HUMAN IMMUNODEFICIENCY VIRUS AND PREGNANCY: PATHOMORPHOLOGICAL FEATURES AND OBSTETRIC AND GYNECOLOGICAL TACTICS

2021 ◽  
pp. 178-184
Author(s):  
Spiridenko G.Yu. ◽  
Petrov Yu.A. ◽  
Bragina T.V.
Keyword(s):  
Human Immunodeficiency Virus ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Reverse Transcriptase ◽  
Reproductive Age ◽  
Risk Of Infection ◽  
Pathological Effect ◽  
Increased Risk ◽  
Immunodeficiency Virus

Currently, due to the increase in the incidence of HIV infection in women of reproductive age, the number of desired pregnancies in such patients has increased. This makes it necessary to study the pathological effect of the human immunodeficiency virus on the placenta, fetus and the female body as a whole. HIV belongs to retroviruses and contributes to the discoordination of a woman's immune mechanisms. Using the gp41 and gp120 glycoproteins, reverse transcriptase, integrase, and protease, the virus destroys CD4 cells and increases the viral load. It founded that the risk of infection of the fetus decreases from 45% to 1% with HIV infection before pregnancy and with antiretroviral therapy throughout its duration. Vertical infection is possible in the intrauterine, intranatal and postnatal periods, the main of which is the period of childbirth-up to 70%. Viral, maternal, placental, fetal, obstetric and neonatal factors contribute to an increased risk of transmission of the pathogen to the fetus. High viral load and antiretroviral therapy lead in the 3rd trimester of pregnancy to the development of chronic placental insufficiency due to the formation of focal and diffuse deciduitis, membranitis, intervillusitis and chorionamnionitis and damage to the hematoplacental barrier. Early diagnosis before 12 weeks of gestation, timely therapy with nucleoside and non-nucleoside reverse transcriptase inhibitors, as well as protease inhibitors during pregnancy, childbirth and in the postpartum period are the main aspects of preventing HIV infection and further disorders of the child's growth and development. The timely choice of the method of delivery, indications and contraindications to delivery through the natural birth canal helps to reduce the risk of infection in a particularly dangerous period - the intrapartum.

Ageing with HIV

2017 ◽  
pp. 651-658
Author(s):  
Amy Justice
Keyword(s):  
Cardiovascular Disease ◽  
Human Immunodeficiency Virus ◽  
Liver Disease ◽  
Antiretroviral Therapy ◽  
Kidney Disease ◽  
Hiv Infection ◽  
Older Individuals ◽  
Increased Risk ◽  
Immunodeficiency Virus

Human Immunodeficiency Virus (HIV) infection, in the era of combination antiretroviral therapy, has become more common among middle-aged and older individuals. Diagnosis and rapid initiation of antiretroviral therapy to suppress the virus below detectable levels are urgent priorities in management. Once achieved, those ageing with HIV infection can expect to live many years, but they remain at increased risk for HIV-associated non-AIDS (HANA) conditions compared to demographically similar uninfected individuals. Because HANA conditions include several forms of cancer, cardiovascular disease, liver disease, and kidney disease, the clinical management of those ageing with HIV is complicated by multimorbidity and polypharmacy at an earlier age than those ageing without HIV infection. The study of ageing with HIV infection may improve our understanding of the effects of long-term viral infection on the ageing process.

Gynaecomastia, hyperprolactinaemia and HIV infection

2005 ◽  
Vol 42 (4) ◽  
pp. 301-303 ◽  
Author(s):  
Sashi Acharya ◽  
J J Rufus Fernando ◽  
Rousseau Gama
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Immune Reconstitution ◽  
Serum Prolactin ◽  
Diagnosis And Management ◽  
Hypogonadotrophic Hypogonadism ◽  
Immunodeficiency Virus ◽  
Hiv Seropositive ◽  
Endocrine Complications

Endocrine complications of human immunodeficiency virus (HIV) and its treatment are being increasingly recognized. We discuss the diagnosis and management of an HIV seropositive man who presented with bilateral gynaecomastia and 'hyperprolactinaemia' due to macroprolactin within six months of starting antiretroviral therapy. We suggest that the gynaecomastia may be a feature of immune reconstitution disease. Measurement of serum prolactin in the investigation of gynaecomastia should be reserved for those with hypogonadotrophic hypogonadism. Since macroprolactin contributes to circulating prolactin in HIV-seropositive subjects, hyperprolactinaemic samples in these patients should be tested for macroprolactin.

scholarly journals Cryptococcal Antigenemia in Human Immunodeficiency Virus Antiretroviral Therapy–Experienced Ugandans With Virologic Failure

2019 ◽  
Vol 71 (7) ◽  
pp. 1726-1731 ◽  
Author(s):  
Edward Mpoza ◽  
Radha Rajasingham ◽  
Lillian Tugume ◽  
Joshua Rhein ◽  
Maria Sarah Nabaggala ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Cryptococcal Meningitis ◽  
Virologic Failure ◽  
Cost Effective ◽  
World Health ◽  
Load Testing ◽  
Viral Loads ◽  
Immunodeficiency Virus

Abstract Background Detectable serum or plasma cryptococcal antigen (CrAg) precedes symptomatic cryptococcal meningitis. The World Health Organization recommends CrAg screening for human immunodeficiency virus–positive persons with CD4 count <100 cells/μL initiating antiretroviral therapy (ART). However, an increasing proportion of patients with cryptococcosis are now ART experienced. Whether CrAg screening is cost-effective in those with virologic failure is unknown. Methods We retrospectively performed nationwide plasma CrAg testing among ART-experienced Ugandan adults with virologic failure (≥1000 copies/mL) using leftover plasma after viral load testing during September 2017–January 2018. For those who were CrAg positive, we obtained ART history, meningitis occurrence, and 6-month survival via medical records review. Results Among 1186 subjects with virologic failure, 35 (3.0%) were CrAg positive with median ART duration of 41 months (interquartile range, 10–84 months). Among 25 subjects with 6-month outcomes, 16 (64%) survived, 7 (28%) died, and 2 (8%) were lost. One survivor had suffered cryptococcal meningitis 2 years prior. Two others developed cryptococcal meningitis and survived. Five survivors were known to have received fluconazole. Thus, meningitis-free survival at 6 months was 61% (14/23). Overall, 91% (32/35) of CrAg-positive persons had viral load ≥5000 copies/mL compared with 64% (735/1151) of CrAg-negative persons (odds ratio, 6.0 [95% confidence interval, 1.8–19.8]; P = .001). CrAg prevalence was 4.2% (32/768) among those with viral loads ≥5000 copies/mL and 0.7% (3/419) among those with viral loads <5000 copies/mL. Conclusions In addition to the CD4 threshold of <100 cells/μL, reflexive CrAg screening should be considered in persons failing ART in Uganda with viral loads ≥5000 copies/mL.

scholarly journals Cervicovaginal Levels of Lactoferrin, Secretory Leukocyte Protease Inhibitor, and RANTES and the Effects of Coexisting Vaginoses in Human Immunodeficiency Virus (HIV)-Seronegative Women with a High Risk of Heterosexual Acquisition of HIV Infection

2007 ◽  
Vol 14 (9) ◽  
pp. 1102-1107 ◽  
Author(s):  
Richard M. Novak ◽  
Betty A. Donoval ◽  
Parrie J. Graham ◽  
Lucy A. Boksa ◽  
Gregory Spear ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
High Risk ◽  
Hiv Infection ◽  
Protease Inhibitor ◽  
Genital Tract ◽  
Secretory Leukocyte Protease Inhibitor ◽  
Low Risk ◽  
High Risk Women ◽  
Increased Risk ◽  
Immunodeficiency Virus

ABSTRACT Innate immune factors in mucosal secretions may influence human immunodeficiency virus type 1 (HIV-1) transmission. This study examined the levels of three such factors, genital tract lactoferrin [Lf], secretory leukocyte protease inhibitor [SLPI], and RANTES, in women at risk for acquiring HIV infection, as well as cofactors that may be associated with their presence. Women at high risk for HIV infection meeting established criteria (n = 62) and low-risk controls (n = 33) underwent cervicovaginal lavage (CVL), and the CVL fluid samples were assayed for Lf and SLPI. Subsets of 26 and 10 samples, respectively, were assayed for RANTES. Coexisting sexually transmitted infections and vaginoses were also assessed, and detailed behavioral information was collected. Lf levels were higher in high-risk (mean, 204 ng/ml) versus low-risk (mean, 160 ng/ml, P = 0.007) women, but SLPI levels did not differ, and RANTES levels were higher in only the highest-risk subset. Lf was positively associated only with the presence of leukocytes in the CVL fluid (P < 0.0001). SLPI levels were lower in women with bacterial vaginosis [BV] than in those without BV (P = 0.04). Treatment of BV reduced RANTES levels (P = 0.05). The influence, if any, of these three cofactors on HIV transmission in women cannot be determined from this study. The higher Lf concentrations observed in high-risk women were strongly associated with the presence of leukocytes, suggesting a leukocyte source and consistent with greater genital tract inflammation in the high-risk group. Reduced SLPI levels during BV infection are consistent with an increased risk of HIV infection, which has been associated with BV. However, the increased RANTES levels in a higher-risk subset of high-risk women were reduced after BV treatment.

Independent Association of Interleukin 6 With Low Dynamic Lung Function and Airflow Limitation in Well-Treated People With Human Immunodeficiency Virus

2020 ◽  
Author(s):  
Rebekka F Thudium ◽  
Andreas D Knudsen ◽  
Jakob Hjorth Von Stemann ◽  
Malene Hove-Skovsgaard ◽  
Hedda Hoel ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Lung Function ◽  
Hiv Infection ◽  
Interleukin 6 ◽  
Smoking Status ◽  
Airflow Limitation ◽  
Pulmonary Diseases ◽  
Increased Risk ◽  
Immunodeficiency Virus ◽  
Chronic Pulmonary Diseases

Abstract Background Human immunodeficiency virus (HIV) infection is associated with an increased risk of chronic pulmonary diseases. We compared cytokine concentrations (interleukin 6 [IL-6], interleukin 1β, 2, 4, 10, and 17A, tumor necrosis factor α, interferon γ, soluble CD14 [sCD14] and soluble CD163 [sCD163]) in people with HIV (PWH) and uninfected controls and investigated whether elevated cytokine concentrations were independently associated with lung function indices in PWH. Methods We performed spirometry and measured cytokine concentrations by Luminex immunoassays or enzyme-linked immunoassay in 951 PWH and 79 uninfected controls from the Copenhagen Comorbidity in HIV Infection study. Regression analyses were used to explore associations between elevated cytokine concentrations and lung function indices. Results PWH were predominantly male (84.6%) and 94.2% had undetectable viral replication. In PWH, elevated IL-6 was associated with lower forced expiratory volume in 1 second (−212 mL [95% confidence interval, −308 to −116 mL]), lower forced vital capacity (−208 mL [−322 to −93 mL]), and airflow limitation (aOR, 2.62 [1.58–4.36]) (all P &lt; .001) in models adjusted for age, sex, ethnicity, smoking status, body mass index, and CD4 T-cell nadir. The association between IL-6 and dynamic lung function was modified by smoking (P for interaction = .005). Conclusion IL-6 levels were elevated and independently associated with low dynamic lung function and airflow limitation in well-treated PWH, suggesting that systemic inflammation may contribute to the pathogenesis of chronic pulmonary diseases.

Atherosclerotic Cardiovascular Events in Patients Infected With Human Immunodeficiency Virus and Hepatitis C Virus

2020 ◽  
Author(s):  
Boun Kim Tan ◽  
Mathieu Chalouni ◽  
Dominique Salmon Ceron ◽  
Alexandre Cinaud ◽  
Laure Esterle ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hepatitis C Virus ◽  
Cardiovascular Risk ◽  
Viral Load ◽  
Hepatitis C ◽  
Baseline Viral Load ◽  
Hiv Viral Load ◽  
Factors Associated ◽  
Increased Risk ◽  
Immunodeficiency Virus

Abstract Background An increased risk of cardiovascular disease (CVD) was reported in patients coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV), without identifying factors associated with atherosclerotic CVD (ASCVD) events. Methods HIV–HCV coinfected patients were enrolled in the ANRS CO13 HEPAVIH nationwide cohort. Primary outcome was total ASCVD events. Secondary outcomes were coronary and/or cerebral ASCVD events, and peripheral artery disease (PAD) ASCVD events. Incidences were estimated using the Aalen-Johansen method. Factors associated with ASCVD were identified using cause-specific Cox proportional hazards models. Results At baseline, median age of the study population (n=1213) was 45.4 (interquartile range [IQR] 42.1−49.0) years and 70.3% were men. After a median follow-up of 5.1 (IQR 3.9−7.0) years, the incidence was 6.98 (95% confidence interval [CI] 5.19−9.38) per 1000 person-years for total ASCVD events, 4.01 (2.78−6.00) for coronary and/or cerebral events, and 3.17 (2.05−4.92) for PAD ASCVD events. Aging (hazard ratio [HR] 1.06, 95% CI 1.01−1.12), prior CVD (HR 8.48, 95% CI 3.14−22.91), high total cholesterol (HR 1.43, 95% CI 1.11−1.83), high-density lipoprotein cholesterol (HR 0.22, 95% CI 0.08−0.63), statin use (HR 3.31, 95% CI 1.31−8.38), and high alcohol intake (HR 3.18, 95% CI 1.35−7.52) were independently associated with total ASCVD events, while undetectable baseline viral load (HR 0.41, 95%CI 0.18−0.96) with coronary and/or cerebral events. Conclusion HIV–HCV coinfected patients experienced a high incidence of ASCVD events. Some traditional cardiovascular risk factors were the main determinants of ASCVD. Controlling cholesterol abnormalities and maintaining undetectable HIV viral load are essential to control cardiovascular risk.

Primitive Neuroectodermal Tumor in a Child with Human Immunodeficiency Virus Infection: A Rare Association

2019 ◽  
Author(s):  
Aman Gupta ◽  
Dharmagat Bhattarai ◽  
Bishnu Kumar Thapa ◽  
Mayur Parkhi ◽  
Pandiarajan Vignesh ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Virus Infection ◽  
Hiv Infection ◽  
Primitive Neuroectodermal Tumor ◽  
Neuroectodermal Tumor ◽  
Rare Association ◽  
Non Hodgkin Lymphoma ◽  
Wide Range ◽  
Immunodeficiency Virus

Abstract Children with human immunodeficiency virus (HIV) infection are reported to have various malignancies, most common being Non-Hodgkin lymphoma. Despite higher risk of malignancies, brain tumors are infrequently described in these children. We report Primitive Neuroectodermal tumor (PNET) in a young boy with HIV infection. PNET has never been described in association with HIV infection. Though a causative association cannot be established, it does emphasize that with longer survivals on effective antiretroviral therapy, we may see a wide range of malignancies more frequently.

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