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1.
JAMA ; 324(16): 1651-1669, 2020 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-33052386

RESUMO

Importance: Data on the use of antiretroviral drugs, including new drugs and formulations, for the treatment and prevention of HIV infection continue to guide optimal practices. Objective: To evaluate new data and incorporate them into current recommendations for initiating HIV therapy, monitoring individuals starting on therapy, changing regimens, preventing HIV infection for those at risk, and special considerations for older people with HIV. Evidence Review: New evidence was collected since the previous International Antiviral (formerly AIDS) Society-USA recommendations in 2018, including data published or presented at peer-reviewed scientific conferences through August 22, 2020. A volunteer panel of 15 experts in HIV research and patient care considered these data and updated previous recommendations. Findings: From 5316 citations about antiretroviral drugs identified, 549 were included to form the evidence basis for these recommendations. Antiretroviral therapy is recommended as soon as possible for all individuals with HIV who have detectable viremia. Most patients can start with a 3-drug regimen or now a 2-drug regimen, which includes an integrase strand transfer inhibitor. Effective options are available for patients who may be pregnant, those who have specific clinical conditions, such as kidney, liver, or cardiovascular disease, those who have opportunistic diseases, or those who have health care access issues. Recommended for the first time, a long-acting antiretroviral regimen injected once every 4 weeks for treatment or every 8 weeks pending approval by regulatory bodies and availability. For individuals at risk for HIV, preexposure prophylaxis with an oral regimen is recommended or, pending approval by regulatory bodies and availability, with a long-acting injection given every 8 weeks. Monitoring before and during therapy for effectiveness and safety is recommended. Switching therapy for virological failure is relatively rare at this time, and the recommendations for switching therapies for convenience and for other reasons are included. With the survival benefits provided by therapy, recommendations are made for older individuals with HIV. The current coronavirus disease 2019 pandemic poses particular challenges for HIV research, care, and efforts to end the HIV epidemic. Conclusion and Relevance: Advances in HIV prevention and management with antiretroviral drugs continue to improve clinical care and outcomes among individuals at risk for and with HIV.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Fatores Etários , Antirretrovirais/economia , Betacoronavirus , Comorbidade , Infecções por Coronavirus/epidemiologia , Esquema de Medicação , Custos de Medicamentos , Farmacorresistência Viral/genética , Substituição de Medicamentos/normas , Quimioterapia Combinada/métodos , Feminino , Infecções por HIV/sangue , Infecções por HIV/diagnóstico , Humanos , Agências Internacionais , Masculino , Pandemias , Pneumonia Viral/epidemiologia , Polimedicação , Profilaxia Pré-Exposição/métodos , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , RNA Viral/sangue , Sociedades Médicas , Estados Unidos , Carga Viral/genética
2.
J Perinat Med ; 48(9): 1001-1007, 2020 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-33055313

RESUMO

Objectives The severe acute respiratory syndrome coronavirus 2 (COVID-19) outbreak in Italy, especially in Lombardy and Bergamo city, represented probably nowadays one of the first major clusters of COVID-19 in the world. The aim of this report is to describe the activity of Bergamo Teratology Information Service (TIS) in supporting the public and health-care personnel in case of drug prescriptions in suspected/confirmed COVID-19 pregnant and lactating patients during COVID-19 outbreak in Italy. Methods All Bergamo TIS requests concerning COVID-19 pregnant and lactating women have been retrospectively evaluated from 1 March to 15 April 2020. Type of medications, drug's safety profile and compatibility with pregnancy and lactation are reported. Results Our service received information calls concerning 48 (9 pregnant, 35 lactating) patients. Among pregnant and lactating women, the requests of information were related to 16 and 60 drugs prescriptions respectively. More than half concerned drugs prescriptions during the first and second trimester (13/16) and during the first six months of lactation (37/60). Hydroxychloroquine and azithromycin were the most involved. Conclusions Hydroxychloroquine and azithromycin at dosages used for COVID-19 may be considered compatible and reasonably safe either in pregnancy and lactation. Antivirals may be considered acceptable in pregnancy. During lactation lopinavir and ritonavir probably exhibit some supportive data from literature that darunavir and cobicistat do not. Tocilizumab may be considered for COVID-19 treatment because no increased malformation rate were observed until now. However caution may be advised because human data are limited and the potential risk of embryo-fetal toxicity cannot be excluded.


Assuntos
Antivirais/efeitos adversos , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Lactação , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Complicações Infecciosas na Gravidez/virologia , Anormalidades Induzidas por Medicamentos , Adulto , Azitromicina/efeitos adversos , Anormalidades Congênitas , Prescrições de Medicamentos , Feminino , Idade Gestacional , Humanos , Hidroxicloroquina/efeitos adversos , Itália , Troca Materno-Fetal , Pessoa de Meia-Idade , Pandemias , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Teratologia
3.
Rev Med Suisse ; 16(712): 2050-2054, 2020 Oct 28.
Artigo em Francês | MEDLINE | ID: mdl-33112519

RESUMO

Mother-to-child transmission (MTCT) is almost inexistent in Switzerland nowadays. This success has been achieved with systematic screening of HIV in pregnant women, provision of antiretroviral treatment (ART), elective cesarean-section (CS), neonatal antiretroviral prophylaxis (ARP) and avoidance of breastfeeding. Elective CS and neonatal ARP are no longer recommended when the viral load (VL) is suppressed. Recent studies have shown that the risk of HIV MTCT through breastfeeding is extremely rare if not zero when the mother is treated, has a suppressed VL and is correctly followed-up. It is time to be open to discuss the risks and benefits of breastfeeding with HIV-infected pregnant women and to enter in a shared decision-making process, as recommended by the new Swiss guidelines. Close monitoring is mandatory in case of breastfeeding.


Assuntos
Aleitamento Materno , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Complicações Infecciosas na Gravidez/tratamento farmacológico , Fármacos Anti-HIV/uso terapêutico , Aleitamento Materno/efeitos adversos , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Mães/estatística & dados numéricos , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Suíça/epidemiologia
4.
J Infect Dev Ctries ; 14(9): 982-986, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-33031085

RESUMO

INTRODUCTION: Nitazoxanide has shown efficacy in vitro against coronavirus infections (MERS, SARS, SARS-CoV-2). The aim of this report is to describe the results of treating COVID-19 positive patients with nitazoxanide in three clinical settings: pregnancy/puerperium, hospitalized patients in an Internal Medicine Service and in an ambulatory setting. METHODOLOGY: This was a prospective follow-up and report of COVID-19 cases in three different situations, pregnant women, hospitalized patients receiving medical attention in an Internal Medicine Service and ambulatory patients residing in Toluca City, and Mexico City. RESULTS: The experience with a first group of 20 women, pregnant (17) or in immediate puerperium (3) was successful in 18 cases with two unfortunate deaths. The five cases treated in an Internal Medicine service showed a positive outcome with two patients weaned from mechanical ventilation. Of the remaining 16 patients treated in an ambulatory setting, all got cured. Nitazoxanide seems to be useful against SARS-CoV-2, not only in an early intervention but also in critical condition as well as in pregnancy without undesired effects for the babies. As an adjunctive therapy budesonide was used that seems to contribute to the clinical improvement. CONCLUSIONS: Nitazoxanide could be useful against COVID-19 as a safe and available regimen to be tested in a massive way immediately.


Assuntos
Antivirais/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Tiazóis/uso terapêutico , Adulto , Assistência Ambulatorial , Infecções por Coronavirus/mortalidade , Feminino , Seguimentos , Hospitalização , Humanos , Masculino , México/epidemiologia , Pandemias , Pneumonia Viral/mortalidade , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/mortalidade , Estudos Prospectivos , Resultado do Tratamento
5.
Artigo em Inglês | MEDLINE | ID: mdl-33027390

RESUMO

The aim of the study was to assess the factors associated with mother-to-child transmission (MTCT) of HIV. The study design is a retrospective cohort. The population consisted of 323 HIV-positive mothers and their newborns, attended at the Perinatal Nucleus/HUPE-UERJ, municipality of Rio de Janeiro, in the period of 2007-2018. The average age of mothers was 27 years (14-44), with 12.7% (41) of adolescents. The majority (66.8%) knew they were infected during pregnancy: 39.4% in the current pregnancy and 27.4% in a previous pregnancy. The incidence of MTCT was 2.7% in 2007-2009, 1% in 2010-2015 and 0 in 2016-2018. The viral load in the 3rd trimester of pregnancy was > 1.000 copies/mL or unknown in all mothers with positive newborns and in 19% (42/221) of mothers with negative newborns (p=0.003). The duration of antiretroviral use was > 4 weeks in 92.3% (264/286) of mothers with HIV-negative newborns and in 2 in the HIV-positive group (p=0.004). One of the 4 infected newborns and 2 of the negative ones did not use oral zidovudine (p=0.04). There was no association between amniorrhexis and MTCT (p=0.99), with the Apgar score in the 5th minute of life (p=0.96), with marital status (p=0.54), ethnicity (p=0.65), adolescence (p=0.42), mode of delivery (p=0.99), beginning of prenatal care (p=0.44) or with maternal comorbidities (p=0.48). The conclusion of the study points out that the main factors associated with MTCT are the elevated maternal viral load in the 3rd trimester, the time of use of ART and the non-administration of zidovudine for the newborns.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Complicações Infecciosas na Gravidez/tratamento farmacológico , Adolescente , Adulto , Fármacos Anti-HIV/administração & dosagem , Feminino , Infecções por HIV/epidemiologia , Humanos , Recém-Nascido , Masculino , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Estudos Retrospectivos , Adulto Jovem
6.
BMC Infect Dis ; 20(1): 792, 2020 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-33106179

RESUMO

BACKGROUND: The program for the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) was launched in 2003 in China, but few studies have been conducted to describe the panorama of PMTCT. We investigated the rate and associated factors of mother-to-child transmission (MTCT) in China from 2004 to 2018. METHODS: HIV-infected pregnant women from two areas in China between 2004 and 2018 were enrolled. Antiretrovirals (ARVs) were provided to the mothers and their babies, and the children were followed and tested for HIV. RESULTS: In total, 857 mothers and their 899 children were enrolled, and the overall MTCT rate was 6.6% (95% CI 5.0-8.2). The MTCT rates of nonintervention, only formula feeding (FF), infant prophylaxis (IP) + FF, single dosage antiretrovirals (sdARVs) + IP + FF, zidovudine (AZT) alone+IP + FF and prenatal combination antiretroviral therapy (cART) + IP + FF were 36.4, 9.4, 10.0, 5.7, 3.8 and 0.3%, respectively. The MTCT rate declined over time. No ARVs, CD4 count < 200/µL, low birth weight, and breastfeeding were associated with MTCT of HIV. For different ARVs, a higher MTCT rate was observed for AZT alone, sdARVs, and no ARVs compared to cART for pregnant women. CONCLUSIONS: Although the overall MTCT rate remains relatively high, the real-world effect of prenatal cART+IP + FF in China has exerted the same protective effects in high-income countries. With the extension of prenatal cART for pregnant women with HIV, the MTCT rate of HIV has gradually declined in China. However, the coverage of prenatal cART for pregnant women should be further improved. The effect of only post-exposure prophylaxis for infants was limited.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Profilaxia Pré-Exposição/métodos , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/epidemiologia , Zidovudina/uso terapêutico , Adolescente , Adulto , Contagem de Linfócito CD4 , China/epidemiologia , Feminino , Seguimentos , Infecções por HIV/virologia , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Gravidez , Complicações Infecciosas na Gravidez/virologia , Fatores de Risco , Adulto Jovem
7.
J Int AIDS Soc ; 23(9): e25622, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32996705

RESUMO

INTRODUCTION: The COVID-19 pandemic has impacted global health service delivery, including provision of HIV services. Countries with high HIV burden are balancing the need to minimize interactions with health facilities to reduce the risk of COVID-19 transmission, while delivering uninterrupted essential HIV prevention, testing and treatment services. Many of these adaptations in resource-constrained settings have not adequately accounted for the needs of pregnant and breastfeeding women, infants, children and adolescents. We propose whole-family, tailored programme adaptations along the HIV clinical continuum to protect the programmatic gains made in services. DISCUSSION: Essential HIV case-finding services for pregnant and breastfeeding women and children should be maintained and include maternal testing, diagnostic testing for infants exposed to HIV, index testing for children whose biological parents or siblings are living with HIV, as well as for children/adolescents presenting with symptoms concerning for HIV and comorbidities. HIV self-testing for children two years of age and older should be supported with caregiver and provider education. Adaptations include bundling services in the same visit and providing testing outside of facilities to the extent possible to reduce exposure risk to COVID-19. Virtual platforms can be used to identify vulnerable children at risk of HIV infection, abuse, harm or violence, and link them to necessary clinical and psychosocial support services. HIV treatment service adaptations for families should focus on family based differentiated service delivery models, including community-based ART initiation and multi-month ART dispensing. Viral load monitoring should not be a barrier to transitioning children and adolescents experiencing treatment failure to more effective ART regimens, and viral load monitoring for pregnant and breastfeeding women and children should be prioritized and bundled with other essential services. CONCLUSIONS: Protecting pregnant and breastfeeding women, infants, children and adolescents from acquiring SARS-CoV-2 while sustaining essential HIV services is an immense global health challenge. Tailored, family friendly programme adaptations for case-finding, ART delivery and viral load monitoring for these populations have the potential to limit SARS-CoV-2 transmission while ensuring the continuity of life-saving HIV case identification and treatment efforts.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Assistência à Saúde , Infecções por HIV/tratamento farmacológico , Pneumonia Viral/epidemiologia , Adolescente , Aleitamento Materno , Criança , Pré-Escolar , Infecções por Coronavirus/prevenção & controle , Família , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Recursos em Saúde , Humanos , Lactente , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Carga Viral
8.
J Chin Med Assoc ; 83(9): 812-816, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32902940

RESUMO

The 2019 novel coronavirus (2019-nCoV, later named SARS-CoV-2) is a pandemic disease worldwide. The spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is continuing at a rapid speed. Till May 4, 2020, there have been 3,407,747 confirmed cases and 238,198 deaths globally. The common symptoms in pregnant women are fever, cough, and dyspnea. Angiotensin-converting enzyme 2 (ACE2) has transient overexpression and increased activity during pregnancy, which is now confirmed as the receptor of SARS-CoV-2 and plays essential roles in human infection and transmission. There is no evidence that pregnant women are more susceptible to SARS-CoV-2. To date, there is no valid medication or vaccination. The immune suppression or modulation during pregnancy increases the risk of severe pneumonia. Remdesivir is an antiviral medication targeting ribonucleic acid (RNA) synthesis that has clinical improvement in the treatment of SARS-CoV-2. Chloroquine is controversial in its effectiveness and safety to treat SARS-CoV-2. Remdesivir is safe in pregnancy. Chloroquine has not been formally assigned to a pregnancy category by the Food and Drug Administration (FDA). The management strategy includes monitoring fetal heart rate and uterine contractions; early oxygenation if O2 saturation is less than 95%; empiric antibiotics for prevention of secondary infection; corticosteroid to treat maternal SARS-CoV-2 disease routinely is not suggested, only for fetal lung maturation in selected cases; and consideration of delivery is according to the obstetric indication, gestational age, and severity of the disease. During epidemics, delivery at 32-34 weeks is considered. The indication for the Cesarean section should be flexible to minimize the risk of infection during the delivery. The newborn should be in isolation ward immediately after birth; breastfeeding is not contraindicated but should avoid direct transmission infection.


Assuntos
Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Peptidil Dipeptidase A/fisiologia , Pneumonia Viral/tratamento farmacológico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Recém-Nascido , Pandemias , Pneumonia Viral/epidemiologia , Gravidez , Sistema Renina-Angiotensina/fisiologia
9.
BMC Infect Dis ; 20(1): 686, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32948149

RESUMO

BACKGROUND: There is limited research to guide TB treatment specifically in pregnant women and few studies have described the presentation of TB in pregnant women. We aimed to understand TB presentation and treatment outcomes in pregnant women in a low HIV burden setting. We describe a cohort of women of childbearing age treated for TB disease in Lima, Peru, and compare clinical presentation and treatment outcomes among pregnant and non-pregnant women between 2009 and 2012, including 36 pregnant women. METHODS: This is a prospective cohort study. Subjects were recruited from across 106 public health centers in Lima, Peru. Baseline demographic, medical history, and drug-susceptibility test results were collected. We used descriptive statistics to describe demographic and clinical characteristics of the women using Pearson chi-squared, Fisher's exact tests, or Kruskal-Wallis. RESULTS: Among 4500 individuals with pulmonary TB disease, 1334 women were included in analysis with 36 (2.69%) pregnant women. Pregnant women had similar demographics, past medical histories, and clinical presentation to non-pregnant women, except being more likely to be married (p = 0.01) and have cardiac disease (p = 0.04) and less likely to have weight loss (p = 0.05). Twenty (71.4%) pregnant women had pan-susceptible TB compared with 616 (63.1%) non-pregnant women; four (14.3%) pregnant women had mono-resistant TB compared with 154 (15.8%) non-pregnant women; and four (14.3%) pregnant women had multi-drug-resistant TB compared with 140 (14.3%) of non-pregnant women (p = 0.53). Twenty-eight (96.6%) pregnant women had a successful outcome (cure, completed treatment, treatment ended early by clinical team) while one (3.4%) had an unsuccessful outcome (treatment failed) and 1074 (97.3%) non-pregnant women had a successful outcome while 30 (2.7%) had an unsuccessful outcome (p = 0.56). CONCLUSION: In this cohort with low HIV co-infection, we found high TB treatment success rates in both pregnant and non-pregnant women, irrespective of drug-susceptibility profiles. If treated appropriately, pregnant women with TB disease can have successful outcomes.


Assuntos
Complicações Infecciosas na Gravidez/tratamento farmacológico , Tuberculose/tratamento farmacológico , Adolescente , Adulto , Antituberculosos/uso terapêutico , Coinfecção/tratamento farmacológico , Feminino , Infecções por HIV , Humanos , Pessoa de Meia-Idade , Peru , Gravidez , Estudos Prospectivos , Resultado do Tratamento , Tuberculose Pulmonar/tratamento farmacológico , Adulto Jovem
11.
J Perinat Med ; 48(9): 985-994, 2020 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-32739908

RESUMO

An issue of the novel coronavirus infection spreading is currently in the first place among others in the list of the international medical community. Due to lack of information, conflicting research findings, multicomponent effect of the virus on the body host, as well as various consequences that the virus triggers in the body, now every medical specialty does study the viral attack pathogenesis. Recent months showed that vascular complications are the most severe in the Coronavirus Disease 2019 (COVID-19) and are the main cause of death in the patients. The mechanisms of vascular complications are complex and affect both the hemostatic system and immune responses, "inflammatory storm", disorders of the renin-angiotensin-aldosterone system, endotheliopathy, etc. Due to the leading role of vascular complications in the viral infection pathogenesis, several groups of patients are at extra risk, including pregnant women, patients with a burdened obstetric history, with hereditary thrombophilia and antiphospholipid syndrome, and patients after in vitro fertilization (IVF). In this category of pregnant women, use of low-molecular-weight heparins (LMWH) is particularly important for both prevention of vascular and obstetric complications, and for pathogenetic therapy of COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Armadilhas Extracelulares/fisiologia , Neutrófilos/ultraestrutura , Pneumonia Viral/complicações , Complicações Infecciosas na Gravidez/virologia , Doenças Vasculares/virologia , Comorbidade , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Parto Obstétrico/métodos , Feminino , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Pulmão/virologia , Pandemias , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/fisiopatologia , Fatores de Risco , Doenças Vasculares/epidemiologia , Doenças Vasculares/prevenção & controle
12.
Oral Dis ; 26 Suppl 1: 165-168, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862534

RESUMO

We present here the first reported case of a non-syndromic cleft lip and palate (NSCLP) in an HIV-exposed newborn of a mother on antiretroviral therapy (ART) in Indonesia. Genetic testing was performed to confirm a suspected genetic condition. Genomic DNA was extracted from the blood, and genetic variations of the interferon regulatory factor 6 (IRF6) rs642961 (Mspl) (G>A) and transforming growth factor alpha (TGFA) BamHI (rs11466297, A>C) and RsaI (rs3732248, C>T) were performed by PCR-RFLP and IRF6 gene analysis by PCR sequencing. Genotyping of DNA sequence variants in the IRF6 gene showed both parents had genotype GA, while the child had genotype GG (genotype wild type). There was no difference observed in the TGFA BamHI gene variant between the child and her mother and father that were wild-type polymorphisms (normal), while the Rsa1 polymorphisms of them were heterozygotes. A genetic variant of IRF6 might be a protective factor for NSCLP, while Rsa1 gene variant (A) allele can be considered to be the risk factor associated with NSCLP development. This case report also highlights the possible etiologic role of ART in NSCLP; therefore, early control of adverse effects of ART might be an important factor in decreasing the incidence of the congenital anomalies in HIV-infected children.


Assuntos
Fenda Labial , Fissura Palatina , Infecções por HIV , Fatores Reguladores de Interferon , Fator de Crescimento Transformador alfa , Antirretrovirais/uso terapêutico , Fenda Labial/genética , Fissura Palatina/genética , Feminino , Variação Genética/genética , Genótipo , Infecções por HIV/tratamento farmacológico , Infecções por HIV/genética , Humanos , Recém-Nascido , Fatores Reguladores de Interferon/genética , Polimorfismo de Nucleotídeo Único , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Fator de Crescimento Transformador alfa/genética
13.
BMC Infect Dis ; 20(1): 601, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32799811

RESUMO

BACKGROUND: Listeriosis is a rare but severe foodborne infectious disease. Perinatal listeriosis is often associated with septicemia, central nervous system (CNS) infection, and serious adverse pregnancy outcomes (miscarriage and neonate death). Here we report the characteristics and outcomes of perinatal listeriosis cases treated over 6 years at Beijing Obstetrics and Gynecology Hospital (BOGH), the largest maternity hospital in China. METHODS: We retrospectively reviewed the records of laboratory-confirmed, pregnancy-associated listeriosis cases treated from January 1, 2013 to December 31, 2018. The clinical manifestations, laboratory results, perinatal complications and outcomes (post-natal follow-up of 6 months) were investigated. RESULTS: In BOGH, 12 perinatal listeriosis cases were diagnosed based on Listeria monocytogenes positive culture, including 10 single pregnancies and 2 twin pregnancies. The corresponding incidence of pregnancy-associated listeriosis was 13.7/100,000 deliveries. Among those cases, four pregnant women and four newborns had septicemia, and two of the neonates with septicemia also suffered CNS infection. All the maternal patients recovered. Two inevitable miscarriages and four fetal stillbirths occurred. Of the eight delivered newborns, six survived, and two died within 2 days from birth. None of the survivors had neurological sequelae during a 6-month follow-up. The overall feto-neonatal fatality rate was 57.1%; notably, this rate was 100% for infections occurring during the second trimester of pregnancy and only 14.3% for those occurring in the third trimester. CONCLUSIONS: Perinatal listeriosis is associated with high feto-neonatal mortality, and thus, a public health concern. Additional large-scale studies are needed to strengthen the epidemiological understanding of listeriosis in China.


Assuntos
Listeriose/tratamento farmacológico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Aborto Espontâneo/epidemiologia , Adulto , Pequim/epidemiologia , Infecções do Sistema Nervoso Central/microbiologia , Feminino , Maternidades/estatística & dados numéricos , Humanos , Incidência , Recém-Nascido , Listeria monocytogenes/isolamento & purificação , Listeriose/diagnóstico , Listeriose/epidemiologia , Morte Perinatal , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez , Estudos Retrospectivos , Sepse/etiologia , Natimorto
14.
Afr J AIDS Res ; 19(2): 135-146, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32780677

RESUMO

Since 2012, PMTCT Option B+ has been recommended by the World Health Organization to reduce vertical transmission but numerous adherence challenges remain. We conducted a qualitative study at baseline using six focus group discussions and 14 in-depth interviews to explore knowledge, beliefs, attitudes and challenges towards the Option B+ strategy for PMTCT among HIV-infected pregnant and post-partum women and health workers engaged in Uganda's national Option B+ PMTCT programme. Data were analysed using a thematic approach to capture latent and manifest content with the social ecological model as a theoretic foundation in order to make contextual sense of key stakeholders' needs for an effective Option B+ intervention. Overall, among all study participants, we found multi-level barriers to adhering to Option B+ cutting across all levels of the social ecological model. In line with the model, our study revealed barriers at personal, relational, organizational and societal levels. Some personal beliefs such as that the baby's health is more important that the mother's, organizational (negative attitudes and behaviour of health workers), structural such as poverty, work conflicts, fear and lack of disclosure related to community stigma were all critical obstacles to women adhering to the Option B+ programme. We found that both health workers and participants in the programme have a relatively clear understanding of the benefits of adhering to their treatment; though a more nuanced understanding and thus emphasis in counselling on side effects, is critical to helping patients adhere.


Assuntos
Infecções por HIV/tratamento farmacológico , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Complicações Infecciosas na Gravidez/tratamento farmacológico , Cooperação e Adesão ao Tratamento/psicologia , Adulto , Feminino , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Humanos , Masculino , Mães , Gravidez , Pesquisa Qualitativa , População Rural , Participação dos Interessados , Uganda/epidemiologia , População Urbana
16.
Obstet Gynecol ; 136(5): 1025-1029, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32618794

RESUMO

BACKGROUND: There are limited data regarding treatment options for pregnant women with severe coronavirus disease 2019 (COVID-19). CASE: A 35-year-old primigravid patient at 22 weeks of gestation presented with 7 days of fever, cough, anosmia, and dyspnea. Nasopharyngeal swab was positive for the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and a chest X-ray demonstrated bilateral patchy infiltrates. Laboratory evaluation was notable for marked elevation of interleukin-6 and C-reactive protein concentrations. On hospital day 3, owing to increased dyspnea and oxygen requirement, the patient was treated with tocilizumab followed by 5 days of remdesivir. She responded well, recovered to room air, and was discharged home after a 9-day hospitalization. CONCLUSION: Tocilizumab and remdesivir may be effective for treatment of severe COVID-19 in pregnancy, but additional data are needed to guide risk-benefit considerations.


Assuntos
Monofosfato de Adenosina/análogos & derivados , Alanina/análogos & derivados , Anticorpos Monoclonais Humanizados/administração & dosagem , Infecções por Coronavirus , Pulmão/diagnóstico por imagem , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Monofosfato de Adenosina/administração & dosagem , Adulto , Alanina/administração & dosagem , Antivirais/administração & dosagem , Betacoronavirus/isolamento & purificação , Proteína C-Reativa/análise , Infecções por Coronavirus/sangue , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/fisiopatologia , Feminino , Humanos , Interleucina-6/sangue , Oximetria/métodos , Pneumonia Viral/sangue , Pneumonia Viral/diagnóstico , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/etiologia , Pneumonia Viral/fisiopatologia , Gravidez , Complicações Infecciosas na Gravidez/sangue , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Radiografia Torácica/métodos , Resultado do Tratamento
18.
BMJ Case Rep ; 13(7)2020 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-32675129

RESUMO

The clinical implications of COVID-19 in pregnancy remain unknown. While preliminary reports demonstrate that pregnant patients have a similar symptomatic presentation to the general population, the appropriate management and timing of delivery in these patients is still unclear, as pregnancy may impose additional risk factors and impede recovery in gravid patients. In this brief report, we present a case of COVID-19 in a pregnant patient with severe respiratory compromise, whose clinical status significantly improved after caesarean delivery. We also address the potential benefits of experimental therapy, including tocilizumab, a monoclonal antibody that targets interleukin-6 receptors.


Assuntos
Antibacterianos/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Betacoronavirus , Cesárea , Infecções por Coronavirus/tratamento farmacológico , Hidroxicloroquina/uso terapêutico , Pneumonia Viral/tratamento farmacológico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Adulto , Azitromicina/uso terapêutico , Ceftriaxona/uso terapêutico , Progressão da Doença , Inibidores Enzimáticos/uso terapêutico , Feminino , Humanos , Pandemias , Período Pós-Parto , Gravidez , Resultado do Tratamento
19.
Syst Rev ; 9(1): 161, 2020 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-32682444

RESUMO

BACKGROUND: Over 4.2 million confirmed cases and more than 285,000 deaths, COVID-19 pandemic continues to harm significant number of people worldwide. Several studies have reported the impact of COVID-19 in general population; however, there is scarcity of information related to pharmacological management and maternal and perinatal outcomes during the pandemic. Altered physiological, anatomical, and immunological response during pregnancy makes it more susceptible to infections. Furthermore, during pregnancy, a woman undergoes multiple interactions with the health care system that increases her chance of getting infected; therefore, managing pregnant population presents a unique challenge. RESEARCH QUESTIONS: This systematic review seeks to answer the following questions in relation to COVID-19: What are the different clinical characteristics presented in maternal and perinatal population? What are the different maternal and perinatal outcome measures reported? What are the distinct therapeutic interventions reported to treat COVID-19? Is it safe to use "medications" used in the treatment of COVID-19 during antenatal, perinatal, postnatal, and breastfeeding? METHOD: The search will follow a comprehensive, sequential three step search strategy. Several databases relevant to COVID-19 and its impact on pregnancy including Medline, CINAHL, and LitCovid will be searched from the inception of the disease until the completion of data collection. The quality of this search strategy will be assessed using Peer Review of Electronic Search Strategies Evidence-Based Checklist (PRESS EBC). An eligibility form will be developed for a transparent screening and inclusion/exclusion of studies. All studies will be sent to RefWorks, and abstraction will be independently performed by two researchers. Risk of bias will be assessed using Cochrane Risk of Bias tool for randomized controlled trials, Newcastle-Ottawa Quality Assessment Scale for non-randomized studies, and for case reports, Murad et al. tool will be used. Decision to conduct meta-analysis will be based on several factors including homogeneity and outcome measures reported; otherwise, a narrative synthesis will be deemed appropriate. DISCUSSION: This systematic review will summarize the existing data on effect of COVID-19 on maternal and perinatal population. Furthermore, to the best of our knowledge, this is the first systematic review addressing therapeutic management and safety of medicines to treat COVID-19 during pregnancy and breastfeeding. SYSTEMATIC REVIEW REGISTRATION: This systematic review has been registered and published with Prospero ( CRD42020172773 ).


Assuntos
Infecções por Coronavirus/tratamento farmacológico , Mortalidade Materna , Mortalidade Perinatal , Pneumonia Viral/tratamento farmacológico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Índice de Apgar , Betacoronavirus , Aleitamento Materno , Feminino , Humanos , Recém-Nascido , Pandemias , Hemorragia Pós-Parto/epidemiologia , Pré-Eclâmpsia/epidemiologia , Gravidez , Sepse/epidemiologia , Resultado do Tratamento
20.
Medicine (Baltimore) ; 99(27): e20915, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629687

RESUMO

RATIONALE: Transmitted resistance to integrase strand inhibitors (INSTI) has been uncommon, but is slowly becoming more prevalent among those living with HIV. In an era with 2-drug regimens for antiretroviral therapy, transmitted resistance for INSTI is alarming. PATIENT CONCERNS: A 28-year-old African American female was recently diagnosed with HIV during a 30-week prenatal visit. DIAGNOSIS: HIV 4th generation test was positive as well as confirmation. Genotype was performed using next generation sequencing. INTERVENTIONS: Patient was initially rapidly started on a dolutegravir based regimen and changed to a protease inhibitor regimen once her genotype reported an S230R mutation. OUTCOMES: Patient became virally suppressed on antiretroviral therapy and delivered an HIV negative baby. LESSONS: INSTI resistance testing should be done for treatment-naïve and INSTI-naïve persons, particularly when considering 2 drug INSTI based regimens.


Assuntos
Farmacorresistência Viral , Infecções por HIV/tratamento farmacológico , Inibidores de Integrase de HIV/efeitos adversos , HIV-1/genética , Complicações Infecciosas na Gravidez/tratamento farmacológico , Diagnóstico Pré-Natal , Inibidores de Proteases/uso terapêutico , Adulto , Feminino , Genótipo , Infecções por HIV/virologia , Humanos , Mutação , Gravidez , Complicações Infecciosas na Gravidez/virologia , Inibidores de Proteases/administração & dosagem
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