Human immunodeficiency virus type-1 (HIV-1) subtypes in Jamaica / Subtipos del virus tipo-1 de la inmunodeficiencia humano (VIH-1) en Jamaica

The subtypes of 141 isolates of human immunodeficiency virus type-1 (HIV-1) from Jamaica were determined by a combination of env and gag heteroduplex mobility analysis (HMA) genotyping. The majority of HIV-1 isolates were subtype B (131/141, 93.0); one (0.8) isolate each of subtypes C, D and E was found and 7 (4.9) were indeterminate. These results and the failure of the sets of primers used to amplify some of the HIV-1 isolates provide strong evidence of genetic diversity of the HIV/AIDS epidemic in Jamaica. Surveillance of the circulating HIV-1 genetic subtypes is a pre-requisite for developing regional vaccine strategies and understanding the transmission patterns of the virus. This is the first study of its kind in Jamaica and the findings complement data from other Caribbean countries. This work supports the view of colleagues from the French and Spanish-speaking Caribbean that an epidemiological network supported by regional laboratories will help track this epidemic accurately with positive outcomes for the public.

Los subtipos de 141 aislados del virus tipo 1 de la inmunodeficiencia humno (VIH-1) en Jamaica, fueron determinados combinando la genotipificación por análisis de heterodúplex (HMA) en los genes env y gag. La mayor parte de los aislados HIV-1 fueron del subtipo B (131/141, 93.0%), se halló uno (0.8%) aislado para cada uno de los subtipos C, D y E, en tanto que 7 (4.9%) fueron indeterminados. Estos resultados y el fallo de los conjuntos de primers usados para amplificar algunos de los aislados de VIH-1, ofrecen fuerte evidencia de la diversidad epidémica del VIH/SIDA en Jamaica. La vigilancia de los subtipos genéticos de VIH-1 en circulación, constituye un pre-requisito, tanto para desarrollar estrategias de vacunas a nivel regional, como para entender los patrones de transmisión del virus. Este es el primer estudio de este tipo en Jamaica, y nuestros hallazgos complementan los datos obtenidos en otros países del Caribe. Coincidimos con nuestros colegas del Caribe francófono e hispano-parlante en cuanto a que una red epidemiológica apoyada por los laboratorios regionales, nos ayudaría a continuar rastreando esta epidemia con exactitud, y con resultados positivos para el público.

HIV seroprevalence, uptake of interventions to reduce mother-to-child transmission and birth outcomes in greater Kingston, Jamaica

BACKGROUND: The seroprevalence of HIV among pregnant women in the Caribbean is 2-3 and increasing. The Kingston Paediatric and Perinatal HIV Programme is developing and implementing a unified programme to eliminate mother-to-child transmission (MTCT) of HIV in Kingston, Jamaica. METHODS: Pregnant women presenting to Kingston Metropolitan Antenatal Clinics, Victoria Jubilee Hospital, Spanish Town Hospital and the University Hospital of the West Indies had HIV serology performed by ELISA, or by the new Determine Rapid Test after receiving group counselling. HIV-positive women were referred to High Risk Antenatal Clinics. Antiretroviral prophylaxis with zidovudine (AZT), or nevirapine was given. Care was administered using a standard protocol by a multi-disciplinary team of public and academic healthcare personnel. RESULTS: In year one, 19,414 women delivered Among 14,054 women who started antenatal care for this period, 5,558 (40) received group counselling and 7,383 (53) received HIV-testing. During the fourth quarter of follow-up, these comparative rates were 66 (2049/3 118) and 72 (2260/3118) respectively. HIV seroprevalence overall was 2.1 (152/7 383). One hundred and seven HIV+ women at varying gestational ages were identified in the programme, 72 had so far received AZT and nine nevirapine (76). 0f 84 deliveries, birth outcomes were 75 live births (89), six neonatal deaths and four maternal deaths (all from HIV/AIDS). Major challenges include repeat pregnancies of 36 despite prior knowledge of HIV seropositivity and poor partner notification with only 30 (32) having a HIV-test. Although rates of HIV testing in pregnant women in Greater Kingston are increasing, rates of testing overall remain sub-optimal. On the labour ward, there was sub-optimal identification of the HIV+ pregnant woman and administration of AZT chemoprophylaxis, along with issues of patient confidentiality and stigma. CONCLUSION: This programme needs strengthening in order to reduce maternal-fetal transmission of HIV in Greater Kingston, Jamaica [quot]pMTCT-PLUS, or comprehensive family-centred care, is the next step[quot]

An assessment of mother-to-child HIV transmission prevention in 16 pilot antenatal clinics in Jamaica

OBJECTIVES: This study aims to determine the number and age distribution of pregnant women testing positive for HIV at 16 selected clinics in Jamaica between 2001 and 2002; the utilization of therapeutic interventions to minimize the risk of mother-to-child transmission (MTCT) and the current status of the HIV-exposed infants and, finally, the number of children who received testing for detection of HIV and to calculate the incidence of MTCT in these children. METHODS: A retrospective study was carried out at sixteen pilot clinic sites by examining the patient records for all confirmed HIV-positive pregnant mothers and the resultant infants at these facilities for the period January 2001 to December 2002. RESULTS: One hundred and twenty-three of 8116 pregnant women newly tested positive during the period January 2001 to December 2002; however, 176 HIV+ women delivered. Fifty-three (30) knew their HIV status prior to participating in the programme. Sixty-two (1.4) and 61 (1.6) tested positive in 2001 and 2002, respectively. One hundred and ten (77) and 113 (83) mothers and infants, respectively, received ARV therapy, (92 - nevirapine, 8 - zidovudine). Twenty-three per cent of pregnant women received no ARV Forty-four (25.0) of the 176 infants had a documented ELISA HIV test before eighteen months of age, none had a PCR test. The health status of 40 (23) of these children was known: 30 (75) were alive and well, five of whom did not receive any ARV, one (2.5) was alive and ill and nine (22.5) were reported dead, five of whom received ARV; 28.6 of infants who did not receive ARV were reported as either dead or ill compared to 13.8 of those receiving ARV CONCLUSION: Though the majority of pregnant women discovered their HIV status during pregnancy, a significant number got pregnant knowing that they were HIV+. The majority of mothers and infants received ARV but the follow-up and testing of infants was limited. Nevirapine is clearly protective in the prevention of MTCT of HIV and should be made universally accessible. All infants delivered to HIV+ mothers should be identified and tested for HIV