Successes and Challenges in the Perinatal HIV-1 Epidemic in the United States as Illustrated by the HIV-1 Serosurvey of Childbearing Women

Mofenson, Lynne

doi:10.1001/archpedi.158.5.422

Cited by 47 publications

(40 citation statements)

References 35 publications

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“…Entre las mujeres VIH positivas se observaron 12 casos (5,1%) de infecciones de herida operatoria, igual número en las controles; por otro lado, en las expuestas hubo 17 casos (7,2%) de infección del tracto urinario, mientras que en las no expuestas se registraron solo seis casos (OR: 3,0; IC95% [1,[2][3][4][5][6][7]7] Entre los otros factores asociados a complicaciones infecciosas (Tabla 3), en los dos grupos, se encontró que las mujeres con incisión tipo media infraumbilical (MIU) tenían mayor probabilidad de presentar una CI en comparación con las mujeres a las que se les hizo una incisión tipo Phannesteil (OR: 2,3; IC 95% [1,[1][2][3][4]5] (25,6) días; rango intercuartil: 3-9 días) que en el grupo de mujeres sin complicación infecciosa (mediana tres días; rango intercuartil: 3-4 días, p<0,001). No se encontró asociación con la edad, ni con el tiempo operatorio.…”

Section: Resultsunclassified

“…El parto por cesárea es indiscutiblemente beneficioso para la disminución de la TV (5)(6) en las mujeres con VIH en general, lo que ha generado un incremento del número de las mismas en pacientes VIH positivas, quienes estarían a su vez en un mayor riesgo de complicaciones debido al compromiso de su estado inmunológico. Si bien la mayoría de estudios perinatales en pacientes VIH se han enfocado a la disminución de la transmisión vertical, estudios más recientes (13)(14)(15) , como el nuestro, buscan evaluar las consecuencias maternas de dichas intervenciones en términos de morbilidad, sobre todo considerando que el beneficio en mujeres con cargas virales indetectables es menor.…”

Section: Discussionunclassified

“…La tasa de transmisión del VIH de la madre al niño puede ser notablemente reducida, hasta menos del 1%, con una serie de medidas entre ellas el parto por cesárea electiva, previa al inicio de trabajo de parto o ruptura de membranas (4)(5) . Así, por ejemplo, un estudio colaborativo europeo (6) encontró que la cesárea sin ninguna otra intervención disminuía la transmisión vertical (TV) hasta en un 50%.…”

Section: Introductionunclassified

“…Resultados. El 13,9% de mujeres VIH positivas presentaron CI y 9,7% del grupo control (OR: 1,5 IC95% [0,9-2,7]); las expuestas (mujeres con VIH) tuvieron mayor probabilidad de tener una infección del tracto urinario (ITU) que las no expuestas (ORa: 4,5 IC95% [1,[4][5][6][7][8][9][10][11][12][13][14]5]). Se encontró asociación entre CI y el tipo de incisión (ORa: 2,3 IC95% [1,1-4,5]) y el tiempo de hospitalización (6 frente a 3 días, p<0,001).…”

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Asociación entre el estado de infección por VIH y complicaciones infecciosas poscesárea electiva

Tejaja

Huayanay

Gutiérrez

et al. 2014

Rev Peru Med Exp Salud Publica

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Objetivos. Determinar la asociación entre VIH y complicaciones infecciosas (CI) después de una cesárea electiva. Materiales y métodos. Estudio de cohortes no concurrentes; se revisaron las historias clínicas de 237 cesáreas electivas en gestantes VIH reactivas atendidas en el Instituto Nacional Materno Perinatal de Perú, realizadas entre 2004 a 2012. Estas fueron pareadas por cirujano y fecha de cesárea con 237 gestantes VIH no reactivas. Se recogieron datos sociodemográficos, clínicos, características de la cesárea y relacionados a la infección por el VIH. Las CI se evaluaron según las recomendaciones del NHI Consensus Development Task Force. Se realizó el análisis bivariado con un nivel de significación del 5% y el cálculo del Odds Ratio (OR) con intervalo de confianza (IC) al 95%. Se construyó un modelo de regresión logística condicional. Resultados. El 13,9% de mujeres VIH positivas presentaron CI y 9,7% del grupo control (OR: 1,5 IC95% [0,9-2,7]); las expuestas (mujeres con VIH) tuvieron mayor probabilidad de tener una infección del tracto urinario (ITU) que las no expuestas (ORa: 4,5 IC95% [1,[4][5][6][7][8][9][10][11][12][13][14]5]). Se encontró asociación entre CI y el tipo de incisión (ORa: 2,3 IC95% [1,1-4,5]) y el tiempo de hospitalización (6 frente a 3 días, p<0,001). Conclusiones. Las mujeres VIH positivas sin tratamiento antirretroviral tuvieron mayor riesgo de CI; aunque no se observó mayor riesgo global de CI en expuestas después de una cesárea electiva. El principal factor de riesgo asociado a una CI poscesárea electiva en mujeres VIH positivas fue el tipo de incisión. Palabras clave: VIH; Embarazo; Cesárea; Complicaciones postoperatorias; Complicaciones infecciosas del embarazo; (fuente: DeCS BIREME). ASSOCIATION BETWEEN HIV INFECTION STATUS AND INFECTIOUS COMPLICATIONS AFTER AN ELECTIVE C-SECTION ABSTRACT Objectives:To determine the connection between HIV and infectious complications (IC) after an elective C-section. Materials and methods.A non-concurrent cohort study was conducted, in which the clinical records of 237 elective C-sections on HIV-positive pregnant women who gave birth at the Instituto Nacional Materno Perinatal (National Maternal Perinatal Institute) between 2004 and 2012 were revised. The records were matched by surgeon and C-section date, with 237 HIV-negative pregnant women. Socio-demographic and clinical data were collected, along with characteristics of the C-section and data related to the HIV infection. IC were evaluated according to the NIH Consensus Development Task Force. The descriptive analysis and the bivariate analysis were carried out with a significance level of 5% for the hypothesis tests and the calculation of the Odds Ratio (OR) with a confidence interval (CI) at 95%. A conditional logistic regression model was built. Results. IC were present in 13.9% of HIV-positive women and 9.7% of the control group (OR: 1.5 CI95% [0.9-2.7]); those who were exposed (women with HIV) were more likely to have a urinary tract infection (UTI) than those who were not exposed (OR...

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Section: Resultsunclassified

Section: Discussionunclassified

Section: Introductionunclassified

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Asociación entre el estado de infección por VIH y complicaciones infecciosas poscesárea electiva

Tejaja

Huayanay

Gutiérrez

et al. 2014

Rev Peru Med Exp Salud Publica

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“…HAART is recommended for HIV-1 positive mothers, to decrease vertical transmission [27]. Although there is no clear knowledge of the direct or indirect consequences of exposure to this complex regimen in the human fetus, studies in cell culture and animal models suggest increased genotoxicity is induced by the combination.…”

Section: Combined Therapymentioning

confidence: 99%

Relevance of experimental models for investigation of genotoxicity induced by antiretroviral therapy during human pregnancy

Olivero

2008

Mutation Research/Reviews in Mutation Research

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The current incidence of HIV-1/AIDS affects around 7,000 pregnant women in the United States. When given during pregnancy, the nucleoside analog AZT significantly reduces maternal-fetal transmission. It has been previously shown that AZT is incorporated into DNA, where it causes mutations in the HPRT and TK genes. It also changes cell cycle gene expression, and induces S-phase arrest, micronuclei, chromosomal aberrations, sister chromatid exchanges, telomeric attrition, and other genotoxic effects in cultured cells. A predicted consequence of these events is genomic instability that together, with clastogenicity may contribute to the carcinogenic potency of AZT. Various aspects of genotoxicity are explored in this contribution seeking to understand the multiple effects of this antiretroviral agent in animal models and humans. This mini-review describes some of the experimental models used to elucidate the genotoxicity induced by antiretroviral therapy during human pregnancy. The use of diverse methods to detect biomarkers of exposure, such as an AZTspecific radioimmunoassay, micronuclei bearing intact chromosomes, and telomeric DNA attrition highlight the role of in-vitro models to elucidate exposure and risk. The relevance of the in vitro models is followed by the introduction of the role of the nucleoside analogs in transplacental carcinogenesis along with the description of a transplacental perfusion model and a transplacental carcinogenesis rodent model. In a more direct clinical application the use of AZT-DNA incorporation as a biomarker of exposure, in experiments conducted in vivo in Erythrocebus patas monkeys and in humans, addresses the possibility of elucidation of potential cancer risk in those infants exposed in utero.Two relevant aspects of this contribution are the potential application of some of the models described in this mini-review, as diagnostic tools in antiretroviral-exposed populations, and the use of these models to understand the nature of the genotoxicities and minimize the undesirable side effects of the antiretroviral therapy.

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Mitochondria‐Specific Mouse Gene Array and its Application in Toxicogenomics

Desai

2009

General, Applied and Systems Toxicology

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In recent years, mitochondria have gained significant attention in toxicology because of their involvement in several drug‐induced toxicities and in the pathogenesis of a number of degenerative diseases. Thus far, numerous molecular and biochemical assays have been developed and utilized to understand the association between mitochondria and drug toxicities or disease processes. However, the knowledge gained by these assays is inadequate to obtain a comprehensive outlook of the mitochondrial activity during toxic exposures and the underlying pathologies. High‐throughput technologies, such as DNA microarray, have great potential in advancing genomic research in toxicology. This technology allows expression profiling of thousands of genes in a single experiment. Building on this technology, a mitochondria‐specific mouse oligonucleotide microarray (MitoChip) was developed, which is described in this review. This review also discusses results generated using the MitoChip in studies that were designed to elucidate the molecular mechanisms of altered mitochondrial function induced by anti‐HIV drugs (zidovudine and lamivudine) and a weight‐loss dietary supplement (usnic acid) in mice. The results from these studies clearly demonstrate that the MitoChip is a valuable genomic tool and can help unravel the underlying molecular basis of impaired mitochondrial function in drug‐induced toxicities.

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Successes and Challenges in the Perinatal HIV-1 Epidemic in the United States as Illustrated by the HIV-1 Serosurvey of Childbearing Women

Cited by 47 publications

References 35 publications

Asociación entre el estado de infección por VIH y complicaciones infecciosas poscesárea electiva

Asociación entre el estado de infección por VIH y complicaciones infecciosas poscesárea electiva

Relevance of experimental models for investigation of genotoxicity induced by antiretroviral therapy during human pregnancy

Mitochondria‐Specific Mouse Gene Array and its Application in Toxicogenomics

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