Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 8 de 8
Filter
1.
J Acquir Immune Defic Syndr ; 91(4): 373-380, 2022 12 01.
Article in English | MEDLINE | ID: mdl-36215978

ABSTRACT

BACKGROUND: An increasing number of women living with perinatally acquired HIV are reaching adulthood and becoming pregnant. Achieving viral suppression is challenging in this population frequently exposed to numerous antiretroviral regimens. This study describes the long-term outcomes of pregnant women living with perinatally acquired HIV in Spain. METHODS: Descriptive, retrospective, multicenter study of the women living with perinatally acquired HIV who gave birth between January 2000 and December 2019 in Madrid. Epidemiological, clinical, and HIV-related data were collected from the first delivery to the end of the study period, including antiretroviral therapy, prevention strategies, and outcomes. RESULTS: Sixty-three live births in 33 women were included. The mean number of pregnancies per women was 1.9 (range: 1-6). At first delivery, women's median age was 20 years (interquartile range: 18-23), 11 (33.3%) had been previously diagnosed with AIDS and 6 (18%) with mental health disorders. Forty percent became pregnant unsuppressed, whereas 81% achieved viral suppression at delivery. Treatment interruptions were common after delivery, as were losses to follow-up, with no positive effect of pregnancy on retention to care or the immune virological situation. Five women (15%) experienced a new AIDS event, and there were 2 deaths (6%) during follow-up. There was 1 case of mother-to-child transmission in a nonadherent woman in whom preventive measures could not be implemented. CONCLUSIONS: Pregnancy in this unique population of women living with perinatally acquired HIV poses particular challenges. Specific strategies, including a multidisciplinary approach, are needed to minimize perinatal transmission risks and improve outcomes during the postpartum period.


Subject(s)
Acquired Immunodeficiency Syndrome , Anti-HIV Agents , HIV Infections , Pregnancy Complications, Infectious , Female , Pregnancy , Humans , Adult , Young Adult , Infectious Disease Transmission, Vertical/prevention & control , Pregnancy Outcome , Anti-HIV Agents/therapeutic use , Pregnancy Complications, Infectious/drug therapy , Pregnancy Complications, Infectious/epidemiology , HIV Infections/drug therapy , HIV Infections/epidemiology , Retrospective Studies , Spain/epidemiology , Acquired Immunodeficiency Syndrome/drug therapy
2.
Front Cell Dev Biol ; 10: 1033080, 2022.
Article in English | MEDLINE | ID: mdl-36742196

ABSTRACT

Stress urinary incontinence (SUI) is a condition that causes the involuntary loss of urine when making small efforts, which seriously affects daily life of people who suffer from it. Women are more affected by this form of incontinence than men, since parity is the main risk factor. Weakening of the pelvic floor tissues is the cause of SUI, although a complete understanding of the cellular and molecular mechanisms of the pathology is still lacking. Reconstructive surgery to strengthen tissue in SUI patients is often associated with complications and/or is ineffective. Mesenchymal stromal cells from the maternal side of the placenta, i.e. the decidua, are proposed here as a therapeutic alternative based on the regenerative potential of mesenchymal cells. The animal model of SUI due to vaginal distention simulating labor has been used, and decidual mesenchymal stromal cell (DMSC) transplantation was effective in preventing a drop in pressure at the leak point in treated animals. Histological analysis of the urethras from DMSC-treated animals after VD showed recovery of the muscle fiber integrity, low or no extracellular matrix (ECM) infiltration and larger elastic fibers near the external urethral sphincter, compared to control animals. Cells isolated from the suburethral connective tissue of SUI patients were characterized as myofibroblasts, based on the expression of several specific genes and proteins, and were shown to achieve premature replicative senescence. Co-culture of SUI myofibroblasts with DMSC via transwell revealed a paracrine interaction between the cells through signals that mediated DMSC migration, SUI myofibroblast proliferation, and modulation of the proinflammatory and ECM-degrading milieu that is characteristic of senescence. In conclusion, DMSC could be an alternative therapeutic option for SUI by counteracting the effects of senescence in damaged pelvic tissue.

3.
PLoS One ; 15(4): e0230109, 2020.
Article in English | MEDLINE | ID: mdl-32271775

ABSTRACT

BACKGROUND: Maternal HIV coinfection is a key factor for mother-to-child transmission (MTCT) of HCV. However, data about HCV MTCT in HIV/HCV-coinfected pregnant women on combined antiretroviral treatment (ART) are scarce. This study assessed the HCV MTCT rate in the Madrid Cohort of HIV-infected women. METHODS: Retrospective study within the Madrid Cohort of HIV-infected pregnant women (2000-2012). Epidemiological, clinical and treatment related variables were analysed for the mother and infant pairs. HCV MTCT rate was determined. RESULTS: Three hundred thirty-nine HIV/HCV-coinfected women and their exposed infants were recorded. A total of 227 (67%) paired mother-children had available data of HCV follow-up and were included for the analysis. Sixteen children (rate 7.0%, 95%CI 3.7-10.4%) were HCV infected by 18 months of age, none of them coinfected with HIV. HIV/HCV-coinfected pregnant women were mostly of Spanish origin with a background of previous injection drug use. HCV-genotype 1 was predominant. The characteristics of mothers that transmitted HCV were similar to those that did not transmit HCV with respect to sociodemographic and clinical features. A high rate (50%) of preterm deliveries was observed. Infants infected with HCV were similar at birth in weight, length and head circumference than those uninfected. CONCLUSION: MTCT rates of HCV among HIV/HCV-coinfected women on ART within the Madrid cohort were lower than previously described. However, rates are still significant and strategies to eliminate any HCV transmission from mother to child are needed.


Subject(s)
Antiretroviral Therapy, Highly Active , Coinfection/transmission , Coinfection/virology , HIV Infections/virology , Health Services Accessibility , Hepacivirus/physiology , Hepatitis C/transmission , Adult , Female , Humans , Infant , Infant, Newborn , Male , Spain
4.
Prog. obstet. ginecol. (Ed. impr.) ; 61(3): 238-243, mayo-jun. 2018. tab, graf
Article in English | IBECS | ID: ibc-174959

ABSTRACT

Objective: In the present study, we evaluated the development of symptoms of overactive bladder in women undergoing surgery for pelvic organ prolapse. Material and methods: We performed an epidemiological, longitudinal, prospective study involving 39 gynecological centers in Spain. The study population included women with symptomatic pelvic organ prolapse who were candidates for vaginal surgery. Patients attended a baseline visit (before surgery) and another visit 1 year after surgery. Pelvic organ prolapse was graded according to the Baden-Walker classification and the Pelvic Organ Prolapse Questionnaire. Urgency, urge incontinence, frequency, and nocturia were evaluated separately. Patients filled out the Epidemiology of Prolapse and Incontinence Questionnaire and the International Consultation on Incontinence Questionnaire. Results: The final sample included 360 women (319 were evaluable at the postsurgery visit). At baseline 58.3%, 38.3%, and 47.2% of women reported urgency, urge urinary incontinence, and frequency, respectively, whereas after surgery these symptoms were reported by 34.5%, 17.2%, and 19.7% (p < 0.001). The percentage of patients reporting nocturia also decreased after surgery from 59.4% to 56.4%, although the difference was not statistically significant. Furthermore, 19.8%, 9.8%, and 7.6% of patients, respectively, reported de novo urgency, urge urinary incontinence, and frequency after surgery. Patients with persistence of postsurgical urge urinary incontinence had significantly higher scores in the International Consultation on Incontinence Questionnaire at baseline. Conclusions: In general, a reduction in overactive bladder symptoms was observed in women undergoing surgical treatment for pelvic organ prolapse


Objetivo: el presente estudio pretende evaluar la evolución de síntomas de vejiga hiperactiva en mujeres intervenidas de prolapso de órganos pélvicos. Material y métodos: estudio epidemiológico, longitudinal, prospectivo, en 39 servicios de ginecología de España, que incluyó mujeres con prolapso de órganos pélvicos sintomático candidatas a cirugía de prolapso por vía vaginal. Se realizó una visita previa y una de seguimiento al año de la cirugía. Se evaluó el prolapso de órganos pélvicos mediante la clasificación de Baden y el cuestionario de prolapso de órganos pélvicos. Las pacientes cumplimentaron el cuestionario de epidemiología de prolapso e incontinencia y el de incontinencia urinaria. Se evaluaron los síntomas de urgencia, incontinencia urinaria de urgencia, frecuencia y nocturia. Resultados: se incluyeron 360 mujeres (319 evaluables en la revisión poscirugía). En la evaluación basal el 58,3%, 38,3% y 47,2% de las mujeres refirieron urgencia, incontinencia urinaria de urgencia y frecuencia, mientras que en la visita poscirugía únicamente el 34,5%, 17,2% y 19,7% las presentaban (p < 0,001). El porcentaje de pacientes que presentaban nocturia también se redujo, del 59,4% al 56,4%, aunque no de forma estadísticamente significativa. Un 19,8%, 9,8% y 7,6% de las pacientes presentaron urgencia, incontinencia urinaria de urgencia y frecuencia de novo tras la cirugía, respectivamente. Las pacientes con persistencia de incontinencia urinaria de urgencia poscirugía presentaron puntuaciones significativamente más elevadas en el cuestionario de incontinencia urinaria en la visita basal. Conclusiones: en general, se observa una reducción de los síntomas de vejiga hiperactiva en mujeres sometidas a cirugía de prolapso de órganos pélvicos


Subject(s)
Humans , Female , Urinary Bladder, Overactive/rehabilitation , Pelvic Organ Prolapse/surgery , Urinary Incontinence, Urge/rehabilitation , Postoperative Complications/epidemiology , Treatment Outcome , Prospective Studies , Urinary Incontinence, Urge/epidemiology , Surveys and Questionnaires
5.
PLoS One ; 12(8): e0183558, 2017.
Article in English | MEDLINE | ID: mdl-28841701

ABSTRACT

BACKGROUND: An increasing number of perinatally HIV-infected women (PHIV) are reaching adulthood and becoming pregnant. Most PHIV women have been exposed to a high number of antiretroviral regimens, and they may have difficulties to achieve viral suppression. Psychosocial problems are not uncommon and could be an important barrier for treatment adherence. The effects of chronic HIV infection and long-term exposure to antiretroviral treatment of PHIV women cause concerns on the developing fetus. The aims of this study were to describe the prevention of mother-to-child transmission strategies in PHIV women and the infant outcomes in the Madrid Cohort of HIV-infected mother-infant pairs. METHODS: All PHIV pregnant women registered in the Cohort that gave birth from 2000 to 2015 were included in the study. RESULTS: Twenty-eight pregnancies in twenty-two perinatally infected women were registered. Most women were Caucasian and heavily treatment-experienced. Nine cases (32.1%) were at high risk of HIV mother-to-child transmission. Maternal HIV-1 viral load was detectable close to delivery in four women (14.3%). The management of these cases was described, and the treatment strategies were discussed. None of the newborns acquired HIV infection. Eight infants (28.6%) were small for gestational age. CONCLUSIONS: This study included a large series of pregnancies among PHIV women attended according to a youth-centered care model. The challenges in the management of this population by health-care providers were described. Specific strategies to minimize perinatal transmission risks should be addressed in future collaborative studies.


Subject(s)
HIV Infections/physiopathology , Pregnancy Complications, Infectious , Pregnancy Outcome , Adolescent , Adult , Anti-HIV Agents/therapeutic use , Female , HIV Infections/complications , HIV Infections/drug therapy , HIV Infections/epidemiology , Humans , Pregnancy , Pregnancy Complications, Infectious/drug therapy , Spain/epidemiology , Viral Load , Young Adult
6.
BMC Infect Dis ; 14: 700, 2014 Dec 24.
Article in English | MEDLINE | ID: mdl-25808698

ABSTRACT

BACKGROUND: Antiretroviral therapy (ART) in pregnancy has resulted in a marked impact on reducing the risk of mother-to-child transmission (MCT) of HIV. However the safety of in utero ART exposure in newborns remains a concern. METHODS: A multicenter prospective observational study of HIV-infected mother and their infants was performed in Madrid, Spain, from 2000 to 2009. Children had regular visits with clinical examination according to protocol until the age of 24 months. An abdominal ultrasound and an echocardiogram were scheduled during follow up. Birth defects (BDs) were registered according to European Surveillance of Congenital Anomalies (EUROCAT). RESULTS: A total of 897 live births from 872 mothers were included. Overall the birth defects prevalence observed was 6.9% (95% CI 5.4-9.1).The most commonly reported birth defects types were in genital organs and urinary system (19 cases, 30.6%) and cardiovascular system (17 cases, 27.4%). There was no increased risk for infants exposed in the first trimester to ARVs compared with unexposed infants. No significant associations were observed between exposure to any individual antiretroviral agent during pregnancy and birth defects CONCLUSION: A higher prevalence of BDs was observed, higher than previously reported. In utero exposure to ART was not proved to be a major risk factor of birth defects in infants. However the relatively small number of patients is a major limitation of this study.


Subject(s)
Anti-Retroviral Agents/adverse effects , Congenital Abnormalities/epidemiology , HIV Infections/transmission , Infectious Disease Transmission, Vertical/prevention & control , Pregnancy Complications, Infectious/prevention & control , Anti-Retroviral Agents/therapeutic use , Cohort Studies , Female , HIV Infections/drug therapy , HIV Infections/prevention & control , Humans , Infant , Infant, Newborn , Male , Pregnancy , Prevalence , Prospective Studies , Risk Factors , Spain/epidemiology
7.
Pediatr Infect Dis J ; 31(10): 1053-8, 2012 Oct.
Article in English | MEDLINE | ID: mdl-22926219

ABSTRACT

BACKGROUND: The objective of the study was to describe temporal patterns in the management of HIV-1 infected women and their newborns and the changes over time in the mother-to-child transmission (MTCT) rates and risk factors. METHODS: A multicenter prospective observational study was performed in Madrid, Spain, from 2000 to 2007. Cohort period 1 (CP1) included births in 2000-2003 and cohort period 2 (CP2) included births in 2004-2007. RESULTS: Of the 803 HIV-infected women and their infants, 427 were in the CP1 and 376 in CP2. Almost all CP2 women received highly active antiretroviral therapy. More women in CP2 received antiretroviral treatment for ≥16 weeks during pregnancy (72.0% in CP1 vs. 84.8% in CP2; P < 0.001). Overall, no differences in trends in mode of delivery were observed. The proportion of women with vaginal deliveries who had undetectable viral loads increased from 31.1% in CP1 to 42.7% in CP2 (P = 0.02). Thirteen children (1.6%, 95% confidence interval: 0.68-2.55) were HIV-1 infected by MTCT. No changes in the rates of infection were observed over time. All the cases of MTCT occurred when antiretroviral treatment was not given or was given for <16 weeks during pregnancy. CONCLUSIONS: Low MTCT rates were observed over time. Lack of timely provision of antiretroviral drugs was the main limitation to develop all preventive interventions available nowadays. Nonsustained control of viral load could be associated with residual transmission.


Subject(s)
HIV Infections/transmission , HIV-1/isolation & purification , Infectious Disease Transmission, Vertical/statistics & numerical data , Adolescent , Adult , Anti-Retroviral Agents/therapeutic use , Child, Preschool , Female , HIV Infections/prevention & control , Humans , Infant , Infant, Newborn , Infectious Disease Transmission, Vertical/prevention & control , Male , Pregnancy , Pregnancy Complications, Infectious/virology , Prospective Studies , Risk Factors , Spain/epidemiology , Young Adult
8.
Med. clín (Ed. impr.) ; 114(8): 286-291, mar. 2000.
Article in Es | IBECS | ID: ibc-6308

ABSTRACT

Fundamento: A pesar de la eficacia probada de la zidovudina (ZDV) administrada a la embarazada en la disminución de la transmisión vertical del VIH-1, existen importantes dudas sobre la efectividad y el cumplimiento en la práctica clínica. Los objetivos han sido determinar la efectividad de la ZDV durante el embarazo a las mujeres con infección por VIH en la reducción de la transmisión vertical (TV) y analizar la tendencia en el tiempo de la prevalencia de infección y de los casos identificados precozmente. Pacientes y Métodos: Se han seleccionado los pares de madres/hijos seguidos prospectivamente desde el nacimiento, en el período comprendido entre el 1 de enero de 1987 y el 30 de octubre de 1997. Se ha considerado infectado al niño con anticuerpos positivos a partir de los 18 meses, o al menos 2 determinaciones mediante reacción en cadena de la polimerasa (PCR) positivas en los primeros 3 meses de vida. Resultados: Se han identificado 229 madres y 248 niños. Se administró ZDV a 34 madres en el embarazo con una media (DE) de 4,7 (3,1) meses. El valor medio de CD4 fue de 465 (261) células * 106/l. Las únicas variables asociadas con un mayor riesgo de transmisión fueron el tiempo de rotura de bolsa (mediana en transmisoras 6 h, mediana en no transmisoras 1,04 h; p = 0,023) y el tratamiento con ZDV. De las madres tratadas durante el embarazo sólo un niño resultó infectado (TV 2,9 por ciento), frente a 37 niños en las no tratadas (TV 17,5 por ciento) (p = 0,029; odds ratio [OR]: 0,14; intervalo de confianza [IC] del 95 por ciento: 0,07-0,92). La prevalencia estimada de infección por VIH-1 en mujeres gestantes en nuestra área se sitúa en torno al 0,39 por ciento (IC del 95 por ciento: 0,34-0,45). En los primeros 5 años del período de estudio, 14 niños (9,7 por ciento) fueron identificados como seropositivos después del período neonatal, en comparación a sólo 3 a partir de 1992 (p = 0,034). Conclusiones: En este estudio, la prevalencia estimada de infección por VIH-1 en mujeres embarazadas es elevada. El tratamiento con ZDV durante el embarazo se asocia a una disminución en la transmisión vertical del VIH-1. Es posible que la disponibilidad de esta medida haya contribuido a la mayor identificación de las embarazadas seropositivas observada en el tiempo. (AU)


Subject(s)
Pregnancy , Adult , Adolescent , Male , Infant, Newborn , Female , Humans , HIV-1 , Zidovudine , Prevalence , HIV Infections , Anti-HIV Agents , Infectious Disease Transmission, Vertical , Prospective Studies , Pregnancy Complications, Infectious , Follow-Up Studies
SELECTION OF CITATIONS
SEARCH DETAIL