Acceptability and impact of zidovudine for prevention of mother-to-child human immunodeficiency virus-1 transmission in France.

We studied the propagation and the impact of zidovudine prevention on the human immunodeficiency virus-1 transmission rate from infected mothers to their infants in the French nationwide prospective cohort. Infection was diagnosed in the children on the basis of at least two positive human immunodeficiency virus-1 polymerase chain reaction tests, culture, or both. The transmission rate among treated women was compared with that among untreated women during the same period and with that among women enrolled in the cohort since 1986. The impact of zidovudine was analyzed according to the women's clinical and biologic characteristics, the mode of delivery, and use of zidovudine therapy before the pregnancy. Nearly 90% of women were treated as soon as the second half of 1994. In 1994 and 1995, 80% of mother-child pairs received at least one of the three phases of preventive treatment. Among the 663 mothers enrolled during these 2 years, only six refused the treatment. Zidovudine treatment was associated with a reduction in the transmission rate of nearly two-thirds, from 14% +/- 6% to 5% +/- 2% (p < 0.01). The degree of reduction was not influenced by the maternal CD4+ cell count or p24 antigenemia at delivery. Zidovudine treatment of the mother before the pregnancy considerably reduced the impact of preventive therapy; the transmission rate was significantly higher among pretreated mothers (20% versus 5%, p < 0.01) even after adjusting for maternal CD4+ cell count. Zidovudine prevention is now widely used in France and has had a major impact on the epidemiology of mother-child human immunodeficiency virus transmission. This justifies a policy of offering human immunodeficiency virus screening to all women before or shortly after the diagnosis of pregnancy.

[Renal parenchymatous involvements in African and Caribbean patients with human immunodeficiency virus infection. Apropos of 10 cases]. / Atteintes rénales parenchymateuses chez des patients africains et antillais infectés par le virus de l'immuno-déficience humaine. A propos de 10 cas.

Between 1989 and 1990, 10 HIV-infected patients with renal involvement (proteinuria and/or renal failure) were followed. The 5 men and 5 women black (4 Haitians, 3 Zairians, 2 Congolese and 1 Angolan). Their mean age was 31.7 +/- 4 years. No known risk factor was identified and transmission was probably heterosexual. When renal disease was diagnosed, 4 patients had AIDS, 5 had ARC and 1 was asymptomatic. Kidney biopsies were performed in 7 patients: 4 HIV-associated nephropathies (HIV AN) with segmental and focal hyalinizations, 1 thrombotic angiopathy, and 2 interstitial nephropathies, 1 with proliferative glomerulonephritis. The clinical, biological and radiographic patterns of 2 of the remaining 3 patients were suggestive of HIV AN. Four of the 6 patients with HIV AN developed end-stage renal disease within 5 +/- 2.5 months; renal function in the other 2 remained stable for 25 and 41 months, respectively, while they were receiving zidovudine, but deteriorated rapidly within weeks of withdrawing this drug. Zidovudine may have delayed the evolution of the nephropathies in these patients.

[Interstitial lymphoid pneumonia and polyadenopathies in patients infected with the LAV/HTLV III virus]. / Pneumonie lymphoïde interstitielle et polyadénopathies chez des sujets infectés par le virus LAV/HTLV III.

Seven patients of Haitian and Central African origin were investigated for interstitial pneumonitis and unexplained chronic lymphadenopathy. A study of broncho-alveolar lavage fluid showed no opportunistic micro-organisms and disclosed a high alveolar lymphocyte count with more than 80% T8+ cells. In 3 patients, open lung biopsy showed lymphoid interstitial pneumonitis. Follicular hyperplasia was a constant finding in lymph nodes. Benign lymphocytic infiltration was found in other organs of all patients, associated with polyclonal hyperimmunoglobulinaemia, low peripheral T4+ cell count and LAV-Ig G antibodies.

[Results of abdominal x-ray computed tomography in 25 patients with the acquired immunodeficiency syndrome or the lymphadenopathy syndrome]. / Résultats de l'examen tomodensitométrique abdominal chez 25 sujets atteints de syndrome d'immuno-dépression acquise ou de syndrome lymphadénopathique.

An abdominal computed tomographic examination was performed to 20 patients with Acquired Immunodeficiency Syndrome (AIDS) and to 5 patients with Lymphadenopathy Syndrome (LAS). Intraabdominal lymph nodes were seen in 18 out of 20 cases of AIDS and in 5 cases of LAS. Lymph nodes have a normal size or are slightly enlarged but they are too numerous. Splenomegaly was found in 17 patients. Rectal modifications secondary to a proctitis were seen in the homosexual patients.