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- ItemAcesso aberto (Open Access)Estudo cardiológico longitudinal em crianças expostas ao vírus da imunodeficiência humana tipo 1 por via perinatal(Sociedade Brasileira de Cardiologia - SBC, 2005-10-01) Diógenes, Maria Suely Bezerra [UNIFESP]; Succi, Regina Célia de Menezes [UNIFESP]; Machado, Daisy Maria [UNIFESP]; Moisés, Valdir Ambrósio [UNIFESP]; Novo, Neil Ferreira [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To determine the frequency of cardiac abnormalities and its natural history in children perinatally exposed to HIV-1. METHODS: Eighty-four children exposed to HIV-1 were evaluated by serial clinical, electrocardiographic (ECG), and Doppler-echocardiographic (ECHO) examinations. RESULTS: Group I - (seroreversion) - 43 children (51.2%). Absence of clinical abnormalities. ECG: incomplete right bundle branch block (RBBB) 5 cases. ECHO: atrial septal defect (ASD) and ventricular septal defect (VSD) - 1 case each. Group II - 41 HIV-infected children (48.8%), of whom 51.2% were found to have cardiac abnormalities. Asymptomatic or mildly symptomatic children without immunosuppression: no clinical and echocardiographic abnormalities; ECG: incomplete right bundle branch block (RBBB) - (2 cases). Children with moderate and severe symptoms and immunological impairment: the following abnormalities were found: 1) clinical (31.7%)-isolated tachycardia (1 case), congestive heart failure (12 cases). 2) electrocardiographic (43.9%)- sinus tachycardia associated with other abnormalities (10 cases), incomplete right bundle branch block (5 cases), left anterior hemiblock (1 case), right anterior hemiblock (1 case), changes in ventricular repolarization (11 cases), right ventricular overload (2 cases), left ventricular overload (1 case), right QRS axis deviation (1 case), and arrhythmias (3 cases). 3) echocardiographic (26.8%)- dilated cardiomyopathy (5 cases), pericardial effusion with tamponade (2 cases), pulmonary hypertension (2 cases), and mitral valve prolapse (1 case). CONCLUSION: Cardiac involvement was a characteristic of the HIV-infected group. Higher prevalence of abnormalities was found among children belonging to the most advanced clinical and immunological category. The most commonly observed clinical, electrocardiographic and echocardiographic findings were congestive heart failure (CHF), changes in ventricular repolarization, and dilated cardiomyopathy, respectively. The latter was reversible in one case. Electrocardiogram changes were significantly more frequent than clinical and echocardiographic changes.
- ItemAcesso aberto (Open Access)HIV-1 viremia during the first 28 weeks of pregnancy is not associated with mother-to-child transmission(Brazilian Society of Infectious Diseases, 2006-08-01) Senise, J.f. [UNIFESP]; Palacios, R. [UNIFESP]; Tanno, Z.n. [UNIFESP]; Lunardi, L. [UNIFESP]; Waghabi, G.r. [UNIFESP]; Vaz, M.j.r. [UNIFESP]; Diaz, Ricardo Sobhie [UNIFESP]; Castelo Filho, Adauto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hospital Ipiranga Interdisciplinary Center for Infectious Diseases in Pregnancy Department of Infectious Diseases and Department of Gynecology and ObstetricsIt is currently recommended that antiretroviral prophylaxis to prevent mother-to-child transmission (MTCT) of HIV be initiated at 14 weeks of gestation. However, the relevance of early-gestation HIV viral load level for intrauterine MTCT is unknown. The objective of this study was to determine the relationship between prenatal maternal viral load and intrauterine MTCT. Records of HIV-infected pregnant women in two centers in Brazil, from 1999 to 2004 were analyzed. Three pregnancy periods were considered: earlier than 14 weeks, 14 to 27 6/7 weeks, and 28 weeks of gestation or more. Peripartum HIV exposure was also computed. Maximum viral load in each period was the measure of HIV exposure. Four hundred fifty-seven HIV-infected pregnant women were evaluated, but 53 were excluded. The MTCT rate was 0.49% (2/404-95% confidence interval (CI95) = 0.14-1.79%). Newborns were not breast-fed. Median viral load for the earlier-than-14-week period was 9,900 copies/mL (P25-75 1,000-50,775 copies/mL), 8,350 copies/mL (P25-75 707-42,000 copies/mL) for the 14 to 27 6/7-week period, and 435 copies/mL (P25-75 90-7,775 copies/mL) after the 28-week period. The peripartum median viral load was 400 copies/mL (P25-75 80-500 copies/mL). MTCT in mothers with VL > 1,000 copies/mL during the first 14 weeks (0.67%, 2/298) was not different from those with VL =1,000 copies/mL (0.0%, 0/96, P=1). Analogously, in the 14 to 27 6/7-week period, MTCT was similar in groups with VL higher (0.68%, 2/292) or lower (0%, 0/106) than 1,000 copies/mL (P=1). Regarding VL >1,000 copies/mL at 28-weeks-or-later and at peripartum periods, MTCT rates were 1.15% (2/173, P = 0.18) and 2.8% (2/71, P = 0.03), respectively. Intrauterine transmission does not seem to be influenced by HIV viremia during the first 28 weeks of pregnancy.
- ItemSomente MetadadadosInteraction between pediatric HIV infection and measles(Future Medicine Ltd, 2011-12-01) Moraes-Pinto, Maria Isabel de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Infections by measles virus and by HIV cause a state of immunodeficiency in the host. While measles virus leads to a transient immunodeficiency with depression of cellular mediated immunity, natural HIV infection leads to a progressive immunodeficiency of both humoral and cellular immunity. This review will focus on the interaction between HIV and measles virus in pediatric patients. Different scenarios of virus interaction will be dissected and their implications for a practical approach in terms of the individual patient and strategies to eliminate measles virus will be discussed.
- ItemSomente MetadadadosThe management of HIV-infected pregnant women(Lippincott Williams & Wilkins, 2012-12-01) Senise, Jorge [UNIFESP]; Bonafe, Simone [UNIFESP]; Castelo, Adauto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose of reviewThe purpose of this article is to update the current practice in the management of HIV-infected pregnant women and present evidence-based recommendations for the reduction of mother-to-child transmission.Recent findingsEarly and sustained control of HIV viral replication is associated with decreasing residual risk of transmission and favors initiating antiretroviral drugs sufficiently early in naive women to suppress viral replication by the third trimester; however, this potential benefit must be balanced against the unknown long-term outcome of first-trimester drug exposure. Efavirenz should whenever possible be avoided in the first trimester of gestation, but its use seems well tolerated for 39 days after last menstrual period when the neural tube closes. Raltegravir may be considered in special circumstances in pregnancy.SummaryThe HIV viral load and the risk factors for prematurity must be considered when deciding when to start antiretroviral treatment in each individual pregnant woman. A ritonavir-boosted protease inhibitor combined with two nucleoside reverse transcriptase inhibitors is currently the most widely used regimen. Among protease inhibitors, lopinavir combined with ritonavir is the most frequently used; however, atazanavir combined with ritonavir is a good alternative. Elective cesarean section is the best delivery mode for pregnant women with viral loads more than 50 copies/ml.
- ItemSomente MetadadadosShort-term antiretroviral therapy to prevent mother-to-child transmission is safe and results in a sustained increase in CD4 T-cell counts in HIV-1-infected mothers(Wiley-Blackwell, 2009-03-01) Palacios, Ricardo [UNIFESP]; Senise, Jorge Figueiredo [UNIFESP]; Vaz, Maria José Rodrigues [UNIFESP]; Diaz, Ricardo Sobhie [UNIFESP]; Castelo, Adauto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Short-term antiretroviral therapy (START) to prevent mother-to-child transmission (MTCT) is currently recommended for all HIV-1-infected pregnant women. the objective of this study was to assess the effect on CD4 cell counts and viral load dynamics the withdrawal of START after birth could generate.This was a 5-year cohort study involving HIV-1-infected pregnant women who presented with CD4 counts > 300 cells/mu L and had received START to prevent MTCT.Seventy-five pregnancies were assessed. in 24 cases, there was a history of antiretroviral therapy prior to prophylaxis. the median baseline CD4 count was 573 cells/mu L. in 75% of cases, prophylaxis was started after 26.6 weeks of gestation. the median CD4 cell count increase over baseline during prophylaxis was 24.5%. in only five cases did HIV-1 viral load remain detectable during prophylaxis. After START, CD4 cell counts did not drop significantly, and the HIV-1 viral load plateau was near the baseline level. the estimated mean time for CD4 count to fall below 300 cells/mu L was 3.5 years and was directly associated with high baseline CD4 cell count, as well as with CD4 increase after prophylaxis, whereas it was negatively correlated with previous use of antiretroviral (ARV) drugs and persistence of detectable HIV-1 viral load during prophylaxis.A potent, well-tolerated prophylactic ARV regimen can improve CD4 cell counts during and after START. in women receiving such prophylaxis, there is a remarkable time interval for CD4 cell counts to drop to levels that indicate treatment.