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The transfer of anti-human immunodeficiency virus nucleoside compounds by the term human placenta
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Citations from the Literature
We identified the women from a prenatal population undergoing routine voluntary HIV-l antibody screening. Results: From July 1, 1989 to December 31, 1990, we screened 13,469 pregnant women; 80 (5.9 per 1000) were HIV-l-infected. One seropositive woman who did not complete a risk-behavior questionnaire was excluded from the study. Seropositivity was associated with a history of crack cocaine use (odds ratio 2.3, 95% confidence interval [CI] l.l-4.8), intravenous drug use (odds ratio 14.5, 95% CI 4.5-46.3), and a history of sexually transmitted diseases (odds ratio 2.6, 95% CI 1.5-4.5). We found a significant interaction (P = 0.01) between a history of crack cocaine use and employment status: Unemployed women who used crack cocaine were 3.5 times more likely to be HIV-linfected than were employed women who used crack cocaine. Conclusions: Crack cocaine use was found to be a risk factor associated with HIV-l infection among pregnant women, particularly those who were unemployed. This finding suggests that the impact of crack cocaine use on HIV transmission may be related to economic factors and possibly to either trading sex for money to buy cocaine or trading sex for the drug.
HeterosexualIy transmittedhuman immunodeficiencyvirus infection among pregnant women in a rural Florida community Ellerbrock T.V.; Lieb S.; Harrington P.E.; Bush T.J.; Schoenlisgh S.A.; Oxtoby M.J.; Howell J.T.; Rogers M.F.; Witte J.J. USA NEW ENGL J MED 1992 327/24 (1704-1709) Background. In the United States, an increasing proportion of women infected with the human immunodeficiency virus (HIV) live in nonmetropolitan areas. Little is known, however, about the risk factors for HIV transmission in women outside large cities. Methods. We interviewed and tested 1082 (99.8%) of 1084 consecutive pregnant women who registered for prenatal care at a public health clinic in western Palm Beach County, Florida. This rural agricultural area of about 36 000 people is known to have a high prevalence of HIV infection. Results. The seroprevalence of HIV was 5.1% (52 of 1011 women). Black women who were neither Haitian nor Hispanic had the highest rate of infection (8.3% [48 of 5751). Only 4 of 1009 women (0.4 percent) reported ever injecting drugs, and the 4 were HIVseronegative; however, 14 of 43 users of ‘crack’ cocaine (33%) had HIV infection. At prenatal registration, 131 of 983 women (13%) tested positive for gonorrhea, chlamydial infection, or syphilis. By multivariate logistic-regression analysis, HIV infection was found to be independently associated with having used crack cocaine (odds ratio, 3.3; P < O.OOl),having had more than two sexual partners (odds ratio, 4.6; P < O.OOl),being black but neither Hispanic nor Haitian (odds ratio, 11; P < O.OOl),having had sexual intercourse with a high risk partner (odds ratio, 5.6; P < O.OOl),and testing positive for syphilis (odds ratio, 3.1; P = 0.015). Nevertheless, 11 of the 52 HIVinfected women (21 percent) reported a total of only two to five sexual partners and no known high-risk partners, had never used crack cocaine, and had no positive tests for sexually transmitted disease. Conclusions. In the rural community we studied, most of the women with HIV infection acquired it through heterosexual contact. The increasing seroprevalence of HIV and the increasing incidence of syphilis and use of crack Int J Gynecol Obstet 42
cocaine mean that other women may be at similar risk of acquiring heterosexually transmitted HIV infection. The transfer of anti-human immunodeficiency virus nucleoside compoundsby the term human placenta Bawdon R.E.; Sobhi S.; Dax J. LISA AM J OBSTET GYNECOL 1992 167/6 (1570-1574) OBJECTIVE: The purpose of this study was to compare the maternal-fetal placental transfer of 2’,3 ‘-dideoxyinosine and 2 ‘,3’-dideoxycytidine with that of 3’-azido-2 ‘,3-dideoxythymidine (azidothymidine). STUDY DESIGN: The perfusion system used carbon 1Clabeled antipyrine as a reference compound to determine the clearance index of each compound. The inhibitor dipyridamole and the endogenous bases were used to determine if these anti-human immunodeficiency virus compounds crossed the placenta other than by simple diffusion. RESULTS: The clearance index of azidothymidine was 0.29 * 0.04 at maternal concentrations of 1.0 to 10 &ml, and the clearance index of 2’,3’-dideoxyinosine was 0.14 f 0.05, which was 48% of the clearance index of azidothymidine. The clearance index of 2’,3’-dideoxyinosine was essentially identical to azidothymidine in the range from 1 to 10 &ml. The results of the closed-closed studies suggest that at therapeutic peak concentrations of 1 to 2 &ml of these compounds in the maternal circulation therapeutic levels will be reached in the fetal circulation. CONCLUSION: These anti-human immunodeficiency virus inhibitors appear to cross the placenta rapidly by simple diffusion because (1) the transfer of the drugs to the fetal circulation was not saturable even at 100 &nl, (2) there was no change in clearance index with the addition of 300 amohl of thymidine, inosine, cytosine, or 30 pmol/l dipyridamole, and (3) there was no accumulation against the maternal fetal or fetal maternal concentration gradient. Changes in T-lymphocyte subpopulationsduring pregnancy complicated by human immunodeficiencyvirus infection Dinsmoor M.J.; Christmas J.T. USA AM J OBSTET GYNECOL 1992 16716(1575-1579) OBJECTIVE: We describe changes in T-lymphocyte subpopulations in pregnancies complicated by human immunodeficiency virus infection. STUDY DESIGN: T-lymphocyte counts were performed every trimester and post partum on all patients with human immunodeticiency virus infection. Patients with a CD4 count <500 cells/mm’ were offered zidovudine after the first trimester. We performed a regression analysis of repeated measures on the total lymphocyte, CD4, and CD8 counts. RESULTS: Twenty-three patients were studied, 10 (43%) of whom took zidovudine. CD4, CD8, and total lymphocyte counts decreased in patients not taking zidovudine but remained stable in patients receiving zidovudine. The differences were not statistically significant. CONCLUSIONS: CD4 and CD8 counts may decrease during pregnancies complicated by human immunodeficiency virus infection, primarily because of decreases in the total lymphocyte count. The use of zidovudine may prevent this decline. The clinical use of absolute CD4 counts during pregnancy requires further study.
Citations from the Literature
We identified the women from a prenatal population undergoing routine voluntary HIV-l antibody screening. Results: From July 1, 1989 to December 31, 1990, we screened 13,469 pregnant women; 80 (5.9 per 1000) were HIV-l-infected. One seropositive woman who did not complete a risk-behavior questionnaire was excluded from the study. Seropositivity was associated with a history of crack cocaine use (odds ratio 2.3, 95% confidence interval [CI] l.l-4.8), intravenous drug use (odds ratio 14.5, 95% CI 4.5-46.3), and a history of sexually transmitted diseases (odds ratio 2.6, 95% CI 1.5-4.5). We found a significant interaction (P = 0.01) between a history of crack cocaine use and employment status: Unemployed women who used crack cocaine were 3.5 times more likely to be HIV-linfected than were employed women who used crack cocaine. Conclusions: Crack cocaine use was found to be a risk factor associated with HIV-l infection among pregnant women, particularly those who were unemployed. This finding suggests that the impact of crack cocaine use on HIV transmission may be related to economic factors and possibly to either trading sex for money to buy cocaine or trading sex for the drug.
HeterosexualIy transmittedhuman immunodeficiencyvirus infection among pregnant women in a rural Florida community Ellerbrock T.V.; Lieb S.; Harrington P.E.; Bush T.J.; Schoenlisgh S.A.; Oxtoby M.J.; Howell J.T.; Rogers M.F.; Witte J.J. USA NEW ENGL J MED 1992 327/24 (1704-1709) Background. In the United States, an increasing proportion of women infected with the human immunodeficiency virus (HIV) live in nonmetropolitan areas. Little is known, however, about the risk factors for HIV transmission in women outside large cities. Methods. We interviewed and tested 1082 (99.8%) of 1084 consecutive pregnant women who registered for prenatal care at a public health clinic in western Palm Beach County, Florida. This rural agricultural area of about 36 000 people is known to have a high prevalence of HIV infection. Results. The seroprevalence of HIV was 5.1% (52 of 1011 women). Black women who were neither Haitian nor Hispanic had the highest rate of infection (8.3% [48 of 5751). Only 4 of 1009 women (0.4 percent) reported ever injecting drugs, and the 4 were HIVseronegative; however, 14 of 43 users of ‘crack’ cocaine (33%) had HIV infection. At prenatal registration, 131 of 983 women (13%) tested positive for gonorrhea, chlamydial infection, or syphilis. By multivariate logistic-regression analysis, HIV infection was found to be independently associated with having used crack cocaine (odds ratio, 3.3; P < O.OOl),having had more than two sexual partners (odds ratio, 4.6; P < O.OOl),being black but neither Hispanic nor Haitian (odds ratio, 11; P < O.OOl),having had sexual intercourse with a high risk partner (odds ratio, 5.6; P < O.OOl),and testing positive for syphilis (odds ratio, 3.1; P = 0.015). Nevertheless, 11 of the 52 HIVinfected women (21 percent) reported a total of only two to five sexual partners and no known high-risk partners, had never used crack cocaine, and had no positive tests for sexually transmitted disease. Conclusions. In the rural community we studied, most of the women with HIV infection acquired it through heterosexual contact. The increasing seroprevalence of HIV and the increasing incidence of syphilis and use of crack Int J Gynecol Obstet 42
cocaine mean that other women may be at similar risk of acquiring heterosexually transmitted HIV infection. The transfer of anti-human immunodeficiency virus nucleoside compoundsby the term human placenta Bawdon R.E.; Sobhi S.; Dax J. LISA AM J OBSTET GYNECOL 1992 167/6 (1570-1574) OBJECTIVE: The purpose of this study was to compare the maternal-fetal placental transfer of 2’,3 ‘-dideoxyinosine and 2 ‘,3’-dideoxycytidine with that of 3’-azido-2 ‘,3-dideoxythymidine (azidothymidine). STUDY DESIGN: The perfusion system used carbon 1Clabeled antipyrine as a reference compound to determine the clearance index of each compound. The inhibitor dipyridamole and the endogenous bases were used to determine if these anti-human immunodeficiency virus compounds crossed the placenta other than by simple diffusion. RESULTS: The clearance index of azidothymidine was 0.29 * 0.04 at maternal concentrations of 1.0 to 10 &ml, and the clearance index of 2’,3’-dideoxyinosine was 0.14 f 0.05, which was 48% of the clearance index of azidothymidine. The clearance index of 2’,3’-dideoxyinosine was essentially identical to azidothymidine in the range from 1 to 10 &ml. The results of the closed-closed studies suggest that at therapeutic peak concentrations of 1 to 2 &ml of these compounds in the maternal circulation therapeutic levels will be reached in the fetal circulation. CONCLUSION: These anti-human immunodeficiency virus inhibitors appear to cross the placenta rapidly by simple diffusion because (1) the transfer of the drugs to the fetal circulation was not saturable even at 100 &nl, (2) there was no change in clearance index with the addition of 300 amohl of thymidine, inosine, cytosine, or 30 pmol/l dipyridamole, and (3) there was no accumulation against the maternal fetal or fetal maternal concentration gradient. Changes in T-lymphocyte subpopulationsduring pregnancy complicated by human immunodeficiencyvirus infection Dinsmoor M.J.; Christmas J.T. USA AM J OBSTET GYNECOL 1992 16716(1575-1579) OBJECTIVE: We describe changes in T-lymphocyte subpopulations in pregnancies complicated by human immunodeficiency virus infection. STUDY DESIGN: T-lymphocyte counts were performed every trimester and post partum on all patients with human immunodeticiency virus infection. Patients with a CD4 count <500 cells/mm’ were offered zidovudine after the first trimester. We performed a regression analysis of repeated measures on the total lymphocyte, CD4, and CD8 counts. RESULTS: Twenty-three patients were studied, 10 (43%) of whom took zidovudine. CD4, CD8, and total lymphocyte counts decreased in patients not taking zidovudine but remained stable in patients receiving zidovudine. The differences were not statistically significant. CONCLUSIONS: CD4 and CD8 counts may decrease during pregnancies complicated by human immunodeficiency virus infection, primarily because of decreases in the total lymphocyte count. The use of zidovudine may prevent this decline. The clinical use of absolute CD4 counts during pregnancy requires further study.