HIV-1: prognóstico materno

Profound modifications in the profile of patients are currently being observed within the epidemic context of AIDS, especially with respect to pauperization and feminization of the disease. The population most frequently affected is in the reproductive age, and among adults aged 18 to 24 years, the ratio is 1 man to 1 woman, a phenomenon occurring uniformly all over the world. One of the main challenges for HIV-1-infected pregnant women and their doctors is the effect of the interaction between HIV infection and pregnancy. The present article is a review of the literature; and its objective is to assess the influence of HIV-1 infection seen from the maternal perspective, with a discussion of immunologic function, maternal prognosis, and the HIV-abortion interface. At present, we cannot conclude that pregnancy has a short-term effect on the evolution of HIV infection, but the concomitance of HIV and pregnancy may adversely affect the prognosis of gestation, especially in view of its frequent association with increased abortion and puerperal morbidity rates.Atualmente, dentro do contexto epidêmico da AIDS observam-se profundas modificações no perfil dos pacientes acometidos, especialmente traduzida pela pauperização e feminilização. A população mais afetada encontra-se em idade reprodutiva e entre adultos de 18 a 24 anos, a relação é de 1 homem para 1 mulher, o que ocorre indiscriminadamente como fenômeno global. Um dos maiores desafios para as gestantes portadoras do HIV-1 e seus médicos assistentes é a repercussão advinda da interação entre a infecção pelo HIV e a gestação. Esse artigo é uma revisão de literatura e tem por objetivos avaliar a influência da infecção pelo HIV-1 sob a perspectiva materna tecendo considerações sobre a função imunológica, o prognóstico materno e a interface HIV e abortamento. Até o presente, não se pode concluir que a gestação tenha, a curto prazo, um efeito norteador da evolução da infecção pelo HIV, porém a concomitância HIV e gestação pode adversamente afetar o prognóstico gestacional, especialmente face à freqüente associação com acréscimo nos índices de aborto e morbidade puerperal

Visceral leishmaniasis (kala-azar) and pregnancy.

OBJECTIVE: The aim of the present review was to close the gap in the approach to pregnant women with visceral leishmaniasis (kala-azar) by providing up-to-date information to obstetricians about physiopathology, epidemiology, vertical transmission, drugs and treatment during pregnancy. BACKGROUND: Infection with Leishmania chagasi during pregnancy is rare and deserves special attention since little information is available regarding the occurrence of visceral leishmaniasis during gestational period and the real possibility of vertical transmission of this disease. Because specific areas in the world are endemic for the disease and considering the continuous growth of the population, cases of pregnant women with visceral leishmaniasis are becoming more frequent. Unfortunately, textbooks on infectious diseases do not include this specific group of patients, and studies in the literature on aspects related to pregnancy and visceral leishmaniasis are scarce. CONCLUSIONS: Vertical transmission of leishmaniasis is possible and the institution of treatment is imperative in cases of pregnant women with kala-azar. Amphotericin B is strongly recommended as the first choice drug due to its fewer maternal-fetal adverse effects

Efeito das drogas anti-retrovirais sobre os valores dos linfócitos TCD4, RNA do HIV-1 e parâmetros antropométricos de neonatos de gestantes portadoras do HIV-1

PURPOSE: To study the effect of antiretroviral drugs administered during pregnancy on CD4 lymphocyte counts and HIV-1 RNA levels of pregnant women and on the anthropometric parameters of their neonates. METHODS: A prospective study was conducted on 57 pregnant women and their neonates divided into 3 groups: ZDV Group, HIV-infected mothers taking zidovudine (n = 20); triple therapy (TT) Group, mothers taking zidovudine + lamivudine + nelfinavir (n = 25), and Control Group, normal women (n = 12). CD4 lymphocyte counts and HIV-1 RNA levels of pregnant women were analyzed during two periods of pregnancy. The perinatal prognosis took into account preterm rates, birth weight, intrauterine growth restriction, perinatal death, and vertical transmission of HIV-1. Data were analyzed statistically using the nonparametric chi-square, Mann-Whitney, Friedman, Kruskal-Wallis, and Wilcoxon matched pairs tests, with the level of significance set at POBJETIVOS: Estudar o efeito das drogas anti-retrovirais sobre a quantificação dos linfócitos TCD4 e RNA do HIV-1 de gestantes portadoras do HIV-1 e parâmetros antropométricos de seus neonatos. MÉTODOS: Estudo prospectivo avaliando 57 gestantes e seus neonatos em três grupos: Grupo AZT, gestantes portadoras do HIV utilizando zidovudina (n=20); Grupo TT, mães utilizando zidovudina+lamivudina+nelfinavir (n=25), e Grupo Controle, mulheres saudáveis (n=12). A quantificação dos linfócitos TCD4 e RNA do HIV-1 de gestantes portadoras do HIV foi analisada em dois períodos durante a gestação. O prognóstico perinatal levou em consideração as taxas de pré-termos, restrição de crescimento intra-útero, mortalidade perinatal e transmissão vertical do HIV-1. Os dados foram analisados utilizando-se testes não paramétricos de qui-quadrado, Mann-Whitney, Friedman, Kruskal-Wallys e Wilcoxon para amostras pareadas, considerando-se significativos valores associados a

High Prevalence of Human Papillomavirus Infection among Brazilian Pregnant Women with and without Human Immunodeficiency Virus Type 1

Objective. To estimate HPV prevalence among pregnant women from Ribeirão Preto, Brazil, and the possible influence of HIV-1 infection on this prevalence. Methods. A cross-sectional study with 44 HIV-positive and 53 HIV-negative pregnant women was conducted. Cervicovaginal specimens were obtained from all women during gynecologic exam. HPV DNA, low and high risk HPV types, was detected using conventional PCR. Statistical analysis used Student's t-test, Mann-Whitney test, Fischer's Exact test, and prevalence ratios with 95% confidence interval. Results. HIV-positive pregnant women had higher proportion of HPV infection than HIV-negative pregnant women (79.5% versus 58.5%; P < .05). HPV positivity prevalence ratio for HIV-positive women was 1.36 (95% CI 1.04–1.8; P = .03). There was significant association between HIV viral load levels and HPV positivity (P < .05). Conclusions. Our results demonstrate higher HPV positivity in HIV-infected pregnant women. Higher values of HIV viral load were associated with HPV positivity

Hypovitaminosis A: cofactor of deleterious clinic outcome in human being

Importante foco de atenção em Saúde Pública tem sido a avaliação de determinados micronutrientes no ser humano, em especial aqueles que se encontram associados à vulnerabilidade orgânica, conseqüente ao desiquilíbrio ou à deficiência desses micronutrientes. Entre os micronutrientes, a hipovitaminose A tem sido objeto de realce devido à significante prevalência em populações de países em desenvolvimento. Este artigo aborda a Vitamina A, enfocando seu metabolismo e as repercussões deletérias, decorrentes de sua deficiência sobre o organismo, suas manifestações no ciclo gravidopuerperal, e sua interação em situações clínicas, específicas.An important focus of attention in Public Health has been micronutrient deficiency in human being because of the enhanced vulnerability of individuals to the effects of micronutrient deficiency or imbalance. Among all micronutrients deficiencies, vitamin A has been one of the most important public health problems, affecting a large percentage of people in developing countries. This article focus on a review of vitamin A metabolism, deleterious repercussions and association with several clinical and obstetrics conditions. It highlights hypovitaminosis A as cofactor of deleterious clinic outcome in human being

Effect of Maternal HIV-1 Status and Antiretroviral Drugs on Haematological Profiles of South African Infants in Early Life

Maternal HIV-1 status and antiretroviral drug exposure may influence the haematological profiles of infants. We recruited infants from 118 uninfected control women and from 483 HIV-1 infected women who received no antiretroviral drugs (n=28), or received single-dose Nevirapine (sdNVP) (n=424) or triple-drug combination therapy (n=31) to reduce HIV-1 transmission. Blood was drawn from infants within 24 hours of delivery or 6-12 weeks post-delivery and full blood counts performed using a fully automated AcT-5-diff haematology analyser and reference controls. Exposed uninfected (EU; no NVP) differed from control infants only in having lower basophil counts and percentages. In all infant groups, leukocyte profiles showed characteristic quantitative changes with age in the first 6 weeks of life. HIV-1 infected infants displayed by 6 weeks elevations in white blood cells, lymphocyte, monocyte and basophil counts, and monocyte and basophil percentages, when compared to EU infants. At birth EU NVP-treated infants exhibited elevated monocyte percentages and counts and basophil counts that did not persist at 6 weeks. Interestingly, EU newborns of mothers with high CD4 counts (> 500 cells/μl) that had taken sdNVP had significantly elevated white blood cell, monocyte and basophil counts when compared to newborn infants of mothers with similar CD4 counts that had not taken sdNVP; this was not evident in infants of mothers with CD4 counts <200 cells/μl. These previously undescribed features may affect immune response capability in early life and clinical consequences of such changes need to be further investigated