Pregnancy in HIV‐infected teenagers in London

Objective

The aim of the study was to describe pregnancies in HIV‐infected teenagers.

Methods

A review of the case notes of HIV‐infected pregnant teenagers aged 13–19 years from 12 London hospitals was carried out for the period 2000–2007.

Results

There were 67 pregnancies in 58 young women, of whom one was known to have acquired HIV vertically. The overall mother‐to‐child transmission (MTCT) rate of HIV was 1.5% (one of 66). There were 66 live births. Median ages at HIV diagnosis and conception were 17 and 18 years, respectively. Sixty‐three per cent of women were diagnosed with HIV infection through routine antenatal screening. Eighty‐two per cent of pregnancies (41 of 50) were unplanned, with 65% of women (26 of 40) using no contraception. Forty‐three per cent of the women (20 of 46) had a past history of a sexually transmitted infection (STI). In 63 pregnancies, antiretroviral therapy was started post‐conception, with prevention of HIV MTCT the only indication in 81% of cases. Fifty‐eight per cent of those on highly active antiretroviral therapy (HAART) had an undetectable HIV viral load by delivery. Eighty‐seven per cent were uncomplicated pregnancies. Seventy‐one per cent delivered by Caesarean section and 21% (14 of 64) had a preterm delivery (<37 weeks). In the 12 months after delivery, 45% of women received contraceptive advice and 25% of women became pregnant again.

Conclusion

Obstetric and virological outcomes were favourable in this group of HIV‐infected young women. However, the majority of pregnancies were unplanned with poor documentation of contraception use and advice and low rates of STI screening. A quarter of women conceived again within 12 months of delivery. Effective measures to reduce STIs, unplanned pregnancies and onward HIV transmission in HIV‐infected teenagers are needed.     

Safety of zoster vaccine in adults from a large managed-care cohort: a Vaccine Safety Datalink study

Abstract. Tseng HF, Liu A, Sy L, Marcy SM, Fireman B, Weintraub E, Baggs J, Weinmann S, Baxter R, Nordin J, Daley MF, Jackson L, Jacobsen SJ, for the Vaccine Safety Datalink (VSD) Team (Kaiser Permanente, Pasadena, CA; Kaiser Permanente, Oakland, CA; Centers for Disease Control and Prevention, Atlanta, GA; Kaiser Permanente, Portland, OR; HealthPartners Research Foundation, Minneapolis, MN; Kaiser Permanente, Denver, CO; and Group Health Cooperative of Puget Sound, Seattle, WA; USA). Safety of zoster vaccine in adults from a large managed‐care cohort: a Vaccine Safety Datalink study. J Intern Med 2012; 271 : 510–520. Objectives. The aim of this study was to examine a large cohort of adults who received the zoster vaccine for evidence of an increased risk of prespecified adverse events requiring medical attention. Design. Two self‐comparison approaches, including a case‐centred approach and a self‐controlled case series (SCCS) analysis were used. Setting. Eight managed‐care organizations participating in the Vaccine Safety Datalink project in the United States. Subjects. A total of 193 083 adults aged 50 and older receiving a zoster vaccine from 1 January 2007 to 31 December 2008 were included. Main outcome measures. Prespecified adverse events were identified by aggregated International Classification of Diseases, Ninth Revision (ICD‐9) codes in automated health plan datasets. Results. The risk of allergic reaction was significantly increased within 1–7 days of vaccination [relative risk = 2.13, 95% confidence interval (CI): 1.87–2.40 by case‐centred method and relative rate = 2.32, 95% CI: 1.85–2.91 by SCCS]. No increased risk was found for the following adverse event groupings: cerebrovascular events; cardiovascular events; meningitis; encephalitis; and encephalopathy; and Ramsay‐Hunt syndrome and Bell’s palsy. Conclusions. The results of this study support the findings from the prelicensure clinical trials, providing reassurance that the zoster vaccine is generally safe and well‐tolerated with a small increased risk of allergic reactions in 1–7 days after vaccination.     

Efficacy of live zoster vaccine in preventing zoster and postherpetic neuralgia

Declining cell-mediated immunity to varicella zoster virus (VZV) in elderly individuals results in virus reactivation manifest by zoster (shingles) and postherpetic neuralgia (PHN). To prevent virus reactivation, a new VZV vaccine (Zostavax; Merck) that boosts cell-mediated immunity to VZV was developed. The 3-year Shingles Prevention Study showed that Zostavax significantly reduced burden of disease because of zoster and PHN. Despite its cost-effectiveness for adults aged 65-75 years, as determined in the United States, Canada and UK, <2% of immunocompetent adults over age 60 years in the United States were immunized in 2007. This was because of a combination of lack of patient awareness of the vaccine, physicians' uncertainty about the duration of protection and different cost-sharing plans for immunization. Nevertheless, zoster vaccine is safe, effective and highly recommended for immunization of immunocompetent individuals over age 60 years with no history of recent zoster.     

A literature review regarding the management of varicella‐zoster virus

Chickenpox and shingles (varicella‐zoster virus [VZV]) pose a threat to individuals who are immunosuppressed and/or have rheumatoid arthritis or another inflammatory musculoskeletal condition. In this paper we present a literature review of the condition, management and prevention. Copyright © 2010 John Wiley & Sons, Ltd.     

针刺治疗老年2型糖尿病合并带状疱疹的临床观察

目的：观察针刺治疗老年2型糖尿病合并带状疱疹的临床疗效。方法选取80例2型糖尿病合并带状疱疹的老年患者,随机均分为治疗组和对照组。治疗组40例采用体针调理同时配合局部围刺的治疗方法,对照组40例采用西药治疗。比较分析两组的疗效和临床症状等相关指标。结果治疗组痊愈31例,好转4例,无效2例,后遗神经痛3例,总有效率为87.5%;对照组痊愈20例,好转6例,无效10例,后遗神经痛4例,总有效率为65.0%。两组疗效差异具有统计学意义（P＜0.05）。治疗组的结痂时间和皮损消退时间明显短于对照组,差异具有统计学意义（P＜0.05）。治疗结束后治疗组患者的空腹及三餐后血糖均明显低于对照组患者,差异具有统计学意义（P＜0.05）。结论针刺治疗老年2型糖尿病合并带状疱疹的效果较好。     

Anal intraepithelial neoplasia and squamous cell carcinoma in HIV‐infected adults

Anal cancer is one of the most common non‐AIDS‐defining malignancies in the era of combination antiretroviral therapy. Its precursor lesion, anal intraepithelial neoplasia (AIN), is highly prevalent in HIV‐infected populations. More than 90% of anal squamous cell cancers are attributable to human papillomavirus (HPV). While the biology of HPV‐related intraepithelial neoplasia is consistent across lower anogenital sites, the natural history of AIN is not well established and cannot be assumed to be identical to that of cervical intraepithelial neoplasia. Screening strategies to prevent anal cancer should be developed based on robust natural history data in HIV‐infected and uninfected populations. Likewise, treatments need to be tested in randomized clinical trials, and reserved for those at significant risk of progression to cancer. This review covers the epidemiology, pathogenesis and immunology of HPV infection, AIN and anal cancer, and summarizes the current diagnosis, screening and treatment strategies in HIV‐infected adults.     

The incidence of herpes zoster in patients with diabetes mellitus: A meta-analysis of cohort studies

The research has correlated the risk factors of herpes zoster with some chronic diseases. This meta-analysis aimed to assess the incidence of herpes zoster in patients with diabetes mellitus.We conducted a literature search using Web of Science and PubMed for articles published from January 1, 2000 to December 31, 2019. The incidence rate ratio and 95% confidence interval for herpes zoster associated with diabetes mellitus was calculated.We included 5 cohort studies for a meta-analysis. The pooled incidences of herpes zoster in patients with diabetes mellitus and in patients without diabetes mellitus were 7.22 and 4.12 per 1000 person-years. The overall risk of developing herpes zoster was significantly higher in patients with diabetes mellitus when compared to those with no diabetes mellitus (incidence rate ratio = 1.60, 95% confidence interval = 1.33–1.93).Patients with diabetes mellitus are substantially at increased risk for the development of herpes zoster. Patients with diabetes mellitus should take into consideration the vaccination to prevent herpes zoster.