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Human immunodeficiency virus infection among inner-city adolescent parturients undergoing routine voluntary screening, July 1987 to March 1991
Citationsfrom the Literature Background. Early diagnosis of human immunodeficiency (HIV) infection in infants born to infected mothers is important for the infants’ medical care, but the presence of maternal antibodies makes serologic tests uninformative. Methods. In a cohort study of 181 infants born to HIV-infected mothers, we asses& the diagnostic value of HIV viral culture and testing for the presence of p24 antigen. The infants were tested at birth, again during the first 3 months, then followed and tested at the age of at least 18 months. Results. Of the 181 infants, 3 died of HIV infection and 37 were seropositive after the age of 18 months. Viral cultures at birth were positive in 19 of the 40 infected infants and in none of the uninfected infants, yielding a sensitivity of 48% (95% confidence interval, 32 to 63%) and a specificity of 100% (95% confidence interval, 97 to 100 percent). By the age of three months, 30 of the 40 infants (75%) had positive cultures; again, there were no false positive results among the infants who were tested a second time, of the 141 who remained uninfected. The sensitivity of testing for p24 antigen at birth was only 18%, with a specificity of 100%. The presence of p24 antigen at birth was associated with the development of early and severe HIV-related disease (P < 0.04). Conclusions. Viral culture. at birth can correctly identify about half of newborns with HIV infection. The fact that this usually sensitive technique fails to identify about half the ultimately infected neonates suggests that vertical transmission of HIV may occur late in pregnancy or during delivery.
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Lindsay MK, Johnson N, Peterson HB; Willis S; Williams H; Klein L Department of Gynecology/Obstetrics, Emory University School of Medicine, Grady Memorial Hospital, PO Box 26158. Atlanta, GA 30335, USA AM J OBSTET GYNECOL 1992 167/4 1(1096-1099) Objective: The objective of our study was to describe the human immunodeficiency virus epidemic among pregnant adolescents undergoing follow-up in a large inner-city hospital. Study design: We conducted a case-control study comparing demographic and risk behaviors of seropositive and seronegative adolescents (aged 13 to 20) identitied from a population undergoing routine voluntary antibody screening at Grady Memorial Hospital in Atlanta, Georgia, between July 1987 and March 1991. Results: Of 10,794 pregnant adolescents screened, 51 (4.711000)were infected with human immunodeficiency virus. More than one fourth of case patients were s 17 years old. Significantly more case patients than controls reported a history of crack cocaine use (10 [ 19.6%] vs. 23 [8.2%] P < 0.05). A majority (58.8%) of case patients reported no risk factors for infection, and the remainder (41.2%) were presumably infected by heterosexual contact. Thirty-nine controls (13.8%) had self-identified risk factors for infection. Conclusions: Pregnant adolescents in our center are at risk for human immunodeficiency virus infection and should be targeted for human immunodeficiency virus education and risk reduction counseling.
Viscarello RR; Williams CJ; DeGennaro NJ; Hobbins JC Division of Maternal-Fetal Medicine, Department of Obstetrics/ Gynecology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA AM J OBSTET GYNECOL 1992 16714I (1080-1085) Objectives: Anticardiolipin antibodies are estimated to occur in 2.2% of all pregnancies and are associated with adverse outcomes including thrombotic events, fetal wastage, intrauterine growth retardation, and preterm delivery. We studied 32 human immunodeticiency virus-seropositive gravidas (1) to determine the prevalence of anticardiolipin antibodies in pregnant women infected with human immunodeficiency virus-l and (2) to investigate the association between the presence of anticardiolipin antibodies and pregnancy outcome, disease status, and perinatal transmission of human immunodeficiency virus-l. Study design: Serum samples obtained at the first prenatal visit were analyzed for anticardiolipin immunoglobulin M and immunoglobulin G by enzyme-linked immunosorbent assay. Relevant antepartum, intrapartum, and postpartum data, including maternal CD4+ lymphocyte subsets, human immunodeficiency virus p24 antigen determinations, Venereal Disease Research Laboratory test, hematocrit, platelet counts, and placental pathologic tissue of the anticardiolipin antibodypositive and anticardiolipin antibody-negative groups were compared. Results: Test results for 17 (53%) of patients were positive for anticardiolipin antibody: 4 had only immunoglobulin M, 1 had only immunoglobulin G, and the remaining 12 had both antibodies. The patients in the anticardiolipin antibodypositive group were delivered of infants with a mean gestational age of 39 weeks and mean birth weight of 2983 gm. In the anticardiolipin antibody-negative group 15 deliveries had a mean gestational age of 36.3 weeks and a mean birth weight of 2330 gm. Conclusions: We conclude that there is a high prevalence of anticardiolipin antibodies in patients who have human immunodeticiency virus, which is not associated with adverse maternal or neonatal outcome, maternal human immunodeficiency ViNS status, or perinatal transmission of human immunodeficiency virus-l.
FetaIbkmdsampBuginhnman~vinrc serqt&Be wemen before eIeetive midbhwster terminationof prw Viscarello RR; Cullen MT; DeGennaro NJ; Hobbins JC Division of Maternal-Fetal Medicine, Department of Obstetrics/Gynecology, Yale University School of Medicine, 333 Cedar St., New Haven, CT 06510. USA AM J OBSTET GYNECOL 1992 167/4 1(1075-1079) Objectives: To explore the diagnostic potential of fetal blood sampling in the prenatal diagnosis of intrauterine human immunodeficiency virus infection and to investigate the transplacental transfer of human immunodeticiency virus antibody and p24 antigen in the second trimester of pregnancy, we studied serum and amniotic fluid obtained from 13 seropositive Int J Gynecol Obstet 41
331
virus
Lindsay MK, Johnson N, Peterson HB; Willis S; Williams H; Klein L Department of Gynecology/Obstetrics, Emory University School of Medicine, Grady Memorial Hospital, PO Box 26158. Atlanta, GA 30335, USA AM J OBSTET GYNECOL 1992 167/4 1(1096-1099) Objective: The objective of our study was to describe the human immunodeficiency virus epidemic among pregnant adolescents undergoing follow-up in a large inner-city hospital. Study design: We conducted a case-control study comparing demographic and risk behaviors of seropositive and seronegative adolescents (aged 13 to 20) identitied from a population undergoing routine voluntary antibody screening at Grady Memorial Hospital in Atlanta, Georgia, between July 1987 and March 1991. Results: Of 10,794 pregnant adolescents screened, 51 (4.711000)were infected with human immunodeficiency virus. More than one fourth of case patients were s 17 years old. Significantly more case patients than controls reported a history of crack cocaine use (10 [ 19.6%] vs. 23 [8.2%] P < 0.05). A majority (58.8%) of case patients reported no risk factors for infection, and the remainder (41.2%) were presumably infected by heterosexual contact. Thirty-nine controls (13.8%) had self-identified risk factors for infection. Conclusions: Pregnant adolescents in our center are at risk for human immunodeficiency virus infection and should be targeted for human immunodeficiency virus education and risk reduction counseling.
Viscarello RR; Williams CJ; DeGennaro NJ; Hobbins JC Division of Maternal-Fetal Medicine, Department of Obstetrics/ Gynecology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA AM J OBSTET GYNECOL 1992 16714I (1080-1085) Objectives: Anticardiolipin antibodies are estimated to occur in 2.2% of all pregnancies and are associated with adverse outcomes including thrombotic events, fetal wastage, intrauterine growth retardation, and preterm delivery. We studied 32 human immunodeticiency virus-seropositive gravidas (1) to determine the prevalence of anticardiolipin antibodies in pregnant women infected with human immunodeficiency virus-l and (2) to investigate the association between the presence of anticardiolipin antibodies and pregnancy outcome, disease status, and perinatal transmission of human immunodeficiency virus-l. Study design: Serum samples obtained at the first prenatal visit were analyzed for anticardiolipin immunoglobulin M and immunoglobulin G by enzyme-linked immunosorbent assay. Relevant antepartum, intrapartum, and postpartum data, including maternal CD4+ lymphocyte subsets, human immunodeficiency virus p24 antigen determinations, Venereal Disease Research Laboratory test, hematocrit, platelet counts, and placental pathologic tissue of the anticardiolipin antibodypositive and anticardiolipin antibody-negative groups were compared. Results: Test results for 17 (53%) of patients were positive for anticardiolipin antibody: 4 had only immunoglobulin M, 1 had only immunoglobulin G, and the remaining 12 had both antibodies. The patients in the anticardiolipin antibodypositive group were delivered of infants with a mean gestational age of 39 weeks and mean birth weight of 2983 gm. In the anticardiolipin antibody-negative group 15 deliveries had a mean gestational age of 36.3 weeks and a mean birth weight of 2330 gm. Conclusions: We conclude that there is a high prevalence of anticardiolipin antibodies in patients who have human immunodeticiency virus, which is not associated with adverse maternal or neonatal outcome, maternal human immunodeficiency ViNS status, or perinatal transmission of human immunodeficiency virus-l.
FetaIbkmdsampBuginhnman~vinrc serqt&Be wemen before eIeetive midbhwster terminationof prw Viscarello RR; Cullen MT; DeGennaro NJ; Hobbins JC Division of Maternal-Fetal Medicine, Department of Obstetrics/Gynecology, Yale University School of Medicine, 333 Cedar St., New Haven, CT 06510. USA AM J OBSTET GYNECOL 1992 167/4 1(1075-1079) Objectives: To explore the diagnostic potential of fetal blood sampling in the prenatal diagnosis of intrauterine human immunodeficiency virus infection and to investigate the transplacental transfer of human immunodeticiency virus antibody and p24 antigen in the second trimester of pregnancy, we studied serum and amniotic fluid obtained from 13 seropositive Int J Gynecol Obstet 41