The impact of race/ethnicity on mother-to-child HIV transmission in the United States in Pediatric AIDS Clinical Trials Group Protocol 316

The present analysis was designed to determine whether race/ethnicity was independently associated with mother-to-child HIV-1 transmission risk in subjects enrolled in a trial of 2-dose intra-partum nevirapine in combination with standard antiretroviral therapy and to determine what factors, including race/ethnicity, predicted maternal viral suppression at the time of delivery. Women enrolled in Pediatric AIDS Clinical Trials Group (PACTG) 316 from sites in the United States and Puerto Rico were included. Distribution of selected maternal disease and treatment characteristics was assessed by race/ethnicity category. Logistic regression models were fit to evaluate possible association of factors with HIV transmission and with viral load at delivery. Variables associated with the outcome at P < 0.05 level were retained in the final models. Of 1052 women randomized at PACTG sites, 891 were included in the present analysis: 572 (64%) were black; 206 (23%) were Hispanic; and 113 (13%) were white. All women who had infected infants were black or Hispanic (11/572 and 3/206, respectively), whereas none of the women identified as white had an infected infant (0/113). This difference was not statistically significant (P = 0.54). White women had higher entry CD4 cell counts and lower HIV-1 RNA at delivery than women of other races/ethnicities. Black and Hispanic women were more likely than white women to start therapy during their current pregnancy but did not initiate prenatal care later. In bivariate models that included antiretroviral type and variables that had values of P < or = 0.25 in univariate analysis, time of antiretroviral initiation, time of prenatal care initiation, and race/ethnicity each retained significance in predicting viral suppression at delivery. Race/ethnicity remained predictive of viral suppression at delivery in a multivariate model incorporating all of these variables (P = 0.01). Higher HIV-1 RNA and lower CD4 cell counts in women identified as black or Hispanic have significant implications for the health of these women and their newborns. Race/ethnicity is significant in predicting viral suppression at the time of delivery.     

团体心理干预对HIV感染者/AIDS患者的影响效果研究

目的以建立HIV感染者/AIDS患者心理支持小组的形式,探讨团体心理干预对HIV感染者/AIDS患者的影响效果。方法实施地点为湖南省某地区的疾病预防控制中心,自愿参加小组心理辅导和干预的HIV/AIDS患者19人组成2个小组,对小组成员进行为期4次,每次3小时的团体心理干预,采用激惹、抑郁和焦虑自评量表（IDA）、社会支持评定量表（SSS）及特质应对方式问卷（TCSQ）对干预效果进行评估。结果干预后小组成员的焦虑、抑郁情绪及由外部环境引起的易激惹状态有所改善;在寻求社会支持和应对问题的方式方面也有显著变化。结论团体心理干预对改善HIV感染者/AIDS患者的心理问题、提高其社会支持和同伴支持、改善应对策略有一定效果,值得应用和进一步的推广。     

Minorities Remain Underrepresented in HIV/AIDS Research Despite Access to Clinical Trials

Background and Objective: The reasons for minority underrepresentation in HIV/AIDS clinical trials remain unclear. We aimed to evaluate the knowledge, experience, and factors that influence minority participation in HIV/AIDS studies in the United States. Methods: An anonymous, bilingual, self-administered survey on study participation was given to HIV-infected adults attending AIDS Clinical Trials Group–affiliated clinics in the United States and Puerto Rico. Chi-square tests were used to evaluate differences by race, first language, and level of education. Logistic regression was used to estimate odds ratio (OR) and 95% confidence interval (CI) for factors associated with being talked to about participation in a study. Results: We analyzed 2,175 complete surveys (221 in Spanish). Among respondents, 31% were White, 40% were Black/African American (AA), and 21% were Hispanic. The overall rate of previous participation in any HIV/AIDS study was 48%. Hispanics were less likely to know about studies compared to Whites and AAs (67% vs 74% and 76%, respectively; P .001). Compared to Whites, AAs and Hispanics were less likely to have been talked to about participating in a study (76% vs 67% and 67%, respectively; P .001). The OR for being talked to about participating in a study was 0.65 (95% CI, 0.52–0.81) for AAs and 0.65 (95% CI, 0.49–0.85) for Hispanics, compared to Whites. AAs and Hispanics were more likely to state that studies were not friendly to their race (17% and 10% vs 4%; P .001). Conclusions: Minorities continue to face barriers for HIV/AIDS trial participation, even when clinical research is available. Enrollment strategies should better target minorities to improve recruitment in HIV/AIDS research.     

团体心理干预对受艾滋病影响儿童的效果研究

目的探讨团体心理干预对受艾滋病影响儿童的影响和效果。方法将自愿参加小组心理辅导和干预的受艾滋病影响儿童28人分为2个小组,对小组成员进行为期7次,每次2～3小时的团体心理干预辅导,采用中文版儿童焦虑性情绪障碍筛查表(SCARED)、中文版儿童抑郁自评量表(DSRS)、社会支持评定量表(SSS)、简易应对方式问卷(SCSQ)及青少年心理韧性量表(RSCA)对干预效果进行评估。结果干预后小组成员的焦虑、抑郁情绪有所改善;在寻求社会支持和心理韧性方面也有显著变化。结论团体心理干预对改善受艾滋病影响儿童的心理问题、增强其社会支持和同伴支持、提高心理韧性方面有一定效果。     

The HIV/AIDS Prevention Research Synthesis Project: implications for federal HIV prevention policy

Scientific research can strongly influence programs and policies at the local, state, and federal level. In this article we review implications for federal public health policy from the HIV/AIDS Prevention Research Synthesis Project, a project that integrates data from individual intervention studies to estimate the influence of HIV risk reduction interventions on social, behavioral, and community changes. We note several important policy changes that have occurred in HIV research and program development as a result of this project. We also describe the project's role in guiding future funding decisions.     

The state of immunology in Africa: HIV/AIDS and malaria.

HIV and malaria are two major infections that are responsible for the greatest burden of diseases, morbidity and mortality in the African population. Successful research has been undertaken in Africa into novel means of monitoring HIV disease progression and in identifying vaccine candidates. The role of IgG isotypes in malaria has been investigated, as have parasite adhesion molecules important for pathogenesis. It is hoped that vaccines for malaria will soon prove successful. However, many problems still face immunology research in Africa.     

The 2004 International AIDS Conference and how to globally counter HIV/AIDS

This article reports noteworthy HIV/AIDS clinical trials presented at the XVth International AIDS Conference, Bangkok, July 2004, and also outlines goals of comprehensive prevention, care, treatment, and monitoring plans. The Bangkok conference theme was "Access for All." Outlined are goals of comprehensive prevention, care, and treatment programs: increased education and prevention efforts, greater involvement of national health authorities, reduction of new HIV infections, increased use of voluntary counseling and testing, increased acceptance and use of condoms, acceptance of an individual's right to be protected against HIV infection during sexual activity, increased support of NGOs, reduction of sexual partners, increased sexual fidelity, availability of antiretroviral medication, prevention of mother-to-child transmission, reduction of AIDS deaths, improved surveillance of sexually transmitted infections, improved blood supply security, increased coordination with tuberculosis and malaria treatment, equity for urban and rural persons, increased orphan services, reduction of orphan rate, greater involvement of local leaders, increased media involvement, reducing HIV/AIDS discussion taboo, reduced injecting drug user needle sharing, and continuing education for health care professionals. Monitoring parameters include incidence and prevalence of HIV infections, use of voluntary counseling and testing, condom use and attitudes to right of protection, AIDS deaths, orphan rate, public advertisements, leadership participation, antiretroviral use and availability, public awareness of services, blood supply security, and professional education.     

Trends in antiretroviral therapy and mother-infant transmission of HIV. The Women and Infants Transmission Study Group

Trends in the vertical transmission rate of HIV and evolving antiretroviral usage between 1990 and 1998 within the Women and Infants Transmission Study were evaluated. A decline in mother-infant transmission was temporally associated with advances in therapy, especially when regimens including a protease inhibitor were included in the analysis.     

Risk factors for perinatal transmission of human immunodeficiency virus type 1 in women treated with zidovudine. Pediatric AIDS Clinical Trials Group Study 185 Team.

BACKGROUND: Maternal, obstetrical, and infant-related factors associated with the risk of perinatal transmission of human immunodeficiency virus type 1 (HIV-1) were identified before the widespread use of zidovudine therapy in pregnant women. The risk factors for transmission when women and infants receive zidovudine are not well characterized. METHODS: We examined the effects of maternal, obstetrical, and infant-related characteristics and maternal virologic and immunologic variables on the risk of perinatal transmission of HIV-1 among 480 women and their infants, all of whom received zidovudine. The women and infants were participating in a phase 3 trial of passive immunoprophylaxis for the prevention of perinatal transmission. RESULTS: In univariate analyses, the risk of perinatal transmission was associated with each of the following: decreased maternal CD4+ lymphocyte counts at base line; decreased maternal HIV p24 antibody levels at base line and delivery; increased maternal HIV-1 titer at base line and delivery; increased maternal HIV-1 RNA levels at base line and delivery; and the presence of chorioamnionitis at delivery. In multivariate analyses, the only independent risk factor was the maternal HIV-1 RNA level at base line (odds ratio for transmission, 2.4 per log increase in the number of copies; 95 percent confidence interval, 1.2 to 4.7; P=0.02) and at delivery (odds ratio, 3.4; 95 percent confidence interval, 1.7 to 6.8; P=0.001). There was no perinatal transmission of HIV-1 among the 84 women who had HIV-1 levels below the limit of detection (500 copies per milliliter) at base line or the 107 women who had undetectable levels at delivery. CONCLUSIONS: Among pregnant women and their infants, all treated with zidovudine, the maternal plasma HIV-1 RNA level was the best predictor of the risk of perinatal transmission of HIV-1. Antiretroviral therapy that reduces the HIV-1 RNA level to below 500 copies per milliliter appears to minimize the risk of perinatal transmission as well as improve the health of the women.     

Africa's children and AIDS -- a continent in crisis. The devastation of the HIV / AIDS pandemic

AIDS is having a major impact upon child health. By mid-1996, UNAIDS estimated that worldwide there were 3 million HIV infections in children. Accordingly, infant mortality rates (IMRs) have increased due to AIDS, reversing declines which had been occurring in many countries over the last few decades. The IMR in 1996 would have been 51.7 per 1000 without AIDS; it is instead 72.8 with AIDS, 40% higher than expected. IMR is 30% higher than expected in Zambia and almost 20% higher in Kenya and Uganda. IMRs should grow considerably during the next decade as the epidemic spreads. Two-thirds of AIDS deaths among children occur among those aged 1-4 years, with countries in southern Africa being the most affected. With regard to life expectancy, many years of life will be lost due to the AIDS epidemic. AIDS has already led to widespread and marked reductions in life expectancy, with life expectancy for females being lower than that for males because women are infected with HIV and die at younger ages than men. Lower life expectancy will lead to an increase in the proportion of orphaned children. It is likely that at least 30 million children are living with HIV-positive parents, at risk of being orphaned in the next few years. The implications of the growing proportions of orphans and challenges in child health are considered.     

Social Stigma,HIV/AIDS Knowledge,and Sexual Risk1

A cross-sectional study of 481 sexually active, heterosexual late adolescents showed that: (a) heterosexual people may be distancing themselves from HIV/AIDS because of its association with the gay community while also engaging in greater behavioral risk for HIV/AIDS; and (b) the ways a person comes to know about HIV/AIDS (perceived knowledge, passive classroom learning, media influence, and knowing people with HIV/AIDS) can be related to sexual risk behavior through the operation of two mediating variables, condom self-efficacy and perceived HIV/AIDS risk. The variables studiedare closely linked with Stage 1 factors in the AIDS Risk Reduction Model. Implications for understanding how stigmatizing can affect behavior are discussed, as well as implications for education in HIV/AIDS related issues.     

Otorhinolaryngology pathologies and HIV/AIDS. Apropos of 19 cases

This work is the result of a retrospective study carried out over three months, from February to April 2002 in the ENT service of Gabriel Touré hospital of Bamako (Mali). The purpose of the study was to find out the prevalence of HIV/aids among ENT patients over the study period. Out of 691 patients, there were 19 cases of seropositivity (2.7%). These seropositive patients were quite often young women, over half of them urban (16/19), jobless and unpaid. The oro-pharyngo-laryngology symptoms though not often obvious in the HIV/AIDS manifestations deserve to be studied more as they can point out possible screening.     

Increasing and Supporting the Participation of Persons of Color Living with HIV/AIDS in AIDS Clinical Trials

Persons living with HIV/AIDS (PLHA) of color are under-represented in AIDS clinical trials (ACTs), which may limit the generalizability of research findings and denies many individuals access to high levels of care and new treatments available through ACTs. Disproportionately low rates of recruitment in health care settings and by providers are a major barrier to ACTs for this group. Moreover, PLHA of color are more likely than their white peers to decline to participate, mainly due to fear and mistrust (although willingness is also high), negative social norms about ACTs, and difficulty navigating the unfamiliar ACT system. We describe a small number of successful behavioral and structural interventions to increase the participation of PLHA of color in screening for and enrollment into ACTs. HIV care settings, clinical trials sites, and trial sponsors are uniquely positioned to develop procedures, supports, and trials to increase the proportion of PLHA of color in ACTs.     

HIV/AIDS pathogenesis and treatment: new twists and turns.

This review focuses on some new insights into human immunodeficiency virus pathogenesis, as it affects CD4 lymphocytes and other key cells in the immune system. It also critically reviews recent progress in anti-retroviral therapy.