预防HIV母婴传播干预措施利用的影响因素分析

目的:了解欠发达地区HIV母婴传播干预措施利用状况及其影响因素,为更好制订预防HIV母婴传播措施提供依据。方法:采用回顾性队列研究的方法,采用自行设计的问卷进行面对面问卷调查,收集社会人口学特征、HIV确认时间,抗逆转录病毒药物应用情况及开始应用时间等。结果:1 045例HIV感染的孕产妇27.3%(285/1 045)是在妊娠前获知HIV感染;89.4%(934/1 045)选择分娩,抗病毒药物的应用率为84.5%(789/934)。多因素分析结果显示高中或以上文化程度的HIV感染孕产妇抗病毒药物应用率(80.5%)高于初中或以下文化程度的孕产妇(86.8%),其OR值为1.587。月收入800～1 000元的HIV感染的孕产妇抗病毒药物应用率高于家庭月收入≤800元,其OR值为0.024。妊娠前获知HIV感染的孕产妇抗病毒药物应用率高于妊娠后获知HIV感染的孕产妇,其OR值为1.602。结论:文化程度高、家庭经济状况好、妊娠前获知HIV感染状况有利于HIV感染孕产妇尽早接受抗病毒药物等HIV母婴传播干预措施的利用。     

Duration of human immunodeficiency virus infection and likelihood of giving birth in a Medicaid population in Maryland

The objective of this study was to examine the effect of duration of human immunodeficiency virus (HIV) infection on a woman's likelihood of giving birth. Using longitudinal data from the Maryland state Human Immunodeficiency Virus Information System and a retrospective cohort design, the authors compared 1,642 women with acquired immunodeficiency syndrome (AIDS) to 8,443 uninfected women enrolled in the Medicaid program between 1985 and 1995. The decade before AIDS diagnosis was divided into four 2.5-year periods. Proximity to AIDS diagnosis served as a proxy for duration of infection. An extension of the Cox model was used to estimate the relative risk for giving birth, with adjustment for covariates and repeated outcomes. The average number of births per 100 person-years was 6.0 for HIV-infected women and 11.1 for uninfected women (adjusted relative risk = 0.63; 95% confidence interval (CI): 0.57, 0.68). Accounting for duration of infection, the adjusted relative risks for birth among HIV-infected women, as compared with uninfected women, were 0.85 (95% CI: 0.71, 1.03), 0.74 (95% CI: 0.63, 0.86), 0.55 (95% CI: 0.47, 0.64), and 0.45 (95% CI: 0.38, 0.55) for successive 2.5-year periods before AIDS diagnosis. Demographic characteristics, contraception, abortion, fetal loss, or drug use could not fully explain the reductions. These results suggest that HIV-infected women experience a progressive reduction in births years before the onset of AIDS. This may compromise estimation of HIV prevalence and interpretation of time trends from serosurveillance of pregnant women.     

Pregnancy, body weight and human immunodeficiency virus infection in African women: a prospective cohort study in Kigali (Rwanda), 1992-1994. Pregnancy and HIV Study Group (EGE)

OBJECTIVE: To study the relationship between human immunodeficiency virus (HIV) infection and body weight in African women during and after pregnancy. METHODS: A prospective cohort study was initiated at the Centre Hospitalier de Kigali in July 1992. Every woman seen at the antenatal clinic and with a gestational age of <28 weeks was offered HIV-1 antibody testing. Comparable numbers of HIV-infected (HIV+) and uninfected (HIV-) women were recruited. At inclusion, socio-demographic characteristics and self-reported pre-pregnancy weight were recorded; height and weight were measured. Each woman enrolled had a monthly follow-up until 9 months after delivery, with a clinical examination including weighing. Three anthropometric indices were used to answer the study objectives: weight, body mass index (BMI), and pregnancy balance. RESULTS: As of April 1994, 101 HIV+ and 106 HIV- women were followed until 5 months after delivery. Weight and BMI during pregnancy were lower in HIV+ women than in HIV- women. After delivery, weight and BMI gains were significantly lower in HIV+ women. Until 5 months after delivery, the mean weight variation was -2.2 kg (standard deviation [SD] = 5.9 kg) in HIV+ women and +0.2 kg (SD = 6.6 kg) in HIV- women (P = 0.007) in comparison to pre-pregnancy weight. Comparisons of the slopes of the weight curves did not show statistical differences throughout the pregnancy, but it did during the post-partum period (P = 0.02). CONCLUSIONS: Our study suggests that HIV infection could impair nutritional status in pregnant women, especially during the post-partum period. Family planning and maternal and child health services including HIV testing and counselling, should consider a nutritional assessment and intervention programme targeted to HIV+ pregnant women.     

Missed Opportunities to Prevent Perinatal Human Immunodeficiency Virus Transmission in 15 Jurisdictions in the United States During 2005–2008

The objective of this study was to identify factors related to failure to receive recommended interventions for the prevention of mother-to-child HIV transmission among HIV-infected pregnant women in the United States. Using Enhanced Perinatal Surveillance data from 2005 through 2008, we identified characteristics of HIV-infected women (n = 5,391) that increased their odds of missing an opportunity to prevent perinatal HIV transmission. Adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) were calculated by using backward step-wise logistic regression analyses to determine the relationship between demographic variables and missed opportunities. Of 4,220 HIV-infected pregnant women with complete data, 2,545 (60%) did not receive all of the recommended interventions. Missed opportunities for prevention occurred more often among HIV-infected women aged 25–34 years (aOR = 1.9, 95% CI = 1.4–2.5), and greater than 34 years (aOR = 2.0, 95% CI = 1.5–2.7) compared to those 13–19 years and among injection drug users (aOR = 1.3, CI = 1.0–1.5) compared to women infected with HIV through heterosexual contact. Clinicians can decrease missed opportunities by routinely providing recommended interventions, especially among HIV-infected women who are injection drug users or aged 25 years or older.     

HIV-infected US youth are at high risk of obesity and poor diet quality: a challenge for improving short- and long-term health outcomes

OBJECTIVE: To examine the relationships among dietary quality, weight status, and human immunodeficiency virus (HIV) infection in US adolescents and young adults. DESIGN: This cross-sectional study was embedded in the Reaching for Excellence in Adolescent Care and Health cohort study of HIV-infected and HIV-uninfected, at-risk youth. Biochemical, clinical, and sociodemographic data were available. Dietary intake was collected using the Block Food Frequency Questionnaire and a modified Healthy Eating Index was calculated to measure diet quality. SUBJECTS/SETTING: Participants included 264 HIV-infected and 127 HIV-uninfected youth 13 to 23 years old (75.2% women, 67.3% African American/non-Hispanic, 20.5% Hispanic, 12.3% other) at 14 clinic sites. STATISTICAL ANALYSES PERFORMED: Determinants of obesity and the modified Healthy Eating Index were tested using logistic and generalized linear regression. RESULTS: About half (51.7%) of participants were overweight or obese. Obesity was positively associated with being a woman, living independently, watching television >or=3 hours per day, previous dieting, and being from the northeastern or southern United States. Youth who were HIV uninfected or HIV infected with CD4 + T cells >or=500 cells/microL had similar obesity rates; overweight (25%) and obesity (20%) was prevalent among women even with CD4 + T cells <200 cells/microL. The modified Healthy Eating Index score was 56.2+/-0.6, reflecting a diet needing improvement. HIV infection, watching television >or=3 hours/day, and being from the Chicago, IL, area were associated with a lower-quality diet. CONCLUSIONS: Obesity is a common nutrition problem for both HIV-infected and uninfected youth; however, HIV-infected youth are at increased risk of developing metabolic abnormalities. Culturally appropriate, client-focused nutrition education will help youth improve their diet and increase physical activity to reduce health consequences associated with both obesity and HIV infection.     

Adherence among women with HIV infection in Puerto Rico: the potential use of modified directly observed therapy (MDOT) among pregnant and postpartum women

Women are the fastest growing segment of the adult population acquiring HIV, and most women infected with HIV are in their reproductive years. The success of HAART is highly dependent upon the ability and willingness of the individual to adhere to complex antiretroviral regimens. Improved adherence among HIV-infected pregnant women will delay disease progression in the mother and should also reduce HIV transmission to the baby. Modified directly observed therapy (MDOT), may benefit this population. MDOT has been shown to be an acceptable and feasible intervention among HIV substance users; however, no-one has yet evaluated the use of MDOT in pregnant and postpartum women. Based on semi-structured interviews with 17 Latina women with HIV infection, we explored women's adherence patterns and barriers to adherence and their perceptions of a hypothetical MDOT program. The vast majority of women positively appraised the MDOT program as an effective means to increase and reinforce adherence to demanding drug regimens. Respondents cited the face-to-face contact, the supportive nature of the relationship, and the practical approach of the program as the primary reasons for the effectiveness of MDOT. Results indicate that MDOT could be an acceptable intervention for pregnant and postpartum Latina women to improve adherence to HAART.     

HIV-infected women's experiences of pregnancy and motherhood in Cape Town,South Africa

Antenatal services provide a valuable opportunity for the uptake of prevention of mother-to-child transmission (PMTCT) of HIV interventions and antiretroviral treatment (ART) for maternal health. While knowledge of HIV status during pregnancy is beneficial to both mother and child, PMTCT programmes may focus more on prevention and the physical aspects of health than the psychosocial impact of HIV on pregnancy and motherhood. The objective of this study was to examine South African women's perceptions of HIV infection in pregnancy and how they related to motherhood in the context of HIV infection. In-depth interviews were conducted with 17 HIV-positive pregnant and 11 ≤ 6-month postpartum women to elicit perspectives on HIV-positive pregnancy and motherhood. For most women who tested in pregnancy, the primary rationale for testing stemmed from a concern for their children; and anxiety around the risk of vertical transmission was highly prevalent. Women did not perceive any superficial differences between themselves and non-infected pregnant women and they compared HIV to any other chronic condition. However, they voiced anxiety about being infected and were preoccupied with keeping their children safe, both in pregnancy and postpartum. They described a diminished sense of pride about motherhood and an additional burden of guilt associated with carrying a vulnerable child, which made pregnancy different for them in comparison to uninfected women. Feeding posed a particularly difficult issue because by choosing formula feeding, women were protecting their children, yet this seemed to diminish their status as a mother, while at the same time publicising messages about being infected with HIV. While women identified externally with the social value of motherhood, the burden of HIV infection was seen as a destabilising threat to their identity as mothers.     

某地孕产妇HIV流行及母婴传播研究

目的：了解新蔡县孕产妇人群中艾滋病病毒（HIV）感染情况，为采取综合干预措施降低母婴传播的发生率提供依据。方法：对全县孕产妇利用孕检时机和在妇幼保健院婚检人群提供自愿咨询和免费HIV抗体检测；对HIV抗体阳性的孕产妇实施综合性干预。结果：2003年7月～2004年，有20 490名孕产妇接受了HIV自愿咨询检测（VCT），HIV抗体阳性12名，阳性率0．06％。12名HIV感染孕产妇中，经单采血浆传播6名（50％），受血传播5名（41．7％），经性接触传播1名（8．3％）；有2人其配偶为HIV抗体阳性。7名孕妇终止妊娠（58．3％），5名产妇接受综合性干预后分娩（41．7％）。结论：通过对孕产妇人群提供HIV自愿咨询检测服务和对该人群中的HIV感染者采取综合性干预措施，可防止和降低HIV母婴传播的发生率。     

德宏州部分农村地区感染HIV孕产妇人口学及社会心理因素调查

目的:对感染HIV孕产妇的人口学和社会心理因素进行调查研究,为制定对该人群有效的HIV/AIDS防控措施提供依据。方法:抽取云南省德宏州HIV感染较为集中的农村地区感染HIV孕产妇作为样本,采用自编的感染HIV孕产妇人口学及社会心理情况调查问卷对目标人群进行调查。结果:知道自己感染HIV的平均时间长度为18.9个月,一半左右孕前接受过HIV检查,检查出HIV血清呈阳性的占了90.9%;72.4%的人有过流产经历,35.6%有过两次以上的流产经历,29.9%生育过小孩,18.4%没有在医院进行产前护理,86.2%为计划内怀孕;90.8%从未吸过烟,74.7%从未喝过酒,1.1%曾经使用过毒品并有戒毒经历,怀孕期间均没有使用过毒品;29.9%从未使用过避孕套,64.4%间断使用过;16.1%报告与吸毒男子发生性行为;3.4%有过商业性行为;58.6%明确知道自己的性伴侣感染了HIV病毒,5.7%怀疑性伴侣感染HIV病毒,8%不知道性伴侣是否感染HIV;86.2%要求性伴侣做HIV检测时,对方表示同意;94.3%有固定性伴侣,表示对方是孩子父亲;与性伴侣关系保持时间平均为36个月,81.6%感觉性伴侣给予的支持程度高,但8%遭遇性伴侣虐待。结论:感染HIV孕产妇的病毒主要是通过性传播感染,大多数属于知道感染HIV的计划内怀孕,感染者存在一定易感性和脆弱性,艾滋病存在进一步通过性及母婴传播的风险,应对女性加强艾滋病防治知识的宣传教育,努力提高母婴阻断技术。     

广东省2014-2017年HIV感染孕产妇及暴露婴儿流行病学特征分析

目的 了解广东省HIV感染孕产妇及暴露婴儿流行病学特征，分析HIV母婴传播（MTCT）相关影响因素。方法 利用"全国预防HIV MTCT信息管理系统"和"广东省婴儿HIV感染早期诊断检测信息管理平台"监测数据，收集分娩时间为2014年1月1日至2017年12月31日的HIV感染孕产妇及暴露婴儿的个案信息，比较HIV暴露婴儿感染组和未感染组孕产妇的人口学特征、孕产史、接受预防MTCT服务及婴儿早期诊断检测等的差异性。采用logistic回归模型分析HIV感染孕产妇和暴露婴儿MTCT的相关影响因素。结果 349例HIV感染孕产妇中，分别在孕前、孕期、产时/产后获知感染状态的占30.4%（106/349）、49.6%（173/349）和20.0%（70/349），性伴感染状态不明确的占39.5%（138/349），未治疗的占13.2%（46/349）；暴露婴儿中，MTCT率为4.2%（15/353），第1、第2次早诊断检测的年龄分别为44（P₂₅~P₇₅：42~50）、96（P₂₅~P₇₅：92~106）d。单因素logistic回归分析结果显示，产时/产后明确感染状态（与孕前确认感染状态相比，OR=5.72，95%CI：1.52~21.61）、孕产妇和暴露婴儿的一方或双方未抗病毒治疗（与孕产妇和暴露婴儿均抗病毒治疗相比，OR=33.56，95%CI：9.04~124.55）增加MTCT风险；人工喂养（与母乳喂养相比，OR=0.07，95%CI：0.01~0.76）可降低MTCT风险。结论 广东省孕产妇的早检测早诊断、抗病毒治疗、人工喂养的多措并举，提高预防MTCT服务能力，有效降低MTCT风险。     

妊娠前后获知HIV感染对预防母婴传播干预措施利用的影响

目的 探讨妇女妊娠前后获知HIV感染对预防母婴传播(PMTCT)干预措施利用的影响.方法 前瞻性调查了2005-2009年河南、广西、云南、新疆四省(自治区)确认HIV感染的孕产妇5552例,5894人次妊娠,了解其社会人口学特征(将调查对象分为15～、25～、35～49岁3个年龄段),以及确认感染的时期、妊娠结局、艾滋病抗病毒药物应用等PMTCT干预措施的实施.采用单因素和非条件logistic多因素回归模型对HIV感染孕产妇实施PMTCT干预措施的影响因素进行分析.结果 HIV感染孕产妇84.5%(4979/5894)年龄在35岁以下,56.0%(3108/5552)为汉族,85.1%(4727/5552)为农民或无业,86.8%(4815/5552)为初中或以下文化程度,31.2%(1836/5894)的感染孕产妇在妊娠前已知HIV感染.31.7%(1869/5894)的HIV感染孕产妇选择人工终止妊娠,妊娠前已知感染者终止妊娠的比例高达43.8%(805/1836).80.0%(3046/3808)分娩的HIV感染孕产妇应用抗病毒药物,92.3%(883/957)的妊娠前已知感染者应用抗病毒药物,远高于当次妊娠才明确感染者[75.9%(2163/2851);x2=120.39,P＜0.05].多变量分析结果显示,妊娠前已知感染较妊娠前未知感染(OR=3.91,95%CI:3.03～5.05)、15～岁年龄段较35～49岁年龄段(OR=0.75,95%CI:0.57～0.98)的HIV感染孕产妇抗病毒药物应用比例较高.结论 妊娠前已知HIV感染有利于感染孕产妇尽早接受抗病毒药物应用等预防母婴传播的干预措施.     

HIV and other predictors of serum beta-carotene and retinol in pregnancy: a cross-sectional study in Zimbabwe

BACKGROUND: Vitamin A status during pregnancy is important to maternal and infant health. OBJECTIVE: Our goal was to identify predictors of serum beta-carotene and retinol. DESIGN: This was a cross-sectional study of 1669 women (22-35 wk of gestation) in Harare, Zimbabwe, who were receiving prenatal care. The statistical effects of age, season, gestational age, gravidity, HIV-1 infection, malaria parasitemia, and serum alpha1-antichymotrypsin (ACT) on serum beta-carotene (log10 transformed) and retinol were estimated by using multiple linear regression analyses. RESULTS: HIV infection was found in 31.5% of the women; 0.4% had malaria. Serum beta-carotene concentrations (geometric x: 0.19 micromol/L) were lower in HIV-infected women than in uninfected women (10beta = 0.78; 95% CI: 0.72, 0.84) and increased with age (10beta = 1.05; 1.02, 1.07) in gravida 1 but not in gravida > or =2 (P for interaction = 0.00002). Serum retinol (x: 0.92 micromol/L) increased with age (beta = 0.004; 0.0001, 0.008) in uninfected women but not in HIV-infected women (P for interaction = 0.02) and was 0.05-micromol/L (0.02, 0.09) lower in HIV-infected women than in uninfected women at 24 y of age. Furthermore, gestational age, season, use of prenatal supplements, and malaria were predictors of serum beta-carotene. Serum retinol was lower in women carrying male (beta = -0.04; -0.08, -0.00005) and multiple (beta = -0.21; -0.35, -0.08) fetuses. Serum ACT concentrations of 0.3-0.4, 0.4-0.5, and >0.5 g/L were associated with 3%, 11%, and 44% lower serum beta-carotene and 0.04-, 0.15-, and 0.41-micromol/L lower serum retinol. Serum ACT (g/L) was higher in women with malaria than in those without (beta = 0.10; 0.03, 0.16) and in gravida 1 than in gravida > or =2 (beta = 0.012; 0.003, 0.021), but was not higher in HIV-infected women than in uninfected women (beta = 0.001; -0.008, 0.011). CONCLUSIONS: HIV infection, malaria, gravidity, and gestational age were predictors of serum beta-carotene and retinol. Serum ACT was an important predictor of both and was associated with gravidity and gestational age.     

Growth of children according to maternal and child HIV, immunological and disease characteristics: a prospective cohort study in Kinshasa, Democratic Republic of Congo.

BACKGROUND: Most HIV-infection in children occurs in sub-Saharan Africa where antiretroviral therapy is seldom available. This study compares the growth progression and retardation of HIV-infected and uninfected children in the Democratic Republic of Congo (formerly Zaire). It estimates the risk for child growth retardation according to child and maternal immunological factors, severity of maternal and child illness, and maternal socioeconomic and marital status. METHODS: In a prospective cohort study of 258 children born to HIV seropositive mothers and 256 children of seronegative mothers in Kinshasa, Congo, the growth in length, weight, and weight-for-length of infected children (n = 68), uninfected children born to seropositive mothers (n = 190), and uninfected children born to uninfected mothers (n = 256) was compared. Serological, anthropometric and other clinical measures were collected monthly from 3-12 months and bi-monthly during the second year of life. Polymerase chain reaction for HIV was performed on bloods drawn at 2 days and 3 months post partum. Length-for-age, weight-for-age, and weight-for-length mean z-scores against National Center for Health Statistics (NCHS) reference data were calculated, and Cox proportional hazards models were used to estimate the risk of falling below -2.00 z-scores as a function of child and maternal immunological, clinical and sociodemographic variables. RESULTS: There was no difference in mean length-for-age at birth between HIV-infected (Group 1) children, uninfected children of infected mothers (Group 2) or Control children, but by 3 months old, HIV-infected children were shorter than both Group 2 and Controls. In weight-for-age and weight-for-length, Group 1 infants were lighter and more wasted at birth and onwards. Group 2 newborns were lighter than Controls at birth, but by three months they had caught up to Controls in both length and weight and remained the same as Controls thereafter. The odds of falling below -2.00 z-scores by 20 months for length, weight, and weight-for-length for HIV-infected children compared to uninfected children were 2.10, 2.84, and 2.56 respectively. Both HIV-infection and associated illnesses were factors associated with child stunting, underweight and wasting. The mother's age, socioeconomic status, presence of father, stage of illness and immune status had no detectable effect on the child's growth in the first two years of life. CONCLUSION: The HIV-infected children in Congo with no access to antiretroviral therapy were stunted, underweight, and wasted compared to same age uninfected children. Both HIV infection and HIV-associated signs and symptoms, not maternal immunological or socioeconomic circumstances, placed children at risk for growth retardation.     

人类免疫缺陷病毒感染孕产妇所产婴儿死亡的影响因素分析

目的 了解我国获得性免疫缺陷综合征(AIDS)高流行地区人类免疫缺陷病毒(HIV)感染孕产妇所产婴儿死亡的影响因素.方法 结合2004年建立的HIV感染孕产妇及所产婴儿随访研究队列,于2008年8-11月对我国4省7县区2004年1月至2007年11月HIV感染孕产妇所产婴儿的死亡状况及其影响因素进行调查.实际收集了498对HIV感染孕产妇及所产婴儿的相关信息.采用单因素和多因素Cox比例风险模型对HIV感染孕产妇所产婴儿死亡的影响因素进行分析.结果 498名婴儿,总观察人年数为406.22人年,死亡45例,死亡密度为110.78/1000人年.单因素分析结果显示,母亲孕产期处于AIDS前期或发病期(RR=1.971,95%CI值:1.143～3.396)、孕产妇生存状况(RR=3.062,95%CI值:1.097～8.550)、经产妇(RR=0.517,95%CI值:0.278～0.961)、自然分娩(RR=0.561,95%CI值:0.345～0.910)、早产(RR=5.302,95%CI值:2.944～9.547)、低出生体重(RR=4.920,95%CI值:2.691～8.994)、母子预防性服用抗逆转录病毒药物(RR=0.227,95%CI值:0.121～0.428)及婴儿感染HIV(RR=5.870,95%CI值:3.232～10.660)等因素影响HIV感染孕产妇所产婴儿的死亡.进一步的多因素分析显示,处于AIDS前期或发病期的孕产妇较处于AIDS潜伏期者所产婴儿死亡危险增加(RR=6.99,95%CI值:1.92～25.64);孕产期CD4~+T淋巴细胞计数低于200个/μl的孕产妇,所产婴儿发生死亡的危险增加(RR=2.05,95%CI值:1.01～4.15);母子未预防性服用抗逆转录病毒药物增加婴儿死亡的危险(RR=6.17,95%CI值:1.62～23.26);早产婴儿死亡危险是足月产婴儿的2.87倍(95%CI值:1.12～7.35);HIV感染婴儿死亡危险是非HIV感染婴儿的9.87倍(95%CI值:3.81～25.62).结论 提高HIV感染孕产妇自身免疫力,降低HIV母婴传播率及HIV感染孕产妇所产婴儿早产、低出生体重的发生率有助于降低婴儿死亡率.     

Body composition in HIV-infected women

Although loss of lean body mass is a common complication of human immunodeficiency virus (HIV) infection that can occur across the disease trajectory, few studies have characterized the body composition of HIV-infected women. We used bioelectrical impedance analysis to characterize the body composition of HIV-infected (n = 56) and uninfected (n = 12) women who were matched on percentage of ideal body weight. The HIV-infected women did not differ from the uninfected women by height-adjusted fat mass or body cell mass. Intergroup comparisons among the HIV-infected women showed that underweight women had significantly less fat mass than did normal-weight women but did not significantly differ with respect to body cell mass. Among all HIV-infected women, CD4(+) lymphocyte count was positively correlated with fat mass (r = 0.32, P = 0.01) but not with body cell mass. No significant correlations were found between any body-composition parameter and plasma viral load. Our findings suggest that, unlike men, HIV-infected underweight women show a preferential loss of fat mass and a relative preservation of body cell mass. This altered pattern of weight loss may relate to higher premorbid fat stores in women and/or hormonal differences.     

HIV and other predictors of serum folate, serum ferritin, and hemoglobin in pregnancy: a cross-sectional study in Zimbabwe

BACKGROUND: Folate and iron status and hemoglobin concentrations are important to maternal and infant health. OBJECTIVE: Our goal was to identify predictors of serum folate, serum ferritin, and hemoglobin. DESIGN: This was a cross-sectional study of 1669 pregnant women (22-35 wk of gestation) in Harare, Zimbabwe, who were receiving prenatal care. The statistical effects of age, season, gestational age, gravidity, HIV-1 infection, malaria parasitemia, and serum alpha1-antichymotrypsin (ACT) on serum folate, serum ferritin (log10 transformed), and hemoglobin were estimated by using multiple linear regression analyses. RESULTS: Serum folate (x: 11.4 micromol/L) was 0.52-nmol/L (95% CI: 0.04, 1.0) lower in HIV-infected women than in uninfected women and 0.65-nmol/L (0.014, 1.28) lower in weeks 25-35 than in weeks 22-25. Serum ferritin (geometric x: 11.6 microg/L) was 0.93 times (0.86, 0.99) lower in HIV-infected women and 2.25 times (1.41, 3.61) higher in women with malaria parasitemia than in uninfected women. Similarly, serum ferritin was 0.71 times (0.63, 0.79) higher in weeks 32-35 than in weeks 22-25 and 1.21 times (1.12, 1.29) higher in gravida > or =3 than in gravida 1. Elevated serum ACT was a strong predictor of serum folate, serum ferritin, and hemoglobin. HIV infection was associated with a 12.9-g/L (8.9, 16.8) lower hemoglobin concentration in women with nondepleted iron stores but low serum retinol and a 7-8-g/L lower hemoglobin concentration in women with other combinations of serum ferritin and retinol (P for interaction = 0.038). Season, age, gestational age, and gravidity were not significant predictors of hemoglobin. Low serum folate, ferritin, and retinol were associated with low hemoglobin. CONCLUSIONS: HIV was associated with lower serum folate, serum ferritin, and hemoglobin. HIV infection was also associated with lower hemoglobin, particularly in women with stored iron and low serum retinol. Low serum folate, ferritin, and retinol were associated with low hemoglobin.     

Pre-vaccine plasma levels of soluble inflammatory indices negatively predict responses to HAV,HBV, and tetanus vaccines in HCV and HIV infection

BackgroundChronic hepatitis C virus (HCV) and HIV infections are associated with impaired responses to neo-antigens contained in hepatitis A virus (HAV)/hepatitis B virus (HBV) vaccines, yet responsible mechanisms are unclear.MethodsACTG 5232 and CFAR0910 were clinical trials where pre-vaccine levels of plasma IP10, IL-6, sCD163 and sCD14 were measured in viremic HCV- (n = 15) or HIV-infected participants (n = 24) and uninfected controls (n = 10). Accelerated dosing HAV/HBV vaccine and tetanus booster were administered and antibody response was measured at 0, 1, 3, 8, and 24 weeks.ResultsPre-vaccine plasma IP10, IL-6, and sCD14 levels were elevated in both HCV and HIV-infected participants, while sCD163 was also elevated in HCV-infected participants. Pre-immunization tetanus antibody levels were lower in HIV-infected than in uninfected participants, while vaccine induced antibody responses were intact in HCV and HIV-infected participants. After HAV/HBV vaccination, HCV and HIV-infected participants had lower and less durable HAV and HBV antibody responses than uninfected controls.Among HCV-infected participants, pre-vaccine plasma IP10, IL-6, sCD14, and sCD163 levels inversely correlated with HAV, HBV and tetanus antibody responses after vaccine. Low HAV/HBV vaccine responses in HIV-infected participants prohibited assessment of immune correlates.ConclusionsDuring HCV and HIV infection markers of systemic inflammation reflect immune dysfunction as demonstrated by poor response to HAV/HBV neo-antigen vaccine.     

Vertical HIV-I-transmission. II. HIV-diagnosis in a child

In newborn children from HIV-infected women early establishment of HIV infection is of importance for optimal therapy of HIV-infected children and avoidance of unnecessary medication in uninfected children. A more than 95% reliable diagnosis of HIV infection can now be obtained at the age of four weeks by polymerase chain reaction (PCR) technology. Before this age a positive PCR result is relevant since it necessitates additional investigation such as measuring anti-HIV drug resistance and may lead to modification of anti-HIV treatment. Prophylaxis against Pneumocystis carinii is not needed if HIV infection can not be demonstrated by PCR after the age of four weeks.     

Studies of vitamins and minerals and HIV transmission and disease progression

HIV-1 infection is having a devastating impact on people in developing countries. Poor nutrition and HIV-related adverse health outcomes contribute to a vicious cycle that may be slowed down by using nutritional interventions, including vitamins and minerals. Among children, periodic supplementation with vitamin A starting at 6 mo of age has been shown to be beneficial in reducing mortality and morbidity among both HIV-infected and uninfected children. Limited data exist on the role of other nutrient supplements among children. Among HIV-infected adults, the safety and the efficacy of vitamin A supplements need further study, although adequate dietary intake of this essential nutrient is recommended. Multivitamin supplements were efficacious in reducing adverse pregnancy outcomes and early childhood infections, and is currently provided to pregnant HIV-infected pregnant women in many programs. The efficacy of such supplements among HIV-negative pregnant women needs further study. Daily multivitamin supplements were found to reduce HIV disease progression among men and women in several observational studies and randomized trials, and to provide an important low-cost intervention that could be provided to adults in early stages of HIV disease to prolong the time before antiretroviral therapy is recommended. Next, research priorities include examining the roles of minerals, including selenium, in HIV infection, as well as determining the safety and the efficacy of micronutrient supplements among individuals who are advanced in their disease and who are receiving antiretroviral therapy.     

From the Centers for Disease Control and Prevention. Progress toward elimination of perinatal HIV infection--Michigan, 1993-2000

In 1994, the U.S. Public Health Service (PHS) issued guidelines for maternal and neonatal zidovudine (ZDV) use to reduce perinatal human immunodeficiency virus (HIV) transmission. These guidelines recommend maternal ZDV use during the second and third trimesters of pregnancy and during labor and delivery (L&D) and administration of ZDV to the neonate for the first 6 weeks of life. In 2001, PHS updated 1995 guidelines for routine HIV counseling and voluntary testing of pregnant women. The Michigan Department of Community Health (MDCH) requires reporting of all children who are perinatally exposed to HIV and follows up these children to monitor their infection status and record demographic, clinical, and laboratory characteristics of infected children. The reporting of perinatally HIV-exposed children enables MDCH to monitor the effectiveness of public health efforts to prevent perinatal HIV transmission and assists the targeting of prevention programs and activities. This report summarizes surveillance data collected through December 31, 2001, on children born to HIV-infected women in Michigan during 1993-2000. The report highlights rapid adoption of PHS guidelines that resulted in the reduction of perinatally acquired HIV infection to historically low levels in Michigan. Improving levels of prenatal care (PNC) for HIV-infected pregnant women, especially substance users, and routine HIV counseling and voluntary testing for all pregnant women are needed to further reduce perinatal HIV infection.