Non-infected Women Research Articles

Maternal obesity, obstetric interventions and post-partum anaemia increase the risk of post-partum sepsis: a population-based cohort study based on Swedish medical health registers

Background: The objective was to estimate whether maternal obesity and/or obstetric interventions are associated with diagnosed maternal post-partum sepsis.Methods: A retrospective observational cohort study including all deliveries in Sweden between 1997 and 2012 (N = 1,558,752). Cases of sepsis (n = 376) were identified by International Classification of Diseases, (ICD-10) codes A40, A41 and O 85 in the Medical Birth Register and the National Patient Register. The reference population was non-infected, and therefore, women with any other infection diagnosis and/or with dispensed antibiotics within eight weeks post-partum were excluded. Information on dispensed drugs was available in the prescribed drug Register. Women with sepsis were compared with non-infected women concerning maternal characteristics and obstetric interventions. Adjusted odds ratios (aOR) were determined using the Mantel–Haenszel technique. Adjustments were made for maternal age, parity and smoking.Results: Obese women (body mass index ≥30) had a doubled risk of sepsis (3.6/10,000) compared with normal weight women (2.0/10,000) (aOR 1.85 (95%CI: 1.37–2.48)). Induction of labour (aOR 1.44 (95%CI: 1.09–1.91)), caesarean section overall (aOR 3.06 (95%CI: 2.49–3.77)) and elective caesarean section (aOR 2.41 (95%CI: 1.68–3.45)) increased the risk of sepsis compared with normal vaginal delivery. Post-partum anaemia due to acute blood loss was associated with maternal sepsis (aOR 3.40 (95%CI: 2.59–4.47)).Conclusions: Maternal obesity, obstetric interventions and post-partum anaemia due to acute blood loss increased the risk of diagnosed post-partum sepsis indicating that interventions in obstetric care should be considered carefully and anaemia should be treated if resources are available.

IL-10 gene polymorphism c.-592C > A increases HPV infection susceptibility and influences IL-10 levels in HPV infected women

Interleukin-10 (IL-10) influences HPV infection and viral persistence, favoring cervical immunosuppression and cervical carcinogenesis. IL-10 levels may be influenced by HPV itself and by IL-10 polymorphisms, including rs1800872 (c.-592C>A). Therefore, we evaluated the influence of IL-10 c.-592C>A polymorphism in HPV infection and in IL-10 plasmatic/cervical levels in HPV infected and non-infected women. The study included 174 infected and 186 non-infected patients. Cervical epithelial scrapings were obtained to determine HPV DNA presence PCR. Peripheral blood samples were obtained to determine IL-10 polymorphism by PCR-RFLP, while IL-10 levels were assessed by ELISA. HPV was more prevalent among allele A carriers (p<0.001), with IL-10 c.-592C>A polymorphism being associated with HPV infection. As demonstrated by binary logistic regression analysis, heterozygotes [ORadj=2.081 95% CI (1.222–3.544), p=0.007] and homozygotes [ORadj=3.745 95% CI (1.695–8.271), p=0.001] showed approximately 2 and 4 time's greater odds, respectively, of presenting HPV when compared to CC patients. Moreover, HPV infected patients carrying polymorphic allele A showed higher IL-10 cervical levels (p=0.039). Binary logistic regression analysis demonstrated that IL-10 cervical levels were not independently associated to CA+AA genotypes (p=0.162), neither to HPV's presence (p=0.061), thus IL-10 cervical levels are possibly increased because of both HPV and allele A presence. Taken together, these findings suggest that IL-10 c.-592C>A polymorphism is independently associated with HPV infection susceptibility exerting influence on IL-10 cervical levels in HPV infected women, thus contributing to cervical carcinogenesis.

Influence of chlamydia infection on DNA damage in patients with cervical cancer.

e17020 Background: The role of Chlamydia trachomatis (Ch. tr.) in development of cervical neoplasia is widely discussed. However, molecular mechanisms of Ch. tr. contribution to carcinogenesis are poorly studied. The purpose of the study was to analyze degrees of DNA damage in blood leucocytes in patients with cervical cancer with Ch. tr. infection and in non-infected patients and healthy women. Methods: DNA damage was assessed by the comet assay, the alkaline single-cell gel electrophoresis (20 min, 300 mA, 20 V, 2 V/cm, 4°C) allowing detection of DNA base modifications leading to alkali-labile sites. The preparations were stained with ethidium bromide solution and microscoped (Axio Imager M2, Zeiss) at the excitation wavelength 520 nm and emission wavelength 640 nm. 200 cells were analyzed in each preparation. Percentage of DNAs in the comet tail (T%DNA) was used as an indicator of DNA damage. DNA damage was assessed in 14 patients with cervical cancer and in 13 healthy women. The data were analyzed using Exsel and Statistika 6.0 programs and Mann-Whitney U test and Student's t-test. Results: Mean T%DNA in 8 cervical cancer patients non-infected with Ch. tr. was 4.35±0.63, being significantly (р=0.012580) higher (by 53.7%) than in women without oncopathology (2.83±0.20). The value in infected patients was 10.44±0.11 which was significantly higher than in non-infected patients (by 2.4 times, р=0.000056) and in healthy women (by 3.7 times, р=0.000000). Thus, presence of Ch. tr. was associated with more than 2 times increase in DNA damage in cervical cancer patients. The results are consistent with previously reported data of cell culture studies according to which chlamydia causes histone modification and DNA double strand breaks [Chumduri C. et al., 2013]. Conclusions: The results confirm the role of chlamydia infection in DNA damage in blood cells in cervical cancer patients which promotes malignant development in organs of the female reproductive system.

Changes in cervical cancer course under the influence of HPV/chlamydia trachomatis co-infection.

e17018 Background: The purpose of the study was to analyze the effect of HPV/Chlamydia trachomatis co-infection on the hormonal status of tumor and visually unchanged cervical tissues in cervical cancer patients. Methods: We studied levels of estrone (E1), estradiol (E2), free estriol (E3), free (fT) and total (T) testosterone, progesterone (P4) and prolactin (PRL) by the ELISA in tumors and visually unchanged cervical tissues of 49 patients with cervical cancer T1b-2aN0M0 with endophytic (25 patients) and exophytic (24 patients) patterns of tumor growth. 13 patients with endophytic tumors and 12 patients with exophytic ones were infected with HPV and Сhlamydia trachomatis (Ch.tr.). HPV infection was determined by Е7 protein expression, Ch.tr. – by IgG and IgА and antigen/DNA in ELISA and PCR. Intact cervical tissues obtained during hysterectomy from 22 non-infected women with endometrial cancer were used as the control. Results: Tumor tissues of the cervix without infection demonstrated increased levels of all sex steroids: estrogens by 3 times, androgens by 3.1 times and progestins by 1.8 times. Co-infected tissues were characterized by the sex-steroid imbalance. We observed reduced coefficients of estrogens to T and fT by 1.6 and 6 times, respectively, compared to intact tissues (most significant in a tumor with endophytic growth pattern) and an increase in the estrogens to P4 ratio by 1.5 times – only in endophytic growth pattern. Androgenic status in co-infected tumor tissues increased by 1.7 in endophytic and by 3.1 times in exophytic growth pattern. PRL level was increased only in co-infected tumors (by 2.5 times). Unchanged co-infected tissues, unlike non-infected samples, showed E2 increase by 2.6 times in exophytic and by 1.5 times in endophytic growth pattern, T increase by 1.6 times only in endophytic tumors and P4 decrease by 1.5 times and PRL increase by 1.8 times regardless the tumor growth pattern. Conclusions: Hormonal profile of both tumor and unchanged cervical tissues was dependent on HPV/Ch. tr. co-infection and tumor growth patterns. The changes could result from HPV and Ch. tr. interaction triggering malignant processes.

Changes in ovarian hormonal status in cervical cancer patients under the influence of combined HPV/chlamydia trachomatis infection.

e17019 Background: The purpose of the study was to analyze hormonal disorders in tissues of histologically unchanged ovaries of patients with cervical cancer infected with HPV/Chlamydia trachomatis. Methods: We studied levels of estrone (E1), estradiol (E2), free estriol (E3), free (fT) and total (T) testosterone, progesterone (P4), steroid-binding globulin (SBG) and prolactin (PRL) by the ELISA in intact ovaries of 25 patients aged 53.4±3.2 years with cervical cancer T1b-2aN0M0. HPV presence was determined by Е7 protein expression, Chlamydia trachomatis (Ch. tr.) – by IgG and IgА to Ch. tr. and antigen/DNA by ELISA and Real-time PCR. Tissues of intact ovaries obtained during hysterectomy from 22 non-infected women of similar age with endometrial cancer T1N0M0 were used as the control. Results: The data demonstrated a sharp decrease in E2 level by 9.3 times and increase in E1 by 2.3 times in intact ovaries of cervical cancer patients infected with HPV and Ch. tr., compared with the values in controls. Changes were noted in the balance between some estrogen fractions: E1 percentage increased by 5 times, E3 – by 2.4 times and E2 percentage decreased by 4 times. Androgenic status in intact ovaries in cervical cancer was characterized with increased levels of T (by 5.1 times) and fT (by 1.6 times). We noted an increase in SBG concentration by more than 3 times in response to the release of androgens registered in ovarian tissue, as well as significant (by 4.4 times) increase in PRL and decrease in P4 by 1.5 times compared with non-infected tissues. Estrogens to P4 ratio in co-infected patients reduced by 1.6 times, while the PRL to P4 ratio increased by 6.4 times, mainly due to disorders in hormone-producing ovarian function. Conclusions: The development of malignant process in the cervix in a combined HPV and Chlamydia trachomatis infection is accompanied by disorders of the endocrine status in tissues of intact ovaries and shows the undeniable role of consequences of HPV/Chlamydia trachomatis coinfection in this process.

Association between Zika virus and fetopathy: a prospective cohort study in French Guiana.

To establish the incidence of fetal central nervous system (CNS) anomalies (including microcephaly), signs of congenital infection and fetal loss in pregnant women infected with Zika virus (ZIKV) and non-infected pregnant women in western French Guiana. This prospective cohort study was conducted between 1 January and 15 July 2016. We evaluated and compared clinical and fetal ultrasound examinations of 301 pregnant women with biological confirmation of ZIKV infection and 399 pregnant women who were negative for ZIKV infection. Overall, the total number of fetuses with CNS involvement was higher in the infected than in the control group (9.0% vs 4.3%; relative risk, 2.11 (95% CI, 1.18-4.13)). Anomalies of the corpus callosum and presence of cerebral hyperechogenicities were significantly more common in the infected group. There was an increased risk of microcephaly in the infected compared with the control group (1.7% vs 0.3%; relative risk, 6.63 (95% CI, 0.78-57.83)), although this was not statistically significant. When the mother was infected during the first or second trimester, there was a greater risk of severe CNS involvement, more signs of infection and intrauterine fetal death than with infection in the third trimester. The rate of vertical transmission in the exposed group was 10.9%. ZIKV infection during pregnancy is associated with a significant risk of fetal CNS involvement and intrauterine fetal death, particularly when infection occurs during the first or second trimesters. Microcephaly was not present in every case of congenital ZIKV syndrome that we observed. Until more is known about this disease, it is paramount to evaluate suspected cases by detailed neurosonography on a monthly basis, paying particular attention to the corpus callosum and the presence of hyperechogenic foci. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Linking hepatitis C virus infection to pre-1994 blood transfusions in female patients.

Most blood transfusions occur in female patients. The introduction of serologic screening practices by blood banks reduced the transfusion-related rate of infection with hepatitis C virus (HCV). In Mexico patients with pre-1994 transfusion history are at high risk of being detected with HCV infection. We aimed at establishing an interrelationship between two variables: pre-1994 transfusion history and rate of infection in women treated in the Guadalajara Metropolitan Area hospitals, in Mexico. Analytical observational case-control study which included both non-infected women and patients diagnosed with hepatitis C virus infection, in whom the pre-1994 transfusion history was determined. The cases were 150 women with confirmed hepatitis C virus serologic diagnosis. The controls were 150 women whose hepatitis C virus-detection serologic tests had yielded negative results. An odds ratio of 9.07 (95% CI: 5.37 – 15.3; p< 0.001) was found where the rate of infection for the case group was 0.72 while the control group had a ratio of 0.22; population attributable risk (PAR) was 0.64 (95% CI: 0.53 – 0.73), while etiologic fraction was 0.88 (95% CI: 0.81 – 0.93). Among women, having been exposed to pre-1994 blood transfusion means a risk 9.07 times higher than not being exposed to blood transfusion in the same time frame.

Clinical practice guideline. Integral Care Guidelines for the prevention, early detection and treatment of pregnancy, childbirth and puerperium complications: Section on toxoplasmosis in pregnancy

Tooplasma infection, an aspect included in the Integral Care Guidelines for prevention, early detection and treatment of complications during pregnancy developed and sponsored by the Department of Science, Technology and Innovation, Colciencias and the Ministry of Health and Social Protection; was selected to develop recommendations that may contribute to its prevention diagnostic and treatment. Guidelines were developed through systematic review of literature, two panels of evaluation, gradation of evidence: SIGN (Scottish Intercollegiate Guidelines Network), discussion panel with users and patients, external evaluation and socioeconomical evaluation of the impact of recommendations. The Toxoplasma gondii infection that occurs during pregnancy may cause serious complications for the fetus and important sequelae for the newborn. A clinical guideline based on the best available scientific evidence, with emphasis on Colombian references, was performed. Experts in parasitology, neonatology and infectious diseases (adult and pediatric) developed the recommendations. It is suggested that the recommendations included in this guideline be followed by healthcare professionals in pregnancy care programs nationwide, with the purpose of lowering the morbidity and mortality related to this disease. Specific recommendations for diagnosis during the first trimester of the pregnancy, recommendations for prevention in noninfected women, identification of fetal or newborn infection and recommendations for treatment in those given cases are included.

Erratum to: Barriers to and Facilitators of Adherence to Exclusive Breastfeeding Practices Among HIV Infected and Non-Infected Women in Jos, Nigeria.

Objectives In Nigeria adherence to exclusive breastfeeding (EBF) practices is currently suboptimal and a better understanding of the factors affecting adherence to EBF is needed. We sought to identify and delineate the barriers to and facilitators of adherence to EBF amongst HIV-infected and uninfected women in Nigeria. Methods We explored the barriers and facilitators to EBF amongst 37 (25 HIV-infected and 12 HIV-uninfected) pregnant women attending an antenatal clinic in Jos, Nigeria. In-depth interviews were conducted with each of the pregnant women in their third trimester of pregnancy and again 1 month after giving birth. Results The themes that emerged were mothers' feeding intentions, significant role players in the decision to breastfeed, perceived barriers (e.g. physiological issues, stigma, employment) and perceived facilitators (e.g. pleasure and enjoyment derived from breastfeeding, natural milk from God, disclosure and family support) associated with EBF. Conclusions Most women preferred EBF and offered it to their infants. However, more efforts are needed to improve support structures at home and at work to accommodate women who choose to do EBF.

The quality of life of HIV-infected and non-infected women post-caesarean section delivery

There is a dearth of literature on the postnatal quality of life (QoL) of women. This study aimed to determine to QoL of HIV-infected and non-infected women post-caesarean section delivery.This prospective, longitudinal and comparative study was conducted at four public hospitals in KwaZulu-Natal. The participants were followed for six-months post-delivery and the QoL was measured using the SF-36 and the pelvic floor impact questionnaire (PFIQ-7).The results showed that the QoL of women were negatively affected post-operatively with the HIV-infected group scoring lower over the six-months.Understanding postpartum QoL problems is essential in efforts to provide effective comprehensive care.

Mental Health and Latent Toxoplasmosis: Comparison of Individuals with and without Anti-Toxoplasma Antibodies.

There is evidence to suggest that the protozoan Toxoplasma gondii affects the mental health of people who are infected with it. The aim of the present study was to examine the relationship between T. gondii and mental health. A total of 200 students (87 men and 113 women) of Jundishapur University of Medical Sciences (Ahvaz, Iran) were tested for the presence of anti-Toxoplasma antibodies and completed the General Health Questionnaire (see Appendix 1, available at: http://www.longwoods.com/content/24938) and a demographic form. Data were analyzed using independent samples t-test, chi-square test and Fisher's exact test. Infected women had significantly lower scores in somatic symptoms (p = 0.04), anxiety/insomnia (p = 0.006) and depression (p = 0.04) compared with non-infected women. Difference in social dysfunction was not significant (p > 0.05). There were no significant differences in somatic symptoms, anxiety/insomnia, depression and social dysfunction between infected and non-infected men (all p > 0.05). Our findings indicate that latent toxoplasmosis can affect some components of mental health just in women.

HIV infection impairs CD8+ resident memory T cell frequency in cervical mucosae

Abstract A critical challenge in establishing a cure for HIV is the elimination of reservoirs of infection. A proposed approach is to reactivate HIV replication in infected cells and eliminate them by eliciting functional CD8+ T-cells. Due to their location and rapid and efficient response, CD8+ resident memory T cells (TRM) represent an ideal candidate, but their frequency and localization in HIV-infected subjects had not been evaluated. Therefore, we quantified frequencies of TRM cells by immunohistochemistry detection of CD8 and CD69 in cervical tissues from 5 HIV-infected and 5 non-infected women. In addition, migration assays of peripheral blood mononuclear cells (PBMC) from HIV-positive and negative donors were performed by plating one million PBMC on the top of a migration chamber placed in a well seeded with confluent HeLa cells. After 24 hours, cells that migrated to the bottom chamber were collected for flow cytometry evaluation. In cervical tissues, TRM numbers and frequencies were significantly different in basal membranes (0.93% in HIV-negative versus 0% in HIV-positive subjects, p=0.006), whereas no differences were seen for total CD8+ T cells. Moreover, in samples from HIV-positive subjects, lower frequencies of CD8+ CD69+ CD103+ T cells were detected between the cells migrated to the bottom chamber in samples from HIV-infected subjects (0.86% versus 3.54%, p=0.002, in HIV-negative versus HIV-positive). In HIV-positive donors, the frequency of CD4+ CD69+ CD103+ expressing CCR5 was significantly lower than for HIV-negative, while expression of CXCR3 and CCR7 were comparable. We propose that HIV impairs frequencies of TRM in the cervical mucosa at least in part by reducing CD8+ T cell migration through a CCR5-mediated mechanism.

Semen residual viral load and reproductive outcomes in HIV-infected men undergoing ICSI after extended semen preparation

The aim of this study was to evaluate the residual presence of the human immunodeficiency virus (HIV) following a triple gradient extended semen wash from ejaculates of serodiscordant couples, and analyse their reproductive outcomes after intracytoplasmic sperm injection (ICSI). For this purpose, a retrospective analysis of our database was performed in serodiscordant couples, with HIV-infected men and non-infected women, using fresh or frozen sperm with ICSI in oocytes from either the patients or donors from January 2006 to September 2013. Overall, the rate of positive HIV test after semen washing was 1.86%. The positive beta human chorionic gonadotrophin, clinical and ongoing pregnancy rates in patients with their own oocytes were 47.1%, 37.5% and 30.8%, respectively, and 58.6%, 50.8% and 39.1%, respectively, in oocyte donation cycles. To summarize, the described method of sperm washing based on triple gradient sperm selection coupled with extensive centrifugations is a highly reliable technique for HIV removal, as it provides lower than reported post-wash positive tests while maintaining high pregnancy rates in assisted reproduction cycles. Despite extensive personnel training and effectiveness of the washing protocol, post-wash HIV test on semen is recommended to identify residual positive samples.

Genotypic characterisation of human papillomavirus infections among persons living with HIV infection; a case-control study in Kumasi, Ghana.

The objective of this study is to describe the burden of human papillomavirus (HPV) infection among women living with HIV and non-infected women in Ghana. A case-control study was conducted involving 107 women living with HIV aged between 18 and 59 years (cases) and 100 non-HIV-infected apparently healthy women (controls) who were recruited from the Kumasi South Hospital, from July to December, 2014. Cervicovaginal swabs were taken from study participants to characterise 28 high- and low-risk HPV genotypes using a multiplex real-time PCR. The overall mean age for the participants was 40.10 ± 9.76 years. The prevalence of high-risk (hr)-HPV genotypes was significantly higher among the cases than the controls (77.4% vs. 41.6%, P < 0.0001). Overall, HPV 58 and 54 were the most predominant high-risk (18.8%) and low-risk (15.0%) genotypes detected. The two most common hr-HPV genotype isolates were 58 (18.8%) and 35 (15.9%) with 58 being the most prevalent among age group 35-44 years compared with hr-HPV 16, 18, 35 and 45, found predominantly among 18-34 age group. Significant variations exist in HPV genotypes among HIV-infected and uninfected women.

Association between HIV infection and bone mineral density in climacteric women

A cross-sectional study was conducted with the purpose of evaluating bone mineral density in HIV seropositive and seronegative climacteric women. HIV infection was negatively associated with bone mineral density in the lumbar spine To assess bone mineral density (BMD) and its associated factors in HIV seropositive and seronegative climacteric women A cross-sectional study with 537 women (273 HIV seropositive and 264 HIV seronegative) aged between 40 and 60 years old receiving follow-up care at two hospitals in Brazil. A questionnaire on clinical and sociodemographic characteristics was completed. Laboratory tests were performed, and BMD was measured at the lumbar spine and hip. Statistical analysis was carried out by Yates and Pearson chi-squared tests, Mann-Whitney test, and multiple linear regression. The mean age was 47.7 years in HIV-seropositive women, and 75 % had nadir CD4 above 200, and 77.8 % had viral load below the detection limit. The mean age in the HIV-seronegative women was 49.8 years. The prevalence of low spinal BMD was 14.6 % in the HIV-seropositive and 4.6 % in the HIV-seronegative women (p < 0.01). The prevalence of low BMD at the femoral neck was 5.6 % in HIV-seropositive and 3.3 % in the HIV-seronegative women (p = 0.38). Multiple analyses showed that the factors associated with lower BMD at the spine were being postmenopausal and being HIV-seropositive. Being overweight was associated with a higher BMD. At the femoral neck, factors associated with lower BMD were being postmenopausal and being white. Being overweight and having a greater number of pregnancies were associated with higher BMD CONCLUSIONS: HIV-seropositive women on long-term antiretroviral treatment and in good immunological conditions exhibited low BMD in the spine (L1-L4). However, BMD in the femoral neck was similar to non-infected women.

Lower reproductive outcomes of oocyte donation cycles in HIV-infected women regardless of viral load and antiretroviral treatment

cultured in 20% oxygen either individually, or in groups of ten, in media G-1/ G-2 with 5mg/ml HSA, in the presence or absence of 10mM carnitine/10mM cysteine/5mM lipoate. Embryo development was analysed through time-lapse and embryo transfers performed. Intracellular levels of reduced glutathione (GSH) were assessed using fluorometric analysis. RESULTS: There was no effect of treatment on blastocyst formation. However, compared to controls, the three antioxidants significantly increased embryo cell numbers when used individually (P<0.05) and to a greater effect when in combination (P<0.01). Embryos cultured in the presence of antioxidants and transferred resulted in significantly longer crown-rump length (11.6 0.1 mm vs. 11.3 0.1 mm; P<0.01), heavier fetuses (209.8 11.8 mg vs. 183.9 5.9 mg; P<0.05) and placentas (103.5 3.1 mg vs. 93.6 2.7 mg; P<0.01) compared to controls. Time-lapse analysis revealed that the combination of antioxidants was associated with faster development rates to expanded (99.8 0.5 h vs. 102.8 0.7h; P< 0.05) and hatching blastocysts (102.6 0.8 h vs. 104.9 1.1 h; P<0.01). Furthermore, the beneficial effects of combining the antioxidants were greater for embryos cultured individually (P<0.0001) as opposed to in groups (P<0.005). Levels of GSHwere significantly decreased in control embryos that were cultured in the absence of antioxidants (P<0.01) compared to in vivo flushed embryos. However when embryos were cultured with antioxidants the levels of GSH was not different to that of in vivo developed embryos. CONCLUSIONS: The presence of antioxidants in culture media has a highly beneficial effect on mouse embryo and fetal development. Further, antioxidants maintained the levels of GSH within embryos providing evidence of a protective intracellular role. Data indicate that supplementation of antioxidants to embryo culture media helps to negate some of the adverse effects of culture in atmospheric oxygen, especially when embryos are cultured individually, as required for specific time-lapse systems and preimplantation genetic screening. Supported by: Vitrolife AB.

Incidence and persistence of carcinogenic genital human papillomavirus infections in young women with or without Chlamydia trachomatis co-infection.

We assessed whether infection with chlamydia increases the incidence of carcinogenic human papillomavirus (HPV) infections and if HPV persistence is affected by chlamydia co-infection. For 1982 women (16–29 years-old) participating in two consecutive rounds of a chlamydia screening implementation trial, swabs were polymerase chain reaction tested to detect chlamydia and 14 carcinogenic HPV genotypes. HPV type-specific incidence and persistence rates were stratified for chlamydia positivity at follow-up. Associations were assessed by multilevel logistic regression analyses with correction for sexual risk factors. HPV type-specific incidence ranged from 1.4% to 8.9% and persistence from 22.7% to 59.4% after a median follow-up of 11 months (interquartile range: 11–12). Differences in 1-year HPV persistence rates between chlamydia -infected and noninfected women were less distinct than differences in HPV incidence rates (pooled adjusted odds ratios of 1.17 [95% CI: 0.69–1.96] and 1.84 [95% CI: 1.36–2.47], respectively). The effect of chlamydia co-infection on HPV-infection risk did not significantly differ by HPV genotype. In conclusion, infection with chlamydia increases the risk of infection by carcinogenic HPV types and may enhance persistence of some HPV types. Although these findings could reflect residual confounding through unobserved risk factors, our results do give reason to explore more fully the association between chlamydia and HPV type-specific acquisition and persistence.

Unique human papillomavirus-type distribution in South African women with invasive cervical cancer and the effect of human immunodeficiency virus infection.

Cervical cancer is the most common cause of cancer-related deaths among South African women. Viral types associated with cervical cancer may differ not only between countries and regions, but possibly also between human immunodeficiency virus (HIV)-infected and noninfected women. In a population with high HIV prevalence, human papillomavirus (HPV)-type infections detected with DNA analyses were reported in a cohort of 299 women diagnosed with invasive cervical cancer. One hundred fifty-four women tested HIV negative, 77 tested HIV positive, and HIV status was unknown for 68 women. The mean age for HIV-positive women was 41.3 years, and that for HIV-negative women was 55.8 years (P < 0.001). Ninety-two percent of women tested HPV-DNA positive. Human papillomavirus types 16 and/or 18 were present in 62% of HIV-negative women and 65% of HIV-positive women. The 5 most common HPV types in HIV-positive women were, in decreasing frequency, HPV 16, 18, 45, 33, and 58. In HIV-negative women, the most common HPV types were HPV 16, 18, 35, and 45, followed by HPV 33 and 52. Human papillomavirus type 45 was more likely in the HIV positive compared with the HIV negative (odds ratio, 3.07; 95% confidence interval, 1.07-8.77). The HIV-positive women had more multiple high-risk HPV-type infections than did the HIV-negative women (27% vs 8%, P = 0.001). A high number of women in South Africa with cervical cancer are HIV positive. Without viral cross-protection, HPV vaccines should prevent around 65% of cervical cancers in this population. Human papillomavirus type 45 infection is significantly linked to HIV and important for future vaccine developments.

RED for PMTCT: An adaptation of immunization’s Reaching Every District approach increases coverage, access, and utilization of PMTCT care in Bondo District, Kenya

Gaps exist in coverage, early access, and utilization of prevention of mother-to-child transmission of HIV (PMTCT) services in Kenya. The Maternal and Child Health Integrated Program, led by Jhpiego, piloted an adaptation of immunization’s Reaching Every District (RED) approach in Bondo District as a way of improving PMTCT care. Routine district-level monthly summary service delivery pre- and post-implementation data were analyzed. Marked improvements resulted in the proportion of HIV-infected and non-infected pregnant women completing four focused prenatal care visits, from 25% to 41%, and the proportion of HIV-exposed infants (HEIs) tested at six weeks, from 27% to 78% (P<0.001). The proportion of HEIs tested for HIV infection at 12months was 52%, while 77% of HEIs were issued antiretroviral prophylaxis by the end of the pilot. Implementation of RED for PMTCT demonstrated that PMTCT services can be delivered effectively in the context of the existing community strategy and resulted in increased coverage, access, and utilization of care for HIV-positive pregnant women and their children.

Meconium aspiration syndrome in infants of HIV-positive women: a case-control study.

Our aim was to determine whether maternal HIV infection in the current era is associated with an increased incidence of meconium aspiration syndrome (MAS) in their infants. Infants born to 149 HIV-positive women at our hospital over a 5-year period were compared with infants born to HIV-negative women in a retrospective case-control study. Charts of all 298 patients included in the study were reviewed for maternal and infant demographics, HIV treatment, vertical transmission and untoward events at delivery or during the hospital course. When compared with HIV-negative women, a greater proportion of HIV-positive women had meconium-stained amniotic fluid (MSAF), 33% vs. 13%, P<0.001; and thick MSAF, 17% vs. 5%, P<0.001, respectively. Seven of 298 infants were admitted to the neonatal intensive care unit for MAS; all seven were born to HIV-positive women (P=0.015). Although in utero exposure to illicit drugs is a reported risk factor for meconium staining of the amniotic fluid and such drug exposure was more common among our HIV-positive sample, controlling for this and other possible covariates did not greatly reduce the association of HIV status with meconium-related complications of delivery. Infants born to HIV-positive women had significantly more MSAF and MAS than infants born to non-infected women. It is unclear whether this association results from maternal HIV infection itself or from anti-retroviral therapy. Maternal and infant care providers should be prepared for this complication when attending to the deliveries of HIV-positive women.