I, too, need care: Narratives of caregivers raising a child with HIV – An input for life coaching approaches

Objectives@#The present study explored the experiences of caregivers raising a child with perinatal HIV infection through a narrative inquiry approach. It uncovered how caregivers learned about their children’s diagnosis, the challenges that they experience in raising their children, and how they cope with the ordeal caused by HIV infection. @*Methods@#A total of ten participants joined the study – five caregivers participated in the key informant interviews (KIIs), with their respective child diagnosed to have perinatal HIV infection joining the focus group discussion (FGD) (n=5). Semi-structured individual interviews were carried out to examine in-depth narratives from the caregivers. We thoroughly analyzed the verbatim interview transcripts using reflexive thematic analysis (RTA) by the six-phase process outlined by Braun and Clarke (2019). NVivo 12 was utilized in the process of data analysis. The transcribed data were uploaded, coded, and analyzed individually. The software helped the organization and expression of the codes and themes.@*Result@#In this study, three major themes and four sub-themes in each theme were generated: a) becoming known: the journey towards testing and treatment, which includes reasons for testing, cause of acquiring HIV, reactions, and treatment, b) passing through challenging times, which cover preparing the child to understand illness, child's awareness and understanding of illness, physical health, and discrimination, and c) receiving essential support which includes an understanding of illness, building hope, needs received, and sources of support.@*Conclusions@#Caregivers with children living with HIV face challenges such as preparing the illness to be known and understood by their child, managing the child’s physical health, and discriminating against others. However, they can live healthy and meaningful lives if they are given comprehensive support from the government, access to quality healthcare and education, and psychosocial interventions. The government and private sectors must make efforts to promote physical, emotional, and mental health care underpinning the well-being of caregivers and children with HIV. The retention of the programs offered by certain organizations (e.g., testing and treatment needs, nutritional and basic needs support, educational supply, and livelihood program for caregivers) and the increase in the number of psychoeducational and support group activities were suggested to significantly help in addressing the concerns of both caregivers and their child with perinatal HIV infection.

Perinatal Transmission and Outcomes of SARS-CoV-2 Infection

Maternal SARS-CoV-2 infection can adversely afect the birth and neonatal outcomes. The authors prospectively enrolled 196 neonates born to 193 SARS-CoV-2–positive mothers to determine the rate of mother-to-baby transmission of SARSCoV-2 and its efect on short-term neonatal outcomes in Indian population. Nineteen babies turned out to be RT-PCR– positive for SARS-CoV-2, carrying a perinatal transmission rate of 9.8%. Rates of prematurity and low birth weight were 12.8% and 18.9% in the neonatal group, respectively. On comparing SARS-CoV-2–positive (n=19) and negative (n=177) neonatal groups, rate of prematurity, hospital admission rate, and death rate were higher in the former group. The placental positivity rate for SARS-CoV-2 was 8.1%, but no relation was found between placental and neonatal infection.

Knowledge of Hepatitis C virus vertical transmission and subsequent pregnancy outcome in virus-positive female blood donors

ABSTRACT Introduction Hepatitis C virus (HCV) can be vertically transmitted from mother to fetus. We evaluated knowledge about HCV vertical transmission in female blood donors who became pregnant following detection of HCV in their donated blood. Methods This was a retrospective descriptive study of females seen at a single blood bank in Sao Paulo, Brazil who were diagnosed with HCV infection in their donated blood. HCV-infected donors who subsequently became pregnant were invited to participate through letters or phone calls. Individuals who agreed to participate were interviewed by questionnaire to evaluate their knowledge on HCV vertical transmission. Results Among 282 HCV-positive female blood donors, 69 reported becoming pregnant after their HCV diagnosis in donated blood. While 24 of these women were successful treated for their infection prior to becoming pregnant, 45 (65.2%) were at risk for vertical HCV transmission either because they had never been treated for HCV, were pregnant before treatment or became pregnant after unsuccessful treatment. Of the 59 women who responded to the question of whether they were informed about the risk of HCV vertical transmission, 58 (98.3%) reported never receiving this information either after obtaining their blood donation results or during their pregnancy. Conclusion The lack of knowledge of HCV-infected women on the possibility for mother-to-child transmission of this virus highlights the critical need to improve communication about pregnancy-related risks between health professionals and HCV-infected women of childbearing age.

Transmisión vertical de hepatitis B: importancia de incorporar el cribado en el control prenatal en Chile / Vertical transmission of hepatitis B: the importance of incorporating screening during pregnancy in Chile

Resumen La transmisión vertical de hepatitis B es responsable de 50% de las infecciones en el mundo e implica 90% de riesgo de evolucionar a hepatitis crónica y sus complicaciones. La inmunoprofilaxis postparto (inmunoglobulina más vacuna) es la medida de prevención más efectiva. Sin embargo, puede existir fracaso a pesar de dicha intervención, debido a factores como alta carga viral o la presencia de HBeAg en la madre, los que sólo pueden evitarse si se hace el diagnóstico y tratamiento durante la gestación. En Chile, en el año 2019 se incorporó la vacunación en los recién nacidos, pero no existe aún cribado durante el embarazo, a diferencia de los países desarrollados. En los últimos años se ha experimentado un aumento acelerado de inmigración proveniente principalmente de América latina y el Caribe, con prevalencias altas en algunos de ellos. Chile debiese avanzar prontamente hacia el cribado de hepatitis B en embarazo.

Abstract Half of cases of hepatitis B around the world are produced from vertical transmission; and 90% of them can evolve to chronic hepatitis and their long term complications. Postpartum immunoprophylaxis (immunoglobulin and vaccine) is the most effective preventive measure. However, despite this prophylaxis, vertical transmission is possible if the mother presents a high viral load or e-antigen. This risk can be reduced only if screening during pregnancy and treatment if needed, are incorporated. In 2019, vaccination for hepatitis B in newborn was incorporated in Chile, but not yet prenatal screening, unlike developed countries. Chile has experienced a growth in immigration from Latin America and Caribbean, some countries with high endemicity included. Prenatal screening in Chile should be promptly incorporated.

HIV-1 mother-to-child transmission in Brazil (1994-2016): a time series modeling

Abstract HIV-1 mother-to-child transmission (HIV-1 MTCT), is an important cause of children mortality worldwide. Brazil has been traditionally praised by its HIV/Aids program, which provides free-of-charge care for people living with HIV-1. Using public epidemiology and demographic databases, we aimed at modeling HIV-1 MTCT prevalence in Brazil through the years (1994-2016) and elaborate a statistical model for forecasting, contributing to HIV-1 epidemiologic surveillance and healthcare decision-making. We downloaded sets of live births and mothers' data alongside HIV-1 cases notification in children one year old or less. Through time series modeling, we estimated prevalence along the years in Brazil, and observed a remarkable decrease of HIV-1 MTCT between 1994 (10 cases per 100,000 live births) and 2016 (five cases per 100,000 live births), a reduction of 50%. Using our model, we elaborated a prognosis for each Brazilian state to help HIV-1 surveillance decision making, indicating which states are in theory in risk of experiencing a rise in HIV-1 MTCT prevalence. Ten states had good (37%), nine had mild (33%), and eight had poor prognostics (30%). Stratifying the prognostics by Brazilian region, we observed that the Northeast region had more states with poor prognosis, followed by North and Midwest, Southeast and South with one state of poor prognosis each. Brazil undoubtedly advanced in the fight against HIV-1 MTCT in the past two decades. We hope our model will help indicating where HIV-1 MTCT prevalence may rise in the future and support government decision makers regarding HIV-1 surveillance and prevention.

Cost-effectiveness and affordability of strategy for preventing mother-to-child transmission of hepatitis B in China / 中华流行病学杂志

Objective To evaluate the cost effectiveness of nationwide prevention of mother to child transmission (PMTCT) strategy for hepatitis B,and estimate the willing to pay and budget impacts on the PMTCT.Methods The decision analytic Markov model for the PMTCT was constructed and a birth cohort of Chinese infants born in 2013 was used to calculate the cost-effectiveness of the PMTCT among them compared with those receiving no intervention.The parameters in the model were obtained from literatures of national surveys or Meta-analysis.The costs,cases of HBV-related diseases and quality-adjusted life-years (QALYs) were obtained from the societal and payer perspectives,respectively.The incremental cost-effectiveness ratio (ICER) was used as measures of strategy optimization.One-way and probability sensitivity analysis were performed to explore the uncertainty of the primary results.In addition,cost-effectiveness acceptability curve and cost-effectiveness affordability curves were drawn to illustrate the cost effectiveness threshold and financial budget of the PMTCT strategy.Results The lifetime cost for PMTCT strategy was 4 063.5 yuan (RMB) per carrier,which was 37 829.7 yuan (RMB) lower compared with those receiving no intervention.Due to the strategy,a total of 24.516 1 QALYs per person would be gained,which was higher than that in those receiving no intervention.From societal perspective,the ICER was-59 136.6yuan (RMB) per additional QALYs gained,indicating that the PMTCT is cost effective.The results were reliable indicated by one-way,multi-way and probability sensitivity analyses.By the CEAC,the willing to pay was much lower than the cost-effectiveness threshold.From the affordability curve of the PMTCT strategy,the annual budget ranged from 590.4 million yuan (RMB) to 688.8 million yuan (RMB),which was lower than the financial ability.Based on the results of cost-effectiveness affordability curves,the higher annual budget was determined,the higher probability of affordability for the PMTCT would be obtained under the same willing to pay state.Only when the annual budget reaches 688.8 million yuan (RMB),the goal of PMTCT would be fully realized.Conclusions The PMTCT strategy in China was cost effective,and the cost is not beyond the financial budget needed and the willing to pay.The strategy,which is consistent with the global hepatitis B elimination efforts,should be conducted widely in China.

Cost-effectiveness and affordability of strategy for preventing mother-to-child transmission of hepatitis B in China / 中华流行病学杂志

Objective To evaluate the cost effectiveness of nationwide prevention of mother to child transmission (PMTCT) strategy for hepatitis B,and estimate the willing to pay and budget impacts on the PMTCT.Methods The decision analytic Markov model for the PMTCT was constructed and a birth cohort of Chinese infants born in 2013 was used to calculate the cost-effectiveness of the PMTCT among them compared with those receiving no intervention.The parameters in the model were obtained from literatures of national surveys or Meta-analysis.The costs,cases of HBV-related diseases and quality-adjusted life-years (QALYs) were obtained from the societal and payer perspectives,respectively.The incremental cost-effectiveness ratio (ICER) was used as measures of strategy optimization.One-way and probability sensitivity analysis were performed to explore the uncertainty of the primary results.In addition,cost-effectiveness acceptability curve and cost-effectiveness affordability curves were drawn to illustrate the cost effectiveness threshold and financial budget of the PMTCT strategy.Results The lifetime cost for PMTCT strategy was 4 063.5 yuan (RMB) per carrier,which was 37 829.7 yuan (RMB) lower compared with those receiving no intervention.Due to the strategy,a total of 24.516 1 QALYs per person would be gained,which was higher than that in those receiving no intervention.From societal perspective,the ICER was-59 136.6yuan (RMB) per additional QALYs gained,indicating that the PMTCT is cost effective.The results were reliable indicated by one-way,multi-way and probability sensitivity analyses.By the CEAC,the willing to pay was much lower than the cost-effectiveness threshold.From the affordability curve of the PMTCT strategy,the annual budget ranged from 590.4 million yuan (RMB) to 688.8 million yuan (RMB),which was lower than the financial ability.Based on the results of cost-effectiveness affordability curves,the higher annual budget was determined,the higher probability of affordability for the PMTCT would be obtained under the same willing to pay state.Only when the annual budget reaches 688.8 million yuan (RMB),the goal of PMTCT would be fully realized.Conclusions The PMTCT strategy in China was cost effective,and the cost is not beyond the financial budget needed and the willing to pay.The strategy,which is consistent with the global hepatitis B elimination efforts,should be conducted widely in China.

Integrating HIV, hepatitis B and syphilis screening and treatment through the Maternal, Newborn and Child Health platform to reach global elimination targets

Every year, an estimated 180 000 babies in the Western Pacific Region are infected by hepatitis B, 13 000 by syphilis and 1400 by HIV through mother-to-child transmission.1 These infections can be largely prevented by antenatal screening, treatment and timely vaccination for newborns. Despite challenges in controlling each disease, major achievements have been made. National immunization programmes have reduced the regional hepatitis B prevalence from over 8% in 1990 to 0.93% among children born in 2012. In addition, HIV testing and treatment have helped keep the regional prevalence of HIV infections at 0.1%. In contrast, the number of maternal syphilis cases is still high in the Western Pacific Region, with an estimated 45 million cases in 2012. Elimination of mother-to-child transmission of these infections cannot be achieved through vertically applied programming and require using and augmenting to the shared Maternal, Newborn and Child Health platform to coordinate, integrate and enable cost efficiencies for these elimination efforts. The Regional Framework for Triple Elimination of Mother-to-Child Transmission of HIV, Hepatitis B and Syphilis in Asia and the Pacific 2018–2030 offers such a coordinated approach towards achieving the triple elimination of mother-to-child transmission of HIV, hepatitis B and syphilis and provides guidance for decision-makers, managers and health professionals working in programmes addressing maternal, newborn and child health, HIV, hepatitis, sexually transmitted infections and immunization.

Reverse Vertical Transmission of Hepatitis-B from Transfusion-infected Children to Biological Mothers.

Background: Perinatal and horizontal are the common modes of transmission of hepatitis-B virus in children. Case characteristics: Two mother-child pairs with children having received multiple blood transfusions in past. Observation: Both the mothers developed acute hepatitis-B infection whereas children were demonstrated to be having chronic infection with hepatitis-B. Outcome: One mother cleared her hepatitis-B in fection whereas it persisted in the other. Both children required anti-viral treatment. Message: Hepatitis-B virus may rarely get transmitted from infected children to their mothers causing acute infection.

High Prevalence of Hepatitis-B Surface Antigen in Pregnant Women Observed in Southwest Nigeria: A Potential Risk for Vertical Hbsag Transmission.

Aim: Nigeria has been classified among the nations highly endemic for viral Hepatitis with a seroprevalence of 2.7-13.3% in normal population. The study determines the seroprevalent rates of hepatitis B virus based on trimester stages in a population of pregnant women. Study Type: Case control. Place of Study: Department of Microbiology, Obafemi Awolowo University, Ile Ife. Materials and Methods: In this case-control study, a total of 300 pregnant women sampled in the population were attending ante-natal clinic at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Southwest Nigeria. A rapid one-step diagnostic strip method was used for Hepatitis B surface antigen (HBsAg) detection and Smart check HBsAg Immunoassay used for confirmation. The study had a structured questionnaire to generate baseline information. One-way analysis of variance (ANOVA) using statistical Package for Social Sciences (SPSS) version 18. Results: High prevalence of HBsAg was observed in pregnant women that are married (6.67%), have multiple sexual partners (7.76%) and indulge in transactional sexual behaviour (7%). Awareness of HbsAg transmission to the fetus by the pregnant mothers (0.95%) and previous HbsAg testing were low (3%). Differentials in the 1st, 2nd and 3rd pregnancy trimesters showed 42.9%, 10.9%, and 18.4% prevalent rates respectively. Conclusion: The result expresses high potential and possible risk associated with HbsAg vertical transmission during the 1st and 2nd trimester of pregnancy. Therefore, proactive approach targeted at this population should be designed to reduce HbsAg transmission to the fetus.

Management of newborn infant born to mother suffering from tuberculosis: Current recommendations & gaps in knowledge.

Tuberculosis (TB) is a global disease with increase in concern with growing morbidity and mortality after drug resistance and co-infection with HIV. Mother to neonatal transmission of disease is well known. Current recommendations regarding management of newborns of mothers with tuberculosis are variable in different countries and have large gaps in the knowledge and practices. We compare and summarize here current recommendations on management of infants born to mothers with tuberculosis. Congenital tuberculosis is diagnosed by Cantwell criteria and treatment includes three or four anti-tubercular drug regimen. Prophylaxis with isoniazid (3-6 months) is recommended in neonates born to mother with TB who are infectious. Breastfeeding should be continued in these neonates and isolation is recommended only till mother is infectious, has multidrug resistant tuberculosis or non adherent to treatment. BCG vaccine is recommended at birth or after completion of prophylaxis (3-6 months) in all neonates.

Prevention of perinatal group B streptococcal infections: A review with an Indian perspective.

Group B Streptococcus (GBS) is an important cause of maternal and neonatal morbidity and mortality in many parts of the world. Asymptomatic colonisation of the vagina and rectum with Group B streptococci is common in pregnancy. Maternal colonisation of GBS can vary depending on ethnicity and geographical distribution. Vertical transmission of this organism from mother to foetus may lead to neonatal GBS disease. Intra-partum use of antibiotics in these women has led to a decrease in the rate of early onset but not late onset GBS disease. Identifi cation of women with GBS is the key factor in the prevention of perinatal GBS disease. There are different screening strategies available to identify women at risk of perinatal GBS disease. Clinicians continue to face the challenge of choosing between preventive strategies to reduce the impact of perinatal GBS disease. Controversy exists regarding the ideal preventive strategy. In India, the mortality and morbidity associated with the GBS disease remains largely a under-recognised problem. This comprehensive review summarises the salient features of GBS disease and discusses the epidemiology, risk factors, screening strategies, intra-partum antibiotic prophylaxis with an Indian perspective and how it compares with the Western nations.

Factores de riesgo asociados a la transmisión madre-hijo del VIH en los pacientes del CAPACITS de Veracruz / Risk factors associated with mother-to-child transmission of HIV in the patients of CAPACITS in Veracruz, Mexico

La infección por el virus de la inmunodeficiencia humana (VIH) puede adquirirse por transmisión perinatal, y el riesgo de adquirirla ha aumentado porque en los últimos años la epidemia ha tomado un patrón heterosexual, lo que aumenta el número de mujeres infectadas, un riesgo potencial para la transmisión perinatal. Objetivo: Determinar los factores de riesgo asociados a la transmisión vertical en recién nacidos hijos de madres con VIH atendidas en el Centro de Atención a Pacientes con Infecciones de Transmisión Sexual y SIDA (CAPACITS) de Veracruz. Material y métodos: Se realizó un estudio de cohorte retrospectivo de una población de madres VIH+ e hijos que acudieron al CAPACITS de Veracruz en el periodo comprendido entre 2007-2012. Se revisaron los expedientes de mujeres embarazadas y sus recién nacidos atendidos en el CAPACITS, y los resultados se analizaron con estadística descriptiva y mediante la prueba de χ² y regresión logística. Resultados: Se estudiaron 50 mujeres que solicitaron control prenatal. Las variables estudiadas fueron factores asociados en la madre y factores relacionados con el recién nacido. En relación al tratamiento antirretroviral en la muestra, nueve embarazadas (18%) no tomaron ningún tratamiento; dos de sus hijos se infectaron. De los casos de madres con tratamiento, ninguno de sus hijos se infectó. Considerando las variables relacionadas con infección en el producto, una madre sin esquema de tratamiento fue el factor principal para el contagio del niño, en segundo lugar fue el conteo de CD4 < 200 células/mm³ y en tercer lugar la carga viral materna. Conclusión: El resultado de nuestro estudio predice que la positividad de los recién nacidos depende del tratamiento antirretroviral de la madre.

HIV infection can be acquired through perinatal transmission. The risk of acquiring this infection has been increased in recent years because the epidemic has taken a heterosexual pattern, which has caused a growth in the number of infected women and a potential risk for perinatal transmission. Objective: To determine the risk factors associated with vertical transmission in newborns to HIV-positive mothers at the Care Center for Patients with Sexually Transmitted Infections and AIDS (CAPACITS) in Veracruz, Mexico. Material and methods: We conducted a retrospective cohort study of a population of HIV-positive mothers and their newborns, who sought care at the CAPACITS of Veracruz between 2007 and 2012. The records of controlled mothers and their children were analyzed using descriptive and inferential statistics. Results: The study was performed in 50 women. The variables studied were: associated factors in mothers and associated factors in newborns. Concerning the antiretroviral treatment in the sample of mothers, nine (18%) did not take any treatment; two of their children became infected. In the case of treated mothers, none of their children became infected. Considering the infection-related variables in the product, the main factor for the spread of the infection to the children was a mother without treatment schedule and, in second place, a CD4 count < 200 cells/mm³. Conclusions: The results of our study predict that the positivity of the newborn depends on the maternal antiretroviral treatment.

Recomendaciones para la prevención de la transmisión perinatal del virus de la inmunodeficiencia humana en Costa Rica / Recommendations for prevention of perinatal transmission of the human immunodeficiency virus in Costa Rica

Se conoce que la transmisión perinatal del VIH es prevenible con la toma de algunas medidas generales y otras específicas. La acción fundamental para lograr esta prevención es identificar temprano durante el embarazo, cuáles mujeres embarazadas están infectadas por VIH. Para conseguir este objetivo es necesario realizar la prueba del ELISA para VIH, a toda embarazada, en su primera consulta prenatal. Las guías para la prevención de la transmisión perinatal de VIH se desarrollaron con el fin de facilitar la aplicación de todas las acciones necesarias para prevenir la transmisión perinatal de VIH en Costa Rica, brindando una óptima atención médica a la madre y al recién nacido. Los elementos fundamentales de estas guías incluyen: tratamiento con 3 antirretrovirales a las mujeres embarazadas VIH+, a apartir de la 12ava semana de gestación, uso intravenoso de Zidovudina en labor, vía de parto por cesárea, suspensión de la lactancia materna, profilaxis con Zidovudina al recién nacido a partir de las 8 horas de edad. Las guías proveen también recomendaciones para proceder en situaciones especiales relacionadas con la embarazada VIH+ y su hijo...

Seroprevalence of hepatitis B infection during pregnancy and risk of perinatal transmission.

Objectives To investigate the seroprevalence of hepatitis B surface antigen (HBsAg) in pregnant women and possible risk factors for perinatal hepatitis B virus (HBV) transmission. Methods Four thousand pregnant women were evaluated using history, examination, and test for serum HBsAg using commercial enzyme immunoassay kits. For HBsAg positive women, liver function tests and a test for hepatitis B e antigen (HBeAg) was done. HBV DNA analysis was done by polymerase chain reaction (PCR). Results Of 4,000 women studied, 37 (0.9%) tested positive for HBsAg. Of these 37 women, 6 (16%) presented with acute hepatitis and 31 (84%) were asymptomatic. The highest HBsAg positivity rate was seen in the age group of 21– 25 years (1.15%) followed by 26–30 years (0.86%). Assessment of risk factors revealed history of tattooing in 29/37 (78.4%) women. HBeAg was positive in 21 of 37 (56.8%) women. Of the 16 HBeAg negative women, 5 were positive for HBV DNA and anti-HBe antibody, 6 had only anti-HBe antibody and 5 had neither HBV DNA nor anti-HBe. Vertical transmission was seen in 65% (13/20) of babies born to mothers who were positive for HBeAg and HBV DNA. In contrast, it was only 9.1% (1/11) for babies born to mothers who were negative for both HBeAg and HBV DNA. Of the 25 babies delivered vaginally, 15 (60%) developed vertical transmission. None of the four babies delivered by elective cesarean section had evidence of vertical transmission. Conclusions Seroprevalence of HBsAg in antenatal women was found to be 0.9%. HBe-antigen and HBV DNA positivity was associated with a higher chance of vertical transmission

The Two Successful Cases of Lamivudine Prophylaxis during Pregnancy to Prevent Vertical Transmission of Hepatitis B Virus Infection / 대한주산의학회잡지

The rate of perinatal transmission of hepatitis B virus (HBV) is decreased through vaccination and HBIG in Korea, however it is estimated that about 3% of pregnant individuals are HBsAg positive. En percent of the children born to high-risk HBV carrier mothers, who show HBeAg positive/high HBV-DNA level become HBsAg carriers despite appropriate immunoprophylaxis and those affected children remain chronic HBsAg carriers and might have advanced liver disease such as liver cirrhosis and hepatocellular carcinoma. To prevent vaccination breakthrough, more potent prophylaxis is needed and several studies have suggested efficacy and safety of lamivudine therapy during pregnancy for reduction of maternal HBV DNA level. We report 2 family cases of successful prevention of vertical transmission with lamivudine during 3rd trimester for mothers who had high HBV-DNA levels and previous HBV carrier children because of immunoprophylaxis failure.

Eficacia del uso de la nevirapina asociado a zidovudina/lamivudina en la transmisión perinatal del VIH / Effectiveness of using neviparine associated to zidovudine/lamivudine in HIV perinatal transmission

El Virus de inmunodeficiencia humana (VIH), es un retrovirus que afecta la inmunidad celular mediante la unión selectiva a células que expresan la molécula CD4 en su superficie, en especial los linfocitos T. Descubierto en la década de los 80, ha cobrado la vida de 20 millones de personas hasta la actualidad, con un remanente de 37.8 millones que aún quedan como portadores. De esta última cifra, más de un 50 son niños infectados perinatalmente, con una tasa de 1.500 por día a nivel mundial23. Se han realizado varios trabajos en la última década (PACTG 076, PACTG 316, entre otros), para comprobar la eficacia de la zidovudina, sola y asociada a otros inhibidores de la transcriptasa. La falta de recursos en países como el nuestro imposibilita la implementación adecuada del esquema profiláctico de transmisión perinatal utilizado en países del primer mundo, por lo que debemos utilizar otras combinaciones terapéuticas aún en estudio. Para documentar la eficacia del esquema más utilizado en nuestro medio: biterapia estándar de lamivudina (3TC) y zidovudina (AZT), más la adición de una monodosis de nevirapina justo antes del parto, se realizó un estudio de cohorte, observacional, retrospectivo y comparativo en el hospital maternidad “Mariana de Jesús”, de la ciudad de Guayaquil, debido a su alta incidencia de casos11. El estudio abarcó madres VIH positivo con embarazos interrumpidos por cesárea durante el año 2004, así como también datos de sus neonatos. A fin de sustentar la eficacia de la terapia, se tomaron en consideración los valores de carga viral, obtenidos por PCR y contaje celular CD4, ambos realizados en los laboratorios del Instituto Nacional de Higiene “Leopoldo Izquieta Pérez”, de Guayaquil. Así como también, datos de laboratorio relevantes a los efectos secundarios que pudieran haber sido ocasionados por esta asociación terapéutica, en especial valores de hemoglobina para el seguimiento del efecto secundario más común de esta terapia que es la anemia.

Human immunodeficiency virus (VIH), is a retrovirus affecting cellular immunity through selective union to cells with CD4 molecule expression in their surfaces, especially T-lymphocytes. Discovered in the 80’s, it has killed 20 million up to now, with a remnant of 37.8 million carriers. From the last figure, more than 50 are children infected in perinatal stage, with a world rate of 1,500 per day23. In the last decade several papers have been made (PACTG 076, PACTG 316, among others), to check the effectiveness of zidovuline, alone, and associated to other transcriptase inhibitors. Lack of resources in countries like ours makes impossible to carry out appropriately the preventive system of perinatal transmission used in the first world countries; therefore we have to use other therapy combinations which are still object of studies. To document the effectiveness of the most used system in our country: standard lamivudine (3TC) and zidovuline (AZT) bitherapy, plus a dose of neviparine just before labor, a cohort, observational, retrospective and comparative study was carried out in the maternity hospital “Mariana de Jesús” in Guayaquil because of it’s high case incidence11. The study included positive HIV mothers with interrupted pregnancies by cesarian section during 2004, as well as their newborn data. In order to uphold the effectiveness of the therapy, viral load values, obtained by PCR and cell count CD4 (both made in the Instituto Nacionalde Higiene “Leopoldo Izquieta Pérez” laboratories), were considered. Laboratory data related to side effects that could be produced by this combined therapy were also considered, especially hemoglobin values to make the follow up of the most common side effect: anemia.

The Knowledge, Attitude and Practices regarding HBV Infection of Married Women in the Reproductive Age Group living in Cantonment Area, Sunjawan, Jammu

The present study was conducted to know the knowledge, attitude and practices of 300 married women in the reproductive age group living in the cantonment area Sunjawan, Jammu regarding HBV infection. Only 20% of the women were found aware of the mode of transmission of HBV. However, 50% of the women were having the misconceptions regarding mode of transmission of HBV. 4% of women, 30% of children up to 5 years and 15% of children above 5 years were fully immunized with hepatitis B vaccine. 80% of children up to 5 years and 75% of children above 5 years were fully immunized as per universal immunization programme. Hence, the results of the study clearly indicated the low immunization rate with vaccine against HBV than that under universal immunization programme and further potentiated the need for implementation of the recommendations in 9th five year plan of India regarding introduction of immunization against HBV in universal immunization programme at the earliest .

Intrafamilial Clustering Of HbsAg and HBV DNA Among The Families Of Carriers.

To find out the clustering of HBV carriers within a family, 50 HBsAg carriers were studied. The distribution of HBsAg was found to be high (33%) among the offspring of HBsAg negative father and positive mother when compared to positive father and negative mother (16%) or where both the parents were HBsAg negative (31%0. The frequency of HBV DNA was also found to be high among the offspring of HBV DNA negative father and HBV DNA positive mother (25%). Male infection leading to a clustering of HBsAg carrier families.