Efficacy of single dose Nevirapine in reducing viral load in HIV positive mother in labour and transmission of HIV infection to new born babies as part of prevention of parent to child transmission

Background

Prevention of parent to child transmission (PPTCT) program was initiated in Armed Forces to reduce the vertical transmission of HIV by instituting single dose Nevirapine (sdNVP) in untreated HIV positive mothers in labour. The aim of this study was to evaluate the role of sdNVP to decrease viral load of HIV infected mother during labour and its efficacy in prevention of mother to child transmission of HIV.

Methods

Thirty antenatal women tested positive for HIV at our PPTCT centre and delivered between Jan 2006 and May 2008 were evaluated. During labour these women were given sdNVP. Newborns were given syrup Nevirapine. The babies were tested for HIV infection at 48 h and six weeks after delivery.

Results

Thirty HIV positive women delivered at our centre and four newborns were found positive for HIV infection at 48 h. After six weeks interval three neonates were detected for HIV infection as one infant at six weeks was found to be negative for HIV infection.

Conclusion

The protection rate of Nevirapine in untreated HIV positive women is not ideal. It is recommended that all HIV positive women should be offered Highly Active Antiretroviral therapy as primary mode for PPTCT.     

Dynamic characteristic analysis of HIV mother to child transmission in China

Objective to explore dynamic characteristics of the HIV mother to child transmission （MTCT） epidemic in China.Methods A deterministic dynamic transmission model was used to determine the effect of key parameters on the likely long-term trends of the HIV MTCT epidemic in China.Matlab 7.0 was used to develop the model.Results The number of the susceptibles （S）,the transmission rate （β）,and the screening proportion （α） of HIV positive pregnant women have the greatest impact on the HIV MTCT epidemic in China.The growth of the MTCT epidemic in China could not be controlled only by decreasing the MTCT transmission rate.The prevalence of HIV positive women should be reduced and more pregnant women should be tested for HIV.Conclusion Prevention of MTCT （PMTCT） should focus not only on the reduction of HIV transmission rates and incidences of HIV among women but also on the increase of HIV testing for pregnant women.The most cost-effective PMTCT means for China should be investigated in future studies.     

The impact of a HIV prevention of mother to child transmission program in a nigerian early infant diagnosis centre

Background:

Mothers infected with human immunodeficiency virus (HIV) can transmit the virus to their babies in utero, intrapartum or postpartum through breastfeeding. Maternal to child transmission can be prevented through administration of antiretroviral drugs to mother and child, and through restriction of breastfeeding. This study evaluated the effectiveness of prevention of mother-to-child transmission (PMTCT) activities in reducing the incidence of HIV infection among exposed babies at the National Hospital Abuja, Nigeria.

Materials and Methods:

Early infant diagnosis laboratory records of 515 exposed babies aged below 18 months who had polymerase chain reaction (PCR) test between January 1^st 2011 and December 31^st 2012 were reviewed. The details of antiretroviral (ARV) therapy commencement for mother and baby, infant feeding choices, mode of delivery and HIV test results were analysed.

Results:

Of the 515 samples tested, 36 (7.0%) were found to be positive. The mean age of exposed children tested was 4 months. Highest prevalence was among children in the age group 6-18 months (16.1%). There was statistically significant association between HIV positive results and age. (P = 0.0000). If the mother and child pairs received ARVs, the prevalence was 1.3%, whereas if the mother only received ARV, then the prevalence was 4.6%, and when only the child received ARV the prevalence was 20.0%. When neither the mother nor the child received ARVs, the prevalence was 66.7%.

Conclusion:

There was a high prevalence of HIV among exposed children in our setting, especially if the mother and child pairs did not receive any form of antiretroviral prophylaxis. This further emphasises the usefulness of ARVs as the single most important intervention in PMTCT. Therefore, there is need to expand antiretroviral coverage, ensure access of the PMTCT program, and provide effective services to support infected children.     

梅毒对HIV-1感染者病毒载量和CD4+T细胞计数的影响

目的:评估梅毒对HIV-1感染者血浆HIV-1病毒载量,CD4 T细胞计数的影响.方法:于1年前对HIV-1感染者进行梅毒ELISA和RPR检测,对RPR检测阳性者根据其CD4 T细胞计数和病毒载量进行配对,与1年后重新检测CD4 T细胞计数与病毒载量比较,用配对资料的t检验分析梅毒对HIV感染者CD4 T细胞与病毒载量的影响.结果:在271例HIV-1感染者中,共11例梅毒阳性者,占4.1%.本研究中包括HIV-1感染者20例,其中10例梅毒与HIV-1共感染者.在梅毒与HIV共感染者病例中,CD4 T细胞计数明显降低(99个细胞/ml),但病毒载量的变化没有显著差异.结论:梅毒显著地降低HIV-1感染者的CD4 T细胞数量,但病毒载量没有明显的变化.为了延缓HIV-1感染者进入AIDS阶段的时间,应加强对梅毒的治疗和采取相应的预防措施.     

HIV合并HCV感染早期患者细胞免疫功能和病毒载量相关性

目的 探讨HIV与HCV合并感染早期患者细胞免疫功能和病毒载量的变化,为临床诊疗提供基础数据依据.方法 以广州市第八人民医院2017年1月—2019年12月收治HIV与HCV合并感染的首诊患者为研究对象,同时另选取HIV单独感染患者和HCV单独感染患者作为对照组.回顾性分析各组患者细胞免疫功能及病毒载量,并进行HIV与...     

替诺福韦对妊娠晚期HBV高载量母婴阻断的效果分析

目的探讨乙肝病毒(HBV)高载量孕妇孕晚期服用替诺福韦阻断HBV母婴传播的效果。方法根据干预方案将2012年1月—2015年5月于深圳市第三人民医院妇产科收治116例HBV高载量孕妇分为观察组(74例)与对照组(42例),观察组患者从孕28周开始口服替诺福韦治疗直至妊娠结束,对照组患者在妊娠期未接受抗病毒药物治疗。结果入组时,观察组和对照组患者血清HBV-DNA水平分别为(7.69±0.54)log~(10)copies/mL和(7.57±0.48)log~(10)copies/mL,差异无统计学意义(P0.05);分娩前,观察组和对照组患者血清HBV-DNA水平分别为(3.81±0.95)log~(10)copies/mL和(7.73±0.52)log~(10)copies/mL,差异有统计学意义(P0.05);观察组和对照组患者的新生儿血清HBV-DNA阳性率分别为0.00%和7.14%,差异无统计学意义(P0.05),但观察组和对照组新生儿HBsAg阳性率分别为4.05%和16.70%,差异有统计学意义(P0.05);观察组有4例患者在抗病毒治疗过程中出现药物不良反应,2例患者表现为轻微恶心、呕吐,1例患者表现为失眠、疲劳、头晕、乏力,1例患者血清肌酐升高,其余患者均未出现药物不良反应,药物不良反应发生率为5.41%。结论 HBV高载量孕妇孕晚期服用替诺福韦的疗效良好,其可有效阻断HBV母婴传播,并且安全性较好。     

深圳市预防艾滋病母婴传播项目孕期晚筛查因素分析

目的 探讨深圳市预防艾滋病母婴传播（PMTCT）项目孕产妇晚筛查的影响因素,以实现早发现和早干预的目标。方法 利用国家妇幼信息系统预防艾滋病母婴传播工作月报表数据,分析2007—2017年深圳市预防艾滋病母婴传播项目(PMTCT)产前门诊检测率、产科病房检测率、孕期检测率的变化趋势。采用横断面调查法,在全市10个区分层随机抽取2015—2017年上报的分娩时才进行艾滋病抗体检测的孕产妇。通过电话问卷以及医疗机构HIS信息系统查询孕期产前门诊就诊情况。根据查询到的就诊日期,在实验室信息检测系统查询HIV抗体检测情况。结果 2007—2017年,深圳市PMTCT项目产前门诊检测率、产科病房检测率和孕期检测率明显上升,差异有统计学意义。自2013年起,产前门诊检测率均超过97.00%,产科病房检测率自2011年起基本达到100.00%。在分娩量持续上升的情况下,孕妇在孕期接受HIV抗体检测的比例持续增加,至2017年已达到98.34%。共587例仅产时进行HIV抗体检测的孕产妇纳入个案分析。其中孕期到过医疗机构产前门诊进行产前保健,但被遗漏开取检验单的占32.37%;孕期已经进行过HIV抗体检测,但分娩时由于各种原因在产科病房重复检测的比例为16.35%;孕妇本人孕期从未进行产前保健的比例为48.38%,孕妇本人拒绝检测的比例为2.90%。其中,2017年产前门诊漏检率为20.35%,较2015年的39.57%和2016年的35.53%明显降低。结论 深圳市预防艾滋病母婴传播（PMTCT）项目质量在10年间明显提升,但仍需进一步采取措施杜绝产前门诊漏筛查情况和产科病房重复检测情况的发生,并对拒绝检测的孕妇采取跟踪追访措施。     

台山市2010-2012年吸毒人群HIV、梅毒和丙肝感染状况调查分析

目的 了解台山市2010-2012年吸毒人群艾滋病病毒(HIV)、梅毒(TP)和丙肝(HCV)的感染情况.方法 对台山市所有新人所的吸毒人群进行HIV、TP和HCV血清学检测.结果 共检测吸毒者1 386人,男性占94.4％,平均年龄(36.1±7.6)岁.艾滋病抗体阳性率为5.7％(79/1 386),梅毒抗体阳性率为2.6％(35/1 386),丙肝抗体阳性率为63.3％(878/1 386).在检出的79名艾滋病感染者中,HIV+TP、HIV+HCV、HCV+TP双重感染率分别为0.3％(4/1 386)、5.5％(76/1 386)和1.9％(26/1 386),HIV+TP+HCV混合性多重感染率为0.3％(4/1 386).结论 台山市吸毒人群HIV、TP、HCV仍存在较高感染率,应加大对吸毒人群的监测和防病知识的宣传力度,采取综合防治干预措施,降低HIV、TP、HCV从高危人群向一般人群扩散和传播的危险性.     

HIV感染者外周血CXCR5+CD4+T细胞水平与HIV病毒载量相关性

目的 研究外周血CXCR5+CD4⁺滤泡辅助性T细胞（follicular helper T,TFH）水平与HIV感染者血浆HIV病毒载量的相关性。方法 纳入2019年1月—2020年12月期间青海省第四人民医院收治的100例HIV感染者,根据CD4⁺T淋巴细胞计数分为A组（CD4⁺T淋巴细胞计数<200/ μL）23例和B组（CD4⁺T淋巴细胞计数200~<500/ μL）77例,以同期行健康体检80名健康者为对照组。分别检测HIV感染者外周血中HIV病毒载量、CD4⁺T淋巴细胞计数和TFH水平以及健康对照组CD4⁺T淋巴细胞计数以及TFH水平,并进行相关性分析。结果 A组血浆HIV病毒载量为（4.70±1.13） log /mL显著高于B组（2.74±0.74）log/mL（P<0.05）。A、B和健康对照组CD4⁺T淋巴细胞计数分别为（113.64±23.44）/μL、（334.10±31.52） / μL和（995.41±49.23） /μL,三者比较差异有统计学意义（P<0.05）。A、B和健康对照组TFH细胞计数绝对值分别为（18.63±5.67） /μL、（59.35±13.73） /μL和(194.85±25.78) /μL,A、B组均低于健康对照组,差异有统计学意义（P<0.05）;A、B和健康对照组TFH细胞百分比分别为（15.83±4.05）%、（17.57±5.08）% 和（19.59±4.25）%,A、B组均低于健康对照组,差异有统计学意义（P<0.05）。Pearson相关性分析显示,HIV病毒载量与CD4⁺T淋巴细胞计数以及TFH细胞计数呈负相关（P<0.05）。结论 HIV感染者外周血CD4⁺T淋巴细胞计数和TFH计数与HIV病毒载量呈负相关,且TFH计数可作为病情诊断和预后评估的重要指标,并有望成为HIV感染免疫治疗的新靶标。