RESUMEN
OBJECTIVE: To determine the prevalence of human immunodeficiency virus type 1 (HIV-1) infection and its association with illicit drug use for mothers being delivered of infants at an inner-city municipal hospital. METHODS: We anonymously tested the umbilical cord blood for HIV-1 antibody of 98.1% (2971/3028) of singleton infants with birth weight greater than 500 g born during 1989 and linked the results to a maternal-infant database from which all identifying information had been removed. RESULTS: Overall, HIV-1 seroprevalence was 3.3% (99/2971). Among HIV-1-seropositive mothers, 79% (78/99) gave no history of ever using injected drugs. Seropositivity for HIV-1 was independently associated with history of maternal cocaine use during pregnancy (odds ratio, 3.55; 95% confidence interval, 2.18, 5.78), history of ever using injected drugs (odds ratio, 6.02; 95% confidence interval, 3.14, 11.6), positive serologic test result for syphilis during pregnancy (odds ratio, 3.37; 95% confidence interval, 1.94, 5.88), and increasing maternal age per year (odds ratio, 1.04; 95% confidence interval, 1.00, 1.09). Voluntary testing programs failed to identify 71% (70/99) of all HIV-1-infected women. Infants placed into foster care were eight times more likely to be HIV-1 seropositive than those discharged to their mothers. CONCLUSIONS: Most HIV-1-infected mothers seem to have acquired the infection via heterosexual transmission rather than via injected drug use. Associations of maternal HIV-1 infection with cocaine use, syphilis, and increasing age probably operate through behaviors that increase maternal risk of exposure to an HIV-1-infected sexual partner or, in the case of syphilis, also through biologic factors that may predispose to HIV-1 transmission. The failure of voluntary testing to identify most HIV-1-infected mothers provides a strong rationale for routine HIV-1 testing during pregnancy and in the newborn period.
Asunto(s)
Anticuerpos Anti-VIH/análisis , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Seroprevalencia de VIH , VIH-1 , Vigilancia de la Población , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/etiología , Abuso de Sustancias por Vía Intravenosa/complicaciones , Serodiagnóstico del SIDA , Adulto , Intervalos de Confianza , Femenino , Sangre Fetal , Infecciones por VIH/sangre , Humanos , Recién Nacido , Modelos Logísticos , Edad Materna , Registro Médico Coordinado , Ciudad de Nueva York/epidemiología , Oportunidad Relativa , Embarazo , Complicaciones Infecciosas del Embarazo/sangre , Factores de Riesgo , Estudios Seroepidemiológicos , Conducta SexualRESUMEN
OBJECTIVE: To determine the maternal risk factors and infant outcome for unattended out-of-hospital deliveries brought to an inner-city public hospital. METHODS: We compared 59 infants born alive out of hospital during 1989 with 151 randomly selected in-hospital live births, all with birth weight greater than 500 g. RESULTS: History of cocaine use during pregnancy (odds ratio [OR], 4.20; 95% confidence interval [CI], 1.68 to 10.5) and lack of Medicaid or other health insurance (OR, 2.15; 95% CI, 1.04 to 4.45) were independently associated with out-of-hospital delivery. Out-of-hospital delivery was associated with hypothermia (defined as admission axillary temperature < 35 degrees C; OR, 20.8; 95% CI, 4.81 to 89.9) and with hypoglycemia (defined as admission glucose reagent strip reading < 2.2 mmol/L [< 40 mg/dL]; OR, 4.41; 95% CI, 1.29 to 15.1) in separate analyses controlling for birth weight and other risk factors. Polycythemia (venous or arterial hematocrit > 0.65 at age > or = 6 hours) occurred in 14% (eight of 59) of out-of-hospital births. The increased neonatal mortality rate for infants born out of hospital (20.3 vs 7.3 per 1000 live births; OR, 2.82; 95% CI, 1.23 to 6.47) was due to an excess of infants weighing 500 to 999 g. CONCLUSIONS: Unattended out-of-hospital births result in increased neonatal morbidity that may be partly preventable by simple interventions used routinely at inhospital deliveries.
Asunto(s)
Parto Domiciliario/efectos adversos , Hospitalización , Trabajo de Parto , Adulto , Femenino , Infecciones por VIH/epidemiología , Humanos , Mortalidad Infantil , Recién Nacido de Bajo Peso , Recién Nacido , Seguro de Salud , Masculino , Medicaid , Ciudad de Nueva York/epidemiología , Embarazo , Complicaciones del Embarazo/epidemiología , Factores de Riesgo , Trastornos Relacionados con Sustancias/epidemiología , Estados Unidos/epidemiologíaRESUMEN
Opportunistic and bacterial infections remain the leading causes of death of Human Immunodeficiency Virus-infected children, despite recent advances in the diagnosis of HIV infection during early infancy; antiretroviral therapies; advances in the treatment of some infections; an improved understanding of the cellular immune systems during early childhood; and new strategies for the prevention of some infections. However, these advances appear to be changing the natural history of pediatric HIV infection, resulting in an improved and longer life for infected children. This article briefly reviews the epidemiology, predictors, and treatments of the most common infections associated with pediatric HIV disease, including Pneumocystis carinii pneumonia, recurrent bacterial infections, candidiasis, herpes group viruses, mycobacterial disease and cryptosporidiosis.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Infecciones Bacterianas/complicaciones , Candidiasis/complicaciones , Trastornos de la Nutrición del Niño/complicaciones , Criptosporidiosis/complicaciones , Infecciones por Citomegalovirus/complicaciones , Infecciones por VIH/complicaciones , Antiinfecciosos/uso terapéutico , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/epidemiología , Candidiasis/diagnóstico , Candidiasis/epidemiología , Candidiasis/terapia , Niño , Criptosporidiosis/diagnóstico , Criptosporidiosis/tratamiento farmacológico , Criptosporidiosis/epidemiología , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/epidemiología , Infecciones por Citomegalovirus/terapia , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Humanos , Incidencia , Lactante , Recién Nacido , Neumonía por Pneumocystis/complicaciones , Neumonía por Pneumocystis/diagnóstico , Neumonía por Pneumocystis/tratamiento farmacológico , Neumonía por Pneumocystis/epidemiología , Valor Predictivo de las Pruebas , RecurrenciaRESUMEN
Standard practices of care for HIV-infected pregnant women and newborns are undergoing rapid changes. Definitive HIV diagnosis in early infancy and improved medical care make it possible for children with HIV infection to live much longer. Widespread underdiagnosis, however, remains a major obstacle to implementing these advances.
Asunto(s)
Servicios de Salud del Niño/normas , Infecciones por VIH/congénito , Infecciones por VIH/prevención & control , Planificación de Atención al Paciente/normas , Femenino , Infecciones por VIH/clasificación , Necesidades y Demandas de Servicios de Salud , Humanos , Inmunización/normas , Recién Nacido , Pobreza , Embarazo , Índice de Severidad de la Enfermedad , Estados UnidosRESUMEN
Orphans and vulnerable youth who live in group homes are at risk of poor mental health and sexual and drug-using behaviors that increase the risk of HIV transmission. This study explores factors related to this risk among youth living in group homes ("children's homes") for orphans and vulnerable children in South Africa, a country afflicted by high levels of parental loss due to HIV. The study explores 1) knowledge and attitudes about HIV, 2) social support, 3) communication with group home caregivers, and 4) the relevance of an existing evidence-based HIV prevention and mental health promotion program to situations where sexual and drug risk behaviors can occur. In-depth qualitative individual interviews were conducted with 20 youth (age 10 to 16 years) residing in two children's homes in Durban, South Africa. Content analysis focused on critical themes related to coping and prevention of risk activities. Respondents exhibited inconsistent and incomplete knowledge of HIV transmission and prevention. They displayed positive attitudes toward people living with HIV, but reported experiencing or witnessing HIV-related stigma. Participants witnessed substance use and romantic/sexual relationships among their peers; few admitted to their own involvement. While relationships with childcare workers were central to their lives, youth reported communication barriers related to substance use, sex, HIV, and personal history (including parental loss, abuse, and other trauma). In conclusion, these qualitative data suggest that evidence-based HIV prevention programs that bring caregivers and youth together to improve communication, HIV knowledge, social support, youth self-esteem, and health care, reduce sexual and drug risk behaviors, and strengthen skills related to negotiating situations of sexual and substance use possibility could benefit youth and childcare workers in children's homes.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Complicaciones Infecciosas del Embarazo , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Embarazo , InvestigaciónAsunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Cara/anomalías , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/transmisión , Femenino , Enfermedades Fetales/diagnóstico , Humanos , Recién Nacido , Embarazo , Complicaciones Infecciosas del EmbarazoRESUMEN
To estimate the cost of hospital care for children infected with the human immunodeficiency virus (n = 37) at Harlem Hospital Center, New York, a cost-based inventory of medical resource consumption was developed. Six thousand thirty-five inpatient days were audited by retrospective chart review. The total cost of care between 1981 and 1986 was +3,362,597. Average lifetime costs were +90,347 per child. One third of the total inpatient days and over 20% of the cost resulted from social rather than medical factors. Per diem costs were highest for children with opportunistic infections (+705) and lowest for homeless "boarder babies" (+466). Boarder babies had a mean length of stay nearly four times longer than those with homes (339 days vs 89 days). The primary predictors of length of stay were maternal intravenous drug use and boarder baby status, regardless of medical need. The unique needs of human immunodeficiency virus-infected children require innovative medical, social, and financial solutions.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/economía , Hospitales Municipales/economía , Hospitales Públicos/economía , Niño , Niño Hospitalizado , Costos y Análisis de Costo , Femenino , Humanos , Tiempo de Internación/economía , Masculino , Registros Médicos , Ciudad de Nueva York , Proyectos de Investigación , Estudios RetrospectivosRESUMEN
This study evaluates genetic influence on susceptibility to perinatal HIV-1 infection among 106 Black infants from New York and San Francisco born to mothers infected with HIV-1. Genes tested by molecular techniques are HLA class II loci DRB1, DPB1 and DQA1; HLA class III loci complement C4A and C4B; alpha and beta interferons; and the constant region of the T-cell receptor beta chain. Of the 106 infants analysed, 54 are infected with HIV and 52 remain uninfected at age 15 months and older. Genotypes in the HLA region appear to influence risk of HIV infection. Specifically, infants with the amino acid sequence -asp-glu-ala-val- at DPB1 positions #84-87 are more likely to be infected (P = 0.001) and infants with the allele DQA1*0102 are less likely to be infected (P = 0.031). Combinations of these two risk factors show a strong dose response (P = 0.0005). HLA DPB1 and DQA1 may play a direct role in immune response associated with HIV-1 infection, or the critical region may be located between these two genes. Characterisation of other class II HLA genes in these infants will allow more precise determination of the role of HLA loci in susceptibility to HIV-1 infection.
Asunto(s)
Infecciones por VIH/epidemiología , VIH-1 , Alelos , Población Negra/genética , Susceptibilidad a Enfermedades/epidemiología , Predisposición Genética a la Enfermedad , Genotipo , Infecciones por VIH/congénito , Infecciones por VIH/genética , Antígenos HLA-D/genética , Humanos , Lactante , Recién Nacido , Ciudad de Nueva York/epidemiología , Factores de Riesgo , San Francisco/epidemiología , Población Urbana/estadística & datos numéricosRESUMEN
OBJECTIVE: To study the role of host genotype in pediatric infection with human immunodeficiency virus type 1 (HIV-1) and progression to acquired immunodeficiency syndrome (AIDS). METHODS: Human leukocyte antigen (HLA) class II and complement C4 genotypes were determined by means of molecular genetic techniques for 243 black children born to HIV-1-infected mothers in New York City and San Francisco. Survival, cumulative incidences of opportunistic infections and encephalopathy, and rates of CD4+ T cell decline were compared in children of different genotypes. RESULTS: Among HIV-1-infected children, the HLA-DR3 haplotype (DRB1*0301-DQA1*0501-DQB1*0201) was associated with increased incidence of encephalopathy, faster rate of CD4+ cell decline, and death before 2 years of age. Deletion of the C4A gene was independently associated with increased incidences of encephalopathy and early death. DPB1*0101 was associated with survival to at least 2 years of age. The presence of DQB1*0604 was associated with increased risk of HIV infection. CONCLUSIONS: These results are consistent with previously reported associations between HLA genotypes and faster progression to AIDS among HIV-infected adults. The DR3 haplotype and C4A deletion may reflect the same underlying mechanism of susceptibility in that the DR3 haplotype is in linkage disequilibrium with other C4A null alleles. In addition, the class II locus DPB1 may have an independent effect on survival.