Amniocentesis in pregnant HIV-infected patients. Absence of mother-to-child viral transmission in a series of selected patients

Objectives

To assess the risk of vertical transmission in HIV-infected pregnant women undergoing diagnostic amniocentesis, and to identify possible predictive factors.

Study design

This was a single center retrospective study. The records of 330 HIV-infected pregnant women booked in our antenatal clinic from 31 January 2001 to 31 January 2006 were analyzed. Women who actually underwent diagnostic amniocentesis (“amniocentesis performed” group) were compared to those eligible for amniocentesis but who did not undergo the procedure (“amniocentesis withheld” group).

Results

During the time period, 318 liveborn babies were delivered (9 HIV infected (2.8%)). Thirty-four women (35 fetuses) were eligible for diagnostic amniocentesis. Amniocentesis was performed in 11 (32.4%) of these women (12 fetuses, none infected among the 9 liveborns) and withheld in 23 (67.6%) women. Among the 19 liveborn babies in this latter group, 1 (5.3%) was infected. There was no statistical difference in vertical transmission rate between the whole cohort of HIV-infected pregnant women and the group of women eligible for amniocentesis; or between the women who actually had or did not have an amniocentesis.The women who did undergo amniocentesis all received highly active antiretroviral combination therapy with three drugs; all but two had an undetectable HIV viral load, only one had immunosuppression and none had HCV co-infection.

Conclusion

No vertical transmission was observed in a group of nine liveborn babies after amniocentesis performed in selected HIV-infected pregnant women. In the presence of high genetic risk during pregnancy, amniocentesis can be considered after proper patient counselling.     

无症状HIV感染者心理特点分析及护理措施

目的:了解无症状HIV感染者的心理特点,并对其进行有效心理护理,以减轻患者身心的痛苦,提高其生存质量。方法:采用艾滋病生存质量量表(WHOQOL-HIV)作为工具,对108名无症状HIV感染者进行心理干预,并收集了他们的人口学资料、生理、心理、环境、社会关系等信息,比较干预前后无症状HIV感染者身心积分的差别。结果5:9%无症状HIV感染者存在心理压力,心理干预前后比较差异有统计学意义。结论:无症状HIV感染者普遍存在心理压力,有效心理干预能改善其身心健康状况,提高其生存质量,为全面防治艾滋病提供了新的思路。     

自我管理对院外抗病毒治疗HIV感染者生活质量的影响

目的探讨自我管理对院外抗病毒治疗的艾滋病(HIV)感染者生活质量的影响。方法将在我院艾滋病咨询处定点抗病毒治疗的40例艾滋病患者随机分为对照组和试验组,每组20例。对照组采用常规健康教育,试验组开始使用抗病毒药物同时,实施自我管理教育。分别在实施自我管理教育前和实施自我管理教育12个月后对两组患者进行自我管理能力、生活质量评价。结果实施自我管理教育前,两组患者自我管理能力、生活质量指数,差异无统计学意义(P>0.05);实施自我管理教育后,试验组自我管理能力、生活质量指数均显著提高(均P<0.05)。结论自我管理教育能提高院外抗病毒治疗HIV感染者的自我管理能力,改善患者生活质量。     

Prevalence and correlates of depression among HIV-infected and -affected older people in rural South Africa

Background

Little is known about depression in older people in sub-Saharan Africa, the associated impact of HIV, and the influence on health perceptions.

Objectives

Examine the prevalence and correlates of depression; explore the relationship between depression and health perceptions in HIV-infected and -affected older people.

Methods

In 2010, 422 HIV-infected and -affected participants aged 50+ were recruited into a cross-sectional study. Nurse professionals interviewed participants and a diagnosis of depressive episode was derived from the Composite International Diagnostic Interview (Depression module) using the International Classification of Diseases diagnostic criteria and categorised as major (MDE) or brief (BDE).

Results

Overall, 42.4% (n=179) had a depressive episode (MDE: 22.7%, n=96; BDE: 19.7%, n=83). Prevalence of MDE was significantly higher in HIV-affected (30.1%, 95% CI 24.0–36.2%) than HIV-infected (14.8%, 95% CI 9.9–19.7%) participants; BDE was higher in HIV-infected (24.6%, 95% CI 18.7–30.6%) than in HIV-affected (15.1%, 95% CI 10.3–19.8%) participants. Being female (aOR 3.04, 95% CI 1.73–5.36), receiving a government grant (aOR 0.34, 95% CI 0.15–0.75), urban residency (aOR 1.86, 95% CI 1.16–2.96) and adult care-giving (aOR 2.37, 95% CI 1.37–4.12) were significantly associated with any depressive episode. Participants with a depressive episode were 2–3 times more likely to report poor health perceptions.

Limitations

Study limitations include the cross-sectional design, limited sample size and possible selection biases.

Conclusions

Prevalence of depressive episodes was high. Major depressive episodes were higher in HIV-affected than HIV-infected participants. Psycho-social support similar to that of HIV treatment programmes around HIV-affected older people may be useful in reducing their vulnerability to depression.     

The role of social support on resilience,posttraumatic growth,hopelessness, and depression among children of HIV-infected parents in mainland China

Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has a profound impact not only on the infected individuals, but also on their families. Children of the HIV-infected parents are particularly affected. The present study examined the relationship between social support, resilience, posttraumatic growth (PTG), hopelessness, and depression among 195 children of HIV-infected parents in mainland China. Results showed that 35.4% of the sample scored above the cutoff of the Children's Depression Inventory. Results from structural equation modeling reported that social support had a significant positive relationship with resilience and PTG. Higher levels of resilience and PTG were associated with lower level of hopelessness which in turn, was associated with lower level of depression. The overall model achieved satisfactory fit. Interventions are needed to improve social support of the children affected by HIV so as to improve their mental health.     

Knowledge,Attitudes, and Practices Regarding Cervical Cancer Screening among HIV-infected Women at Srinagarind Hospital: A Cross-Sectional Study

Introduction: In recent years, the lives of HIV-infected patients in Thailand have improved significantly due to continuous advances in treatment. However, the rate of cancer related to HIV infection (especially cervical cancer) is likely to increase. Although the World Health Organization (WHO) recommends Papanicolaou testing in all HIV-infected women, few of these patients receive this kind of screening in Thailand. Therefore, we conducted this study to evaluate the knowledge, attitudes, and practices of these patients with regard to cervical cancer screening. Materials and Methods: This cross-sectional study was conducted in HIV-infected women aged 18-65 years from April to November 2019 via a self-administered cervical cancer screening questionnaire, which consisted of four parts: demographic data, knowledge, attitudes, and practices. Results: Three hundred HIV-infected women were recruited. Most of the participants had good attitudes toward screening and practiced adequate screening (75.3% and 71.3%, respectively). However, only 62 participants (20.7%) demonstrated adequate knowledge. The crucial factors that were associated with adequate screening practice were age 40-49 years-old (AOR =3.26, 95%CI=1.02-10.37), CD4 cell count (AOR = 3.41, 95%CI = 1.29-8.99), having been advised about cervical cancer screening (AOR= 6.23, 95%CI 1.84-21.07), and attitude toward screening (AOR= 5.7, 95%CI = 2.23-14.55). The major reasons for not undergoing screening were embarrassment (41.86%), lack of symptoms (41.86%), fear of the results (36.04%), and fear of pain (36.04%). Conclusion: The reasons for inadequate testing were disregard and misconceptions about the procedure. To prevent invasive cervical lesions in HIV-infected women, health care providers should inform these patients about the importance of regular cervical cancer screening.     

HIV感染者家属心身症状与社会支持关系

目的 了解人类免疫缺陷病毒(HIV)感染者家属的心身症状、应对方式、社会支持的现状,分析心身症状与应对方式、社会支持之间的关系.方法 使用症状自评评定量表(SCL-90)、应对方式、社会支持量表,对湖北省12个县市的44名HIV感染者家属进行问卷调查.结果 (1)HIV感染者家属心身症状的严重程度均高于正常人群;(2)心身健康状况可能存在一定的性别差异;(3)家属的积极应对方式与正常人群无异,但消极应对方式明显高于正常人群;(4)家人是家属最重要的支持来源,家属获得的朋友支持明显不足;(5)家属心身症状与其应对方式,社会支持的关系尚不清晰.结论 在为HIV感染者提供帮助的过程中,应加强对感染者家属的心理健康状况的重视与关注.     

Fatty acid composition of plasma lipids in HIV-infected children. Comparison with seroreverters

Children infected with the type-1 human immunodeficiency virus (HIV) are at risk of nutritional deficiencies leading to an impaired polyunsaturated fatty acid (PUFA) status. The aim of the present study was to compare the PUFA composition of plasma lipid classes (total lipids, phospholipids (PL), cholesteryl esters (CE) and triglycerides) in well-growing HIV-infected children with an age-matched group of HIV-seroreverter children born to infected mothers. Eighteen HIV children, of both sexes, mean age 4.6 y, most of whom under combined antiretroviral regimen, were compared with 18 seroreverters, mean age 5.4 y, comparable for demographic, anthropometric and dietary characteristics. All children had adequate growth parameters (weight and height > 3rd percentile). The plasma fatty acid content was similar in the two groups. HIV seropositive subjects showed lower linoleic acid (LA) levels in all the plasma lipid fractions, with higher 20:3n-9 and 20:5n-3 levels in PL and CE. The plasma PL triene/tetraene ratio (marker of relative LA deficiency) related positively to the viral load and negatively to the blood CD4+ lymphocyte count. Compared to age-matched seroreverter subjects, HIV-seropositive children show a lipid fatty acid status suggestive of relative LA deficiency and increased turnover of the PUFA series.     

Maternal complications after Caesarean section in HIV-infected pregnant women

A study of maternal complications after elective Caesarean section in HIV-infected women was carried out from January 1999 to April 2001. The control group consisted of all the seronegative pregnant women who underwent the elective Caesarean section during the study period. The study group was divided into two subgroups. Subgroup 1 patients were given 600 mg zidovudine (ZDV) orally and 300 mg lamivudine (3TC) daily from 34 to 38 weeks' gestation. Subgroup 2 patients were given 600 mg ZDV orally daily from 34 to 38 weeks' gestation and 150 mg nevirapine orally on the morning of the Caesarean section day. In both groups, the elective Caesarean section was carried out at 38 weeks' gestation and ZDV syrup (2 mg/kg) was given orally to the newborn immediately in the operating theatre and then every 6 h for 4 weeks. No statistically significant differences in maternal complications were found between the HIV-infected and non HIV-infected women.