Reducing the Odds Preventing Perinatal Transmission of HIV in the United States (1999) / Chapter Skim
Currently Skimming:
4 Natural History, Detection, and Treatment of HIV Infection in Pregnant Women and Newborns
4 Natural History, Detection, and Treatment of HIV Infection in Pregnant Women and Newborns
Pages 45-53
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 45... ...
Improved detection and treatment of HIV infection in pregnant women has greatly reduced perinatal HIV transmission in the United States. In addition, advances in the early diagnosis and treatment of HIV-infected infants have markedly improved the clinical outcome following perinatal infection.
|
From page 46... ...
FACTORS ASSOCIATED WITH HIV MATERNAL-CHILD TRANSMISSION The observed variability in reported transmission rates probably reflects the multiple factors that influence perinatal HIV transmission. Several studies have
|
From page 47... ...
STRATEGIES TO PREVENT PERINATAL HIV TRANSMISSION Recent advances in our understanding of the timing and pathogenesis of vertical HIV infection have led to the evaluation of a variety of strategies to prevent vertical HIV transmission, including the management of maternal coinfections, maternal nutritional intervention, bypassing the route of exposure, maternal and infant antiretroviral therapy, and vaccination. The primary focus has been on the use of perinatal antiretroviral therapy to prevent vertical HIV transmission.
|
From page 48... ...
While the risk of vertical HIV transmission in this study was directly correlated with maternal blood viral load and indirectly correlated with maternal CD4 count, the treatment effect was independent of maternal viral load and CD4 count (Sperling et al., 1996~. Studies conducted in the United States and Europe indicate widespread acceptance of the recommended ZDV regimen, and report resultant reductions in transmission rates to between 3% and 10% (Fiscus et al., 1996; Mayaux et al., 1997~.
|
From page 49... ...
The Phase I evaluation of combination antiretroviral regimens, including protease inhibitors, in pregnant women and young infants is now under way through the ACTG. An ACTG Phase IIIIII trial evaluating the efficacy of nevirapine (a nonnucleoside reverse transcriptase inhibitor)
|
From page 50... ...
so ca · v, of be · - ~ o a' be ¢ o no c)
|
From page 51... ...
In a recently reported study, cesarean section appeared to reduce the risk of vertical HIV-1 transmission; however, the benefit of cesarean section was only apparent when performed prior to the onset of labor and in mother-infant pairs who received ZDV (Mandelbrot et al., 1998~. Virocidal cleansing of the birth canal prior to vaginal delivery has also been proposed as a means of reducing intrapartum HIV transmission, though a study in Malawi that evaluated chlorhexidine vaginal cleansing during labor did not find an overall reduction in transmission (Bigger et al., 1996~.
|
From page 52... ...
With efficient transfer of antibodies from an infected woman to her fetus during the third trimester of pregnancy, all infants born at or near term to an HIV-infected woman will be HIV-seropositive; uninfected infants may retain passively acquired antibodies through 18 months of age. The detection of HIV proviral genome in peripheral blood mononuclear cells using the polymerase chain reaction (DNA PCR)
|
From page 53... ...
When maternal serostatus is unknown, however, HIV antibody testing of the newborn is important for the identification of children at risk for perinatal HIV infection and early referral for appropriate medical evaluation and care. Control of viral replication and preservation of the developing immune system have been demonstrated in infants who initiated intensive combination antiretroviral therapy in early infancy (Luzuriaga et al., 1997~.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.