The AmRo study: pregnancy outcome in HIV-1-infected women under effective highly active antiretroviral therapy and a policy of vaginal delivery.

OBJECTIVE: To explore pregnancy outcome in HIV-1-positive and HIV-negative women, and mother-to-child transmission (MTCT) according to mode of delivery under effective highly active antiretroviral therapy (HAART). DESIGN: Cohort of 143 pregnant HIV-1-infected women including a matched case-control study in a 2:1 ratio of controls to cases (n=98). SETTING: Academic Medical Center in Amsterdam and Erasmus Medical Center in Rotterdam, the Netherlands. POPULATION: Consecutive referred HIV-1 infected pregnant women treated with HAART and matched control not infected pregnant women. MAIN OUTCOME MEASURES: MTCT, preterm delivery, low birthweight, pre-eclampsia. RESULTS: MTCT was 0% (95% CI 0-2.1%). Seventy-eight percent of HIV-1-infected women commenced and 62% completed vaginal delivery. The calculated number of caesarean sections needed to prevent a single MTCT was 131 or more. Preterm delivery rates were 18% (95% CI 11-27) in women infected with HIV-1 and 9% (95% CI 5-13) in controls (P=0.03). HAART used at <13 weeks of gestation was associated with a 44% preterm delivery rate compared with 21% when HAART was started at or after 13 weeks and 14% in controls. (Very) low birthweight and incidence of pre-eclampsia were not different between HIV-1 and controls. CONCLUSIONS: We have not demonstrated any MTCT after vaginal delivery in women effectively treated by HAART. The HAART-associated increase in preterm delivery rate is mainly seen after first trimester HAART use.

[Highly active antiretroviral therapy (HAART) in HIV-positive pregnant women in the Netherlands, 1997-2003: safe, effective and with few side effects]. / Krachtige antiretrovirale therapie (HAART) bij HIV-positieve zwangeren in Nederland, 1997-2003: veilig, effectief en met weinig bijwerkingen.

OBJECTIVE: To assess the side effects, safety and efficacy of highly active antiretroviral therapy (HAART) in a cohort of HIV-infected pregnant women in the Netherlands. DESIGN: Retrospective. METHOD: Data were collected from the medical records of HIV-infected pregnant women who received HAART during pregnancy in the period 1 January 1997-1 June 2003 at 14 HIV-specialized centres in the Netherlands. The inclusion criteria were at least a triple drug regimen and birth at 20 or more weeks of gestation. Information was collected about patient characteristics, HAART prescribed, side effects, viral load response, mode of delivery and HIV-status of the neonate. RESULTS: A total of 267/413 women satisfied the inclusion criteria. Most women (n = 199) had not previously received anti-retroviral therapy and started HAART between weeks 21 and 28 of the pregnancy. The two most frequently used regimens contained nelfinavir (57%) or nevirapine (31%). Gastrointestinal side effects were more frequently observed in the nelfinavir group, while rash and hepatotoxicity were more frequently reported in the nevirapine group. Efficacy and pregnancy outcome were similar in both groups. Two infants (0.7%) were HIV-infected. CONCLUSION: HAART regimens containing nelfinavir or nevirapine in HIV-infected pregnant women were safe, effective and well tolerated.

[Social skills of the elderly, a literature review]. / Sociale vaardigheden van ouderen, een literatuuroverzicht.

The literature is reviewed on: the value attached to social skills for the elderly, ideas about the relationship between age and social skills, and empirical research of this relationship. It is shown that several authors stress the importance of social skills by pointing to the far-reaching changes in social situation that many of the elderly have to cope with. In addition to this, it is believed that the elderly are--generally speaking--less skillful than the young. This is thought to be the result of an atrophy of skills, and changes in social standards. Research to support this view is rare, and limited to the cross-sectional approach.

May mothers taking acenocoumarol breast feed their infants?

In 20 women receiving Sintrom post partum, the acenocoumarol concentration in serum and breast milk at different times was measured. Even at the time of maximal serum concentration, or for the following 6 h, no acenocoumarol could be detected in the breast milk. In accordance with this finding, no effect of breast feeding on Thrombotest values of the infants could be demonstrated. These data suggest that mothers taking acenocoumarol for a short period may safely breast feed their infants.

Determination of nanogram levels of the anticoagulant acenocoumarin in serum by high-performance liquid chromatography.

A simple, rapid, and sensitive method for the determination fo the short-acting coumarin anticoagulant acenocoumarin in human serum is described. This drug is estracted from the acidified biological matrix together with the internal standard 5-methoxypsoralen. Separation and quantitation are performed on a high-performance liquid chromatograph with a reversed-phase column and an ultraviolet detector operating at 308 nm. Accuracy and precision are good. The lowest limit of detection is 15 microgram/L, which means that acenocoumarin concentrations can be measured in serum from the subtherapeutic to the toxic range. This method can also be used for rapid measurement of warfarin serum concentrations.