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1.
Int J STD AIDS ; 25(4): 303-5, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24047886

RESUMO

A sample of 123 HIV-positive women aged 50 years and over showed high rates of late diagnosis with CD4 count <350 (71%), significant co-morbidities (90%), high rates of premature menopause (6.8%) and early menopause (6.8%) and cervical cytological abnormalities (47%). Specific interventions to improve care in this group should include yearly cervical cytology, early counselling with regard to reproductive options, menopause management and screening for sexually transmitted infections (STIs).


Assuntos
Atenção à Saúde , Infecções por HIV/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Fármacos Anti-HIV/uso terapêutico , Densidade Óssea , Contagem de Linfócito CD4 , Comorbidade , Diagnóstico Tardio , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Humanos , Auditoria Médica , Menopausa , Pessoa de Meia-Idade , Infecções por Papillomavirus/epidemiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/epidemiologia , Reino Unido/epidemiologia , Carga Viral
3.
HIV Med ; 12(10): 632-6, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21569189

RESUMO

OBJECTIVES: The aim of the current study was to assess the effect of maternal HIV infection, treated or untreated, on the degree of placental invasion, as assessed by the pulsatility index of the uterine arteries during a Doppler examination at 11(+0) -13(+6) weeks' gestation. METHODS: This was a nested case-control study in which a uterine artery Doppler examination was performed in the first trimester in 76 HIV-positive women. Each woman was matched with 30 HIV-negative women. As the pulsatility index of the uterine arteries depends on a number of maternal and fetal characteristics, its values in each case and control were expressed as multiples of the median (MoM) of the unaffected group. RESULTS: Among the 76 HIV-positive women, 33 (43.4%) were on antiretroviral treatment at the time of the Doppler examination, including 14 women (42.4%) on nucleoside reverse transcriptase inhibitors (NRTIs) and a protease inhibitor, 18 women (54.5%) on NRTIs and a nonnucleoside reverse transcriptase inhibitor and one woman (3.1%) on monotherapy. Compared with the HIV-negative women, the HIV-positive women were more likely to be heavier (P<0.01), to be of African origin (P<0.01), to be nonsmokers (P=0.01) and to deliver smaller neonates earlier (P<0.01). The median adjusted pulsatility index of the uterine arteries was not statistically different between the cases and controls [1.07; interquartile range (IQR) 0.85-1.24 MoM vs. 0.99; IQR 0.81-1.20 MoM; P= 0.28] or, in HIV-positive women, between those receiving and not receiving antiretroviral treatment (P=0.12). CONCLUSIONS: HIV-positive women with uncomplicated pregnancies have normal placental perfusion in the first trimester of pregnancy.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/diagnóstico por imagem , Complicações Infecciosas na Gravidez/diagnóstico por imagem , Ultrassonografia Pré-Natal , Artéria Uterina/diagnóstico por imagem , Adulto , Estudos de Casos e Controles , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/fisiopatologia , Inibidores da Protease de HIV/uso terapêutico , Humanos , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/fisiopatologia , Primeiro Trimestre da Gravidez , Inibidores da Transcriptase Reversa/uso terapêutico , Artéria Uterina/efeitos dos fármacos , Artéria Uterina/fisiopatologia
4.
Int J STD AIDS ; 22(1): 11-4, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21364060

RESUMO

The pharmacokinetics of antiretroviral drugs in pregnancy is poorly understood. We reviewed the use of therapeutic drug monitoring (TDM) in clinical settings to document plasma concentrations of lopinavir during pregnancy and investigated how clinicians acted upon TDM results. A retrospective review was carried out of all HIV-infected pregnant women taking boosted lopinavir-based highly active antiretroviral therapy (HAART) at five National Health Service (NHS) centres in the UK between May 2004 and March 2007. Seventy-three women in receipt of lopinavir were identified, of whom 89% had plasma lopinavir concentrations above the suggested minimum recommended for wild-type HIV. Initial TDM results prompted dosage change in 10% and assessment of adherence and/or pharmacist review in 11%. TDM was repeated in 29%. TDM can play an important role in the clinical management of HIV-positive pregnant women, allowing informed dose modification and an alternative measure of adherence.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/farmacocinética , Infecções por HIV/tratamento farmacológico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Pirimidinonas/administração & dosagem , Pirimidinonas/farmacocinética , Adolescente , Adulto , Monitoramento de Medicamentos , Feminino , Humanos , Lopinavir , Plasma/química , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Reino Unido , Adulto Jovem
5.
HIV Med ; 12(2): 118-23, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20807252

RESUMO

OBJECTIVE: The aim of the study was to describe pregnancies in HIV-infected teenagers. METHODS: A review of the case notes of HIV-infected pregnant teenagers aged 13-19 years from 12 London hospitals was carried out for the period 2000-2007. RESULTS: There were 67 pregnancies in 58 young women, of whom one was known to have acquired HIV vertically. The overall mother-to-child transmission (MTCT) rate of HIV was 1.5% (one of 66). There were 66 live births. Median ages at HIV diagnosis and conception were 17 and 18 years, respectively. Sixty-three per cent of women were diagnosed with HIV infection through routine antenatal screening. Eighty-two per cent of pregnancies (41 of 50) were unplanned, with 65% of women (26 of 40) using no contraception. Forty-three per cent of the women (20 of 46) had a past history of a sexually transmitted infection (STI). In 63 pregnancies, antiretroviral therapy was started post-conception, with prevention of HIV MTCT the only indication in 81% of cases. Fifty-eight per cent of those on highly active antiretroviral therapy (HAART) had an undetectable HIV viral load by delivery. Eighty-seven per cent were uncomplicated pregnancies. Seventy-one per cent delivered by Caesarean section and 21% (14 of 64) had a preterm delivery (<37 weeks). In the 12 months after delivery, 45% of women received contraceptive advice and 25% of women became pregnant again. CONCLUSION: Obstetric and virological outcomes were favourable in this group of HIV-infected young women. However, the majority of pregnancies were unplanned with poor documentation of contraception use and advice and low rates of STI screening. A quarter of women conceived again within 12 months of delivery. Effective measures to reduce STIs, unplanned pregnancies and onward HIV transmission in HIV-infected teenagers are needed.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Infecções por HIV/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Aborto Induzido/estatística & dados numéricos , Adolescente , Terapia Antirretroviral de Alta Atividade , Contagem de Linfócito CD4 , Feminino , Infecções por HIV/transmissão , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Expectativa de Vida , Londres/epidemiologia , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Adulto Jovem
6.
BJOG ; 118(7): 844-8, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21062401

RESUMO

OBJECTIVE: To investigate whether the sonographic and maternal serum biochemical markers used in first-trimester screening for chromosomal abnormalities are altered in pregnancies affected by maternal HIV infection. DESIGN: Nested case-control study. SETTING: Routine antenatal visit in a teaching hospital. POPULATION: Ninety HIV-positive and 450 HIV-negative pregnant women. METHODS: Findings from first-trimester antenatal visit for calculation of the risk for chromosomal abnormalities were compared between HIV-positive (treated and untreated) and HIV-negative women. MAIN OUTCOME MEASURES: First-trimester maternal serum free ß human chorionic gonadotrophin (free ß-hCG) pregnancy-associated plasma protein-A (PAPP-A) and fetal nuchal translucency thickness (NT), were compared. RESULTS: There were no statistically significant differences between the HIV-positive and HIV-negative women in the median maternal levels of free ß-hCG, PAPP-A and fetal NT. However, within the HIV-positive group those receiving antiretroviral treatment (n = 41) had a significantly lower median multiple of the median (MoM) for free ß-hCG (0.74, interquartile range [IQR] 0.45-1.32 MoM) than HIV-positive women on no treatment (1.03, IQR 0.76-1.85 MoM; P = 0.006) and HIV-negative women (1.0, IQR 0.68-1.47 MoM; P = 0.003). There was no correlation between the level of free ß-hCG or PAPP-A and maternal viral load or CD4(+) count. CONCLUSIONS: Maternal levels of free ß-hCG in treated HIV-positive pregnant women were lower compared with those in non-treated HIV-positive and HIV-negative women, whereas the PAPP-A levels and fetal NT remained unaltered.


Assuntos
Aneuploidia , Gonadotropina Coriônica Humana Subunidade beta/sangue , Soropositividade para HIV/complicações , Medição da Translucência Nucal , Complicações Infecciosas na Gravidez , Primeiro Trimestre da Gravidez , Proteína Plasmática A Associada à Gravidez/metabolismo , Substâncias para o Controle da Reprodução/sangue , Adulto , Terapia Antirretroviral de Alta Atividade/métodos , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Soropositividade para HIV/tratamento farmacológico , Hospitais de Ensino , Humanos , Valor Preditivo dos Testes , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico por imagem , Complicações Infecciosas na Gravidez/tratamento farmacológico , Sensibilidade e Especificidade , Trissomia/diagnóstico , Ultrassonografia Pré-Natal
8.
Int J STD AIDS ; 20(11): 757-60, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19759048

RESUMO

The aim of this study was to examine sexual behaviour, condom use and rates of sexually transmitted infections (STIs) among attendees at a dedicated on-site STI clinic at a South London HIV centre. Data were prospectively collected by using a nurse-completed questionnaire. Ninety-eight percent of women reported one or no sexual partners in the preceding three months, whereas 57% of men who have sex with men (MSM) reported two or more partners. Only 28% of women, 53% of heterosexual men and 29% of MSM always used a condom for vaginal or anal intercourse. Positive STI diagnoses were found in 17.5% of women, 20% of heterosexual men and 49% of MSM. Twenty percent of patients who reported always using a condom and 38% of MSM reporting no sexual activity in the preceding three months had an STI. These results highlight the need for safe sex promotion and STI screening in HIV-infected patients regardless of self-reported sexual activity.


Assuntos
Preservativos/estatística & dados numéricos , Infecções por HIV/epidemiologia , Sexo Seguro/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Infecções Sexualmente Transmissíveis/epidemiologia , Adulto , Idoso , Feminino , Heterossexualidade , Homossexualidade Masculina , Humanos , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores de Risco , Parceiros Sexuais , Inquéritos e Questionários
10.
Int J STD AIDS ; 19(8): 559-60, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18663046

RESUMO

HIV-positive women may be reluctant to attend gynaecology or family planning clinics for fear of divulging their condition. Therefore, a referral clinic was opened within the HIV clinic. Retrospective case-note reviews of 197 new patients revealed 109 with a variety of medical gynaecology conditions (menorrhagia being the commonest) and 88 sought contraception. The full range of contraceptives was used, including Mirena for the treatment of menorrhagia as well as contraception and the combined pill adjusted for interaction with liver enzyme-inducing antiretroviral drugs. The acceptance of contraceptive advice and gynaecological evaluation by the patients has resulted in improved reproductive health services for these HIV-positive women. In centres with large cohorts of HIV-positive women, this type of one-stop specialist clinic will be very effective in providing high-quality reproductive health care and hence, this type of clinic is recommended for such centres.


Assuntos
Instituições de Assistência Ambulatorial , Anticoncepção , Serviços de Planejamento Familiar , Ginecologia , Soropositividade para HIV , Adolescente , Adulto , Comportamento Contraceptivo , Feminino , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/tratamento farmacológico , Doenças dos Genitais Femininos/epidemiologia , Humanos , Auditoria Médica , Pessoa de Meia-Idade , Serviços de Saúde Reprodutiva
11.
Int J STD AIDS ; 19(1): 14-5, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18275640

RESUMO

Women attending a dedicated medical gynaecology and family planning referral clinic for women with HIV were surveyed using a standard questionnaire about their knowledge and attitudes to post-exposure prophylaxis after sexual exposure (PEPSE) and emergency hormonal contraception (EHC). Eighty percent of them had not heard of PEPSE, but once informed about it, 86% said they would inform a partner about it. Less than 10% had any idea of the duration of effectiveness. Seventy-three percent of the women knew about EC and 45% of them had used it previously. Ninety-eight percent of them would use it in the future if necessary. Eighty percent of them knew its period of effectiveness. There is a clear need for information about PEPSE, which needs to be delivered around the time of HIV diagnosis and reinforced later. Some women will need help in discussing it with HIV-negative partners.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Quimioprevenção , Anticoncepção Pós-Coito/métodos , Anticoncepcionais Pós-Coito/uso terapêutico , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Inquéritos e Questionários
12.
J Clin Virol ; 41(2): 152-3, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18055251

RESUMO

The uptake of antenatal HIV testing in England and Scotland improved from 33% in 1998 to 92% in 2004 after implementing an opt-out policy. However, there is the potential for missing HIV seroconversion during pregnancy unless a further test is carried out between antenatal booking, which mostly occurs between 12-14 weeks, and delivery. We report a 32-year old Caucasian woman who developed a primary symptomatic HIV infection late in pregnancy. Unfortunately, despite antiretroviral treatment, caesarean section and formula feeding to reduce the risk of mother to child transmission (MCT), the baby was found to be infected by 12 weeks of age. Despite a 95% uptake rate at King's College Hospital, another HIV seroconversion during late pregnancy was detected after the partner was admitted with AIDS defining diagnoses. In the absence of national data on HIV seroconversion rates in pregnancy, further maternal HIV testing later in pregnancy, especially for women at-risk in an ethnically diverse area such as London, should be considered.


Assuntos
Infecções por HIV/transmissão , Soropositividade para HIV , HIV-1/imunologia , Transmissão Vertical de Doenças Infecciosas , Complicações Infecciosas na Gravidez/virologia , Adulto , Feminino , Infecções por HIV/virologia , Humanos , Recém-Nascido , Gravidez
13.
Int J STD AIDS ; 18(6): 424-6, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17609038

RESUMO

The objective of this study was to assess changes in the uptake of sexually transmitted infection (STI) screening resulting from implementation of a specific STI clinic for HIV-positive patients. An audit of STI screening in HIV-positive patients was undertaken before and after the establishment of the clinic. Significant increases in the number of patients having a sexual health discussion and annual health screen were seen. High rates of positive results were found in all patient groups. National guidelines recommend regular STI screening for all HIV-positive patients. A specific clinic for HIV-positive patients is feasible and acceptable and may result in an increase in uptake of STI screening.


Assuntos
Infecções por HIV/diagnóstico , HIV , Programas de Rastreamento/métodos , Papel do Profissional de Enfermagem , Adulto , Instituições de Assistência Ambulatorial , Feminino , Infecções por HIV/enfermagem , Infecções por HIV/virologia , Humanos , Masculino , Programas de Rastreamento/enfermagem , Pessoa de Meia-Idade
15.
Sex Transm Infect ; 83(1): 59-63, 2007 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17005542

RESUMO

OBJECTIVES: To evaluate the effectiveness of interventions to prevent mother-to-child transmission of HIV at a large teaching hospital in South East London, and to assess reasons for the small numbers of transmissions that continue to occur. DESIGN: A database of all pregnant women diagnosed as HIV positive between 1993 and 2005 was reviewed, with detailed (retrospective) case-note review of all mother-infant pairs where HIV transmission occurred. SETTING: King's College Hospital, London, UK, a teaching hospital serving an ethnically diverse and socially deprived population. RESULTS: 296 pregnancies to 274 women were recorded. 9 of 296 (3.0%) women were lost to follow-up before the end of the pregnancy. Of 287 pregnancies followed up until after delivery, 6 (2.1%) resulted in HIV infection in the infant. More recently, between 2000 and 2004, this transmission rate was even lower, at 3 in 231 (1.3%). Each of these six women had complications, including late presentation to services and defaulting follow-up appointments, which were likely to increase the risk of HIV transmission. Four of the six transmissions occurred in utero. CONCLUSION: The overall transmission rate of 2% attests to the efforts of the multidisciplinary care team in managing this population which is often hard to reach. Clearly, good systems are needed to trace those women who default. Further data are needed regarding in utero transmissions.


Assuntos
Infecções por HIV/transmissão , HIV-1 , HIV-2 , Complicações Infecciosas na Gravidez/prevenção & controle , Adolescente , Adulto , Fármacos Anti-HIV/uso terapêutico , Feminino , Infecções por HIV/prevenção & controle , Humanos , Lactente , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas , Londres , Gravidez , Diagnóstico Pré-Natal , Estudos Retrospectivos
16.
Int J STD AIDS ; 17(12): 851-3, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17212865

RESUMO

We evaluated the management of genital herpes simplex virus (HSV) infection at our clinic. Over six months, 135 patients with primary HSV and 97 patients with recurrent HSV attended. Sixty percent of patients presenting within five days of primary infection were treated with oral acyclovir. Only 53% of patients with primary HSV were given written/verbal information. Follow-up appointments were attended by 78%. Seventy-seven percent of patients with recurrent HSV had at least one viral isolate typed and 72% of patients experiencing episodes exceeding, annually, six were offered suppressive therapy. Our results demonstrate successful management of patients with HSV infections but recommendations are made to reach the standards set by BASSH. Furthermore, we illustrate that improved documentation would go a long way in validating the result.


Assuntos
Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Herpes Genital/tratamento farmacológico , Herpes Genital/virologia , Auditoria Médica , Adulto , Feminino , Humanos , Masculino , Estudos Retrospectivos
18.
Sex Transm Infect ; 81(3): 276-7, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15923302

RESUMO

We report the case of an HIV infected patient with Streptococcus bovis bacteraemia and meningitis associated with gastrointestinal Strongyloides stercoralis infection. To our knowledge, this has been reported once previously and serves as a reminder to actively exclude asymptomatic S stercoralis infection in HIV infected individuals presenting with bacteraemia.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Meningites Bacterianas/etiologia , Infecções Estreptocócicas/etiologia , Streptococcus bovis , Strongyloides stercoralis , Estrongiloidíase/complicações , Adulto , Animais , Bacteriemia/etiologia , Colite/parasitologia , Feminino , Humanos
19.
Br J Radiol ; 76(911): 824-31, 2003 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-14623785

RESUMO

For intravascular brachytherapy with catheter-based systems, AAPM Task Group 60 has recommended measurements that should be made to characterize the sources. Beta emitters, including (90)Sr/(90)Y are ideal for intravascular brachytherapy, but problems arise in measuring dose distributions in the high dose gradient region at short distances from the source. In this paper, measurements of radial and orthogonal dose distributions and dose profiles for a (90)Sr/(90)Y source train using polyacrylamide gel (PAG) dosimetry and a high-field 4.7 Tesla MRI scanner are presented and compared with measurements made with two types of radiochromic film, MD-55 and HD-810. For the PAG system, the dose distributions were determined with in-plane resolutions of 0.4 mm and 0.2 mm. The measurements of absorbed dose distributions both orthogonal and parallel to the source axis show good agreement between the PAG and radiochromic film. The absolute dose at a radial distance of 2 mm in the central 32 mm of a line parallel to the axis was measured. For the PAG the measured absorbed dose was 1.25% lower, for MD-55 4% higher and for the HD-810 1.6% higher when compared with the value given by the source calibration. These results confirm that both absorbed dose and dose distributions for high gradient vascular brachytherapy sources can be measured using PAG but the disadvantages of gel manufacture and the need for access to a high resolution scanner suggests that the use of radiochromic film is the method of choice.


Assuntos
Resinas Acrílicas , Braquiterapia/métodos , Dosimetria Fotográfica/normas , Calibragem , Doenças Cardiovasculares/radioterapia , Humanos , Imageamento por Ressonância Magnética/métodos , Imagens de Fantasmas , Dosagem Radioterapêutica
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