ABSTRACT
We reviewed the antenatal HIV testing history, clinical presentation and outcome of 25 infants diagnosed with HIV between 1 January 2001 and 31 December 2005 in a tertiary referral hospital in London. Of the 25 cases, 21 had received antenatal care in the UK. Twelve mothers had not had an antenatal HIV test, four had tested positive antenatally, while five had had a negative HIV test on antenatal booking, implying seroconversion in pregnancy. When mothers had not been diagnosed antenatally, infants presented with severe infections, which were fatal in six cases. The majority (65%) of the children have long-term neurological sequelae. HIV seroconversion is an important cause of infant HIV in the UK.
Subject(s)
HIV Infections/diagnosis , Infectious Disease Transmission, Vertical , Pregnancy Complications, Infectious/diagnosis , Prenatal Diagnosis , Antiretroviral Therapy, Highly Active , Female , HIV Infections/drug therapy , HIV Infections/epidemiology , HIV Seropositivity/epidemiology , Humans , Infant , Male , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Retrospective Studies , United Kingdom/epidemiologyABSTRACT
BACKGROUND: Adherence to antiretroviral therapy is critical to treatment outcomes. Adherence studies in other therapeutic areas of medicine suggest that once-daily regimens support improved adherence when compared to twice-daily therapy. An expansion in the range of once-daily antiretrovirals is making once-daily therapy possible for persons with HIV infection. METHODS: A 24-week randomized open-label simplification study of twice-daily regimens based on stavudine immediate release or zidovudine to an all once-daily regimen based on the stavudine prolonged-release capsule (PRC), in persons with complete virological suppression on regimens also including efavirenz and lamivudine, was carried out. Subjects were assessed for adherence [using the Medication Event Monitoring System (MEMS) cap; Aardex Corporation, Union City, CA, USA], quality of life, tolerability and efficacy. RESULTS: Forty-three patients were randomly assigned: 21 remained on their original regimen and 22 switched to once-daily therapy with stavudine PRC. Although high levels of adherence and good quality of life were present at study enrollment, adherence declined to a significantly lesser extent at week 24 in the group that switched to once-daily therapy. Efficacy was maintained in both groups and there were no differences in tolerability or toxicity. CONCLUSIONS: Subjects switching from twice-daily therapy to once-daily therapy demonstrate less of a decline in adherence over 24 weeks. A once-daily regimen including stavudine PRC is as effective and tolerable as a regimen containing the twice-daily formulation.
