Social Return on the investment of the elimination of the vertical transmission of Chagas, HIV / AIDS, HB and Syphilis: Case of a Municipality of the Province of Buenos Aires

Introducción:se busca cuantificar los retornos de la inversión asociados a una intervención en el sistema público de salud de un municipio de la Provincia de Buenos Aires, Argentina, consistente en el fortalecimiento de la estrategia denominada Eliminación de la Transmisión Maternoinfantil de la Infección por VIH, Sífilis, enfermedad de Chagas Congénita e Infección Perinatal por Hepatitis B (ETMI-PLUS). Metodología: el estudio (cuantitativo) se basa en la metodología de Retorno Social de la Inversión (RSI). Se establecieron definiciones ad-hoc para la medición de los retornos sobre la base de los datos disponibles provenientes de diversas fuentes: información primaria de la Secretaría de Salud del MAB; tasas de transmisión congénita de cada enfermedad notificados al Sistema Nacional de Vigilancia de Salud; presupuestos detallados de los recursos asignados al proyecto por parte de la Fundación Mundo Sano y costos de tratamientos e insumos de nomencladores oficiales. Resultados: por cada peso invertido para reforzar la ETMI-PLUS en el MAB, se obtuvo un retorno de casi 4 pesos, gracias a las mejoras en la eliminación vertical de las cuatro enfermedades y al descenso de las complicaciones cardiacas en las mujeres embarazadas diagnosticadas con chagas y tratadas oportunamente. Conclusiones: estos resultados sugieren la existencia de una relación retorno-inversión favorable, analizada bajo una perspectiva conservadora, ya que, se incluyen exclusivamente los ahorros para el sistema de salud y se excluyen otras dimensiones de los retornos vinculadas con las mejoras en los resultados alcanzados.Introduction: we seek to quantify the returns on investment associated with an intervention in the public health system of a Municipality of the Province of Buenos Aires, Argentina. This intervention consists of strengthening the strategy for the Elimination of Mother-to-Child Transmission of HIV Infection, Syphilis, Congenital Chagas Disease and Perinatal Hepatitis B Infection, a strategy called ETMI-PLUS. Methodology: the study (quantitative) is based on the Social Return on Investment (RSI) methodology. Ad-hoc definitions are established for the measurement of returns based on the information available from various sources: primary information from the Ministry of Health of the MAB; rates of congenital transmission of each disease reported to the National Health Surveillance System; detailed budgets of the resources assigned to the project by Fundación Mundo Sano and costs of treatments and supplies from official nomenclators. Results: for each argentinean peso invested in strengthening the ETMI-PLUS in the MAB, a return of almost 4 pesos would have been obtained thanks to the improvements in the vertical elimination of the 4 diseases and the reduction of cardiac complications in pregnant women. Conclusions: these results suggest the existence of a return / investment relationship favorable to the intervention, analyzed under a conservative analysis since savings for the health system are exclusively included and other dimensions of returns associated with improvements in results are excluded.Fil: Monteverde, Laura Malena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Centro de Investigaciones y Estudios Sobre Cultura y Sociedad. Centro de Investigaciones en Ciencias Económicas | Universidad Nacional de Córdoba. Centro de Investigaciones y Estudios Sobre Cultura y Sociedad. Centro de Investigaciones en Ciencias Económicas; ArgentinaFil: Silvestrini, Constanza. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; Argentina. Fundación QUANT; ArgentinaFil: Pereiro, Ana Cristina. Fundación Mundo Sano. Instituto de Neurociencias de Buenos Aires. Área de Investigación Científica; ArgentinaFil: Wolovich, Tamara. Centro de Atencion Primaria de la Salud Numero 10 28 de Diciembre (caps 10) ; Municipalidad de Almirante Brown (buenos Aires);Fil: Ceriotto, Mariana. Centro de Atencion Primaria de la Salud Numero 16 Doctor Rafael Calzada (caps 16) ; Gobierno de la Provincia de Buenos Aires;Fil: Castelli, Juan Manuel. Municipio de Almirante Brown; Argentin

Lopinavir/ritonavir dosing during pregnancy in Brazil and maternal/infant laboratory abnormalities

OBJECTIVES: To describe laboratory abnormalities among HIV-infected women and their infants with standard and increased lopinavir/ritonavir (LPV/r) dosing during the third trimester of pregnancy. METHODS: We evaluated data on pregnant women from NISDI cohorts (2002-2009) enrolled in Brazil, who received at least 28 days of LPV/r during the third pregnancy trimester and gave birth to singleton infants. RESULTS: 164 women received LPV/r standard dosing [(798/198 or 800/200 mg/day) (Group 1)] and 70 increased dosing [(> 800/200 mg/day) (Group 2)]. Group 1 was more likely to have advanced clinical disease and to use ARVs for treatment, and less likely to have CD4 counts > 500 cells/mm³. Mean plasma viral load was higher in Group 2. There were statistically significant, but not clinically meaningful, differences between groups in mean AST, ALT, cholesterol, and triglycerides. The proportion of women with Grade 3 or 4 adverse events was very low, with no statistically significant differences between groups in severe adverse events related to ALT, AST, total bilirubin, cholesterol, or triglycerides. There were statistically significant, but not clinically meaningful, differences between infant groups in ALT and creatinine. The proportion of infants with Grade 3 or 4 adverse events was very low, and there were no statistically significant differences in severe adverse events related to ALT, AST, BUN, or creatinine. CONCLUSION: The proportions of women and infants with severe laboratory adverse events were very low. Increased LPV/r dosing during the third trimester of pregnancy appears to be safe for HIV-infected women and their infants.Eunice Kennedy Shriver - National Institute of Child Health and Human Development (NIH

Lower respiratory tract infections among human immunodeficiency virus-exposed, uninfected infants

Objectives: To evaluate whether maternal HIV disease severity during pregnancy is associated with an increased likelihood of lower respiratory tract infections (LRTIs) in HIV-exposed, uninfected infants.Methods: HIV-exposed, uninfected, singleton, term infants enrolled in the NISDI Perinatal Study, with birth weight >2500 g were followed from birth until 6 months of age. LRTI diagnoses, hospitalizations, and associated factors were assessed.Results: of 547 infants, 103 (18.8%) experienced 116 episodes of LRTI (incidence = 0.84 LRTIs/100 child-weeks). Most (81%) episodes were bronchiolitis. Forty-nine (9.0%) infants were hospitalized at least once with an LRTI. There were 53 hospitalizations (45.7%) for 116 LRTI episodes. None of these infants were breastfed. the odds of LRTI in infants whose mothers had CD4% = 29 (p = 0.003). the odds of LRTI in infants with a CD4+ count (cells/ mm(3)) = 750 (p = 0.002). Maternal CD4+ decline and infant hemoglobin at the 6-12 week visit were associated with infant LRTIs after 6-12 weeks and before 6 months of age.Conclusions: Acute bronchiolitis is common and frequently severe among HIV-exposed, uninfected infants aged 6 months or less. Lower maternal and infant CD4+ values were associated with a higher risk of infant LRTIs. Further understanding of the immunological mechanisms of severe LRTIs is needed. (C) 2010 International Society for Infectious Diseases. Published by Elsevier B.V. All rights reserved.NICHDUniv São Paulo, Fac Med Ribeirao Preto, BR-14049900 Ribeirao Preto, SP, BrazilWESTAT Corp, Rockville, MD 20850 USAUniv Caxias Sul, Rio Grande Do Sul, BrazilHosp Diego Paroissien, Buenos Aires, DF, ArgentinaUniversidade Federal de São Paulo, São Paulo, BrazilUniv W Indies, Kingston 7, JamaicaHosp Juan Fernandez, Buenos Aires, DF, ArgentinaHosp Agudos Dra Cecilia Grierson, Buenos Aires, DF, ArgentinaNICHD, Pediat Adolescent & Maternal AIDS Branch, CRMC, NIH,DHHS, Bethesda, MD USAUniversidade Federal de São Paulo, São Paulo, BrazilNICHD: N01-HD-3-3345NICHD: HHSN267200800001CNICHD: N01-DK-8-0001Web of Scienc

Combined evaluation of sexually transmitted infections in HIV-infected pregnant women and infant HIV transmission

Background Sexually transmitted infections (STIs) including Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Treponema pallidum (TP), and cytomegalovirus (CMV) may lead to adverse pregnancy and infant outcomes. The role of combined maternal STIs in HIV mother-to-child transmission (MTCT) was evaluated in mother-infant pairs from NICHD HPTN 040. Methodology Urine samples from HIV-infected pregnant women during labor were tested by polymerase chain reaction (PCR) for CT, NG, and CMV. Infant HIV infection was determined by serial HIV DNA PCR testing. Maternal syphilis was tested by VDRL and confirmatory treponemal antibodies. Results A total of 899 mother-infant pairs were evaluated. Over 30% had at least one of the following infections (TP, CT, NG, and/or CMV) detected at the time of delivery. High rates of TP (8.7%), CT (17.8%), NG (4%), and CMV (6.3%) were observed. HIV MTCT was 9.1% (n = 82 infants). HIV MTCT was 12.5%, 10.3%, 11.1%, and 26.3% among infants born to women with CT, TP, NG or CMV respectively. Forty-two percent of HIV-infected infants were born to women with at least one of these 4 infections. Women with these infections were nearly twice as likely to have an HIV-infected infant (aOR 1.9, 95% CI 1.1-3.0), particularly those with 2 STIs (aOR 3.4, 95% CI 1.5-7.7). Individually, maternal CMV (aOR 4.4 1.5-13.0) and infant congenital CMV (OR 4.1, 95% CI 2.2-7.8) but not other STIs (TP, CT, or NG) were associated with an increased risk of HIV MTCT. Conclusion HIV-infected pregnant women identified during labor are at high risk for STIs. Co-infection with STIs including CMV nearly doubles HIV MTCT risk. CMV infection appears to confer the largest risk of HIV MTCT.NICHD (NICHD)(Brazilian AIDS Prevention Trials International Network), NIAID/ NIHNational Institute of Allergy and Infectious Diseases (NIAID)Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)National Institute of Mental Health (NIMH)Boehringer Ingelheim Pharmaceuticals Inc. (BIPI)GlaxoSmithKline, on behalf of ViiV HealthcareCepheid for the testing of CTNG in a prior HPTNUCLA Children's Discovery and Innovation Institute (CDI) through the Harry Winston Fellowship AwardUCLA AIDS InstituteUCLA Center for AIDS Research (CFAR) NIH/ NIAIDUCLA Pediatric AIDS Coalition, and WestatNIH/NICHDDavid Geffen UCLA Sch Med, Los Angeles, CA 90095 USAWestat Corp, Rockville, MD USAFundacao Oswaldo Cruz FIOCRUZ, Rio De Janeiro, RJ, BrazilUS Dept State, Off Global AIDS Coordinator, Washington, DC 20520 USAElizabeth Glaser Pediat AIDS Fdn, Washington, DC USAHosp Geral Nova Iguacu, Nova Iguacu, RJ, BrazilHosp Fed Servidores Estado, Rio De Janeiro, RJ, BrazilUniv Witwatersrand, SAMRC & Perinatal HIV Res Unit, Johannesburg, South AfricaStellenbosch Univ, Tygerberg Hosp, Cape Town, South AfricaHosp Conceicao, Porto Alegre, RS, BrazilHosp Femina, Porto Alegre, RS, BrazilIrmandade Santa Casa Misericordia Porto Alegre, Porto Alegre, RS, BrazilUniv Fed Minas Gerais, Belo Horizonte, MG, BrazilUniv Sao Paulo, Ribeirao Preto Med Sch, Sao Paulo, BrazilFdn Maternal & Infant Hlth FUNDASAMIN, Buenos Aires, DF, ArgentinaUniv Fed Sao Paulo, Escola Paulista Med, Sao Paulo, SP, BrazilEunice Kennedy Shriver Natl Inst Child Hlth & Hum, NIH, Bethesda, MD USAUCLA, Fielding Sch Publ Hlth, Los Angeles, CA USAUCSD Sch Med, La Jolla, CA USAUC Davis Sch Med, Davis, CA USABoston Univ, Sch Med, Boston, MA 02118 USAUniv Fed Sao Paulo, Escola Paulista Med, Sao Paulo, SP, BrazilNICHD (NICHD): HHSN267200800001C, N01-HD-8-0001Brazilian AIDS Prevention Trials International Network: NIAID/ NIH [U01 AI047986National Institute of Allergy and Infectious Diseases (NIAID): U01 AI068632, UM1AI068632, UM1AI068616, UM1AI106716NIMH: AI068632NG in a prior HPTN :040UCLA Center for AIDS Research (CFAR) NIH/ NIAID: AI02869, AI28697NIH/NICHD: HHSN275201300003CWeb of Scienc

Argentine Consensus of congenital toxoplasmosis

La transmisión vertical de la infección por Toxoplasma gondii ocurre cuando la madre se infecta por primera vez en el transcurso del embarazo. El diagnóstico de la infección materna y la del re cién nacido se logra con el conjunto de pruebas serológicas, hallazgos clínicos y ecográficos. El reconocimiento temprano de la infección materna permite un tratamiento que reduce la tasa de transmisión y el riesgo de daño en el producto de la concepción. El objetivo de este consenso de expertos fue revisar la literatura científica para actualizar las recomendaciones de práctica clínica respecto de la prevención, el diagnóstico y el tratamiento de la toxoplasmosis congénita en nuestro país.Mother-to-child transmission in Toxoplasma gondii infection occurs only when the infection is acquired for the first time during pregnancy. Diag nosis of maternal infection and the newborn is achieved by a combination of serological tests, clinical features and ultrasound images. An early diagnosis of maternal infection allows treatment that offers a reduction both in transmission rate and risk of congenital damage. The aim of this expert consensus was to review the scientific literature which would enable an update of the clinical practice guideline of prevention, diagnosis and treatment of congenital toxoplasmosis in our country.Fil: Durlach, Ricardo A.. Asociación Argentina de Zoonosis; ArgentinaFil: Freuler, Cristina. Hospital Aleman; ArgentinaFil: Messina, Matías. Hospital Aleman; Argentina. Asociación Argentina de Zoonosis; ArgentinaFil: Freilij, Hector León. Gobierno de la Ciudad de Buenos Aires. Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas; ArgentinaFil: Gonzalez Ayala, Silvia Elena. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; ArgentinaFil: Venturini, María Cecilia. Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias. Departamento de Epizootiología y Salud Pública. Laboratorio de Inmunoparasitología; ArgentinaFil: Kaufer, Federico. Hospital Aleman; ArgentinaFil: García, Fabiana. Centro de Estudios Infectológicos Dr. Daniel Stamboulia; ArgentinaFil: Ceriotto, Mariana. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: Pardini, Lais Luján. Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias. Departamento de Epizootiología y Salud Pública. Laboratorio de Inmunoparasitología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Nadal, Mónica Zaida. Hospital Materno Infantil Ramon Sarda ; Gobierno de la Ciudad Autonoma de Buenos Aires;Fil: Ortiz de Zárate, Marcela. Hospital Materno Infantil Ramon Sarda ; Gobierno de la Ciudad Autonoma de Buenos Aires;Fil: Schneider, Vanessa. Hospital Aleman; ArgentinaFil: Mayer Wolf, Micaela. Hospital Aleman; ArgentinaFil: Jacob, Néstor. Gobierno de la Ciudad Autonoma de Buenos Aires. Hospital General de Agudos Doctor Cosme Argerich.; ArgentinaFil: Abuin, Juan Carlos. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: Altcheh, Jaime Marcelo. Gobierno de la Ciudad de Buenos Aires. Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas; ArgentinaFil: Fiameni, Facundo. Hospital Aleman; ArgentinaFil: Salomon, Cristina del Carmen. Universidad del Aconcagua. Facultad de Ciencias Médicas; ArgentinaFil: Ledesma, Bibiana. Dirección Nacional de Instituto de Investigación. Adm.nacional de Laboratorio E Instituto de Salud "dr.c.g.malbran". Instituto Nacional de Enfermedades Infecciosas. Departamento de Parasitología; ArgentinaFil: Guarnera, Eduardo. Asociación Argentina de Zoonosis; Argentin

Argentine Consensus of congenital toxoplasmosis

La transmisión vertical de la infección por Toxoplasma gondii ocurre cuando la madre se infecta por primera vez en el transcurso del embarazo. El diagnóstico de la infección materna y la del re cién nacido se logra con el conjunto de pruebas serológicas, hallazgos clínicos y ecográficos. El reconocimiento temprano de la infección materna permite un tratamiento que reduce la tasa de transmisión y el riesgo de daño en el producto de la concepción. El objetivo de este consenso de expertos fue revisar la literatura científica para actualizar las recomendaciones de práctica clínica respecto de la prevención, el diagnóstico y el tratamiento de la toxoplasmosis congénita en nuestro país.Mother-to-child transmission in Toxoplasma gondii infection occurs only when the infection is acquired for the first time during pregnancy. Diag nosis of maternal infection and the newborn is achieved by a combination of serological tests, clinical features and ultrasound images. An early diagnosis of maternal infection allows treatment that offers a reduction both in transmission rate and risk of congenital damage. The aim of this expert consensus was to review the scientific literature which would enable an update of the clinical practice guideline of prevention, diagnosis and treatment of congenital toxoplasmosis in our country.Fil: Durlach, Ricardo A.. Asociación Argentina de Zoonosis; ArgentinaFil: Freuler, Cristina. Hospital Aleman; ArgentinaFil: Messina, Matías. Hospital Aleman; Argentina. Asociación Argentina de Zoonosis; ArgentinaFil: Freilij, Hector León. Gobierno de la Ciudad de Buenos Aires. Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas; ArgentinaFil: Gonzalez Ayala, Silvia Elena. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; ArgentinaFil: Venturini, María Cecilia. Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias. Departamento de Epizootiología y Salud Pública. Laboratorio de Inmunoparasitología; ArgentinaFil: Kaufer, Federico. Hospital Aleman; ArgentinaFil: García, Fabiana. Centro de Estudios Infectológicos Dr. Daniel Stamboulia; ArgentinaFil: Ceriotto, Mariana. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: Pardini, Lais Luján. Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias. Departamento de Epizootiología y Salud Pública. Laboratorio de Inmunoparasitología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Nadal, Mónica Zaida. Hospital Materno Infantil Ramon Sarda ; Gobierno de la Ciudad Autonoma de Buenos Aires;Fil: Ortiz de Zárate, Marcela. Hospital Materno Infantil Ramon Sarda ; Gobierno de la Ciudad Autonoma de Buenos Aires;Fil: Schneider, Vanessa. Hospital Aleman; ArgentinaFil: Mayer Wolf, Micaela. Hospital Aleman; ArgentinaFil: Jacob, Néstor. Gobierno de la Ciudad Autonoma de Buenos Aires. Hospital General de Agudos Doctor Cosme Argerich.; ArgentinaFil: Abuin, Juan Carlos. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: Altcheh, Jaime Marcelo. Gobierno de la Ciudad de Buenos Aires. Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas; ArgentinaFil: Fiameni, Facundo. Hospital Aleman; ArgentinaFil: Salomon, Cristina del Carmen. Universidad del Aconcagua. Facultad de Ciencias Médicas; ArgentinaFil: Ledesma, Bibiana. Dirección Nacional de Instituto de Investigación. Adm.nacional de Laboratorio E Instituto de Salud "dr.c.g.malbran". Instituto Nacional de Enfermedades Infecciosas. Departamento de Parasitología; ArgentinaFil: Guarnera, Eduardo. Asociación Argentina de Zoonosis; Argentin

Hypertension, preeclampsia and eclampsia among HIV-infected pregnant women from Latin America and Caribbean countries

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the US National Institutes of Health or the Department of Health and Human Services.Made available in DSpace on 2015-04-08T14:09:55Z (GMT). No. of bitstreams: 2 license.txt: 1914 bytes, checksum: 7d48279ffeed55da8dfe2f8e81f3b81f (MD5) josehenrique_pilotto_IOC_2014.pdf: 431330 bytes, checksum: a8336627d368ba0512d9a5f379c494dc (MD5) Previous issue date: 2014Universidade Federal do Rio de Janeiro. Instituto de Puericultura e Pediatria Martagão Gesteira. Rio de Janeiro, RJ, Brasil.Westat. Rockville, MD, USA.Westat. Rockville, MD, USA.Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Hospital das Clínicas. Ribeirão Preto, SP, Brasil.Irmandade da Santa Casa de Misericórdia de Porto Alegre. Porto Alegre, RS, Brasil.Universidade Federal de Minas Gerais. Faculdade de Medicina. Belo Horizonte, MG, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de AIDS e Imunologia Molecular. Rio de Janeiro, RJ, Brasil.Dr. Cecilia Grierson Hospital. Infectious Diseases Unit. Buenos Aires, AR.Universidade Federal do Rio de Janeiro. Instituto de Puericultura e Pediatria Martagão Gesteira. Rio de Janeiro, RJ, Brasil.National Institute of Health. Eunice Kennedy Shriver National Institute of Child Health and Human Development. Maternal and Pediatric Infectious Disease Branch. Bethesda, MD, USA.National Institute of Health. Eunice Kennedy Shriver National Institute of Child Health and Human Development. Maternal and Pediatric Infectious Disease Branch. Bethesda, MD, USA.Objectives: To evaluate the incidence of and risk factors for hypertensive disorders in a cohort of HIV-infected pregnant women. Methods: Hypertensive disorders (HD) including preeclampsia/eclampsia (PE/E) and pregnancy induced hypertension, and risk factors were evaluated in a cohort of HIV-infected pregnan

Lower respiratory tract infections among human immunodeficiency virus-exposed, uninfected infants

Objectives: To evaluate whether maternal HIV disease severity during pregnancy is associated with an increased likelihood of lower respiratory tract infections (LRTIs) in HIV-exposed, uninfected infants. Methods: HIV-exposed, uninfected, singleton, term infants enrolled in the NISDI Perinatal Study, with birth weight >2500 g were followed from birth until 6 months of age. LRTI diagnoses, hospitalizations, and associated factors were assessed. Results: Of 547 infants, 103 (18.8%) experienced 116 episodes of LRTI (incidence = 0.84 LRTIs/100 child-weeks). Most (81%) episodes were bronchiolitis. Forty-nine (9.0%) infants were hospitalized at least once with an LRTI. There were 53 hospitalizations (45.7%) for 116 LRTI episodes. None of these infants were breastfed. The odds of LRTI in infants whose mothers had CD4% <14 at enrollment were 4.4 times those of infants whose mothers had CD4% >= 29 (p = 0.003). The odds of LRTI in infants with a CD4+ count (cells/ mm(3)) <750 at hospital discharge were 16.0 times those of infants with CD4+ >= 750 (p = 0.002). Maternal CD4+ decline and infant hemoglobin at the 6-12 week visit were associated with infant LRTIs after 6-12 weeks and before 6 months of age. Conclusions: Acute bronchiolitis is common and frequently severe among HIV-exposed, uninfected infants aged 6 months or less. Lower maternal and infant CD4+ values were associated with a higher risk of infant LRTIs. Further understanding of the immunological mechanisms of severe LRTIs is needed. (C) 2010 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.NICHD[N01-HD-3-3345]NICHD[HHSN267200800001C]NICHD[N01-DK-8-0001

Missed opportunities for prevention of mother-to-child transmission of HIV-1 in the NISDI Perinatal and LILAC cohorts

Presentes no NISDI Perinatal: Beatriz Grinsztejn; Valdiléa Veloso (Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil).Submitted by Fábio Marques ([email protected]) on 2018-11-07T17:49:40Z No. of bitstreams: 1 Missed opportunities for prevention_Beatriz_Grinsztejn_INI_LapClin-AIDS_2012.pdf: 93703 bytes, checksum: 255b016f6919f81ff71e5fdecdb0aee8 (MD5)Approved for entry into archive by Regina Costa ([email protected]) on 2018-11-16T15:14:25Z (GMT) No. of bitstreams: 1 Missed opportunities for prevention_Beatriz_Grinsztejn_INI_LapClin-AIDS_2012.pdf: 93703 bytes, checksum: 255b016f6919f81ff71e5fdecdb0aee8 (MD5)Made available in DSpace on 2018-11-16T15:14:25Z (GMT). No. of bitstreams: 1 Missed opportunities for prevention_Beatriz_Grinsztejn_INI_LapClin-AIDS_2012.pdf: 93703 bytes, checksum: 255b016f6919f81ff71e5fdecdb0aee8 (MD5) Previous issue date: 2012Pediatric, Adolescent, and Maternal AIDS Branch, CRMC, NICHD, NIH, DHHS. Bethesda, USA.Westat. Rockville, Maryland, USA.Westat. Rockville, Maryland, USA.Universidade Federal do Rio de Janeiro. Hospital Clementino Fraga. Serviço de Doenças Infecciosas. Rio de Janeiro, RJ, Brasil.Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Ribeirão Preto, SP, Brasil.Hospital Dra. Cecilia Grierson. Unidad de Enfermedades Infecciosas. Buenos Aires, Argentina.Nossa Senhora da Conceição Hospital. Serviço de Doenças Infecciosas. Porto Alegre, Brasil.Universidade Federal de São Paulo. Faculdade Paulista de Medicina. Departamento de Pediatria. São Paulo, Brasil.Hospital Geral de Nova Iguaçu. HIV Family Care Clinic./ Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de AIDS e Imunologia Molecular. Rio de Janeiro, Brasil.Universidad Nacional Mayor de San Marcos. D.A. Instituto Carrión de Medicina Tropical. Sección de Epidemiología. Lima, Perú.Irmandade da Santa Casa de Misericordia de Porto Alegre. Porto Alegre, Brasil.OBJECTIVE: To evaluate cases of mother-to-child transmission of HIV-1 at multiple sites in Latin America and the Caribbean in terms of missed opportunities for prevention. METHODS: Pregnant women infected with HIV-1 were eligible for inclusion if they were enrolled in either the NISDI Perinatal or LILAC protocols by October 20, 2009, and had delivered a live infant with known HIV-1 infection status after March 1, 2006. RESULTS: Of 711 eligible mothers, 10 delivered infants infected with HIV-1. The transmission rate was 1.4% (95% CI, 0.7-2.6). Timing of transmission was in utero or intrapartum (n=5), intrapartum (n=2), intrapartum or early postnatal (n=1), and unknown (n=2). Possible missed opportunities for prevention included poor control of maternal viral load during pregnancy; late initiation of antiretrovirals during pregnancy; lack of cesarean delivery before labor and before rupture of membranes; late diagnosis of HIV-1 infection; lack of intrapartum antiretrovirals; and incomplete avoidance of breastfeeding. CONCLUSION: Early knowledge of HIV-1 infection status (ideally before or in early pregnancy) would aid timely initiation of antiretroviral treatment and strategies designed to prevent mother-to-child transmission. Use of antiretrovirals must be appropriately monitored in terms of adherence and drug resistance. If feasible, breastfeeding should be completely avoided. Presented in part at the XIX International AIDS Conference (Washington, DC; July 22-27, 2012); abstract WEPE163

Determinants of Treatment Access in a Population-based Cohort of HIV-positive Men and Women Living in Argentina

Objective: To report emerging data on the use of highly active antiretroviral therapy (HAART)in Argentina by assessing patterns of HAART access and late vs early treatment initiation in apopulation-based cohort of adults infected with HIV type-1.Design: The Prospective Study on the Use and Monitoring of Antiretroviral Therapy (PUMA) is astudy of 883 HIV-positive individuals enrolled in the Argentinean drug treatment program.Individuals were 16 years of age and older and were recruited from 10 clinics across Argentina.Methods: Sociodemographic and clinical characteristics were examined using contingency tables(Pearson chi-square test and Fisher exact test) for categoric variables and Wilcoxon rank-sum testfor continuous variables. To analyze time to initiation of HAART we used Kaplan-Meier methodsand Cox regression.Results: Patients who initiated HAART were more likely to be older, have an AIDS-defining illness,be an injection drug user (IDU), have a lower median CD4 cell count, have a higher median viralload, and be less likely to be men who have sex with men (MSM). In multivariate analysis, AIDSdefiningillness and plasma viral load were significantly associated with time to starting therapy.Patients who received late access were more likely to be diagnosed with AIDS and have highermedian plasma viral loads than those receiving early access.Conclusion: Our results indicate that despite free availability of treatment, monitoring, and carein Argentina, a significant proportion of men and women are accessing HAART late in the courseof HIV disease. Further characterization of the HIV-positive population will allow for a morecomprehensive evaluation of the impact of HAART within the Argentinean drug treatmentprogram