RESUMO
OBJECTIVES: Puerto Rico (PR), is the fifth highest jurisdiction of the United States of America (US) with respect to HIV prevalence and the leading in cervical cancer incidence. This cross-sectional study describes the prevalence and correlates of cervical HPV infection among a clinic-based sample of 302 women living with HIV/AIDS in PR. METHODS: Data collection included questionnaires, blood and cervical samples. Multivariable logistic regression models were used to estimate the magnitude of association (adjusted Prevalence odds ratio [aPOR]) between HPV cervical infection and other covariates. RESULTS: Mean age of participants was 40.3 years (± 10.3SD). The prevalence of HPV infection was 50.3%; 41.1% for low-risk types and 29.5% for high-risk types. Having ≥ 10 lifetime sexual partners (aPOR = 2.10, 95% CI:1.02-4.29), an abnormal Pap (aPOR = 3.58, 95% CI:1.93-6.62), active genital warts (aPOR = 3.45, 95% CI:1.60-7.42), and CD4 counts ≤ 200 (aPOR = 4.24, 95% CI: 1.67-10.78) were positively associated with any cervical HPV infection. Similar results were observed for HR HPV infection. CONCLUSIONS: A high burden of HPV co-infection exists among women living with HIV/AIDS in this population. Given the high incidence of HIV in PR and the higher risk of cervical cancer among women living with HIV/AIDS, HPV vaccination should be promoted in this population.
Assuntos
Colo do Útero/virologia , Coinfecção/epidemiologia , Infecções por HIV/epidemiologia , Hispânico ou Latino , Infecções por Papillomavirus/etnologia , Infecções por Papillomavirus/epidemiologia , Adulto , Coinfecção/virologia , Condiloma Acuminado/epidemiologia , Condiloma Acuminado/etiologia , Condiloma Acuminado/virologia , Efeitos Psicossociais da Doença , Estudos Transversais , DNA Viral , Feminino , Infecções por HIV/complicações , Infecções por HIV/virologia , Humanos , Modelos Logísticos , Razão de Chances , Papillomaviridae/genética , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/virologia , Prevalência , Porto Rico/epidemiologia , Fatores de Risco , Parceiros Sexuais , Inquéritos e Questionários , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/etiologia , Neoplasias do Colo do Útero/virologiaRESUMO
OBJECTIVES: Antiretroviral therapy during pregnancy is recommended to reduce the risk of mother-to-child transmission of HIV and for maternal care management. Physiological changes during pregnancy can affect pharmacokinetics, potentially altering pharmacological activity. We therefore evaluated the pharmacokinetics of twice-daily (bid) darunavir in HIV-1-infected pregnant women. METHODS: HIV-1-infected pregnant women receiving an antiretroviral regimen containing darunavir/ritonavir 600/100 mg bid were enrolled in this study. Total and unbound darunavir and total ritonavir plasma concentrations were obtained over 12 h during the second and third trimesters and postpartum. Total darunavir and ritonavir plasma concentrations were determined using a validated high-performance liquid chromatography tandem mass spectrometry assay and unbound darunavir was determined using (14) C-darunavir-fortified plasma. Pharmacokinetic parameters were derived using noncompartmental analysis. RESULTS: Data were available for 14 women. The area under the plasma concentration-time curve from 0 to 12 h (AUC12h) for total darunavir was 17-24% lower during pregnancy than postpartum. The AUC12h for unbound darunavir was minimally reduced during pregnancy vs. postpartum. The minimum plasma concentration (Cmin) of total and unbound darunavir was on average 43-86% and 10-14% higher, respectively, during pregnancy vs. postpartum. The antiviral response (< 50 HIV-1 RNA copies/mL) was 33% at baseline and increased to 73-90% during treatment; the percentage CD4 count increased over time. One serious adverse event was reported (increased transaminase). All 12 infants born to women remaining in the study at delivery were HIV-1-negative; four of these infants were premature. CONCLUSIONS: Total darunavir exposure decreased during pregnancy. No clinically relevant change in unbound (active) darunavir occurred during pregnancy, suggesting that no dose adjustment is required for darunavir/ritonavir 600/100 mg bid in pregnant women.
Assuntos
Infecções por HIV/metabolismo , Inibidores da Protease de HIV/farmacocinética , HIV-1 , Complicações Infecciosas na Gravidez/metabolismo , Ritonavir/farmacocinética , Sulfonamidas/farmacocinética , Adolescente , Adulto , Darunavir , Esquema de Medicação , Feminino , Sangue Fetal/química , Infecções por HIV/tratamento farmacológico , Inibidores da Protease de HIV/administração & dosagem , Humanos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Resultado da Gravidez , Ritonavir/administração & dosagem , Sulfonamidas/administração & dosagem , Adulto JovemRESUMO
OBJECTIVE: There are limited antiretroviral options for use in the treatment of HIV infection during pregnancy. The purpose of this study was to assess the safety, efficacy and appropriate dosing regimen for ritonavir (RTV)-boosted atazanavir in HIV-1-infected pregnant women. METHODS: In this nonrandomized, open-label study, HIV-infected pregnant women were dosed with either 300/100 mg (n=20) or 400/100 mg (n=21) atazanavir/RTV once-daily (qd) in combination with zidovudine (300 mg) and lamivudine (150 mg) twice daily in the third trimester. Pharmacokinetic parameters [maximum observed plasma concentration (C(max) ), trough observed plasma concentration 24 hour post dose (C(min) ) and area under concentration-time curve in one dosing interval (AUC(τ) )] were determined and compared with historical values (300/100 mg atazanavir/RTV) for HIV-infected nonpregnant adults (n=23). RESULTS: At or before delivery, all mothers achieved HIV RNA <50 HIV-1 RNA copies/mL and all infants were HIV DNA negative at 6 months of age. The third trimester AUC(τ) for atazanavir/RTV 300/100 mg was 21% lower than historical data, but the C(min) values were comparable. The C(min) value for atazanavir/RTV 400/100 mg was 39% higher than the C(min) for atazanavir/RTV 300/100 mg in historical controls, but the AUC(τ) values were comparable. Twice as many patients in the 400/100 mg group (62%) had an increase in total bilirubin (>2.5 times the upper limit of normal) as in the 300/100 mg group (30%). Atazanavir (ATV) was well tolerated with no unanticipated adverse events. CONCLUSIONS: In this study, use of atazanavir/RTV 300/100 mg qd produced C(min) comparable to historical data in nonpregnant HIV-infected adults. When used in combination with zidovudine/lamivudine, it suppressed HIV RNA in all mothers and prevented mother-to-child transmission of HIV-1 infection. During pregnancy, the pharmacokinetics, safety and efficacy demonstrated that a dose adjustment is not required for ATV.
Assuntos
Infecções por HIV/prevenção & controle , Inibidores da Protease de HIV/farmacocinética , HIV-1 , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Oligopeptídeos/farmacocinética , Complicações Infecciosas na Gravidez/tratamento farmacológico , Piridinas/farmacocinética , Ritonavir/farmacocinética , Adulto , Sulfato de Atazanavir , Contagem de Linfócito CD4 , Esquema de Medicação , Quimioterapia Combinada , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Infecções por HIV/transmissão , Inibidores da Protease de HIV/administração & dosagem , HIV-1/imunologia , Humanos , Oligopeptídeos/administração & dosagem , Gravidez , Complicações Infecciosas na Gravidez/virologia , Porto Rico/epidemiologia , Piridinas/administração & dosagem , Ritonavir/administração & dosagem , África do Sul/epidemiologia , Estados Unidos/epidemiologia , Carga ViralRESUMO
HIV infection is increasing in minority groups, particularly in African American and Hispanic women. Although the incidence of HIV dementia has decreased since the advent of highly active antiretroviral treatment, prevalence of neurocognitive complications has increased as patients are now living longer. This study's purpose was to determine the psychometric properties of the Spanish-language HIV Dementia Scale (HDS) in a group of HIV-infected women. We recruited 96 women: 60 HIV-seropositive and 36 HIV-seronegative. Modification of the HDS into a Spanish-language version consisted of translating the instructions, substituting four words in Spanish (gato, media, azul, piña), increasing 1 second in the psychomotor speed because the Spanish alphabet has more letters than the English alphabet, and not offering clues for memory recall. Cognitive impairment (CI) was defined according to the modified American Academy of Neurology HIV-dementia criteria including an asymptomatic CI group. Statistical analysis consisted of analysis of variance to determine group differences and receiver operator characteristics (ROC) to determine the optimal cutoff point for the screening of CI. HDS-Spanish total score and subscores for psychomotor speed and memory recall showed significant differences between HIV-seronegative and women with HIV-dementia (p < 0.001) and between HIV-seropositive women with normal cognition and those with HIV-dementia (p < 0.001). The optimal cutoff point of 13 or less had performance characteristics of 87% sensitivity and 46% specificity for HIV-associated CI (50.0% positive predictive value, 85.0% negative predictive value). The HDS-Spanish translation offers a useful screening tool with value for the identification of Hispanic women at risk of developing HIV-associated symptomatic neurocognitive disturbances.
Assuntos
Complexo AIDS Demência/classificação , Complexo AIDS Demência/diagnóstico , Complexo AIDS Demência/epidemiologia , Adulto , Depressão/classificação , Feminino , Soronegatividade para HIV , Soropositividade para HIV , Humanos , Testes de Inteligência , Memória , Pessoa de Meia-Idade , Estudos Prospectivos , Psicometria , Desempenho Psicomotor , Porto Rico/epidemiologia , Curva ROC , Reprodutibilidade dos TestesRESUMO
The AIDS pandemic had a significant impact in Puerto Rico, especially among the heterosexual populations, in particular women. Women are one of the fastest growing risk groups with HIV/AIDS in the USA and constitute about half of the AIDS cases in the world. During the past 10 years Puerto Rico has ranked among the top 5 jurisdictions in the United States in AIDS cases rates, among men, women and children. In 1987 a universal prenatal HIV screening program was implemented in the University Hospital catchment area consisting of approximately 5,000 deliveries per year. Because of the early identification of pregnant women living with HIV, access to lifesaving clinical research and the implementation of multiple strategies and comprehensive care, the perinatal HIV transmission has been reduced to zero since 1997, with a blip of one case in 2002, and none since then. The availability and access to clinical and behavioral research has been one of the key elements for this success story. The programs involved and responsible for this spectacular outcome, namely the Maternal Infant Studies Center (CEMI-Spanish Acronym) and Gamma Projects at the University of Puerto Rico School of Medicine are described. The cost savings impact of stopping mother-infant perinatal HIV-1 transmission has been calculated to be approximately $34 to $58 million dollars in 10 years. The impact of the effectiveness of these programs in having healthy uninfected infants, prolonging and improving the quality of life of those living with HIV, and providing hope to families affected by this epidemic is incalculable.
Assuntos
Humanos , Transmissão Vertical de Doenças Infecciosas , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Faculdades de Medicina , Avaliação de Programas e Projetos de Saúde , Porto RicoRESUMO
CONTEXT: Despite the success of highly active antiretroviral therapy, the optimal approach for preventing perinatal HIV-1 transmission is not known. OBJECTIVE: A retrospective survey was conducted at six centers in the United States and Puerto Rico from January 1997 to October 1998 to evaluate the effects of protease inhibitor use during pregnancy on maternal and infant safety, prematurity rate, and frequency of perinatal HIV-1 transmission. RESULTS: In the study, 91 live infants, including 3 sets of twins, and 1 neonate who died shortly after birth were born to 89 women. HIV perinatal transmission rate in this series was 0 (95% confidence interval [CI], 0%-3%). Prematurity rate was 19.1%, comparable to rates in earlier reports of HIV-1-infected women. In multiple regression analysis, only cocaine use and premature rupture of membranes were associated with prematurity (p =.03 and.008, respectively). The gestational week during which the protease inhibitors were initiated was not found to be significantly associated with prematurity. Adverse maternal, obstetric, and infant events possibly related to protease inhibitors were uncommon. CONCLUSIONS: Protease inhibitors appeared generally safe in mothers and infants in this series. No perinatal HIV-1 transmission occurred. Further prospective, controlled studies are needed to define the optimal management of HIV-1 in pregnancy.
Assuntos
Terapia Antirretroviral de Alta Atividade , Infecções por HIV/transmissão , Inibidores da Protease de HIV/administração & dosagem , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Complicações Infecciosas na Gravidez/tratamento farmacológico , Adolescente , Adulto , Índice de Apgar , Linfócitos T CD4-Positivos , Feminino , Infecções por HIV/prevenção & controle , Humanos , Lamivudina/administração & dosagem , Modelos Lineares , Estudos Multicêntricos como Assunto , Gravidez , Porto Rico , Análise de Regressão , Estudos Retrospectivos , Inibidores da Transcriptase Reversa/administração & dosagem , Inquéritos e Questionários , Estados Unidos , Carga Viral , Zidovudina/administração & dosagemRESUMO
During the past five years there have been significant advances in the knowledge of the factors that affect mother-to-infant HIV-1 transmission. Diverse interventions have been designed and proven effective in reducing the risk of such transmission. In reviewing the pivotal literature in such respect implications for public policy are also analyzed. Because of the constant evolution of the interventions, the public policies also need constant revisions. The impact of viral load assessment during pregnancy and its relationship to transmission risks is discussed, as well as the effectiveness of elective Caesarean delivery. The latter has both positive and negative aspects which merit consideration. Newer approaches, such as highly active anti retroviral therapies (HAART), which have shown to decrease the AIDS mortality, have also shown zero transmission in small cohorts. Shorter and cheaper interventions are also somewhat effective and are good alternatives to resource poor countries.
Assuntos
Síndrome da Imunodeficiência Adquirida/transmissão , Fármacos Anti-HIV/uso terapêutico , HIV-1 , Transmissão Vertical de Doenças Infecciosas , Complicações Infecciosas na Gravidez , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Adulto , Cesárea , Ensaios Clínicos como Assunto , Feminino , HIV-1/genética , HIV-1/isolamento & purificação , Humanos , Recém-Nascido , Lamivudina/uso terapêutico , Masculino , Monitorização Fisiológica , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Política Pública , RNA Viral/análise , Sistema de Registros , Inibidores da Transcriptase Reversa/uso terapêutico , Fatores de Risco , Carga Viral , Zidovudina/uso terapêuticoRESUMO
Women have been placed at a vulnerable situation regarding the HIV epidemic. Recent advances in antiretroviral therapies have placed in evidence the gender disparities and the new challenges to overcome them. The mortality of AIDS has decreased dramatically in the United States and Puerto Rico as a consequence of new combination therapies. Still, women constitute the fastest growing group of AIDS cases. There are gender differences in access to treatment and care, economic income and social and personal power. Among women's barriers to care are the lack of knowledge about AIDS in women by health providers, the family responsibilities and the burden and fear of disclosure. The authors suggest the need for empowerment as strategy for attaining better health and improving the quality of life in women living with HIV.
Assuntos
Infecções por HIV/prevenção & controle , Saúde da Mulher , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Feminino , HumanosRESUMO
The HIV/AIDS epidemic has presented many challenges to both: researchers and care providers. In addition, the concepts and models of human behavior needed a re-examination in response to this pandemic. We are redefining both empowerment and sexual negotiation for women living with HIV. Empowerment is defined as a process of awareness throughout which women recognize their capacity to achieve individual and social changes. This process involves a mental and spiritual awareness that will enable them to focus on their physical, psychological and social aspects. For women living with HIV, this is also a strategy for survival. For women living with HIV, sexual negotiation is a straightforward issue: it is either safer sex or nothing. Safer sexual practices then are a consequence or by-product of the process of empowerment. To facilitate this process our approach is directed to the individual, in an attempt to reach the inner power source that all human beings share.
Assuntos
Infecções por HIV , Comportamento Sexual , Mulheres , Atitude Frente a Saúde , Feminino , Humanos , PesquisaRESUMO
A tri-functional in vitro evaluation has been utilized to analyze peripheral blood mononuclear cells (BMNC) from HIV-infected patients, which allows for the classification of these individuals into convenient stages, according to the number of in vitro parameters affected. The classifying functional parameters are: the mitochondrial metabolic activity of freshly isolated BMNC, measured by an MTT reduction assay, the detection of apoptosis in 72 hour cultures of these cells assessed by propidium iodide staining and dual parametric flow cytometric analysis, and their proliferative response to pokeweed mitogen. Our results indicate that HIV-infected patients at different stages of their clinical disease, can present dysfunctions in one, two or three of the above-mentioned parameters. Based on these results, patients can be classified into four newly-described stages which are Stage 0, including uninfected controls and all patients with unaffected parameters, and Stages 1, 2 and 3, including patients having one, two or all three parameters affected, respectively. This type of immunological evaluation and classification of HIV-infected patients has the potential of becoming a predictive tool in the longitudinal follow-up of their HIV infection.