No abstract

This is the first longitudinal evaluation of perceived quality of life in HIV-positive pregnant subjects. We conclude that perceived quality of life differs between HIV-positive and HIV-negative pregnant women. These differences may not be manifest during initial antenatal visits but may develop as pregnancy, the disease process, and other life events specific to delivery and the postpartum period interact and affect overall perceived quality of life. Longitudinal evaluation of quality-of-life issues may be important in the comprehensive care of HIV-positive women during pregnancy.

OBJECTIVES: To assess the knowledge of universal precautions for the delivery and operating rooms by residents and students and to evaluate their use of universal precautions. STUDY DESIGN: Obstetrics and gynecology (ob/gyn) residents (n = 30) and students (n = 31) from an inner-city, teaching hospital were polled by anonymous questionnaire to assess their knowledge of the appropriate barrier equipment for certain ob/gyn procedures. To determine actual compliance with universal precautions, 459 ob/gyn procedures were observed. We noted the use of appropriate barrier equipment for each procedure: gloves for pelvic exam and face shields, gowns, gloves, and booties for vaginal delivery, cesarean delivery, and dilation and curettage. The True Epistat statistical software program was used to perform simple regression analysis. RESULTS: Thirty residents (100%) knew the appropriate barrier equipment required for each type of procedure performed. One student (< 1%) did not know that booties were appropriate for the surgical procedures. Rationale for lack of compliance with universal precautions elicited by the questionnaire included time constraints (64%), inconvenience (52%), and presumption that patient was not infected (34%). The observed rate of compliance with universal precautions by participants indicates that individual compliance was inversely related to the years of experience (overall compliance rate of students was 96%; for first-year residents, 92%, second-year residents, 89%, third-year residents, 84%, fourth-year residents, 78%; r = -0.9918, P = 0.0009). CONCLUSIONS: Knowledge regarding universal precautions was nearly 100%, while overall observed compliance was only 89%. Compliance with universal precautions was better among students (96%) than among residents (88%). Compliance with universal precautions was inversely related to years of experience.

The inflammatory cytokines interleukin-1␤ (IL-1␤), IL-6, and tumor necrosis factor alpha (TNF-␣) have been associated with increased human immunodeficiency virus (HIV) expression and enhanced lymphocyte adhesion to trophoblastic cells in experimental systems. To determine if there is a correlation between the expression of these cytokines and the levels of HIV transcripts in trophoblasts of term placentas from HIV-infected women, we studied the placentae of 30 HIV-positive and 13 control gravidae. Twenty-three of the HIV-positive women received zidovudine (ZDV) as prophylaxis against HIV vertical transmission; only one of the seven women who did not receive ZDV was a transmitter, for an overall vertical transmission rate of 3.8%. Cytokine production was measured by enzyme-linked immunosorbent assay in the supernatants of trophoblastic cell cultures. Additionally, cytokine transcripts and HIV gag sequences were determined by a quantitative reverse transcription-PCR assay. In general, trophoblastic cells of HIV-positive placentas expressed significantly higher levels of IL-1␤, IL-6, and TNF-␣ than those of control placentas. All placentas from HIV-positive women expressed HIV gag transcripts at either a low (<156 copies per g of total RNA) or a high (>156 copies per g of total RNA) level. There was a statistically significant positive association between the basal level of TNF-␣ production and the level of HIV gag transcripts of HIV-positive placental trophoblastic cells. Nevertheless, these data, coupled with a low transmission rate, would indicate that some other factors, perhaps working in concert with cytokines, are necessary for vertical transmission of HIV from mother to infant.