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1.
BMC Infect Dis ; 21(1): 118, 2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33499820

RESUMO

BACKGROUND: Early infant diagnosis of HIV infection is challenging in sub-Saharan Africa, particularly in rural areas, leading to delays in diagnosis and treatment. Use of a point-of-care test would overcome many challenges. This study evaluated the validity of a novel point-of-care p24 antigen detection test (LYNX) in rural and urban settings in southern Zambia. METHODS: Two studies were conducted: a cross-sectional study from 2014 to 2015 at Macha Hospital (LYNX Hospital study) and a longitudinal study from 2016 to 2018 at 12 health facilities in Southern Province, Zambia (NSEBA study). In both studies, children attending the facilities for early infant diagnosis were enrolled and a blood sample was collected for routine testing at the central lab and immediate on-site testing with the LYNX test. The performance of the LYNX test was measured in comparison to nucleic acid-based testing at the central lab. RESULTS: In the LYNX Hospital study, 210 tests were performed at a median age of 23.5 weeks (IQR: 8.9, 29.0). The sensitivity and specificity of the test were 70.0 and 100.0%, respectively. In the NSEBA study, 2608 tests were performed, including 1305 at birth and 1222 on children ≥4 weeks of age. For samples tested at birth, sensitivity was 13.6% (95% CI: 2.9, 34.9) and specificity was 99.6% (95% CI: 99.1, 99.9). While specificity was high for all ages, sensitivity increased with age and was higher for participants tested at ≥4 weeks of age (80.6%; 95% CI: 67.4, 93.7). Children with positive nucleic acid tests were more likely to be negative by the LYNX test if their mother received antiretroviral therapy during pregnancy (60.7% vs. 24.2%; p = 004). CONCLUSIONS: Considering the high specificity and moderate sensitivity that increased with age, the LYNX test could be of value for early infant diagnosis for infants ≥4 weeks of age, particularly in rural areas where centralized testing leads to long delays. Point-of-care tests with moderate sensitivity and high specificity that are affordable, easy-to-use, and easily implemented and maintained should be developed to expand access to testing and deliver same-day results to infants in areas where it is not feasible to implement nucleic acid-based point-of-care assays.


Assuntos
Proteína do Núcleo p24 do HIV/análise , Infecções por HIV/diagnóstico , Testes Imediatos , Fármacos Anti-HIV/uso terapêutico , Estudos Transversais , Testes Diagnósticos de Rotina , Diagnóstico Precoce , Estudos de Viabilidade , Feminino , Proteína do Núcleo p24 do HIV/sangue , Infecções por HIV/congênito , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Humanos , Testes Imunológicos , Ciência da Implementação , Lactente , Recém-Nascido , Transmissão Vertical de Doença Infecciosa , Estudos Longitudinais , Masculino , Triagem Neonatal/métodos , Sistemas Automatizados de Assistência Junto ao Leito , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/epidemiologia , População Rural , Sensibilidade e Especificidade , Zâmbia/epidemiologia
2.
Eur J Obstet Gynecol Reprod Biol ; 244: 114-119, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31785467

RESUMO

OBJECTIVES: HPV infection may differ in women who are HIV-positive since birth (perinatally infected, P-HIV) and those who acquire HIV later in life (non-perinatally infected, NP-HIV). We assessed the HPV prevalence in relation to the HIV acquisition route and HPV vaccination status. STUDY DESIGN: Case control study comparing 22 P-HIV with 22 NP-HIV patients. Cervical, anal and oral specimen were collected for HPV PCRs. The primary outcome was the prevalence of cervical, oral and anal HPV in P-HIV and NP-HIV patients. The secondary outcome was to identify risk factors for HPV infection. Comparative statistics for two independent groups, univariate and multivariable logistic regression analyses were used. RESULTS: There were no differences between perinatally and non-perinatally infected women. Cervical dysplasia was found in 12/44 (27 %) patients and high-risk HPV (hrHPV) in 30 % of cervical (of which 89 % were hrHPV other than 16 and 18), in 3 % of oral and 65 % of anal specimens. All woman were using combined antiretroviral therapy (cART) and 64 % had HIVRNA < 20 cp/ml. A CD4 count <350/mm³ was associated with cytological abnormalities (OR: 13.52, p = 0.002) and with cervical HPV (OR: 6.11; p = 0.04); anal HPV was associated with a previous cervical dysplasia and concomitant cervical HPV infection. None of thirteen vaccinated patients had a 6/11/16/18 HPV infection. CONCLUSION: In this small series of women under cART, we did not observe a difference in HPV infection in relation to the route of HIV acquisition. The high prevalence of hrHPV other than 16 and 18 support the use of a 9-valent vaccine.


Assuntos
Infecções por HIV/congênito , Infecções por HIV/complicações , Infecções por Papillomavirus/epidemiologia , Adulto , Canal Anal/virologia , Bélgica/epidemiologia , Estudos de Casos e Controles , Colo do Útero/virologia , Feminino , Humanos , Infecções por Papillomavirus/virologia , Prevalência , Adulto Jovem
3.
PLoS One ; 14(12): e0224930, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31805059

RESUMO

BACKGROUND: HIV-associated cognitive deficiency in perinatally HIV-infected (PHIV) children has been studied in Western countries in a population of which an increasing proportion has been internationally adopted. Studies often lack an appropriate internationally adopted HIV-uninfected control group, potentially confounding the relationship between HIV and cognitive functioning. This study aims to further elucidate the association between treated HIV infection and cognitive development by addressing the background of international adoption. METHODS: We cross-sectionally studied the impact of HIV on cognition by comparing PHIV children and HIV- uninfected controls, matched for age-, sex-, ethnicity-, socioeconomic status (SES)- and adoption status. We used a standardized neuropsychological test battery to measure intelligence (IQ), and the cognitive domains of processing speed, working memory, executive function, learning ability and visual-motor function and compared outcomes using lineair regression models, adjusted for IQ. We determined cognitive profiles and cognitive impairment by using multivariate normative comparison (MNC) and explored associations with HIV disease- and treatment-related factors. RESULTS: We enrolled fourteen PHIV children (mean age 10.45 years [1.73 SD], 93% adopted from sub-Saharan Africa at a median age of 3.3 years [IQR 2.1-4.2]) and fifteen HIV- uninfected controls. Groups did not clinically nor statistically differ in age, sex, ethnicity, SES, region of birth, adoption status and age at adoption. PHIV scored consistently lower on all cognitive domains and MNC outcomes. Compared to controls, PHIV children had a significant lower IQ (mean 81 [SD 11] versus mean 97 [SD 15], p = 0.005), and a poorer cognitive profile by MNC (Hotelling's T2 mean -4.36 [SD 5.6] versus mean 0.16 [SD 4.5], p = 0.021), not associated with HIV disease- and treatment-related factors. Two PHIV (14%) and one control (7%) were classified as cognitively impaired (p = 0.598). CONCLUSIONS: Findings indicate treated HIV-infection to be independently associated with lower IQ and poorer cognitive profiles in PHIV children, irrespective of a background of international adoption.


Assuntos
Fármacos Anti-HIV/efeitos adversos , Cognição , Infecções por HIV/fisiopatologia , Deficiência Intelectual/etiologia , Adoção , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos de Coortes , Estudos Transversais , Feminino , Infecções por HIV/congênito , Infecções por HIV/tratamento farmacológico , Humanos , Lactente , Testes de Inteligência , Internacionalidade , Masculino , Estudos Prospectivos
4.
J Acquir Immune Defic Syndr ; 82(5): 462-467, 2019 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-31714424

RESUMO

BACKGROUND: Life expectancy of HIV patients has increased considerably as a result of antiretroviral therapy (ART), and cardiovascular (CV) disease has emerged as an important late concern. People with HIV infection could have an impaired systolic function; however data on diastolic function and markers of CV risk, such as epicardial adipose tissue (EAT) and intima-media thickness (IMT), are lacking. Aim of this study is to evaluate left ventricular function, EAT, and IMT in children and adolescents with vertically acquired HIV infection. METHODS: We enrolled 29 subjects on ART (13, 45% men; median age of 13.0, and interquartile range 9-18), and 29 age-matched controls. All patients and controls underwent echocardiographic evaluation, with study of the systolic and diastolic function and measurement of the EAT, and a carotid ultrasound study for IMT measurement. RESULTS: Comparing HIV-infected patients to healthy controls, we found a statistically significant increase of EAT and IMT (mean ± SD) (EAT: 3.16 ± 1.05 vs 1.24 ± 0.61 mm; P < 0.0001. IMT: 0.77 ± 0.15 vs 0.51 ± 0.11 mm; P < 0.0001), and a significant reduction of ejection fraction, evaluated with the biplane Simpson method (mean ± SD) (58.5% ± 6.66% vs 66% ± 4.24%; P = 0.029). These results are not related with age, gender, degree of lipodystrophy, dyslipidemia, hyperinsulinism, and ART duration or the use of single antiretroviral classes. CONCLUSIONS: Vertically infected HIV children and adolescents show an increased thickness of EAT and IMT, expression of potentially increased CV risk. They also show an impaired systolic function.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Espessura Intima-Media Carotídea , Infecções por HIV/fisiopatologia , Transmissão Vertical de Doença Infecciosa , Disfunção Ventricular Esquerda/fisiopatologia , Adolescente , Fármacos Anti-HIV/uso terapêutico , Estudos de Casos e Controles , Criança , Ecocardiografia , Feminino , Infecções por HIV/congênito , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pericárdio/diagnóstico por imagem , Volume Sistólico , Sístole , Disfunção Ventricular Esquerda/diagnóstico por imagem
5.
J Acquir Immune Defic Syndr ; 82(5): 483-490, 2019 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-31714427

RESUMO

There are limited data on infants with HIV starting antiretroviral therapy (ART) in the neonatal period. We investigated the association between the timing of ART initiation and time-to-suppression among infants who tested HIV-positive and initiated ART within the first 28 days of life. The effect was estimated using cumulative probability flexible parametric spline models and a multivariable generalized additive mixed model was performed to test nonlinear associations. Forty-four neonates were included. Nineteen (43.2%) initiated ART within 7 days of life and 25 (56.8%) from 8 to 28 days. Infants treated within 7 days were 4-fold more likely to suppress earlier than those treated after 7 days [Hazard ratio (HR) 4.01 (1.7-9.5)]. For each week the ART initiation was delayed, the probability of suppression decreased by 35% (HR 0.65 [0.46-0.92]). Age at ART start was linearly associated with time-to-suppression. However, a linear association with normally distributed residuals was not found between baseline viral load and time-to-suppression, with no association found when baseline viral loads were ≤5 log(10) copies/mL, but with exponential increase in time-to-suppression with > log5 copies/mL at baseline. Starting ART within 7 days of life led to 4-fold faster time to viral suppression, in comparison to initiation from 8 to 28 days.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/tratamento farmacológico , Infecções por HIV/transmissão , Transmissão Vertical de Doença Infecciosa , Fármacos Anti-HIV/uso terapêutico , Contagem de Linfócito CD4 , Criança , Pré-Escolar , Quimioterapia Combinada , Feminino , Seguimentos , Infecções por HIV/congênito , Infecções por HIV/imunologia , Inibidores da Protease de HIV/uso terapêutico , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Inibidores da Transcriptase Reversa/uso terapêutico , Fatores de Tempo , Carga Viral
8.
Biomedica ; 39(Supl. 2): 66-77, 2019 08 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31529835

RESUMO

Introduction: Prevention of mother-to-child transmission of the human immunodeficiency virus (HIV) is essential to limit the spread of the disease. Colombian data about HIV infection in pregnancy are scarce, as well as on the results of the strategies used worldwide to reduce perinatal transmission. Objective: To describe the characteristics and outcomes of pregnant women infected with HIV and their children in a reference center in Medellín. Materials and methods: We conducted a retrospective observational study for the 2012-2015 period by studying the clinical records of newborns exposed to HIV and their mothers. We evaluated the characteristics of prenatal care, deliveries, and infant postnatal care, as well as the follow-up data to confirm or exclude HIV transmission. Results: We included 106 infants and their mothers. We found that 39,6% of mothers knew about the HIV diagnosis before pregnancy and 58,5% were diagnosed during pregnancy; 95.3% of them attended prenatal controls, but only 46.5% as of the first trimester; 95% of them received antiretrovirals, but 23.9% started therapy just during the third trimester. Only 63% of women had a viral load for HIV after 34 weeks of gestation. None of the 103 children with follow up had confirmed presence for HIV and in 88% of them, it was discarded. Conclusions: No cases of perinatal HIV transmission were found in the study. However, difficulties and delays persist in prenatal care, in timely maternal follow-up to confirm or discard HIV, and for early detection of maternal co-infections and their effects on newborns.


Assuntos
Infecções por HIV/transmissão , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Complicações Infecciosas na Gravidez , Cuidado Pré-Natal , Qualidade da Assistência à Saúde , Adulto , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Cesárea , Colômbia/epidemiologia , Comorbidade , Diagnóstico Precoce , Feminino , Fidelidade a Diretrizes , Infecções por HIV/congênito , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , HIV-1 , Hospitais Urbanos , Humanos , Cuidado do Lactente , Recém-Nascido , Masculino , Guias de Prática Clínica como Assunto , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/epidemiologia , Estudos Retrospectivos , Centros de Cuidados de Saúde Secundários , Doenças Sexualmente Transmissíveis/epidemiologia , Adulto Jovem
9.
J Adolesc Health ; 65(5): 702-705, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31481285

RESUMO

PURPOSE: Suicide is the second leading cause of death among youth in the U.S., yet there are few studies on suicide among youth with perinatally acquired HIV infection (YPHIV). Our aim was to determine if suicide attempts differed for YPHIV compared with perinatally HIV-exposed but uninfected peers (YPHEU). METHODS: Data come from a longitudinal behavioral health cohort (N = 340) of YPHIV (n = 206) and YPHEU (n = 134) recruited between ages 9 and 16 years and interviewed with psychosocial batteries every 12-18 months. Logistic regression analyses were conducted to assess the association between reported suicide attempt and participants' HIV status. We assessed whether baseline demographic characteristics and sexual orientation were potential confounding factors. Fisher's exact tests were used to evaluate the association between first attempted suicide and HIV status within age groups. RESULTS: YPHIV were more likely to make a suicide attempt than YPHEU (odds ratio = 2.35, 95% confidence interval = 1.28-4.34). Youth most often reported their first attempt between the ages of 14-18 years. Demographic characteristics and sexual orientation were not associated with attempted suicide. CONCLUSIONS: YPHIV compared with YPHEU were more likely to report a suicide attempt, and this difference emerged during late adolescence and persisted through young adulthood.


Assuntos
Infecções por HIV/psicologia , Tentativa de Suicídio/estatística & dados numéricos , Adolescente , Estudos de Casos e Controles , Criança , Feminino , Infecções por HIV/congênito , Humanos , Estudos Longitudinais , Masculino , Fatores de Risco , Tentativa de Suicídio/psicologia , Adulto Jovem
10.
AIDS Patient Care STDS ; 33(10): 440-448, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31524504

RESUMO

This study explores health care providers' perceptions of similarities and differences in the sexual and reproductive needs of adolescents with perinatally acquired HIV (PHIV) and behaviorally acquired HIV (BHIV). Interviews (n = 13) and online surveys (n = 46) were completed by medical and social service providers (n = 30, n = 29, respectively) who care for adolescents with HIV. Eligible providers were recruited using snowball sampling. Responses to open-ended questions were coded for emergent themes. Sixty-eight percent of participants perceived differences in the sexual and reproductive health needs of adolescents with PHIV and BHIV. Differences included factors related to psychosocial, sexual, and medical needs. Providers believed adolescents with PHIV had integrated their diagnosis into their identity, were more adept at communicating with providers, and were more sexually cautious than youth with BHIV. Providers perceived adolescents with BHIV as more comfortable discussing sex-related issues, and suggested youth with PHIV were more comfortable accessing health care. Adolescents with PHIV were thought to have complex medical histories/treatment and greater knowledge of illness/medications. Existing research on adolescent-reported sexual and reproductive health knowledge and experiences in care suggests that provider and adolescent perspectives do not always align. Mode of transmission may provide some information about psychosocial functioning and sexual behavior. However, assumptions about sexual and reproductive health needs based solely on mode of transmission may contribute to gaps in sexual and reproductive health care. Future research is needed to examine whether these differing perspectives indeed lead to discrepancies in the care provided to adolescents with HIV.


Assuntos
Comportamento do Adolescente/psicologia , Serviços de Saúde do Adolescente/organização & administração , Infecções por HIV/congênito , Infecções por HIV/psicologia , Pessoal de Saúde/psicologia , Necessidades e Demandas de Serviços de Saúde , Saúde Reprodutiva , Comportamento Sexual/psicologia , Saúde Sexual , Adolescente , Adulto , Feminino , Infecções por HIV/tratamento farmacológico , Comportamentos Relacionados com a Saúde , Acesso aos Serviços de Saúde , Humanos , Transmissão Vertical de Doença Infecciosa , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Percepção , Reprodução , Serviços de Saúde Reprodutiva/organização & administração , Serviços de Saúde Reprodutiva/estatística & dados numéricos
11.
J Adolesc Health ; 65(5): 651-659, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31395514

RESUMO

PURPOSE: Antiretroviral monotherapy and treatment interruption are potential strategies for perinatally HIV-infected adolescents (PHIVA) who face challenges maintaining effective combination antiretroviral therapy (ART). We assessed the use and outcomes for adolescents receiving monotherapy or undergoing treatment interruption in a regional Asian cohort. METHODS: Regional Asian data (2001-2016) were analyzed to describe PHIVA who experienced ≥2 weeks of lamivudine or emtricitabine monotherapy or treatment interruption and trends in CD4 count and HIV viral load during and after episodes. Survival analyses were used for World Health Organization (WHO) stage III/IV clinical and immunologic event-free survival during monotherapy or treatment interruption, and a Poisson regression to determine factors associated with monotherapy or treatment interruption. RESULTS: Of 3,448 PHIVA, 84 (2.4%) experienced 94 monotherapy episodes, and 147 (4.3%) experienced 174 treatment interruptions. Monotherapy was associated with older age, HIV RNA >400 copies/mL, younger age at ART initiation, and exposure to ≥2 combination ART regimens. Treatment interruption was associated with CD4 count <350 cells/µL, HIV RNA ≥1,000 copies/mL, ART adverse event, and commencing ART age ≥10 years compared with age <3 years. WHO clinical stage III/IV 1-year event-free survival was 96% and 85% for monotherapy and treatment interruption cohorts, respectively. WHO immunologic stage III/IV 1-year event-free survival was 52% for both cohorts. Those who experienced monotherapy or treatment interruption for more than 6 months had worse immunologic and virologic outcomes. CONCLUSIONS: Until challenges of treatment adherence, engagement in care, and combination ART durability/tolerability are met, monotherapy and treatment interruption will lead to poor long-term outcomes.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Adolescente , Adulto , Terapia Antirretroviral de Alta Atividade , Ásia , Contagem de Linfócito CD4 , Estudos de Casos e Controles , Criança , Estudos de Coortes , Progressão da Doença , Feminino , Infecções por HIV/congênito , Humanos , Gravidez , Carga Viral/efeitos dos fármacos , Adulto Jovem
12.
J Int AIDS Soc ; 22(8): e25386, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31441211

RESUMO

INTRODUCTION: Adolescents with perinatally acquired HIV (PHIV) are at risk of chronic disease due to long-standing immune suppression, HIV disease and antiretroviral therapy (ART) exposure. However, there are few data on multisystem disease in this population. We investigated the overlapping burden of neurocognitive, cardiovascular, respiratory and/or renal impairment among PHIV positive (PHIV+) adolescents. METHODS: In this cross-sectional analysis, participants aged 9 to 14 years on ART for >6 months were recruited from seven sites across Cape Town from July 2013 through March 2015, together with age-matched HIV-negative (HIV-) adolescents. Impairment at enrolment was assessed across neurocognitive functioning (using the youth-International HIV Dementia Scale); cardiac function (echocardiogram abnormality); respiratory function (abnormal spirometry) and renal function (abnormal glomerular filtration rate). RESULTS AND DISCUSSION: Overall, 384 PHIV+ and 95 HIV- adolescents were included (mean age, 11.9 years; 49% female). Median age of ART initiation was 4.2 years (IQR: 1.7 to 7.6) and median CD4 count was 709 (IQR: 556 to 944) with 302 (79%) of PHIV+ adolescents virologically suppressed. Abacavir and Zidovudine were the most commonly used nucleoside reverse transcriptase inhibitors (NRTIs) with 60% of adolescents on non-nucleoside reverse transcriptase inhibitors (NNRTI) and 38% on a protease inhibitor (PI). Among PHIV+ adolescents, 167 (43.5%) had single system impairment only, 110 (28.6%) had two systems involved, and 39 (10.2%) had three or four systems involved. PHIV+ participants had more 2-system and 3-system impairment than HIV-, 110 (28.6%) versus 17 (17.9%), p = 0.03 and 39 (10.2%) versus 3 (4.3%), p = 0.03. PHIV+ participants who had failed a year of school (73.8% vs. 46.4%, p = 0.00) and with a viral load >1000 copies/mL at enrolment (16.8% vs. 8.1%, p = 0.03) were more likely to have dual or multisystem impairment. Of those with cardiac impairment, 86.7% had an additional system impaired. Similarly, in those with neurocognitive impairment, almost 60% had additional systems impaired and of those with respiratory impairment, 74% had additional systems impaired. CONCLUSIONS: Despite relatively early ART initiation, there is a substantial burden of multisystem chronic impairment among PHIV+ adolescents. This phenomenon needs to be further explored as this population ages and begins to engage in adult lifestyle factors that may compound these impairments.


Assuntos
Antirretrovirais/uso terapêutico , Doenças Cardiovasculares/etiologia , Transtornos Cognitivos/etiologia , Infecções por HIV/complicações , Nefropatias/etiologia , Doenças Respiratórias/etiologia , Adolescente , Contagem de Linfócito CD4 , Criança , Estudos Transversais , Didesoxinucleosídeos/uso terapêutico , Feminino , Infecções por HIV/congênito , Infecções por HIV/tratamento farmacológico , Humanos , Transmissão Vertical de Doença Infecciosa , Masculino , África do Sul , Carga Viral , Zidovudina/uso terapêutico
13.
Biosci Trends ; 13(1): 107-109, 2019 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-30686815

RESUMO

Prevention of mother-to-child transmission (PMTCT) program offer a range of services for women of reproductive age living with or at risk of contracting the human immunodeficiency virus (HIV) in order to maintain their health and to protect their infants from acquiring HIV. The program has made significant progress in eliminating HIV. Thanks to the provision of PMTCT services, around 1.4 million HIV infections among children were prevented between 2010 and 2018. PMTCT program in China has developed substantially over the past few years, highlighting the national response to HIV/AIDS. Although huge strides have been made in PMTCT, a number of important issues, such as prevention at each step, monitoring of PMTCT services, and early infant diagnosis, need to be addressed in the future.


Assuntos
Infecções por HIV/prevenção & controle , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Feminino , Infecções por HIV/congênito , Infecções por HIV/transmissão , Humanos , Gravidez , Complicações Infecciosas na Gravidez
15.
Enferm Infecc Microbiol Clin ; 37(2): 100-108, 2019 02.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29724618

RESUMO

INTRODUCTION: Late Diagnosis (LD) of Human Immunodeficiency Virus (HIV) infection (CD4 lymphocytes <350/µl at diagnosis of the disease), deteriorates the condition of those affected and increases the probability of transmission. The objective of the present study was to analyse the prevalence of LD, to identify missed diagnostic opportunities (MDO) and to find out which level of the health care delivery system they took place. METHODS: Retrospective, observational and descriptive study of the population diagnosed with infection of HIV/AIDS in the period 2011-2015 in Aragon. MDO were identified during the 3 years prior to diagnosis of the disease in all levels of the health care delivery system as well as frequentation of consultations. The indicator conditions (IC) that generated more MDO were analysed according to the latest recommendations for early diagnosis of HIV in the health care setting. RESULTS: 435 newly diagnosed HIV/AIDS cases were analysed. 45.1% were diagnosed in Primary Healthcare (PH). 49.4% presented criteria of LD and 61.1% were infected through heterosexual contact. The majority of MDO (68.5%) were given in PH. The IC that generated the most MDO were seborrheic dermatitis/exanthema (19.4%) and fever of unknown origin (10.3%). However, the IC that were associated with higher LD were pneumonia acquired in the community and unjustified weight loss. CONCLUSION: In Aragon, prevalence of LD is high, the main route of infection is heterosexual and most of MDO go unnoticed in PH. The dissemination of current guidelines for requesting IC guided HIV testing and HIV screening across the preoperative period will result in an effective measure to decrease the LD.


Assuntos
Diagnóstico Tardio , Infecções por HIV/diagnóstico , Avaliação de Sintomas , Adolescente , Adulto , Criança , Pré-Escolar , Dermatite Seborreica/epidemiologia , Diagnóstico Precoce , Emigrantes e Imigrantes/estatística & dados numéricos , Eritema/epidemiologia , Feminino , Febre de Causa Desconhecida/epidemiologia , Infecções por HIV/congênito , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Pneumonia/epidemiologia , Prevalência , Atenção Primária à Saúde , Estudos Retrospectivos , Espanha/epidemiologia , Perda de Peso , Adulto Jovem
16.
J Trop Pediatr ; 65(2): 107-113, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-29912465

RESUMO

BACKGROUND: Nigeria has the highest burden of paediatric HIV in the world. HIV infection may result in significant life stressors, on both the infected children and their caregivers. METHODS: This included a hospital-based cross-sectional and comparative study. Subjects and controls who met the inclusion criteria were enrolled consecutively. Their socio-demographic variables were obtained and GHQ-28 was used to assess their psychosocial status. RESULTS: A total of 154 caregivers of HIV-infected children (subjects) and 154 caregivers of HIV-negative children (controls) were enrolled into this study. In total, 42 (27.3%) and 112 (72.7%) of the subjects were males and females, respectively, compared with 37 (24.0%) and 117 (76.0%) of the controls, respectively. The prevalence of psychosocial disorders among the subjects and controls was 39 and 2.6%, respectively (p < 0.001; odds ratio: 23.936). The patterns of psychosocial disorders among the caregivers of HIV-infected children were somatic symptoms (85%), anxiety/insomnia (80%), social dysfunction (63.3%) and severe depression (48.3%). CONCLUSION: There is a high prevalence of psychosocial disorders among caregivers of HIV-infected children.


Assuntos
Cuidadores/psicologia , Infecções por HIV/congênito , Transtornos Mentais/epidemiologia , Estresse Psicológico/epidemiologia , Adolescente , Adulto , Ansiedade/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos Transversais , Depressão/epidemiologia , Feminino , Infecções por HIV/psicologia , Humanos , Masculino , Saúde Mental , Nigéria/epidemiologia , Prevalência , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Estresse Psicológico/complicações , Inquéritos e Questionários
17.
Acta Paediatr ; 107 Suppl 471: 7-16, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30570796

RESUMO

AIM: This study aimed to test a model which involved clans and health providers to increase antenatal care attendance in rural minority areas of China with high HIV prevalence. METHODS: Formative research was conducted to determine barriers and facilitators to antenatal care use. A strategy involving clans in addressing the barriers identified was developed. Implementation of the new strategy was done through three plan-do-study-act (PDSA) cycles, lasting four months each. RESULTS: Awareness and uptake of antenatal care increased significantly after the intervention. The proportion of post-partum women who used any antenatal care increased from 21.3% to 64.5% (p < 0.001), and the proportion who knew that antenatal care is necessary increased from 77.8% to 89.8% (p < 0.001). The proportion of pregnant women who attended antenatal care (p < 0.001) and the proportion of pregnant women who went for a first antenatal care visit in early pregnancy (p < 0.001) all showed increasing trends during the study period. CONCLUSION: Involving clans in antenatal care programmes in rural minority areas of China had an impact on antenatal care use. A quality improvement approach incorporating PDSA cycles can help local health authorities make context-specific, evidence-informed decisions to improve uptake of health services.


Assuntos
Relações Familiares , Infecções por HIV/congênito , Conhecimentos, Atitudes e Prática em Saúde , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pré-Natal , China , Feminino , Infecções por HIV/prevenção & controle , Implementação de Plano de Saúde , Humanos , Masculino , Gravidez , População Rural
18.
J Assoc Nurses AIDS Care ; 29(6): 822-834, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30369413

RESUMO

The goal of our project was to examine health and social service provider views of factors that influence the nature and timing of sexual and reproductive health (SRH) information shared with adolescents with perinatally acquired HIV (PHIV). Health care (n = 6) and social service (n = 7) providers (11.6 mean years caring for adolescents with PHIV) completed audio-recorded interviews that were transcribed, and coded for emerging themes. Analyses revealed multiple levels of influence best understood in the context of the ecological model. Adolescent factors included cognitive development, comfort level with sexuality talk, and disclosure status. Guardian/parent hesitancy, values, and concerns regarding disclosure comprised the microsystem. Exosystem-level factors included disclosure as a prerequisite to SRH education, provider comfort, and relationship with the adolescent. Finally, broader structural aspects of the macrosystem included mandatory disclosure laws and quality of school-based SRH education. Across systems, findings underscored the central importance of disclosure in the provision of SRH information.


Assuntos
Comportamento do Adolescente/psicologia , Aconselhamento , Infecções por HIV/congênito , Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Saúde Reprodutiva , Educação Sexual/métodos , Comportamento Sexual/psicologia , Saúde Sexual , Adolescente , Adulto , Feminino , Comunicação em Saúde , Pessoal de Saúde , Humanos , Entrevistas como Assunto , Masculino , Pesquisa Qualitativa , Adulto Jovem
19.
Adv Neonatal Care ; 18(5): 330-340, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30239402

RESUMO

BACKGROUND: Human immunodeficiency virus (HIV) is caused by a cytopathic lentivirus. HIV without adequate treatment during pregnancy can result in maternal to child transmission (MCT) of the virus. Sequelae can include severe lifelong morbidities, shorter life expectancies, and high mortality rates without antiretroviral therapy. PURPOSE: To discuss epidemiological trends, pathophysiology, and clinical care guidelines including those for diagnosis, treatment, and management of MCT of HIV in the United States. To emphasize the importance of prompt identification, prophylaxis, and treatment of at-risk infants. METHODS: PubMed, CINAHL, MEDLINE, and Google Scholar were used to search key words-maternal to child transmission, HIV, HIV in pregnancy, and neonatal HIV-for articles that were relevant and current. The World Health Organization, Centers for Disease Control and Prevention, and UNICEF were also utilized for up-to-date information on the topic. FINDINGS: Timely identification, intervention, and treatment are necessary to prevent MCT of HIV. Membrane rupture duration is not associated with higher transmission rates with adequate viral suppression. IMPLICATIONS FOR PRACTICE: An evidence-based maternal/neonatal collaborative approach to care for the prevention and management of MCT of HIV including adherence to combined antiretroviral therapy (cART) should be emphasized. Early testing, prophylaxis, and treatment for neonates at risk, as well as education on current clinical care guidelines for caregivers. IMPLICATIONS FOR RESEARCH: Pregnancy complications of cART. MCT rates in conjunction with birthing practices and restrictions among women living with HIV with low to undetectable viral loads.


Assuntos
Infecções por HIV , Transmissão Vertical de Doença Infecciosa , Terapia Antirretroviral de Alta Atividade/métodos , Feminino , HIV , Infecções por HIV/congênito , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Recém-Nascido , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Masculino , Profilaxia Pós-Exposição/métodos , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle
20.
J Assoc Nurses AIDS Care ; 29(6): 902-913, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29784521

RESUMO

Disclosing to a child that s/he is living with HIV is necessary to promote adherence to treatment and improve health outcomes. Facilitating disclosure between caregivers and children remains a challenge for health workers. Understanding how health workers are involved in and perceive the disclosure process is integral to engaging with such challenges. We held group discussions with and surveyed 73 physicians, nurses, and counselors across 16 randomly selected facilities in two rural South African health districts, exploring their experiences of supporting disclosure between caregivers and children. Ninety percent of those surveyed agreed that children should be informed of their HIV status. Differences between categories of health workers regarding training, involvement in the disclosure process, and perceived responsibility for disclosure support led to inconsistent disclosure practices within facilities. Disclosure-strengthening interventions must consider the composition of the health worker team and the role that each category of health worker performs in their local settings.


Assuntos
Cuidadores/psicologia , Infecções por HIV/congênito , Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Revelação da Verdade , Adolescente , Antirretrovirais/uso terapêutico , Criança , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pesquisa Qualitativa , População Rural , África do Sul , Inquéritos e Questionários
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