Factores perinatales asociados con la infección por VIH en hijos de mujeres seropositivas / Perinatal factors associated with HIV infection in infants of seropositive women

Objetivo: Evaluar la relación entre diferentes factores perinatales y la transmisión vertical del virus de la inmunodeficiencia humana (VIH).Método: Estudio observacional prospectivo. Desde el primer caso conocido en la Unidad del VIH en 1985 hasta abril de 1994, se compararon las características maternas y los parámetros neonatales de 62 niños infectados y 115 no infectados, todos ellos nacidos de mujeres VIH-seropositivas. Resultados: Las características de las madres (edad en el parto, número de abortos o estado de salud durante la gestación) que transmitieron el VIH a sus hijos fueron similares a las de aquéllas cuyos hijos no se infectaron. Nuestros resultados coinciden con otros estudios que consideran la utilización de zidovudina durante la gestación y la cesárea como medidas protectoras frente a la transmisión perinatal del VIII. Las tasas de complicaciones neonatales fueron similares para niños infectados y no infectados, pero las características del desarrollo intrauterino, como el bajo peso al nacer (OR= 1,8, p= 0,63) o pequeño para la edad gestacional (OR= 2,35, p= 0,19), fueron predictivas de infección en los hijos de mujeres seropositivas. La lactancia materna también se asoció con un incremento en la tasa de transmisión (OR= 4,02, p= 0,09). Conclusión: Hay factores de riesgo maternos, fetales y obstétricos asociados con la infección perinatal por VIH y, por tanto, hay que realizar una serie de intervenciones durante la gestación para minimizar la transmisión maternoinfantil del virus (AU)

Características sociales y clínicas de un grupo de madres infectadas por VIH en Valencia: influencia de la drogadicción parenteral / Social and clinical characteristics of mothers with HIV infection: the influence of intravenous drug addiction

Objetivo: Al principio de conocerse la infección por el virus de la inmunodeficiencia humana (VIH), la causa más importante de su transmisión en las mujeres occidentales fue el consumo de drogas por vía parenteral. El objetivo de nuestro trabajo consistió en describir las principales características sociales y clínicas de un grupo de madres seropositivas, y en analizar su relación potencial con el uso intravenoso de drogas. Métodos: Realizamos un estudio observacional prospectivo con 220 mujeres infectadas por VIH que presentaban la particularidad de haber dado a luz niños con riesgo de infección. Se incluyeron todas las madres reclutadas en la Unidad VIH de un hospital de Valencia que tuviesen definido el diagnóstico de su infección durante el período de estudio comprendido entre el primer caso materno conocido en 1985 y 1993. El análisis de los datos se basó en un análisis univariado. Resultados: La transmisión del virus se produjo por mantener relaciones heterosexuales en un 27,7 por ciento de las mujeres estudiadas, y a través de la drogadicción parenteral en el 69,1 por ciento. Se detectó mayor número de madres que abortaron, con antecedentes penales y abandono domiciliario entre las usuarias de drogas por vía parenteral (UDVP), con odds ratio (OR) de 1,8 (p = 0,087), 8,95 (p = 0,012) y 15 (p = 0,000), al compararlas con las madres no UDVP. Además las UDVP presentaron mayor probabilidad de contraer la infección por hepatitis B o C (OR = 7,06, p = 0,000) y de tener asociados otros hábitos tóxicos como tabaquismo (OR = 6,19, p = 0,000) y alcoholismo (OR = 5,91, p = 0,117).Conclusiones: Muchas de las características analizadas en estas mujeres estaban más relacionadas con el consumo de droga inyectada que con la infección por VIH, tales como la mayor frecuencia de abortos electivos, antecedentes penales, abandono domiciliario, politoxicomanías y antecedentes patológicos como hepatitis B o C (AU)

[Social and family characteristics in children born to women infected by the human immunodeficiency virus]. / Características sociofamiliares de los niños nacidos de mujeres infectadas por el virus de la inmunodeficiencia humana.

OBJECTIVES: To evaluate the social and family characteristics of children born to women infected by the human immunodeficiency virus (HIV). As secondary objectives, to analyse their schooling and the number of hospital admissions and lengths of stay that these children required. DESIGN: A prospective observation study. SETTING: HIV unit in a children's hospital. INCLUSION CRITERIA: all the children recruited from the HIV unit who had their infection status defined during the study period, understood as between the first known case in 1985 and April 1994. The sample included 177 children (62 HIV-infected and 115 not infected). MEASUREMENTS AND MAIN RESULTS: Through an interview the social, family and school variables were collected. On comparison between infected and non-infected children, there were no important differences as to the lack of protection of the new-born (8.1% vs 13%), scant mother-child relationship (31.2% vs 36.5%) or people responsible for the custody of these children. Less schooling and greater problems of school integration were detected in infected cases, with odds ratios of 2.68 (p = 0.004) and 11.36 (p = 0.004), respectively. Children infected also needed more admissions (4.3 +/- 5.7) than the non-infected (1.7 +/- 0.9) (p = 0.001), and more days of hospital stay (75.1 +/- 110.3 vs 23.3 +/- 19.6) (p = 0.0003). CONCLUSIONS: Infected children and non-infected children had similar social and family characteristics. However, less schooling, problems of school integration, and more and longer hospital admissions were related to HIV infection in children, and not so much to their status as children of seropositive mothers.

[Social and clinical characteristics of a group of mothers infected with HIV in Valencia: influence of parenteral drug addiction]. / Características sociales y clínicas de un grupo de madres infectadas por VIH en Valencia: influencia de la drogadicción parenteral.

OBJECTIVE: In the first years after the finding of HIV-infection, the main was for its transmission among western women was the intravenous drug addiction. The objective of our work consisted in evaluating the main social and clinical characteristics of a group of seropositive mothers, and in analyzing their potential relationship with intravenous consumption of drugs. METHOD: We performed an observational prospective study in 220 HIV-infected women who had recently given birth to children with high risk for infection. We included every women at an HIV Unit of a hospital in Valencia who had been diagnosed of HIV infection at any moment between the first mother-child transmission reported in 1985 and 1993. The analysis was based on univariate analysis. RESULTS: The virus transmission was produced by heterosexual relations in a 27.7% of the study women and due to the parenteral drug addiction in 69.1%. We detected more women who had an abortion, with criminal antecedents and parental abandonment among those who were intravenous drug users (IVDU), with OR of 1.8 (p = 0.087), 8.95 (p = 0.012) and 15 (p = 0.000), when compared with those mothers non-IVDU. Besides, IVDU presented a higher probability for getting hepatitis B or C infection and for other toxic habits, as smoking (OR = 6.19, p = 0.000) or alcoholism (OR = 5.91, p = 0.017). CONCLUSION: Many of the analysed characteristics in these women were more related with the consumption of injected drug than with the HIV infection, such as the greater frequency of elective abortions, criminal antecedents, parental abandonment, multiple drug abuse and pathological precedents like hepatitis B or C.

[Vertical transmission rate of the immunodeficiency virus: determinant factors and comparison of results]. / Tasas de transmisión vertical del virus de la inmunodeficiencia humana: factores determinantes y comparación de resultados.

Although all newborns to HIV-seropositive mothers have IgG anti-HIV antibodies, since these antibodies cross the placental barrier, only a small proportion of these children are actually infected with the virus. The main objective of this study consisted in estimating the vertical transmission rate of HIV in our environment. A prospective review was conducted of 236 children with HIV infection risk as they were born to HIV seropositive mothers. To calculate the mother-to child transmission we selected only 121 children controlled from birth and for a minimal time of 18 months at Hospital Infantil La Fe. Twenty-one out of these definitely classified 121 children were infected, representing a rate of 16.5%, similar to the rate reported in other European studies. By means of the stratified analysis some factors related to an increased transmission risk for HIV from mother to child were investigated. The possible causes that can explain the variability in the calculated rates for the different groups of investigation since the first pediatric AIDS case was detected are also discussed.

[Delay in childhood tuberculosis detection as a negative factor in the anti-tuberculosis struggle]. / El retraso en la detección de tuberculosis infantil como factor negativo en la lucha antituberculosa.

Childhood morbidity due to tuberculosis infection in Spain is not diminishing at the expected rate in relation with available knowledge and facilities. An important factor is the delay in diagnosis, which evaluation constitutes the objective of this publication. Said delay is due to several causes, patient does not consult on time (mean value between onset of symptoms and consult is 34.3 days), or physician does not think in tuberculosis as first diagnosis, which meant an added mean delay of 7.6 days more. These delays mean an important detriment for the patient, and one of the objectives in the anti-tuberculosis struggle is to shorten delays through information to the lay public and health professionals on the highly important current issue of tuberculosis.

[Mortality from acute respiratory infections and influenza (1976-1980)]. / Mortalidad por infecciones respiratorias agudas e influenza (1976-1980).

Acute respiratory infections (ARI) and influenza (flu) are extremely common illnesses, which make up the main causes of medical consultation and absence from work. OBJECTIVE. To discover the level of mortality because of ARI and flu in the Health Areas within the Community of Valencia; to analyse their possible relationship with socio-economic factors and also to identify higher-risk groups according to age and sex. DESIGN. Retrospective study. SITE. The Community of Valencia. PATIENTS OR OTHER PARTICIPANTS. Mortality data across the Community were obtained from the mortality statistics published by the Generalitat (Government) of Valencia during the five-year period of 1976 to 1980. MAIN MEASUREMENTS AND RESULTS. The results establish that Health Areas 4, 6, 7, 9-12 and 18 present less mortality because of ARI and flu. These are the better areas, socio-economically speaking, although the data are without statistical significance. A spectacular increase in mortality in the age-group of those over 70 was observed, with no great differences found between the sexes. CONCLUSIONS. Given that the main interventions to prevent these diseases are based on vaccination, it would be useful to carry out vaccination programmes with greater thoroughness in those areas identified as of high risk.

[Respiratory tuberculosis mortality in the health region of the Valencia community (1976-1980]. / Evolución de la mortalidad por tuberculosis respiratoria en las áreas de salud de la Comunidad Valenciana (1976-1980).

Respiratory tuberculosis continues to be a health and social problem in Spain. The data for carrying out this study was obtained from the Monographic Health Studies: death rate statistics, published by the Regional Government of Valencia for the 1976-1980 five-year period. In this study, the standardized death rates and the standardized causes thereof, with regard to respiratory tuberculosis have been calculated using direct method. In addition, the distribution of tuberculosis has been broken down according to age and sex using specific rates and statistical tests to compare proportions. The results obtained make it possible to compare the different Health Care Areas with regard to the Region of Valencia, it being established that Areas 2, 5, 9-12 and 21 are those revealing an overly high death rate due to respiratory tuberculosis. Likewise, the predominance of this cause of death among men and among the groups most up in age must be stressed, due to the importance of this disease in the working environment and diverse socioeconomic factors.

[An analysis of the mortality from extrapulmonary tuberculosis in the catchment areas of the community of Valencia (1976-1980)]. / Análisis de la mortalidad por tuberculosis extrapulmonar en las áreas de salud de la Comunidad Valenciana (1976-1980).

Tuberculosis is a chronic infectious disease produced by Mycobacterium tuberculosis or Koch's bacillus, which mainly affects the airways and, less frequently, other organs in the body. Tuberculosis is still a health and social problem in Spain. The data of this study were obtained from "Monografías Sanitarias", "Análisis de Mortalidad", published by "Generalitat Valenciana", the standard mortality rate was calculated by direct methods. Mortality is not the best sanitary parameter to study the real situation of this disease, because the present methods of treatment are effective and death caused by tuberculosis is very rare. Despite the aforementioned fact, when comparing the mortality data of different health areas during a period between 1976 and 1980, we confirm that this disease persists as a cause of death in our community.