The relationship of the duration of ruptured membranes to vertical transmission of human immunodeficiency virus.

OBJECTIVE: Intrapartum events may play a role in determining the likelihood of vertical transmission of human immunodeficiency virus-1. Timing and duration of rupture of membranes have been shown to modify transmission risk of other organisms but have not been examined for human immunodeficiency virus. This study was undertaken to assess the relationship between duration of rupture of membranes, maternal immune status, and transmission of human immunodeficiency virus. METHODS: The Mothers' and Infants' Cohort Study enrolled 207 human immunodeficiency virus-positive women and their infants at five study sites in Brooklyn and the Bronx, New York between January 1986 and January 1991. One hundred twenty-seven woman-infant sets for whom antepartum CD4+ levels were available, the infant's human immunodeficiency virus infection outcome was known, and the duration of ruptured membranes could be determined were included in this analysis. RESULTS: Thirty of the 127 evaluable infants (24%) were infected. Women with low CD4+ levels (< 20%) were significantly more likely to transmit the virus if rupture of membranes was > or = 4 hours (relative risk 4.53, 95% confidence interval 1.14 to 1.81, p = 0.02). The same association was not observed among women with higher CD4+ levels (relative risk 1.11, 95% confidence interval 0.52 to 2.69, p = 0.69). No association with the duration of labor or mode of delivery was seen. CONCLUSIONS: In this urban North American cohort women with low CD4+ levels were significantly more likely to transmit human immunodeficiency virus to their offspring if the duration of rupture of membranes was > or = 4 hours.

Human immunodeficiency virus infection in pregnant women under care at AIDS clinical trials centers in the United States.

The federal government supports a nationwide network of medical centers to evaluate promising therapies against the human immunodeficiency virus (HIV) and the opportunistic infections and cancers that characterize AIDS. Forty-five obstetricians from the 49 medical centers receiving federal research support for the conduct of AIDS-related clinical trials, in preparation for a meeting, provided summary information about the number and clinical status of the known HIV-infected pregnant women under their care and the prenatal screening policies for HIV infection at their institutions. In the 12-month period before December 1989, an estimated 1000-1801 HIV-infected women delivered at these centers. The majority (82%) were asymptomatic, 12% were symptomatic, and 6% had AIDS. Routine T-cell testing of infected women was done as part of prenatal care in only 30 of 45 centers. Pneumocystis carinii pneumonia was reported in 35 women. Zidovudine was administered during pregnancy in 29 women. Formal prenatal screening policies have been implemented at the majority (43 of 45) of the medical centers. Most of the infected women identified at these centers chose to continue the pregnancy. With the increasing incidence of HIV infection in women, information concerning the clinical and immunologic state of pregnant infected women and the present use of antiretroviral and other related therapeutics during pregnancy can guide the approach to women's health care and is crucial to the design and implementation of AIDS clinical trials.

HIV seroprevalence surveys of childbearing women--objectives, methods, and uses of the data.

A seroprevalence survey of human immunodeficiency virus (HIV) among childbearing women is being conducted in 43 States and Territories as one of the family of HIV seroprevalence surveys. This blinded survey, in which serologic test results are not linked to identifiable persons, uses neonatal dried blood specimens on filter paper to test for maternal antibodies to HIV. This survey provides relatively unbiased estimates of prevalence of HIV infection in the population of women delivering live children during given survey periods, by month or quarter of delivery, geographic area, and demographic subgroup. This objective will be met while protecting the integrity and efficient conduct of neonatal screening programs and ensuring patient anonymity. Information from this survey will be used to (a) assess the levels and trends of HIV infection in women and infants, (b) help develop and evaluate prevention programs, and (c) project the number of women and children who will develop HIV infection and the acquired immunodeficiency syndrome (AIDS) and will require health care and social services in the future.

Knowledge of AIDS among hospital workers: behavioral correlates and consequences.

Incidents of suboptimal care being rendered to AIDS patients have been documented. Using a voluntary anonymous questionnaire, we surveyed the employees of a large urban hospital in order to evaluate the knowledge, attitudes and professional behavior of the staff regarding AIDS. Responses were obtained from 1194 (60%) of the staff. Poor knowledge of the transmission of AIDS was documented, with 50% of workers stating that AIDS can be spread through ordinary non-sexual contact and 23% through the air by a cough or a sneeze. One-third of employees believed that they should be able to refuse to care for patients with AIDS. Extreme anxiety in dealing with AIDS patients was noted by 25% of employees, and only 16% of the employees would volunteer to work on an AIDS ward. Knowledge regarding AIDS was demonstrated to be a predictor of positive attitudes, appropriate professional behavior and lower anxiety in dealing with AIDS patients. The goal of hospital education programs on AIDS must be to ensure the incorporation of accurate information into the belief system of workers.