The continuum of HIV care in Catalonia

The objective was to produce a cascade of care for Catalonia to gain a public health perspective on the overall quality of HIV services and allow comparison with other countries. It was constructed using the Integrated Epidemiological Surveillance System of HIV in Catalonia and data from the PISCIS Cohort. Estimates of the number of people living with HIV in Catalonia are modelled using Spectrum Projection Package 2011 (UNAIDS/WHO). Totals for each stage in the cascade are obtained by applying to the preceding stage a proportion estimated from available surveillance and cohort data. Undiagnosed HIV was estimated from the European literature. The proportions retained in care, on ART and virally suppressed were derived from the PISCIS cohort. Programmatic data on ART consumption was used to validate estimates. By the end of 2011 there were about 33,000 people living with HIV in Catalonia, 71% of which had been both diagnosed and linked to care. We estimate that 61% of all HIV infected persons were retained in care, 56% were on ART and 48% were virally suppressed. These figures data are comparable, although slightly lower, than that of France or the UK. The Cascade of HIV Care in Catalonia is similar to other western European countries such as France and the UK. Direct estimates of the undiagnosed HIV population and linkage to care are desirable but the contribution of cohort data to the cascade highlights their continued importance in HIV surveillance and design of evidence-based health strategies.     

Low uptake of HIV testing and no HIV positivity in stable serodiscordant heterosexual partners of long-term treated HIV-infected Thais

The objective of this study was to characterize HIV-serodiscordant heterosexual couples and to evaluate acceptance for HIV testing and HIV prevalence in nonindex partners. We conducted a cross-sectional study with quantitative and qualitative components. Two cohorts of 1767 HIV-positive people were screened to identify heterosexual HIV-serodiscordant couples. HIV-positive partners (index) were administered a questionnaire; CD4, viral load (VL), and antiretroviral therapy (ART) history were gathered from clinical records. HIV-negative/unknown status partners (nonindex) were invited for a similar questionnaire and HIV testing. In-depth interviews with three HIV-serodiscordant couples were conducted. Two hundred and ninety-seven index partners agreed to enroll in this study. The median duration of the relationship was 10 years, and 81% were sexually active. All but two index partners were on ART, and 98% had VL < 1000 copies/mL. Only 111 (37%) nonindex partners came for HIV testing, and all of them tested HIV-negative. In addition, only 41% of nonindex partners had HIV testing in the last one year. The main reasons for the nonindex partners not to come for HIV testing were “no interest” (n = 117, 63%) and “nondisclosure of HIV status” (n = 46, 25%). The latter was substantiated and explained by the qualitative outcome of this study, suggesting relation to stigma against HIV-positive people. Our results support the WHO recommendation for starting ART for treatment and prevention in HIV-serodiscordant couples at any CD4 count. Furthermore, we recommend the dissemination of data showing that no HIV transmission in heterosexual couples through sex practice has been observed provided VL is suppressed. This could be a powerful tool for effective fight against stigma and self-stigma in people living with HIV.     

Vascular and cellular changes accompany altered expression of angiopoietins in placenta of non-complicated ART pregnancies

Background: ART is steadily performed for infertility cases and most of the previous researches have focused on complicated pregnancies. Nonetheless, few ones have concerned with placenta of ART in non-complicated pregnancies.Objectives: To investigate the expression of angiopoietins (ANG) and their receptor, TIE-2, in placenta of full-term non-complicated pregnancies having ART (n = 28) versus those with spontaneous conception (n = 28) together with the histological as well as morphometric analysis.Results: While no prominent changes were noticed in the histological structure of the placenta ART pregnancies, it showed a significant decrease (p < 0.05) in the percentage of syncytial area and numbers of syncytial knots with insignificant reduction in the placental villous area. Vascular changes in the form of significant decrease (p < 0.05) in the chorionic vessel diameter and significant increase (p < 0.05) in percentage of vessel area were detected in the ART placenta. In addition, the levels ANG-1, ANG-2 and TIE-2 were significantly increased (p < 0.05) in the ART placentas compared with those of SC.Conclusions: We demonstrated that there is an altered expression of angiopoietins accompanying the morphometric changes occurring in placenta of ART pregnancies. These changes may indicate vascular and cellular adaptation mechanism for a potential subclinical hypoxia in placenta of ART even in non-complicated pregnancies.     

Systemic oxidative stress could predict assisted reproductive technique outcome

Purpose

Previous studies have indicated that OxS (oxidative stress) may appear as a possible reason for poor ART outcome. Our aim was to study OxS levels in both partners of couples seeking Assisted reproduction Technology (ART).

Methods

Altogether 79 couples were recruited. Oxidative DNA damage (8-OHdG) and lipid peroxidation (8-EPI) were measured, and clinical background and ART outcomes were recorded.

Results

Both OxS markers accurately reflected clincal conditions with prominent negative effects attributable to genital tract infections, endometriosis, uterine myoma and smoking. Furthermore, the level of OxS was also affected by partner’s state of health. The highest 8-EPI levels were detected in both partners when biochemically detectable pregnancies did not develop into clinically detectable pregnancies (in women, 97,8 ± 16,7 vs 72.9 ± 22,9, p = 0.007; in men, 89.6 ± 20,4 vs 72,1 ± 22,6, p = 0.049).

Conclusions

To conclude, high grade systemix OxS in both partners may negatively affect the maintenance and outcome of pregnancy. Applying the detection of OxS in ART patients may select patients with higher success rate and/or those who require antioxidant therapy. This would lead to improvement of ART outcome as well as natural fertility.

Electronic supplementary material

The online version of this article (doi:10.1007/s10815-015-0466-6) contains supplementary material, which is available to authorized users.     

Elective Single Embryo Transfer: an update to UK Best Practice Guidelines

A significant number of multiple pregnancies and births worldwide continue to occur following treatment with Assisted Reproductive Technologies (ARTs). Whilst efforts have been made to increase the proportion of elective single embryo transfer (eSET) cycles, the multiple pregnancy rate or MPR remains at a level that most consider unacceptable given the associated clinical risks to mothers and babies, and the additional costs associated with neonatal care of premature and low birth weight babies. Northern Europe, Australia and Japan have continued to lead the way in the adoption of eSET. Randomised controlled trials or RCTs, meta-analyses and economic analyses support the implementation of an eSET policy, particularly in light of recent advances in ARTs. This paper provides a review of current evidence and an update to the eSET guidelines first published by Cutting et al. (2008) Cutting, R., Morroll, D., Roberts, S., Pickering, S., &; Rutherford, A. (on behalf of BFS and ACE). (2008). Elective Single Embryo Transfer: Guidelines for Practice British Fertility Society and Association of Clinical Embryologists. Human Fertility, 11, 131–146.[Taylor &; Francis Online] , [Google Scholar] intended to assist ART clinics in the implementation of an effective eSET policy.     

T cell anergy and activation are associated with suboptimal humoral responses to measles revaccination in HIV‐infected children on anti‐retroviral therapy in Nairobi,Kenya

HIV‐infected children are less capable of mounting and maintaining protective humoral responses to vaccination against measles compared to HIV‐uninfected children. This poses a public health challenge in countries with high HIV burdens. Administration of anti‐retroviral therapy (ART) and revaccinating children against measles is one approach to increase measles immunity in HIV‐infected children, yet it is not effective in all cases. Immune anergy and activation during HIV infection are factors that could influence responses to measles revaccination. We utilized a flow cytometry‐based approach to examine whether T cell anergy and activation were associated with the maintenance of measles‐specific immunoglobulin (Ig)G antibodies generated in response to measles revaccination in a cohort of HIV‐infected children on ART in Nairobi, Kenya. Children who sustained measles‐specific IgG for at least 1 year after revaccination displayed significantly lower programmed cell death 1 (PD‐1) surface expression on CD8⁺ T cells on a per‐cell basis and exhibited less activated CD4⁺ T cells compared to those unable to maintain detectable measles‐specific antibodies. Children in both groups were similar in age and sex, CD4⁺ T cell frequency, duration of ART treatment and HIV viral load at enrolment. These data suggest that aberrant T cell anergy and activation are associated with the impaired ability to sustain an antibody response to measles revaccination in HIV‐infected children on ART.     

Risks of nonchromosomal birth defects,small-for-gestational age birthweight,and prematurity with in vitro fertilization: effect of number of embryos transferred and plurality at conception versus at birth

Journal of Assisted Reproduction and Genetics - Excess embryos transferred (ET) (&gt; plurality at birth) and fetal heartbeats (FHB) at 6 weeks’ gestation are associated with reductions...     

山东省人类辅助生殖技术的应用现状分析

目的了解山东省开展人类辅助生殖技术(ART)的应用现状及存在问题，提出相应的解决对策．为科学、合理的应用该项技术提供依据。方法采用信访法和访谈法相结合的调查方法，对全省8家生殖医学中心进行调查。结果山东省开展ART的生殖医学中心技术总体水平居于全国前列。但使用过程中仍存在许多不规范之处，亟待改进。结论行政管理部门应加强对ART技术使用的规范化管理，尽量避免由于技术使用不规范而引起的并发症以及社会、伦理方面的问题。