Lopinavir/ritonavir dosing during pregnancy in Brazil and maternal/infant laboratory abnormalities.

OBJECTIVES: To describe laboratory abnormalities among HIV-infected women and their infants with standard and increased lopinavir/ritonavir (LPV/r) dosing during the third trimester of pregnancy. METHODS: We evaluated data on pregnant women from NISDI cohorts (2002-2009) enrolled in Brazil, who received at least 28 days of LPV/r during the third pregnancy trimester and gave birth to singleton infants. RESULTS: 164 women received LPV/r standard dosing [(798/198 or 800/200 mg/day) (Group 1)] and 70 increased dosing [(> 800/200 mg/day) (Group 2)]. Group 1 was more likely to have advanced clinical disease and to use ARVs for treatment, and less likely to have CD4 counts > 500 cells/mm³. Mean plasma viral load was higher in Group 2. There were statistically significant, but not clinically meaningful, differences between groups in mean AST, ALT, cholesterol, and triglycerides. The proportion of women with Grade 3 or 4 adverse events was very low, with no statistically significant differences between groups in severe adverse events related to ALT, AST, total bilirubin, cholesterol, or triglycerides. There were statistically significant, but not clinically meaningful, differences between infant groups in ALT and creatinine. The proportion of infants with Grade 3 or 4 adverse events was very low, and there were no statistically significant differences in severe adverse events related to ALT, AST, BUN, or creatinine. CONCLUSION: The proportions of women and infants with severe laboratory adverse events were very low. Increased LPV/r dosing during the third trimester of pregnancy appears to be safe for HIV-infected women and their infants.

Lopinavir/ritonavir dosing during pregnancy in Brazil and maternal/infant laboratory abnormalities

OBJECTIVES: To describe laboratory abnormalities among HIV-infected women and their infants with standard and increased lopinavir/ritonavir (LPV/r) dosing during the third trimester of pregnancy. METHODS: We evaluated data on pregnant women from NISDI cohorts (2002-2009) enrolled in Brazil, who received at least 28 days of LPV/r during the third pregnancy trimester and gave birth to singleton infants. RESULTS: 164 women received LPV/r standard dosing [(798/198 or 800/200 mg/day) (Group 1)] and 70 increased dosing [(> 800/200 mg/day) (Group 2)]. Group 1 was more likely to have advanced clinical disease and to use ARVs for treatment, and less likely to have CD4 counts > 500 cells/mm³. Mean plasma viral load was higher in Group 2. There were statistically significant, but not clinically meaningful, differences between groups in mean AST, ALT, cholesterol, and triglycerides. The proportion of women with Grade 3 or 4 adverse events was very low, with no statistically significant differences between groups in severe adverse events related to ALT, AST, total bilirubin, cholesterol, or triglycerides. There were statistically significant, but not clinically meaningful, differences between infant groups in ALT and creatinine. The proportion of infants with Grade 3 or 4 adverse events was very low, and there were no statistically significant differences in severe adverse events related to ALT, AST, BUN, or creatinine. CONCLUSION: The proportions of women and infants with severe laboratory adverse events were very low. Increased LPV/r dosing during the third trimester of pregnancy appears to be safe for HIV-infected women and their infants.

Vertical transmission of hepatitis C virus in a hospital in southern Brazil.

BACKGROUND: There still are controversies concerning the vertical transmission of hepatitis C virus. AIM: To evaluate the prevalence of antibodies against hepatitis C virus in pregnant women, as well as the rate of vertical transmission of this virus. PATIENTS AND METHODS: Between August 1998 and November 1999, 1,090 consecutive pregnant women were screened for anti-hepatitis C virus; positive results were confirmed by the polymerase chain reaction assay. Patient's viral load was evaluated by the branched deoxyribonucleic acid assay. Hepatitis C virus genotype was identified by direct sequencing of the polymerase chain reaction amplification products. The same tests were performed in the children born from infected mothers at the 1st and 6th month of life. RESULTS: Of the 1,090 mothers surveyed, 29 were positive for anti-hepatitis C virus (prevalence of 2.66%). Twenty-five patients presented with hepatitis C virus RNA, with a median hepatitis C virus viral load of 3.132 +/- 5.891 MEq/mL. Twenty-two patients (six human immunodeficiency virus-coinfected) were followed and gave birth to 23 children; 18 of them had blood samples tested at the 1st month of life, and 22, at the 6th month. Vertical transmission rate was 5.56%; it affected a girl who had hepatitis C virus RNA detectable only in the 1st month sample (41.570 MEq/mL). The mother who transmitted hepatitis C virus was coinfected with human immunodeficiency virus and presented with an hepatitis C virus viral load of 3.765 MEq/mL, with 100% homology with her daughter's hepatitis C virus genotype. CONCLUSION: These results suggest that the prevalence of hepatitis C virus infection in pregnant women should not be neglected, and early diagnosis of vertical transmission and the follow up of infected children should be emphasized.

Vertical transmission of hepatitis C virus in a hospital in southern Brazil

RACIONAL: Ainda existem controvérsias em relação à transmissão vertical do vírus da hepatite C (VHC). OBJETIVO: Avaliar a prevalência dos anticorpos contra o VHC (anti-VHC) em mulheres grávidas, bem como a percentagem de transmissão vertical observada. PACIENTES E MÉTODOS: Entre agosto de 1998 e novembro de 1999, 1.090 mulheres grávidas consecutivas realizaram a determinação do anti-VHC. A confirmação do teste foi feita pela reação em cadeia da polimerase. A carga viral foi determinada pelo b-DNA e o genótipo por seqüenciamento. Os mesmos testes foram realizados no 1º e 6º mês de vida, nas crianças nascidas de mães infectadas. RESULTADOS: Das 1.090 mães estudadas, 29 apresentaram positividade para o anti-VHC (prevalência de 2,66%). Em 25 pacientes foi demonstrado o RNA do VHC, sendo que a carga viral média foi de 3,132 ± 5,891 MEq/mL. Vinte e duas pacientes (6 co-infectadas com o vírus da imunodeficiência humana) foram seguidas e deram à luz a 23 crianças, das quais 18 tiveram seu sangue testado no 1º mês e 22 no 6º mês. Foi observada transmissão vertical em 5,56% dos casos. Assim, em uma criança do sexo feminino foi detectado o RNA do VHC (41,570 MEq/mL). A mãe desta criança estava co-infectada pelo vírus da imunodeficiência humana e apresentava carga viral de 3,765 MEq/mL, com 100% de homologia no genótipo viral. CONCLUSAO: Estes resultados sugerem que a prevalência da infecção pelo VHC em gestantes não deve ser negligenciada e que um diagnóstico precoce e o seguimento das crianças infectadas deve ser preconizado.

Vírus da hepatite C em gestantes: prevalência e avaliação do risco do aleitamento materno / Hepatites C virus in pregnant women: prevalence and evaluation of breast - feeding risk

Este estudo avaliou a prevalência do anti-HCV em gestantes de um hospital geral, bem como a presença do vírus da hepatite C (VHC) no leite materno. Para tanto, foram avaliadas prospectivamente 1.090 gestantes, nas quais foi realizada a pesquisa do anti-HCV. Nas pacientes reagentes foi feita a pesquisa do RNA viral pela reação em cadeia da polimerase (PCR), sendo que nas que amamentavam foram colhidas amostras de leite para pesquisa do HCV RNA. Observou-se uma prevalência do anti-HCV em 2,66 por cento das gestantes, sendo que o HCV RNA foi positivo em 82,61 por cento das analisadas. Seis gestantes apresentavam coinfecção pelo vírus da imunodeficiência humana. Quando se avaliaram 12 amostras de leite materno, o HCV RNA foi negativo. Os autores concluem que a prevalência do VHC em gestantes não deve ser desconsiderada e que o aleitamento materno não é um fator relevante na transmissão do VHC.

Transmissão vertical da infecção pelo vírus C da hepatite

O presente estudo teve como objetivo avaliar a prevalência da infecção pelo vírus C da hepatite (HCV) entre gestantes em um hospital geral, bem como estudar a incidência da infecção pelo HCV através da transmissão vertical. Também estudou-se a possibilidade da associação da transmissão vertical do HCV com a carga viral materna e com a coinfecção materna pelo vírus da imunodeficiência humana (HIV), bem como o papel do aleitamento na transmissão vertical. Do presente, estudo conclui-se que a prevalência do anti-HCV nas gestantes avaliadas foi de 2,66%, sendo infreqüente a transmissão vertical (5,56%). Por outro lado, a não detecção do genoma viral no leite materno permite que o incentivo ao aleitamento não seja contra-indicado em função da infecção pelo HCV.

Estudo clínico, laboratorial e histológico em doadores de sangue anti-HCV positivos / Clinical, biochemical, and histologic research in anti-HCV positive blood donors

Com o presente trabalho pretendeu-se verificar, em um estudo prospectivo clínico-bioquímico-histopatológico, o grau de comprometimento hepático causado pelos vírus da hepatite C em doadores de sangue. Uma amostra de 60 indivíduos anti-HCV ELISA 2 positivos, confirmados por RIBA 2 ou PCR, dentre 37.335 doadores consecutivamente rastreados durante o biênio 93-94, foram submetidos a determinaçôes sanguíneas das chamadas provas de funçäo hepática e submetidos à punçäo-bipsia hepática segundo a técnica de Menghini. Em relaçäo aos exames laboratoriais, a alanina-aminostransferase foi o teste que mais frequentemente se mostrou alterado, fazendo-o em quase 2/3 dos casos, ao passo que a análise histológica demonstrou a presença de hepatopia crônica em cerca de 80 por cento da amostra. Foi observada forte associaçäo entre elevçäo desta enzima e presença de hepatopatia crônica, embora a intensidade desta elevaçäo näo se correlacione com a gravidade da lesäo histológica