Distribution of maternal and infant human papillomavirus: risk factors associated with vertical transmission.

OBJECTIVE: To evaluate the rate of human papillomavirus (HPV) infection in pregnant women and their neonates, and the risk factors associated with vertical transmission of HPV infection from mothers to neonates. STUDY DESIGN: Cervical HPV testing was undertaken in pregnant women over 36 weeks of gestation, and mouth secretions and oral mucosa of neonates were tested for HPV immediately after delivery. HPV-positive neonates were rechecked 2 months postpartum to identify the persistence of HPV infection. In HPV-positive mothers, the placenta, cord blood and maternal peripheral blood were also analysed for HPV to confirm whether transplacental HPV infection occurred. RESULTS: HPV was detected in 72 of 469 pregnant women (15.4%) and in 15 neonates (3.2%). Maternal HPV positivity was associated with primiparity and abnormal cervical cytology. The rate of vertical transmission was 20.8%, and all HPV-positive neonates were born from HPV-positive mothers. Vertical transmission was associated with vaginal delivery and multiple HPV types in the mother. Neonates with HPV showed a tendency for higher maternal total HPV copy number than neonates without HPV, but this difference was not significant (p=0.081). No cases of HPV infection were found in the infants at 2 months postpartum, and no HPV was detected in placenta, cord blood or maternal blood. CONCLUSIONS: Vertical transmission of HPV is associated with vaginal delivery and multiple HPV types in the mother; however, neonatal HPV infection through vertical transmission is thought to be a transient.

Decrease of initial CD4+ T-cell counts at the time of diagnosis of HIV infection in Korea; 1988-2006.

The aim of the study was to evaluate the trends of initial CD4+ T-cell counts (CD4+) at HIV diagnoses and to identify the factors influencing the annual changes of CD4+ cell counts in Korea during 1988-2006. As a retrospective study, 2613 individuals (>/=15 years at diagnosis, their CD4+ counts were measured within six months) were selected from all 4580 HIV-infected Koreans diagnosed between 1985 and 2006. The mean CD4+ cell counts in all the selected individuals was 312 cells/mm(3), and this value decreased significantly by 20.3 cells/mm(3)/year over the 19 year study period. Men had lower CD4+ cell count than women by 22.7 cells/mm(3), and age at HIV diagnosis had an inverse relationship with CD4+ cell counts of 23.5 cells/mm(3) lower per 10 years advancing age. Cases diagnosed in hospitals showed CD4+ cell count levels 33.9 cells/mm(3) lower than public institutions by 33.9 cells/mm(3). Gender and age seemed to affect trends of CD4+ count; however the institution where cases were diagnosed had the strongest effect on decreasing CD4+ cell counts. The results suggest that HIV diagnoses in recent years are being made in later stages of HIV infection and that it is imperative to develop more efficient programmes for early HIV diagnosis to prevent transmission.

The current status of HIV screening laboratories in Korea assessed by a questionnaire survey of participants in the KCDC HIV EQAS (2006).

Using a questionnaire, we assessed the current status of the quality management systems at HIV screening laboratories in Korea. The Korea Centres for Disease Control and Prevention HIV external quality assurance scheme (EQAS) questionnaire includes 18 items divided into five groups related to HIV testing: personnel, HIV test processes, participation in the Quality Assurance programme and HIV testing equipment. Five hundred and sixty-one HIV screening laboratories participated in this questionnaire investigation; data were collected from 233 public health centres, 309 hospitals or clinics, eight blood centres and 11 commercial laboratories. The total number of HIV screening tests was about 5.5 million in 2005. The average number of HIV tests per institution was highest in blood centres (308 561), followed by commercial laboratories (56 084), hospital or clinic laboratories (6756), and public health centres (1751). Equipment and HIV test methods varied between HIV screening laboratories, and, to manage the quality of their HIV testing, most laboratories participated in several evaluation programmes such as EQAS or a laboratory accreditation programme. This study is the first questionnaire survey of HIV testing laboratories in Korea. The results could be used to evaluate and promote the quality management of HIV testing laboratories.