The rapid diagnosis of HIV-1 infection in mothers in Puerto Rico: a crucial testing strategy for maximal reduction of perinatal transmission

This study was designed to evaluate early post partum rapid HIV testing of infants as surrogates for their mothers. In a screening of 971 infants whose mother's HIV-1 status was not known at delivery, 22 (= 2.26) were found positive for antibodies by ELISA. Five were new cases and two (40) were from transmitting mothers. This is in contrast with the UPR Women and Infants Transmission Study (UPR WITS) in which of 186 HIV-1 infected mothers none were transmitters. These were selected among thousands screened for anti-HIV-1 antibodies over a period of almost 5 years studied (September, 1996 through August, 2001). These results clearly indicate that all mothers at delivery should have a rapid test to determine their HIV-1 status to allow in the positive cases rapid intervention strategies to prevent perinatal transmission.

Intracellular studies of the nucleoside reverse transcriptase inhibitor active metabolites: a review

Nucleoside reverse transcriptase inhibitors (NRTIs) plasma concentrations do not correlate with clinical efficacy or toxicity. These agents need to be phosphorylated to become active against HIV-infection. Thus, the characterization of the NRTIs intracellular metabolite pharmacological parameters will provide a better understanding that could lead to the development of more rational dose regimens in the HIV-infected population. Furthermore, intracellular measurements of NRTIs may provide a better marker with respect to clinical efficacy and toxicity than plasma concentrations. Thus, in this article we review the latest information regarding the intracellular pharmacological parameters of zidovudine (ZDV) and lamivudine (3TC) active metabolites in HIV infected patients including the results from our recent clinical studies. We will start the discussion with ZDV and 3TC clinical efficacy, followed by systemic pharmacokinetics studies. We will then discuss the in vitro and in vivo intracellular studies with particular emphasis in the method development to measure these metabolites and we will conclude with the most current data from our clinical trials.

Impericia médica en Puerto Rico: 1990-1996 / medical negligence in Puerto Rico: 1990-1996

The purpose of this communication is to present the statistical information of the medical and hospital professional liability situation in Puerto Rico from 1990 to 1996. The Medical Institutional liability is a topic of great relevancy and importance to the people of Puerto Rico and the leaders responsible for establishing policies for the health care services. The Reports on Medical and Hospital Professional Liability from 1991 to the 1996 produced by the Examining Physicians Board were reviewed. The liability claims from 1991 to the 1996 totaled 4054. During the seven years analyzed, 3506 cases were closed against physicians and institutions, a payment was issued in 1272 cases (36.3 percent), for a total compensation of $56,268,053. The risk of a legal claim is greater for the group of Plastic Surgeons and Emergency Medicine. The probability of a plaintiff receiving a compensation payment in a case of medical malpractice is approximately 36 percent, usually receiving a third of the total of the award as suggested by the medical literature. A thoughtful analysis of the current medical liability situation and defensive medicine should be done with the purpose of protecting the fiduciary function of the physicians with respect to the health of their patients, this is the function that guarantees a physician-patient relationship that is healthy, righteous and empathic

Recomendaciones para el manejo de mujeres con infección VIH / Guidelines fot the management of women with HIV infection

During the second decade of AIDS the spread of this disease has encompassed most areas of the world. In Puerto Rico the epidemic has been different than in the mainland USA. Our initial cases were mostly associated to intravenous drug use and subsequently heterosexual transmission. Sexual transmission of HIV is the principal cause of AIDS for women in Puerto Rico. AIDS is also the principal cause of death in young women in Puerto Rico (ages 25-40). Therefore the counselling to women has to include the universality of the risk. Data from seroprevalence studies show a high prenatal seroprevalence (1 per cent ) in the San Juan Metropolitan Health Region. In view of the high prenatal seroprevalence, universal offering of HIV counselling and testing is recommended. Gynecologic evaluation is essential in the follow-up of women with HIV infection and should include frequent evaluations to determine the frequent occurrence of premalignant lesions in the cervix that may be associated to immunosuppression

Pulmonary tuberculosis in an infant with AIDS: a case report

Reportamos el caso de un infante de nueve meses de edad referído al Hospital Pediátrico Universitario con pulmonía. En admisión el paciente presentó angustia respiratoria, linfadenipatía generalizada y hepatoesplenomegalia. Infección simultánea con Mycobacterium tuberculosis y el Virus de Immunodeficiencia Humana (HIV) fue documentada. La epidemiología, el diagnóstico y manejo de niños con el Síndrome de Immunodeficiencia Adquirida (SIDA) se discuten, se presentan recomendaciones en el manejo de niños con infección combinada de HIV y tuberculosis