Substances abuse in HIV positive pregnant women

Substances abuse and HIV infection are major health issues globally, with a significant increase in morbidity and mortality. But what are the consequences of the association between the two, especially in a pregnant woman? Substance abuse in a pregnant HIV positive woman, regardless of the substance used (tobacco, alcohol, marijuana, cocaine, opioids etc.) is at greater risk of HIV maternal-fetal transmission, as well as obstetric, neonatologic and pediatric complications, such as miscarriage, abruptio placentae, premature birth, eclampsia, fetal alcohol syndrome, stillbirth, sudden infant death syndrome and neurological deficits. For these reasons cessation of substance abuse is mandatory before planning a pregnancy, especially for HIV infected women. This can be achieved through counselling, guidance towards rehab facilities and prenatal screening programs, often with optimistic results, as pregnancy is the time with the highest success rate regarding substance abuse cessation than any other time in a woman’s life.

Failure of preventive measures leading to mother-to-child hiv transmission. Case report.

Despite significant advances in antiretroviral treatment (ARV) and HIV infection prevention, about 400 children worldwide are still diagnosed daily with HIV infection, most cases due to perinatal transmission. It is estimated that the knowledge and rigorous application of prophylactic measures to reduce the vertical transmission of infection would significantly reduce this risk to less than 1%. We report the case of a 5 months old infant coming from a pregnancy with HIV risk and multiple risk factors for transmission of the vertical infection, who did not receive postnatal testing and treatment. The diagnosis was established during infancy, falling into the AIDS stage by cytomegalovirus (CMV) disease with retinal sequelae occlusion. ARV treatment was initiated late, but from the moment of diagnosis, requiring further changes due to drug interactions, lack of availability and resistance to TARV. Although the patient’s progression was marked by severe comorbidities: sequelae of CMV disease, mixed HIV and CMV encephalopathy, pulmonary tuberculosis, repetitive respiratory and digestive opportunistic infections, the evolution of immunological parameters was slowly favorable under treatment. Proper implementation of prophylactic measures in the newborn and the pregnant woman could have significantly reduced the risk of HIV transmission to the patient, with a high probability that she would not have been infected. The case reported reflects the failure of strategies to prevent HIV / AIDS infection in pregnant women and newborns; conclusions must be drawn to avoid similar situations.

The impact of HIV infection on the development of cutaneous cancers

Human immunodeficiency virus (HIV) infection continues to be an important public health issue. Immunosuppression is responsible for the development of much comorbidity among HIV-infected patients. Of these, malignancies play an important role in the prognosis of the disease. Cancers diagnosed in HIV-infected patients can be divided into two main categories: AIDS-defining cancers and non-AIDS-defining cancers. In the second category, skin cancers represent an important subgroup, the most common being basal cell carcinoma, squamous cell carcinoma and melanoma.

Irritable bowel syndrome and probiotics place in therapeutic strategies

Irritable bowel syndrome is a frequent digestive condition, with an unclear etiopathogeny. Very probably intestinal dysbiosis plays an important role. For the moment there are no guidelines for treatment. There is scientific evidence for several therapies: modification of diet, non-resorbable antibiotics (rifaximin-α) and probiotics. Giving probiotics after each antibiotic course (an association of Bifidobacterium longum BB536 and Lactobacillus rhamnosus HN001) supplemented with vitamin B6 may be an optimal strategy.