Postpartum changes in plasma viral load and CD4 percentage among HIV-infected women from Latin American and Caribbean countries: the NISDI Perinatal Study

Saludos
Dr. Carlos Erazo
http://www.scielo.br/pdf/mioc/v106n1/16.pdf

The goal of this study was to evaluate changes in plasma human immunodeficiency virus (HIV) RNA concentration [viral load (VL)] and CD4+  percentage (CD4%) during 6-12 weeks postpartum (PP) among HIV-infected women and to assess differences according to the reason for receipt of antiretrovirals (ARVs) during pregnancy [prophylaxis (PR) vs. treatment (TR)]. Data from a prospective cohort of HIV-infected pregnant women (National Institute of Child Health and Human Development International Site Development Initiative Perinatal Study) were analyzed. Women experiencing their first pregnancy who received ARVs for PR (started during pregnancy, stopped PP) or for TR (initiated prior to pregnancy and/or continued PP) were included and were followed PP. Increases in plasma VL  (≥ 0.5 log 10 ) and decreases in CD4% (≥ 20% relative decrease in CD4%) between hospital discharge (HD) and PP were assessed. Of the 1,229 women enrolled, 1,119 met the inclusion criteria (PR: 601; TR: 518). At enrollment, 87%  were asymptomatic. The median CD4% values were: HD [34% (PR); 25% (TR)] and PP [29% (PR); 24% (TR)]. The  VL increases were 60% (PR) and 19% (TR) (p < 0.0001). The CD4% decreases were 36% (PR) and 18% (TR) (p < 0.0001). Women receiving PR were more likely to exhibit an increase in VL [adjusted odds ratio (AOR) 7.7 (95%  CI: 5.5-10.9) and a CD4% decrease (AOR 2.3; 95% CI: 1.6-3.2). Women receiving PR are more likely to have VL increases and CD4% decreases compared to those receiving TR. The clinical implications of these VL and CD4% changes remain to be explored. 

Vertical transmission of HIV-1 in the western region of the State of São Paulo

Saludos colegas
Dr. Carlos Erazo

http://www.scielo.br/pdf/rsbmt/v44n1/02.pdf

ABSTRACT

Introduction: This study aimed to determine the prevalence of vertical HIV-1 transmission  in the western region of the State of São Paulo, Brazil. Methods: The study analyzed the medical records of HIV-1-infected mothers and infant pairs living in the municipalities of São Paulo Regional Health Departments DRS II (Araçatuba) and DRS XI (Presidente Prudente). From March 2001 to March 2006, blood samples were collected and referred to the Molecular Biology Unit of the Adolfo Lutz Institute (ALI), Presidente Prudente. HIV-1-RNA viral load was determined by bDNA assay. Results: The number of births (109/217, 50.2%) and vertical HIV-1 transmissions (6/109, 5.5%) that occurred in DRS II was similar to births (108/217, 49.8%) and vertical transmissions (7/108, 6.5%) in DRS XI (p > 0.05). Although 80% (4/5) of the infected children were male in DRS II, while in DRS XI, 75% (6/8) were female, no differences between sex regarding infected and noninfected children in the regions of Araçatuba and Presidente Prudente were verified. The overall vertical HIV-1 transmission rate was 6%. No consistent reduction in the prevalence of vertical HIV-1 transmission occurred over the years. About 20% of mothers did not know the HIV-1 status 

of their newborns eight months after delivery. Conclusions: In the present study, MTCT prevalence rates were about 70% higher than those previously determined in the State of São Paulo, with no reduction throughout the period. Furthermore, a significant number of mothers did not know the HIV-status of their newborns eight months after delivery

Acceptability of donated breast milk in a resource limited South African setting

Estimados colegas, continuo colocando información en este sitio donde podemos continuar informandonos de lo que existe en cuanto a VIH.

Saludos 

Dr. Carlos Erazo

http://www.internationalbreastfeedingjournal.com/content/pdf/1746-4358-6-3.pdf

Background 

The importance of breast milk for infants’ growth, development and overall health is widely recognized. In situations where women are not able to provide their infants with sufficient amounts of their own breast milk, donor breast milk is the next preferred option. Although there is considerable research on the safety and scientific aspects of donor milk, and the motivations and experiences of donors, there is limited research addressing the attitudes and experiences of the women and families whose infants receive this milk. This study therefore examined attitudes towards donated breast milk among mothers, families and healthcare providers of potential recipient infants.  

Methods 

The study was conducted at a public hospital and nearby clinic in Durban, South Africa. The qualitative data was derived from eight focus group discussions which included four groups with mothers; one with male partners; and one with grandmothers, investigating attitudes towards receiving donated breast milk for infants. There was also one group each with nurses and doctors about their attitudes towards donated breast milk and its use in the hospital. The focus groups were conducted in September and October 2009 and each group had between four and eleven participants, leading to a total of 48 participants. 

Results 

Although breast milk was seen as important to child health there were concerns about undermining of breast milk because of concerns about HIV and marketing and promotion of formula milks. In addition there were concerns about the safety of donor breast milk and discomfort about using another mother’s milk. Participants believed 3 that education on the importance of breast milk and transparency on the processes 

involved in sourcing and preparing donor milk would improve the acceptability.  

Conclusions 

This study has shown that there are obstacles to the acceptability of donor milk, mainly stemming from lack of awareness/familiarity with the processes around donor breast milk and that these could be readily addressed through education. Even the more psychological concerns would also likely be reduced over time as these educational efforts progress. With government and health care worker endorsement and commitment, breast milk donation could have a promising role in improving child health.

The STEP Study Provides a Hint That Vaccine Induction of the Right CD8 1 T Cell Responses Can Facilitate Immune Control of HIV

Estimados colegas , este es un estudio interesante vale la pena leerlo.

Saludos 

Dr. Carlos Erazo

The STEP study was a large, randomized, placebo-controlled, test-of-concept vaccine trial using an Ad5 vector expressing human immunodeficiency virus (HIV)–1 Gag, Pol, and Nef designed to induce T cell immunity to HIV-1. This trial was stopped and unblinded in 2007 after an interim analysis showed that the vaccine did not achieve efficacy for the 2 primary study end points, HIV-1 acquisition and plasma HIV-1 RNA levels 3 months after diagnosis of HIV-1 infection, and suggested that vaccinated individuals with high preexisting antibody titers against Ad5 might be at a higher risk of acquiring HIV-1 infection [1–2]. These results initiated reconsideration in the HIV-1 research field of the role of T cells in protection from HIV-1 infection and disease progression.

http://jid.oxfordjournals.org/content/203/6/753.full.pdf+html

“One Teabag Is Better than Four”: Participants Response to the Discontinuation of 2% PRO2000/5 Microbicide Gel in KwaZulu-Natal, South Africa

Estimados colegas, otro artículo.

Saludos 

Dr. Carlos Erazo

http://www.plosone.org/article/info:doi/10.1371/journal.pone.0014577

Introduction

The Microbicides Development Programme evaluated the safety and effectiveness of 0.5% and 2% PRO2000/5 microbicide gels in reducing the risk of vaginally acquired HIV. In February 2008 the Independent Data Monitoring Committee recommended that evaluation of 2% PRO2000/5 gel be discontinued due to futility. The Africa Centre site systematically collected participant responses to this discontinuation.

Methods

Clinic and field staff completed field reports using ethnographic participant observation techniques. In-depth-interviews and focus group discussions were conducted with participants discontinued from 2% gel. A total of 72 field reports, 12 in-depth-interviews and 3 focus groups with 250 women were completed for this analysis. Retention of discontinued participants was also analysed. Qualitative data was analysed using NVivo 2 and quantitative data using STATA 10.0.

Results

Participants responded initially with fear that discontinuation was due to harm, followed by acceptance after effective messaging, and finally with disappointment. Participants reported that their initial fear was exacerbated by being contacted and advised to visit the clinic for information about the closure. Operational changes were subsequently made to the contact procedures. By incorporating feedback from participants, messages were continuously revised to ensure that information was comprehensible and misconceptions were addressed quickly thereby enabling participants to accept the discontinuation. Participants were disappointed that 2% PRO2000/5 was being excluded as a HIV prevention option, but also that they would no longer have access to gel that improved their sexual relationships with their partners and assisted condom negotiations. In total 238 women were discontinued from gel and 185 (78%) went on to complete their scheduled follow-up period.

Discussion

The use of qualitative social science techniques allowed the site team to amend operational procedures and messaging throughout the discontinuation period. This proved instrumental in ensuring that the discontinuation was successfully completed in a manner that was both understandable and acceptable to participants.

Associação entre violência por parceiro íntimo contra a mulher e infecção por HIV

Estimados colegas , otro artículo interesante.

Saludos

Dr.Carlos Erazo

RESUMO

OBJETIVO: Analisar a associação entre a violência por parceiro íntimo contra mulheres e a infecção ou suspeita de infecção pelo vírus da imunodefi ciência humana (HIV).

MÉTODOS: Estudo transversal com base em dados de questionários aplicados face-a-face e de prontuários médicos de 2.780 mulheres de 15 a 49 anos, atendidas em unidades do sistema único de saúde da Grande São Paulo, SP, em 2001-2002. As mulheres foram categorizadas em: usuárias em tratamento 

por serem “soropositivas para o HIV”, com “suspeita de HIV” e aquelas que procuraram os serviços por outros motivos. A violência por parceiro íntimo contra mulheres na vida foi categorizada por gravidade e recorrência dos episódios de violência. A associação com o desfecho foi testada pelo modelo de Poisson com variância robusta e ajustada por variáveis sociodemográfi cas, sexuais e reprodutivas.

RESULTADOS: A prevalência de violência foi de 59,8%. Sofrer violência reiterada e grave apresentou maior associação de infecção confi rmada pelo HIV (RP = 1,91). A violência independente da gravidade e da recorrência dos episódios apresentou maior associação para a suspeita de infecção por HIV (RP = 1,29). 

CONCLUSÕES: A violência por parceiro íntimo contra mulheres tem papel relevante nas situações de suspeita e confi rmação da infecção pelo HIV, sendo essencial incluir sua detecção, controle e prevenção como parte da atenção integral à saúde das mulheres.

HCV co-infection in HIV positive population in British Columbia, Canada

Estimados colegas este es otro artículo interesante.

Saludos

Dr. Carlos Erazo

http://www.biomedcentral.com/content/pdf/1471-2458-10-225.pdf

Abstract

Background: As HIV and hepatitis C (HCV) share some modes of transmission co-infection is not uncommon. This study used a population-based sample of HIV and HCV tested individuals to determine the prevalence of HIV/HCV coinfection, the sequence of virus diagnoses, and demographic and associated risk factors. Methods: Positive cases of HIV were linked to the combined laboratory database (of negative and positive HCV antibody results) and HCV reported cases in British Columbia (BC).

Results: Of 4,598 HIV cases with personal identifiers, 3,219 (70%) were linked to the combined HCV database, 1,700  (53%) of these were anti-HCV positive. HCV was diagnosed first in 52% of co-infected cases (median time to HIV identification 3 1/2 years). HIV and HCV was diagnosed within a two week window in 26% of cases. Among individuals who were diagnosed with HIV infection at baseline, subsequent diagnoses of HCV infection was independently associated with: i) intravenous drug use (IDU) in males and females, Hazard Ratio (HR) = 6.64 (95% CI: 4.86-9.07) and 9.76 (95% CI: 5.76-16.54) respectively; ii) reported Aboriginal ethnicity in females HR = 2.09 (95% CI: 1.34-3.27) and iii) males not identified as men-who-have-sex-with-men (MSM), HR = 2.99 (95% CI: 2.09-4.27). Identification of HCV first compared to HIV first was independently associated with IDU in males and females OR = 2.83 (95% CI: 1.84-4.37) and 2.25 (95% CI: 1.15-4.39) respectively, but not Aboriginal ethnicity or MSM. HIV was identified first in 22%, with median time to HCV identification of 15 months; Conclusion: The ability to link BC public health and laboratory HIV and HCV information provided a unique opportunity to explore demographic and risk factors associated with HIV/HCV co-infection. Over half of persons with HIV infection who were tested for HCV were anti-HCV positive; half of these had HCV diagnosed first with HIV identification a median 3.5 years later. This highlights the importance of public health follow-up and harm reduction measures for people identified with HCV to prevent subsequent HIV infection.

Short-course zidovudine for perinatal HIV-1 transmission in Bangkok, Thailand: a randomised controlled trial

Estimados colegas, aqui un artículo interesante en cuanto a la Transmisión materno infantil.
Saludos
Dr. Carlos Erazo


http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-3WBNMWW-7&_user=10&_coverDate=03/06/1999&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_searchStrId=1656570567&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=cd7a81cfe38a07a91f1e78f5db2d535c&searchtype=a

DEPOSITO DE INFORMACION SOBRE EL ESTUDIO HSH

http://sites.google.com/site/ecuadorencuestahsh2010/home

Introduction to Biostatistics

Otro curso gratis para poder ingresar lea el silabus que esta en el siguiente link>

http://www.ccghe.jhmi.edu/assets/Biostats_Syllabus2.pdf

Saludos
Dr. Carlos Erazo

Introduction to Research Ethics Distance Education Online Course http://ccghe.org

Introduction to Research Ethics
Distance Education Online Course
http://ccghe.org

Estimados Colegas este curso on line es gratuito, les adjunto el link para que se enteren de este curso y participen los que esten interesados.

Saludos

Dr, Carlos Erazo
http://www.ccghe.jhmi.edu/assets/Research_Ethics_Online_Syllabus.pdf