells were CD3+CD8+, and >80% of the CD3+CD4+ cells were memory cells. CONCLUSION: The immune profile of the genital tract lymphocytes is suggestive of a local mucosal immune response. (Am J Obstet Gynecol 1997;176:158-65.)
A high delivery maternal plasma HIV-1 RNA level (viral load VL) is a risk factor for mother-to-child transmission and poor maternal health.
To identify factors associated with detectable VL at ...delivery despite initiation of highly active antiretroviral therapy (HAART) during pregnancy.
Multicenter observational study. (ClinicalTrial.gov: NCT00028145).
67 U.S. AIDS clinical research sites.
Pregnant women with HIV who initiated HAART during pregnancy.
Descriptive summaries and associations among sociodemographic, HIV disease, and treatment characteristics; pregnancy-related risk factors; and detectable VL (>400 copies/mL) at delivery.
Between 2002 and 2011, 671 women met inclusion criteria and 13.1% had detectable VL at delivery. Factors associated with detectable VL included multiparity (16.4% vs. 8.0% nulliparity; P = 0.002), black ethnicity (17.6% vs. 6.6% Hispanic and 6.6% white; P < 0.001), 11th grade education or less (17.6% vs. 12.1% had a high school diploma; P = 0.013), initiation of HAART in the third trimester (23.9% vs. 12.3% and 8.6% in the second and trimesters, respectively; P = 0.003), having an HIV diagnosis before the current pregnancy (16.1% vs. 11.0% during the current pregnancy; P = 0.051), and having the first prenatal visit in the third trimester (33.3% vs. 14.3% and 10.5% in the second and third trimesters, respectively; P = 0.002). Women who had treatment interruptions or reported poor medication adherence were more likely to have detectable VL at delivery.
Data on many covariates were incomplete because women entered the study at varying times during pregnancy.
A total of 13.1% of women who initiated HAART during pregnancy had detectable VL at delivery. The timing of HAART initiation and prenatal care, along with medication adherence during pregnancy, were associated with detectable VL at delivery. Social factors, including ethnicity and education, may help identify women who could benefit from focused efforts to promote early HAART initiation and adherence.
U.S. Department of Health and Human Services.
The objectives of this study were to ascertain the acceptance rate of human immunodeficiency virus type 1 (HIV-1) testing in a high-prevalence area and to describe the sociodemographic and clinical ...characteristics of seropositive women diagnosed in the prenatal setting.
A retrospective review was carried out of the prenatal HIV-1 counseling and testing program at University Hospital, Newark, NJ (1989-1990).
Sixty-seven percent (741/1,114) of the women offered HIV-1 counseling services accepted testing and 40 (40/741:5.3%) new cases were identified. Heterosexual contact was the primary exposure (17:52%) of these women, of whom 13 (73%) had negative syphilis serologies. Sixty-four percent were asymptomatic. The mean absolute CD4 lymphocyte count in seropositive women was 514 +/- 305 cells/mm(3) . Severe immunosuppression was seen in 7/32 (22%) patients. Seventy-three percent (24/33) depended on public-assistance programs for their health-care services.
A voluntary HIV-1 counseling and testing program is well accepted in the prenatal setting. It can provide early identification of asymptomatic seropositive women and infants at risk and lead to early intervention and therapy.
Objective: The objectives of this study were to ascertain the acceptance rate of human immunodeficiency virus type 1 (HIV-1) testing in a high-prevalence area and to describe the sociodemographic and ...clinical characteristics of seropositive women diagnosed in the prenatal setting. Methods: A retrospective review was carried out of the prenatal HIV-1 counseling and testing program at University Hospital, Newark, NJ (1989-1990). Results: Sixty-seven percent (741/1,114) of the women offered HIV-1 counseling services accepted testing and 40 (40/741:5.3%) new cases were identified. Heterosexual contact was the primary exposure (17:52%) of these women, of whom 13 (73%) had negative syphilis serologies. Sixty-four percent were asymptomatic. The mean absolute CD4 lymphocyte count in seropositive women was 514 ± 305 cells/mm^3. Severe immunosuppression was seen in 7/32 (22%) patients. Seventy-three percent (24/33) depended on public-assistance programs for their health-care services. Conclusions: A voluntary HIV-1 counseling and testing program is well accepted in the prenatal setting. It can provide early identification of asymptomatic seropositive women and infants at risk and lead to early intervention and therapy.
Idiopathic myelofibrosis is a rare myeloproliferative disorder characterized by excessive accumulation of connective tissue in the bone marrow in association with anemia, splenomegaly, and ...extramedullary hematopoiesis. The cause of this disease is unknown, and the prognosis is generally poor. To our knowledge, this is the first case report of a patient with idiopathic myelofibrosis who carried a term pregnancy. In spite of the increased perinatal risks, a favorable outcome was possible with close antepartum surveillance.
Prenatal diagnosis of maternal diseases common to HIV infection may alert the clinician to potential HIV infection in the infant, with resultant early diagnosis and treatment. Although of limited ...value in the first months of life, imaging studies can be beneficial in selected cases and may be the first clue to the diagnosis of AIDS. The multisystem involvement frequently seen in AIDS necessitates multiple imaging modalities. Recurrent pneumonia, particularly Pneumocystis carinii pneumonia, may be first suggested by the chest radiograph. Brain atrophy and white matter disease, shown on MR imaging or CT early in life, can suggest AIDS. Ultrasonography is not only crucial for prenatal fetal assessment, but it also is important for evaluation of the common findings of hepatomegaly, adenopathy, and tumors, as well as inflammatory fluid collections.
Zidovudine remains part of combination antiretroviral therapy. Pharmacological studies rely on quantitation of active triphosphates in peripheral blood mononuclear cells. This study evaluated the ...impact of female sex and contraceptive therapy on zidovudine plasma and intracellular pharmacokinetics and the impact of contraceptive therapy on HIV viral load.
Serial plasma and intracellular zidovudine pharmacokinetics following oral and intravenous dosing were determined in 18 men and 20 women treated with zidovudine. Women could repeat pharmacokinetics assessment following 2 months oral or injectable contraceptive therapy. Zidovudine plasma and intracellular mono-, di- and triphosphate concentrations were determined by liquid chromatography tandem mass spectrometry. Plasma and cervical viral loads were determined preceding and following 2 months of contraceptive therapy in women.
Men exhibited higher area under the concentration versus time curve for intracellular zidovudine and zidovudine-monophosphate following oral and intravenous dosing and higher zidovudine triphosphate following oral dosing. There was no difference between men and women in plasma zidovudine parameters. Furthermore, contraceptive therapy had no effect on zidovudine plasma or intracellular pharmacokinetics or on plasma or cervical HIV-1 RNA levels.
Using an optimized pharmacokinetic design, this study indicated men exhibit significantly higher zidovudine-monophosphate and zidovudine-triphosphate exposure following zidovudine oral administration, having implications for drug toxicity and overall tolerance of zidovudine therapy. The lack of an effect of contraceptive therapy on zidovudine pharmacokinetics is surprising in light of previous pharmacokinetic studies for drugs eliminated primarily through glucuronidation. Contraceptive therapy had no effect on plasma or cervical viral load, results consistent with previous findings.
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