Unique Challenges of Hepatitis C in Infants,Children, and Adolescents

Purpose

Hepatitis C, a chronic disease with deadly consequences, is no longer predominantly a disease of older people.

Placental Hofbauer cells assemble and sequester HIV-1 in tetraspanin-positive compartments that are accessible to broadly neutralizing antibodies

Introduction

Within monocyte-derived macrophages, HIV-1 accumulates in intracellular virus-containing compartments (VCCs) that are inaccessible to the external environment, which implicate these cells as latently infected HIV-1 reservoirs. During mother-to-child transmission of HIV-1, human placental macrophages (Hofbauer cells (HCs)) are viral targets, and have been shown to be infected in vivo and sustain low levels of viral replication in vitro; however, the risk of in utero transmission is less than 7%. The role of these primary macrophages as viral reservoirs is largely undefined. The objective of this study is to define potential sites of viral assembly, accumulation and neutralization in HCs given the pivotal role of the placenta in preventing HIV-1 infection in the mother-infant dyad.

Methods

Term placentae from 20 HIV-1 seronegative women were obtained following caesarian section. VCCs were evaluated by 3D confocal and electron microscopy. Colocalization R values (Pearson''s correlation) were quantified with colocalization module of Volocity 5.2.1. Replication kinetics and neutralization studies were evaluated using p24 ELISA.

Results

We demonstrate that primary HCs assemble and sequester HIV-1_BaL in intracellular VCCs, which are enriched in endosomal/lysosomal markers, including CD9, CD81, CD63 and LAMP-1. Following infection, we observed HIV-1 accumulation in potentially acidic compartments, which stained intensely with Lysotracker-Red. Remarkably, these compartments are readily accessible via the cell surface and can be targeted by exogenously applied small molecules and HIV-1-specific broadly neutralizing antibodies. In addition, broadly neutralizing antibodies (4E10 and VRC01) limited viral replication by HIV-1-infected HCs, which may be mediated by FcγRI.

Conclusions

These findings suggest that placental HCs possess intrinsic adaptations facilitating unique sequestration of HIV-1, and may serve as a protective viral reservoir to permit viral neutralization and/or antiretroviral drug entry in utero.     

艾滋病病毒与婴儿喂养研究

母婴传播是艾滋病的重要传播途径之一,是儿童感染艾滋病病毒的最主要途径.婴儿喂养方式对艾滋病病毒的母婴传播产生着重要的影响,同时也影响着艾滋病病毒感染母亲所生婴儿的生存状况.该文从艾滋病病毒感染母亲对婴儿喂养方式的选择意愿、不同喂养方式、婴儿生存状况、母乳喂养与艾滋病病毒母婴传播率及对人工喂养安全性评价等方面,介绍了目前国际上对艾滋病病毒感染母亲所生婴儿喂养方面研究的进展,为基层向艾滋病病毒感染母亲传递婴儿喂养方面的信息提供参考.     

Haematological parameters of HIV-1-uninfected infants born to HIV-1-infected mothers

Aim: To investigate haematological parameters in infants born to HIV-1-infected mothers and exposed to combination antiretroviral therapy (ART) used to prevent mother-to-child transmission (MTCT). Methods: A 2-y single-centre follow-up study performed in 109 infants born to HIV-1-positive mothers. Exclusion criteria for the infants were HIV-1 infection, perinatal death, or insufficient information. Haematological parameters of the remainder of 92 infants born to HIV-1-infected mothers and exposed to ART in utero and neonatally were compared with 75 matched non-ART-exposed children. Results: Transmission rate of HIV-1 was 1.8% and occurred when the mother was not compliant with the treatment. In the HIV-1/ART-exposed children there was a long-lasting reduction in absolute neutrophil counts (ANC) until at least 8 mo of age. According to PACTG toxicity scores, 16 infants were suffering from grade II or more (moderate-to-severe) toxicity of ART on ANC. In a multivariable analysis of maternal and neonatal risk factors, pregnancy duration was correlated with moderate-to-severe toxicity on ANC. There were no clinical implications detected, e.g. increased infections or antibiotic treatment.

Conclusion: ART is successful in preventing MTCT, but alterations in haematological parameters may persist for a long period. The clinical implications remain uncertain. This suggestion increases the importance to continue prospective follow-up on the haematological parameters in ART/HIV-exposed children.     

福州市孕产妇HIV感染现状及实施预防母婴传播干预措施情况分析

[目的]了解福州市孕产妇艾滋病病毒（HIV）感染状况,分析对HIV阳性孕产妇实施预防母婴传播干预措施的效果。[方法]对福州市2004-2008年孕产妇HIV抗体检测资料和阳性孕产妇及其分娩婴儿实施综合干预措施情况进行分析。[结果]2004-2008年合计检测84514名孕产妇,检出26例HIV感染者,感染率为0．03oA。26例阳性孕产妇中,9例选择终止妊娠,17例选择分娩并接受全部或部分干预措施。对7例满18个月的幼儿检测HIV抗体．1例阳性。[结论]福州市孕产妇艾滋病处于低流行状态。对HIV阳性孕产妇实施综合干预措施对降低母婴传播的发生有一定作用。     

预防艾滋病母婴传播阻断后儿童健康状况调查研究

目的：探讨预防艾滋病母婴传播阻断后对儿童健康状况的影响。方法：于2014年3月至2015年3月间,在该院选择40例进行分娩的艾滋病阳性孕妇设为阻断组,选择同时期收治的40例健康孕妇设为对照组,对阻断组孕妇进行预防艾滋病母婴传播阻断,对两组进行随访,统计对比两组儿童健康状况。结果：阻断组儿童12月内腹泻病发病率、呼吸道疾病发病率、营养不良发生率及18月内艾滋病检测阳性率、死亡率与对照组相比无明显差异（P＞0.05）。结论：预防艾滋病母婴传播阻断能有效改善儿童健康状况,可在临床推广运用。     

Should Caesarian Section Be Offered to Women With Recurrent Genital Herpes Simplex Lesions After >4 Hours of Ruptured Membranes?

Background

Neonatal herpes simplex virus (HSV) infection and its implications have been well defined. Several methods are recommended to mitigate the risk of maternal transmission of HSV to the neonate, including CS, suppressive antiviral therapy for the mother, and prophylaxis for the infant. The utility of CS in women who present with a duration of rupture of membranes greater than 4 hours remains a question.

Correlates of women's knowledge of mother-to-child transmission of HIV and its prevention in Tanzania: a population-based study

Studies that explored women's knowledge on mother-to-child transmission (MTCT) of HIV and its prevention (PMTCT) in the general population are currently lacking. This paper examined factors associated with having adequate knowledge of MTCT of HIV and PMTCT among a nationally representative sample of women in Tanzania. We conducted a cross-sectional analysis including 10,299 women from the 2011–2012 Tanzania HIV/AIDS and Malaria Indicator Survey. The outcome of interest was the presence of adequate knowledge on MTCT and PMTCT of HIV. We used multivariable logistic regression to identify factors associated with having adequate knowledge on MTCT and PMTCT of HIV. Results revealed that the overall prevalence of having adequate knowledge on MTCT and PMTCT of HIV was low (46%). We found a statistically significant difference in the proportions of having adequate knowledge between HIV-negative and HIV-positive women (45% vs. 56%; p?MTCT and PMTCT of HIV was positively associated with experiencing at least one pregnancy, having some education, having higher household wealth, residing in urban area, being exposed to HIV education, having tested for HIV, knowing a place to get HIV test, and having comprehensive knowledge on HIV and AIDS. Among HIV-seropositive women, experiencing at least one pregnancy and having comprehensive knowledge on HIV and AIDS were strongly associated with having adequate knowledge on MTCT and PMTCT of HIV (Adjusted odds ratio: aOR 2.78, 95% CI 1.21, 6.37 and aOR 1.71, 95% CI 1.15, 2.73, respectively). Further efforts are needed to enhance HIV/AIDS education among women of childbearing age and strengthen PMTCT services in Tanzania.     

Pregnancy outcomes in young mothers with perinatally and behaviorally acquired HIV infections in Rio de Janeiro

Background

Perinatally HIV-infected children are surviving into adulthood, and getting pregnant. There is a scarcity of information on health and pregnancy outcomes in these women.