RESUMEN
Although vertical transmission of HIV-1 can occur through breast-feeding, little is known about the effect of colostrum, duration of breast-feeding, mixing feeding, and nipple pathology. We used retrospective cohort data to examine the association between breast-feeding-related factors and transmission of HIV-1 from mother to child in São Paulo State, Brazil. Information on maternal and postnatal factors was collected by medical record review and interview. Infection status was determined for 434 children by anti-HIV-1 tests performed beyond 18 months of age or diagnosis of AIDS at any age. Among 168 breast-fed children, the risk of transmission of HIV-1 was 21%, compared with 13% (p = .01) among 264 children artificially fed. Breast-feeding was independently and significantly associated with mother-to-child transmission of HIV-1 after controlling for stage of maternal HIV-1 disease (odds ratio [OR] = 2.2; 95% confidence interval [CI], 1.3-3.8). A trend was shown toward an increased risk of transmission with longer duration of breast-feeding, a history of bleeding nipples, and introduction of other liquid food before weaning, but these associations were not statistically significant. History of colostrum intake or cracked nipples without bleeding were not associated with transmission. Most of the women who breast-fed were unaware of their HIV-1 infection status at the time of delivery. Avoidance of mixed feeding and withholding of breast-feeding in the presence of bleeding nipples should be considered in further research as strategies to reduce postnatal transmission of HIV-1 in settings in which safe and sustainable alternatives for breast-feeding are not yet available.
Asunto(s)
Lactancia Materna , Infecciones por VIH/transmisión , VIH-1 , Transmisión Vertical de Enfermedad Infecciosa , Alimentación con Biberón , Brasil , Estudios de Cohortes , Calostro , Intervalos de Confianza , Femenino , Humanos , Alimentos Infantiles , Recién Nacido , Pezones/patología , Oportunidad Relativa , Embarazo , Factores de Riesgo , Factores de TiempoRESUMEN
OBJECTIVES: To evaluate the effect of maternal, obstetric, neonatal and post-natal factors on the risk of vertical transmission of HIV-1. DESIGN: Multicentre retrospective cohort study. SETTING: Obstetric and paediatric clinics in four cities in Sao Paulo State, Brazil. MAIN OUTCOME: Child's HIV-1 infection status. METHODS: Data were collected by standardized record abstraction and interview on 553 children born to women identified as HIV-1-infected before or at delivery. Paediatric infection was determined by immunoglobulin G anti-HIV-1 tests at age 18 months or by AIDS diagnosis at any age. Multivariate logistic regression was used to assess the effect of potential risk factors on vertical transmission of HIV-1. RESULTS: HIV-1 infection status was determined for 434 children (follow-up rate of 78%); 69 were classified as HIV-1-infected [transmission risk, 16%; 95% confidence interval (CI), 13-20%]. In multivariate analysis, advanced maternal HIV-1 disease [odds ratio (OR), 4.5; 95% CI, 2.1-9.5], ever breastfed (OR, 2.2; 95% CI, 1.2-4.2), child's negative Rhesus blood group (OR, 2.5; 95% CI, 1.2-5.5), third trimester amniocentesis (OR, 4.1; 95% CI, 1.2-13.5) and black racial group (OR, 0.3; 95% CI, 0.1-0.9) were independently and significantly associated with mother-to-child transmission of HIV-1. Transmission was increased marginally with prematurity, more than 10 lifetime sexual partners and prolonged duration of membrane rupture. No association was found between child's HIV-1 infection and mode of delivery or serological evidence of syphilis during pregnancy. CONCLUSION: These findings support the importance of severity of maternal HIV-1 disease in the risk of vertical transmission of HIV-1, indicate measures to reduce transmission by avoiding amniocentesis and breastfeeding and suggest that race and Rhesus blood type may be markers for genetic susceptibility to infection.
Asunto(s)
Lactancia Materna , Infecciones por VIH/transmisión , VIH-1 , Transmisión Vertical de Enfermedad Infecciosa , Consumo de Bebidas Alcohólicas , Amniocentesis , Brasil/epidemiología , Cesárea , Susceptibilidad a Enfermedades , Femenino , Edad Gestacional , Infecciones por VIH/prevención & control , Humanos , Lactante , Recién Nacido , Masculino , Edad Materna , Análisis Multivariante , Embarazo , Complicaciones Infecciosas del Embarazo , Grupos Raciales , Sistema del Grupo Sanguíneo Rh-Hr , Factores de Riesgo , Conducta SexualRESUMEN
OBJECTIVE: To validate a method for salivary testing for HIV infection in children older than 12 months. METHODS: Oral fluid samples were collected via sponge foam swabs from children born to HIV-positive mothers and were tested for antibodies to HIV-1 and HIV-2 with an IgG antibody capture enzyme-linked immunosorbent assay and a modified Western blot for confirmation. In each child serum antibody status was the standard used to validate the salivary antibody test. RESULTS: We obtained 331 oral fluid samples from children born to HIV-positive mothers. The specificity and sensitivity of salivary testing compared with results on sera were both 100% (297 of 297 (95% confidence interval 98.8 to 100%) and 34 of 34 (95% confidence interval 89.7 to 100%), respectively). Compliance in the study population increased from 91% to 97% when mothers were offered the opportunity to provide oral fluid from their children instead of blood specimens. CONCLUSION: Salivary testing provides an accurate and acceptable noninvasive method for assessing the HIV infection status of children born to infected mothers by using IgG antibody capture enzyme-linked immunosorbent assay alone with a strategy of duplicate retesting of reactive specimens.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Anticuerpos Anti-VIH/análisis , VIH-1/inmunología , Transmisión Vertical de Enfermedad Infecciosa , Saliva/inmunología , Femenino , Humanos , Lactante , Recién Nacido , Embarazo , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: To examine the association between fetal outcome and the steady state haematology of mothers with homozygous sickle cell disease. DESIGN: A retrospective observational study. The data were taken from dockets kept at the Sickle Cell Clinic and verified by interview with 45% of the patients. SETTING: The Sickle Cell Clinic at the University Hospital of the West Indies or two peripheral clinics operated by the staff of the MRC Laboratories. SUBJECTS: All women aged 14 years or older with homozygous sickle cell disease who had experienced at least one pregnancy in the period 1977 to 1986. MAIN OUTCOME MEASURES: Three fetal outcomes including miscarriages, perinatal deaths, and birthweight. RESULTS: There were 270 singleton pregnancies in 175 women with an overall fetal wastage of 32.2%. There was a significant increased risk of perinatal death with low maternal fetal haemoglobin level, but there were no haematological associations with miscarriages or birthweight. CONCLUSIONS: These data suggest that maternal steady-state haematology has little influence on fetal outcome, with the exception that mothers with high HbF levels are less prone to perinatal deaths. Further study is required to investigate acute haematological changes associated with pregnancy.
Asunto(s)
Anemia de Células Falciformes/sangre , Hemoglobina Fetal/análisis , Hemoglobinas/análisis , Complicaciones Hematológicas del Embarazo/sangre , Aborto Espontáneo/sangre , Aborto Espontáneo/epidemiología , Adolescente , Adulto , Anemia de Células Falciformes/mortalidad , Peso al Nacer , Femenino , Muerte Fetal , Humanos , Recién Nacido , Embarazo , Complicaciones Hematológicas del Embarazo/mortalidad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
The prevalence, incidence, and risk factors associated with proliferative sickle retinopathy (PSR) were investigated in 786 patients with homozygous sickle cell (SS) disease and 533 patients with sickle cell haemoglobin C (SC) disease. PSR was more common in SC disease, in which there was a significant predominance of males, and it increased with age in both genotypes. In SC disease the risk of developing PSR was highest between 15 and 24 years in males, between 20 and 39 years in females, and in SS disease between 25 and 39 years in both sexes. PSR tended to be bilateral, especially in SC disease. There was no evidence of familial clustering of PSR in SC siblings, and insufficient numbers of SS siblings were available to test for clustering. Haematological risk factors associated with PSR in SS disease were a high haemoglobin in males and a low fetal haemoglobin in both sexes and in SC disease, a high mean cell volume, and a low fetal haemoglobin in females.
Asunto(s)
Anemia de Células Falciformes/complicaciones , Enfermedades de la Retina/epidemiología , Adolescente , Adulto , Factores de Edad , Anemia de Células Falciformes/sangre , Niño , Preescolar , Femenino , Enfermedad de la Hemoglobina SC/sangre , Enfermedad de la Hemoglobina SC/complicaciones , Humanos , Incidencia , Lactante , Recién Nacido , Jamaica , Masculino , Prevalencia , Análisis de Regresión , Enfermedades de la Retina/etiología , Enfermedades de la Retina/genética , Factores de Riesgo , Factores SexualesRESUMEN
Maculopathy is the commonest cause of severe visual loss from diabetic retinopathy in Jamaica [5]. Ophthalmic assessment of 158 black Jamaican maturity onset diabetics referred randomly from the primary and secondary health centres, demonstrated maculopathy in 48% of patients. Duration of diabetes was a strong risk factor for maculopathy (p less than 0.001). Poor compliance with diabetic and hypertensive therapy may influence the prevalence of maculopathy.
Asunto(s)
Retinopatía Diabética/epidemiología , Mácula Lútea , Enfermedades de la Retina/epidemiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Población Negra , Ceguera/etiología , Presión Sanguínea , Retinopatía Diabética/complicaciones , Femenino , Humanos , Jamaica/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Distribución Aleatoria , Análisis de Regresión , Enfermedades de la Retina/etiología , Factores de Riesgo , Factores Sexuales , Agudeza VisualRESUMEN
The pregnancy related changes in fetal haemoglobin (HbF) have been observed in 152 pregnancies in 125 women with homozygous sickle cell (SS) disease and related to steady state levels in the same individual. Statistically significant increases in the first and second trimesters, were followed by significant falls below steady state levels in the third trimester and postpartum period. Although these corresponded to a mean increase of 0.7% and a mean decrease of 1.6%, much greater changes occurred in some individuals. Mean levels had not returned to steady state values 1 year after delivery. The hormonal changes in pregnancy appear to have profound effects on HbF level in SS disease, the mechanisms of which require further study.
Asunto(s)
Anemia de Células Falciformes/sangre , Hemoglobina Fetal/análisis , Complicaciones Hematológicas del Embarazo/sangre , Femenino , Humanos , Periodo Posparto/sangre , Embarazo , Factores de TiempoRESUMEN
Gall stones were detected by ultrasonography in 30 of 226 (13%) children with homozygous sickle cell disease aged 5-13 years participating in a cohort study from birth. Children with gall stones had significantly lower total haemoglobin and fetal haemoglobin and higher bilirubin concentrations, but further analysis showed that the apparent effects of haemoglobin and fetal haemoglobin concentration were secondary to their relationship with bilirubin concentrations. Abdominal pain crises were significantly associated with gall stones but both factors appeared to reflect an increased clinical severity and were probably not causally related. No patients had symptoms specific of gall stones and an association with abdominal pain crisis should not, of itself, be considered an indication for surgery.
Asunto(s)
Anemia de Células Falciformes/complicaciones , Colelitiasis/etiología , Adolescente , Factores de Edad , Anemia de Células Falciformes/sangre , Anemia de Células Falciformes/genética , Niño , Preescolar , Colelitiasis/sangre , Colelitiasis/diagnóstico , Estudios de Cohortes , Femenino , Hemoglobinas/análisis , Homocigoto , Humanos , Hiperbilirrubinemia/etiología , Masculino , Factores de Riesgo , UltrasonografíaRESUMEN
A controlled, randomised, prospective trial of Argon laser trabeculoplasty (ALT) was carried out on 48 eyes of 30 black Jamaican patients with primary open-angle glaucoma. All eyes had uncontrolled intra-ocular pressures (greater than or equal to 22 mm Hg) despite medical therapy. Treatment was successful in controlling intraocular pressure in 68% of eyes after 12 months follow-up (p = 0.004). The average drop in intraocular pressure attributable to ALT was 6.6 mmHg. Argon laser trabeculoplasty is an effective adjunct in managing to control intraocular pressure in black Jamaican glaucoma patients.
Asunto(s)
Población Negra , Glaucoma de Ángulo Abierto/cirugía , Terapia por Láser , Trabeculectomía , Adulto , Anciano , Argón , Femenino , Estudios de Seguimiento , Glaucoma de Ángulo Abierto/etnología , Glaucoma de Ángulo Abierto/fisiopatología , Humanos , Presión Intraocular , Masculino , Persona de Mediana Edad , Valores de ReferenciaRESUMEN
Some epidemiologic features of the painful crisis in homozygous sickle cell disease were examined in a retrospective study of 995 painful crises. Previously reported associations with cold weather and pregnancy were confirmed. There was a striking increase in painful crises in male patients between the ages of 15 and 25 years, whereas female patients showed little age-related change. The frequency of painful crises correlated positively with hemoglobin levels and reticulocyte counts in both sexes and negatively with mean corpuscular volume in female patients. There was a striking increase in painful crises in male patients with hemoglobin levels above 8.5 g/dL (greater than 85 g/L). High hemoglobin levels appear to be an important risk factor for painful crises.