Transmission Of Human Immunodeficiency Virus Infection Research Articles

Antiretroviral treatment for HIV infection and AIDS

Background: Antiretroviral therapy is the cornerstone treatment for people living with human immunodeficiency virus (HIV). Clinical practice guidelines for antiretroviral therapy have been developed.Current Concepts: After the introduction of zidovudine, more than 30 antiretroviral agents have been approved for the treatment of HIV infection. Since a controlled trial proved the efficacy and safety of combination antiretroviral therapy, virologic suppression, immune reconstitution, and long-term survival of people living with HIV have been achievable goals. Early antiretroviral treatment for all people living with HIV is an effective strategy to maintain individual health and prevent the transmission of HIV infection. Selecting an appropriate combination antiretroviral therapy requires careful consideration of various factors, including regimen characteristics, pretreatment viral load and CD4+ cell counts, comorbid conditions, and the anticipated level of compliance. Ongoing advances in antiretroviral treatment, such as the development of long-acting injectables and medications targeting multidrug-resistant HIV, address challenges in the treatment of HIV infection.Discussion and Conclusion: Although cure of HIV infection is impossible with current antiretroviral treatment, HIV infection has become a chronic disease with long-term survival. Hence, clinicians should have knowledge of antiretroviral treatment guidelines.

Characterization of spatial and temporal transmission of HIV infection in Surabaya, Indonesia: Geographic information system (GIS) cluster detection analysis (2016–2020)

The high prevalence of human immunodeficiency virus (HIV) infections has become a devastating public health problem in Indonesia. In response, the government has taken measures to reduce the transmission of HIV and the number of deaths from HIV/acquired immunodeficiency syndrome (AIDS). However, these efforts have not successfully reduced the spread of HIV in Surabaya. In this study, we analyzed the factors that could influence the spread of HIV in Surabaya using a Geographic Information System. We conducted a spatial analysis of HIV/AIDS clusters in Surabaya from 2016 to 2020. Spatial autocorrelation and spatiotemporal analysis were used to identify local HIV clustering. In addition, the Global Moran's I index was applied to detect HIV clustering at the sub-district level. The results showed that HIV mostly occurred among males (683/969; 70.3%) in the economic age group (20–35 years) and that the infection was transmitted mostly through sexual intercourse (942/969; 97.2%). The hotspots were located in Central and Southern Surabaya, including the Genteng, Tegal Sari, Gubeng, and Sawahan sub-sub-districts. Western Surabaya (Benowo and Pakal) was the only hot spot in 2018. In conclusion, the spatial and temporal analysis of HIV, coupled with an assessment of the factors that drive the epidemic, can assist the government to formulate policies and design targeted interventions to prevent and control the epidemic in Surabaya, Indonesia.

Common facts and fictions about HIV transmission, prevention and treatment among PLWHA attending a tertiary healthcare centre in North-Western Nigeria

Objectives:The transmission, prevention, and treatment of the human immunodeficiency virus (HIV) are greatly influenced by human behavioral practices. This makes knowledge of some truths (facts) and lies (fictions) about the disease extremely important in its prevention and control. Several studies on the assessment of knowledge about HIV infection have been undertaken among the general population, but only a few have involved people living with HIV/AIDS (PLWHA). This study was conducted to assess the level of knowledge and understanding on transmission, prevention, and treatment of HIV infection among PLWHA attending an adult anti- retroviral therapy (ART) clinic at Federal Medical Centre, Birnin Kebbi, North-western Nigeria.
 Method: The study was conducted as a hospital-based descriptive cross-sectional study using interviewer-administered questionnaires among 62 patients, selected by convenience sampling technique, attending adult ART-clinic over a period of 8 weeks. The data was analyzed using SPSS-16.
 Result: More than 70% of the respondents scored above 75% in the questions on modes of transmission of HIV infection. However, 73.4% of the respondents believed HIV infection was curable, and 40.6% believed there is commercially available vaccination against HIV infection. There were statistically significant associations between high mean scores (75% and above) in questions on modes of transmission and prevention of HIV, and being of Hausa ethnicity (p-value=0.013), having a senior secondary or higher level of education (p-value=0.014) and being a resident in an urban setting (pvalue=0.003)
 Conclusion: There is a fairly good basic knowledge about HIV transmission, prevention and treatment among the respondents; however, there is need for improvement in knowledge on certain lies/fictions regarding the disease.

HIV-1 Transmission among Injecting Drug Users is Principally Derived from Local Circulating Strains in Guangxi, China

ObjectiveThe mode of human immunodeficiency virus (HIV) transmission via injection drug use (IDU) still exists, and the recent shift in IDU-related transmission of HIV infection is largely unknown. The purpose of this study was to analyze the spatiotemporal sources and dynamics of HIV-1 transmission through IDU in Guangxi. MethodsWe performed a molecular epidemiological investigation of infections across Guangxi from 2009 to 2019. Phylogenetic and Bayesian time-geographic analyses of HIV-1 sequences were performed to confirm the characteristics of transmission between IDUs in combination with epidemiological data. ResultsAmong the 535 subjects, CRF08_BC (57.4%), CRF01_AE (28.4%), and CRF07_BC (10.7%) were the top 3 HIV strains; 72.6% of infections were linked to other provinces in the transmission network; 93.6% of sequence-transmitted strains were locally endemic, with the rest coming from other provinces, predominantly Guangdong and Yunnan; 92.1% of the HIV transmission among people who inject drugs tended to be transmitted between HIV-positive IDUs. ConclusionHIV recombinants were high diversity, and circulating local strains were the transmission sources among IDUs in Guangxi. However, there were still cases of IDUs linked to other provinces. Coverage of traditional prevention strategies should be expanded, and inter-provincial collaboration between Guangxi, Yunnan, and Guangdong provinces should be strengthened.

A Review of Basic Knowledge of HIV Infection for Orthodontic Management of HIV Patients.

Human immunodeficiency virus (HIV) is a retrovirus that causes an infection affectingimmunity-providing white blood cells. The HIV pandemic is far from over and is a major socio-economical burden. As there is no cure yet, prevention of new infections is the major path to control the infection. There is a low chance of orthodontic procedures carrying a risk ofHIV infection transmission. It is important to have knowledge about the disease to effectively and safely treat known or unknown patients with HIV.

National HIV programme testing recommendations.

In recognition of the morbidity and mortality associated with human immunodeficiency virus (HIV), the Joint United Nations Programme on HIV/acquired immunodeficiency syndrome (AIDS) (UNAIDS) aims to end the epidemic by setting and striving to achieve the ambitious 95-95-95 targets. However, Singapore is still not performing well in the first UNAIDS target. The National HIV Programme (NHIVP) developed this set of recommendations based on an adaptation of major international guidelines from the World Health Organization and the US Centers for Disease Control and Prevention. The goals of this recommendation are: (1) to increase the uptake of HIV testing; (2) to allow earlier detection and identification of individuals with unrecognised HIV infection; (3) to facilitate linkage to clinical services; and (4) reduce further transmission of HIV infection in Singapore.

CD4 Tcells are rapidly depleted from tuberculosis granulomas following acute SIV co-infection.

HIV/Mycobacterium tuberculosis (Mtb) co-infected individuals have an increased risk of tuberculosis prior to loss of peripheral CD4 Tcells, raising the possibility that HIV co-infection leads to CD4 Tcell depletion in lung tissue before it is evident in blood. Here, we use rhesus macaques to study the early effects of simian immunodeficiency virus (SIV) co-infection on pulmonary granulomas. Two weeks after SIV inoculation of Mtb-infected macaques, Mtb-specific CD4 Tcells are dramatically depleted from granulomas, before CD4 Tcell loss in blood, airways, and lymph nodes, or increases in bacterial loads or radiographic evidence of disease. Spatially, CD4 Tcells are preferentially depleted from the granuloma core and cuff relative to B cell-rich regions. Moreover, live imaging of granuloma explants show that intralesional CD4 Tcell motility is reduced after SIV co-infection. Thus, granuloma CD4 Tcells may be decimated before many co-infected individuals experience the first symptoms of acute HIV infection.

HIV and pregnancy: realities of XXI century

The human immunodeficiency virus (HIV) continues to be a major global public health issue, having claimed 34 million lives so far. 38 million people are living with HIV around the world. 2 million of these people are children. The high medical, social and economic significance of HIV infection is determined by the widespread and severe course of the disease. Every year, up to 2.7 million new infections are registered worldwide. Up to 30 % of cases of HIV infection in pregnant women are detected for the first time during pregnancy-related examinations. Every year, 1.49 million babies are born to HIV-positive women worldwide. The current tasks are to preserve the health of women and reduce the risk of transmission of HIV infection from mother to child. The article analyzes the results of Russian and foreign studies concerning the problems of pregnant HIV-positive women, published in international databases. The aim of the work is to analyze the data of studies aimed at studying the effect of HIV infection on the course of pregnancy.

Trend of HIV Infection and Associated Risk Factors at Integrated Counselling and Testing Centre in a Tertiary Care Hospital in Bihar: A Retrospective Study

Introduction: Human Immunodeficiency Virus (HIV) infection became a major global health issue and a priority in many countries because it is the leading cause of morbidity and mortality throughout the world. In India, about 71% of total annual new HIV infections were reported from Telangana, Bihar, West Bengal, Uttar Pradesh, Andhra Pradesh, Maharashtra, Karnataka, Gujrat, Tamil Nadu and Delhi. The major cause of concern is that around 25% of the infected people are not aware that they are infected by HIV virus and is one of the major risk factor responsible for the spread of HIV infection. Aim: To evaluate the trends, pattern and associated risk factors responsible for the spread of Human Immunodeficiency Virus (HIV) infection in patients who attended Integrated Counselling and Testing Centre (ICTC) of a tertiary care centre of Bihar, India. Materials and Methods: A retrospective study was conducted on the available records of all the patients who attended ICTC of a tertiary care centre in Bihar, India, between January 2016 to December 2018. The data regarding the age, sex, marital status, educational status and behavioural pattern of the patients tested for HIV infection at the ICTC were assessed and analysed. Descriptive statistical analysis was done. Results: The total of 16333 and 15969 patients received counselling and testing services respectively during the study period. The prevalence of HIV infection was 3.70%, amongst whom 64.38% were males and 32.93% were females including 2.69% pregnant female patients. The ratio of seropositive male to seropositive female was 2.07:1. Maximum seroreactivity was found in 35-49 years age group (38.57%) followed by 25-34 years age group (28.42%). The major factor for the transmission and spread of HIV infection was unprotected sexual contact (88.33%) followed by mother to child transmission, infected blood and its products and infected needles and syringes. Illiteracy (45%) and unawareness was the major associated factor for spread of HIV infection. Conclusion: The high prevalence of HIV infection can be minimised by creating awareness, following safe sexual practices, promoting antenatal screening, procuring blood and its product from authorised blood banks where proper screening of Transfusion Transmitted Infections (TTI) is done.

COVID-19 Pandemic as "Curate's Egg" on Human Immunodeficiency Virus Infection: A Commentary.

It is a high time not to sideline human immunodeficiency virus (HIV) response during the 2019 coronavirus disease (COVID-19) crisis. COVID-19 will affect the decade’s hard-earned gains from HIV care delivery and response. At the same time, it could be an important time for the COVID-19 containment response to help minimize the occurrence of a new infection. Sexual contact is the main transmission ways in HIV dynamics. However, COVID-19 prevention and control strategies such as movement restrictions, physical and social distancing will reduce exposure to such kinds of risk behaviors. Those containment strategies, including stringent infection prevention and control at health facilities, may minimize transmission of HIV infection and will reduce the incidence of new HIV infection. While recognizing the immense challenges of the COVID-19 pandemic, efforts should be made by governments and international organizations to maintain the response to HIV and to ensure that the progress made against HIV is not lost. In addition, it is very crucial to undertake further researches on the status of new HIV infection during the COVID-19.

Target Molecules and Delivery Vehicles for Anti-HIV Drugs In vitro and In vivo.

Acquired Immune Deficiency Syndrome (AIDS) is the most serious stage of Human Immunodeficiency Virus (HIV) infection. The combinatorial Anti-Retroviral Therapy (cART) is widely used in suppressing HIV-1 infection and enhancing life span of infected patients to a significant level. However, delivery of therapeutic molecules is still a major challenge in vivo. The studies showed that the anti-HIV drugs delivered via nanocarriers could be selectively accumulated in infected cells accompanied by low side effects. On the other hand, HIV-1 infection kinetics is different in macrophages and T-cells suggesting various effects of antiretroviral drugs against HIV-1 in these target cells. Current anti-HIV therapeutic studies have focused on developing drug delivery systems targeted specifically to HIV-infected host cells. Indeed, the drug targeting can significantly lead to reduce in drug toxicity, drug dose, and increase in treatment efficacy through localizing its pharmacological activity to the site of interest. This review describes development of novel drug targeting systems used in suppressing the transmission and treatment of HIV infections.

ACTUAL ISSUES IN HIV INFECTION AND PREVENTION OF PERINATAL HIV TRANSMISSION IN THE SOUTH OF RUSSIA

One of the serious negative consequences of the HIV infection epidemic is the involvement of women of reproductive age and children into the epidemic process. The problem of vertical HIV infection transmission does not lose its relevance and causes the need for continuous monitoring of measures to prevent the transmission of HIV from mother to child. The aim of the study is to evaluate the effectiveness of a set of measures to prevent the transmission of HIV infection from mother to child in the South of Russia.Materials and methods. The common methods of variation statistics were used in the work to analyze the data from the reporting forms of monitoring by Rospotrebnadzor «Imformation on measures for the prevention of HIV infection, hepatitis B and C, detection and treatment of HIV patients» and federal reporting forms N 61 «Information on contingents of patients with a disease caused by a human immunodeficiency virus (HIV)» for 2016 and 2017, presented by the territorial Centers for Prevention and Control of AIDS of 15 RF subjects of the Southern Federal District and the North Caucasus Federal District.Results. In 2017, compared to 2016, the decrease in the number of births in HIV-positive women was traced on the territory of the South of Russia. In 2017, target levels of mother-child coverage with chemoprevention of mother-to-child transmission of HIV during pregnancy (over 92%) and during childbirth (more than 93,5%) were achieved in the Southern Federal District and the North Caucasus Federal District. A high proportion of women with a detectable level of HIV replication before birth was revealed.Conclusion. The implementation of the recommended by standards preventive measures and the provision of antiretroviral drugs allowed to significantly increase the coverage of HIV infected pregnant women and their newborns with antiretroviral prophylactic treatment by 2018 which prevented HIV infection transmission from mothers to 8840 children. The problems that prevent the implementation of the full range of measures for the prevention of the vertical transmission of HIV in the South of Russia are identified and approaches for their solution are suggested.

Pregnancy Rates and Outcomes of HIV-Infected Women in Korea.

BackgroundAntepartum, intrapartum, and postpartum preventive measures with antiretroviral drugs, appropriate delivery methods, and discouraging breastfeeding significantly decrease the risk of mother-to-child transmission of human immunodeficiency virus (HIV) infection. Herein, we investigated the pregnancy outcomes in HIV-infected Korean women.MethodsWe retrospectively reviewed medical records of childbearing-age HIV-infected women between January 2005 and June 2017 at four tertiary care hospitals in Korea.ResultsAmong a total of 95 HIV infected women of child-bearing age with 587.61 years of follow-up duration, 15 HIV-infected women experienced 21 pregnancies and delivered 16 infants. The pregnancy rate was 3.57 per 100 patient-years. Among the 21 pregnancies, five ended with an induced abortion, and 16 with childbirth including two preterm deliveries at 24 and 35 weeks of gestation, respectively. The two preterm infants had low birth weight and one of them died 10 days after delivery due to respiratory failure. Among the 14 full-term infants, one infant was small for gestational age. There were no HIV-infected infants.ConclusionThe pregnancy rate of HIV-infected women in Korea is lower than that of the general population. Although several adverse pregnancy outcomes were observed, mother-to-child transmission of HIV infection was successfully prevented with effective preventive measures.

Knowledge, attitude, and practice of dentists toward patients with human immunodeficiency virus and hepatitis B virus infections in Bhubaneswar, Odisha, India

Background: During routine dental work, dentists and dental students can be exposed to human immunodeficiency virus (HIV) and hepatitis B virus (HBV). The aim of the present study was to assess the knowledge, attitude, and practice of the dentists toward HIV- and HBV-infected patients in Bhubaneswar, Odisha, India. Materials and Methods: A cross-sectional study was conducted among dentists practicing in Bhubaneswar, Odisha, India, from December 2016 to April 2017. A total of 200 practitioners (89 males and 111 females) participated in the study. A pretested validated questionnaire related to the knowledge, attitude, and practices (knowledge – 17, attitude – 13, and practice – 17) of the dentists toward HIV- and HBV-infected patients was distributed among dental practitioners. Results: Almost 80% of the dental practitioners had existing fear and concern of the infection transmission from HIV and HBV patients, and this was the primary cause of refusal to treat these infected patients. Conclusion: The dentists did not have proper knowledge in the field of transmission of HIV and HBV infections. Fear and concern of being infected make them to refuse treating these patients. Therefore, training dentists to improve their attitudes toward the treatment of these patients is necessary.

Molecular and Virological profile of Professional Sex Workers (PSW) and their Partners at the beginning of ARV Treatment at IST Matonge in Kinshasa

Background: Professional Sex Workers (PSW) and their partners are considered as vulnerable populations at high risk of transmission for Sexually Transmitted Infections (STIs) as well as infection with the Human Immunodeficiency Virus (HIV). Objective: The objective of this work was to determine the molecular and virological profile of PSW and their clients at the beginning of Antiretroviral Treatment (ART) followed at the IST Matonge center in the city of Kinshasa. Methods: Twenty (20) subjects diagnosed HIV-1 positive by serology at IST-Matonge voluntarily participated in this work. This is the PSW and their partners, all aged over 18 and naive ART. Blood samples were collected in 5 ml tubes with EDTA anticoagulant. After extraction of the RNA from the plasma collected using the QIAGEN RNA kit, a Quantitative Real-Time PCR (qPCR) was used for the determination of the Viral Load (VL). Then Reverse Transcriptase PCR (RT-PCR) and Nested PCR were used to amplify the regions of interest on Protease and Reverse Transcriptase for subsequent sequencing by the Sanger method. Results: Twenty (20) patients were included in this work. Forty-five percent (45%) of the patients were women. The median age was 43 years. The median value of the VL of the included patients was 5.53 log10 RNA copies/ml. The dominant subtype in this population was K with 25%. Conclusion: Professional Sex Workers and their partners remain a population at risk for transmission of HIV infection which has a particular molecular profile and most begin treatment with a poor viral prognosis of treatment.

A consensus for occupational health management of healthcare workers infected with human immunodeficiency virus, hepatitis B virus, and / or hepatitis C virus.

Occupational health management plays an important role in the prevention of provider-to-patient transmission in healthcare workers infected with human immunodeficiency virus (HIV), hepatitis B virus (HBV), and/or hepatitis C virus (HCV). Therefore, the Japan Society for Occupational Health's Research Group on Occupational Health for Health Care Workers has proposed a consensus for the management of healthcare workers infected with HIV, HBV, and/or HCV based on recent evidence for each concerned group. The consensus recommends that: (1) employers in medical institutions should establish a policy of respecting the human rights of healthcare workers, management strategies for occupational blood exposure, and occupational health consultation; (2) occupational health staff should appropriately assess the risk of provider-to-patient transmission of HIV, HBV, and/or HCV infection and rearrange their tasks if necessary. When conducting risk assessment, occupational health staff should obtain informed consent and then cooperate with the physician in charge as well as infection control experts in the workplace; (3) healthcare workers infected with HIV, HBV, and/or HCV should disclose their employment to their treating physician and consult with their doctor regarding the need for special considerations at work; and (4) supervisors and colleagues in medical institutions should correctly understand the risks of HIV, HBV, and HCV infection and should not engage in any behavior that leads to discrimination against colleagues infected with HIV, HBV, and/or HCV.

Risks associated with mother-to-child transmission of HIV infection.

Nguefack F, Koki-Ndombo P, Ngoh R, Soh Fru F, Kinkela MN, Chiabi A. Risks associated with mother-to-child transmission of HIV infection. Turk J Pediatr 2017; 59: 426-433. Early infant diagnosis (EID) permits the detection of Human Immunodeficiency Virus (HIV) infection in exposed children from 4-6 weeks by polymerase chain reaction (PCR). The aim of this study was to assess some maternal and infant characteristics associated with HIV infected children in an EID program. A retrospective study was performed using records of HIV exposed children enrolled in the EID program from 2009 to 2013. Patients recruited were from various health structures and at different clinical stages; some for the Prevention of Mother-to-Child Transmission (PMTCT) follow up, others with signs of HIV infection. Data was collected from completed hospital records of children aged 6 weeks to 18 months containing at least two PCR, one PCR and one serologic test, or one PCR test and viral load. HIV infection was considered if one of the of tests was positive. In all, 130 (5.3%) exposed children with only one positive PCR test, and 1,442 (59%) others with information lacking in their record were excluded. A total 107 out of 871 infants enrolled (12.2%) were infected. Only, 32.7% of the mothers were on antiretroviral therapy (ART). Of these, 53.3% had their first PCR performed between 6 weeks and 6 months. Children were less likely to be HIV infected when their mothers received antiretroviral (ARV) (OR=0.15, 95% CI 0.07-0.30, P=0.000). Factors associated with HIV infection in the children were the lack of ARV prophylaxis (OR=2.07, 95%CI 1.05-4.09, P=0.035) and having mixed feeding (OR=3.91, 95% CI 1.66-9.24, P=0.002) in multivariate analysis. The high rate of infection associated with the maternal and infant correlates of HIV infected children would result from the poor implementation of the PMTCT. Systematic screening of pregnant and breastfeeding women should be reinforced and the lifelong ARVs for PMTCT (Option B+) be promoted.

The importance of assessing self-reported HIV status in bio-behavioural surveys.

In bio-behavioural surveys measuring prevalence of infection with human immunodeficiency virus (HIV), respondents should be asked the results of their last HIV test. However, many government authorities, nongovernmental organizations, researchers and other civil society stakeholders have stated that respondents involved in such surveys should not be asked to self-report their HIV status. The reasons offered for not asking respondents to report their status are that responses may be inaccurate and that asking about HIV status may violate the respondents’ human rights and exacerbate stigma and discrimination. Nevertheless, we contend that, in the antiretroviral therapy era, asking respondents in bio-behavioural surveys to self-report their HIV status is essential for measuring and improving access to – and coverage of – services for the care, treatment and prevention of HIV infection. It is also important for estimating the true size of the unmet needs in addressing the HIV epidemic and for interpreting the behaviours associated with the acquisition and transmission of HIV infection correctly. The data available indicate that most participants in health-related surveys are willing to respond to a question about HIV status – as one of possibly several sensitive questions about sexual and drug use behaviours. Ultimately, normalizing the self-reporting of HIV status could help the global community move from an era of so-called exceptionalism to one of destigmatization – and so improve the epidemic response worldwide.

Mother-to-child transmisson of HIV: an eight-year experience

Mother-to-child transmission of human immunodeficiency virus (HIV) can be prevented by prenatal, perinatal and postnatal interventions. Although the incidence of HIV infection in Turkey is low, the number of cases are increasing in years. The aim of this study was to evaluate the characteristics of infants with HIV-positive mothers followed in a pediatric HIV center in Istanbul, Turkey and to describe the vertical transmission of HIV infection among the cases. Clinical and laboratory features of HIV-infected mothers and their exposed infants, followed in our department between June 2007 and February 2015 were retrieved from medical records retrospectively. The data about HIV infection and pregnancy course were confirmed with medical records when possible otherwise based on mothers' self-reports. Clinical and laboratory data about the birth and after birth of the babies in the other centers were obtained from the related centers. A total of 32 HIV-exposed infants (18 female, 14 male) were followed in eight years. HIV infection could be diagnosed in 15 (46.9%) mothers before pregnancy, in 10 (31.3%) during pregnancy and in seven (21.8%) during delivery. Nine of the mothers (28.1%) did not receive antiretroviral therapy during pregnancy. The median age for the patients at the admission were 13.5 days in which the earliest was a day and the latest was 420 (14 months) days. Three of the infants were fed with breast milk. Four infants (12.5%) did not receive antiretroviral prophylaxis. Cotrimoxazol prophylaxis were given approximately to 60% (n= 19) of the infants starting from 4-6 weeks. HIV viral load could be tested within the first 48 hours among 20 infants and except one, all was found as negative. A total of two infants (6.2%) were infected with HIV and their initial viral loads were 89.500 and 87.500 copies/ml, respectively. One of the infant was delivered vaginally and his mother's HIV status was detected during delivery. The mother of other infected infant was diagnosed only three weeks before birth and delivered with cesarean section. Both mothers had high viral loads just before delivery (> 102.000 and 67.000 copies/ml, respectively). One of the infants infected with HIV died in the 4(th) month due to pulmonary infection and sepsis. This study reveals a high rate of perinatally transmitted HIV infection and mortality. The limited number of cases involved in this one-center study should be taken into account while interpreting this result. All pediatric HIV centers in Turkey should work as partners for more precise national results. Nevertheless, our results draw attention to the lack of prenatal follow-up evaluation in women. In particular, the prompt diagnosis of HIV infection in pregnancy should be provided or not to be missed and follow-up of pregnant women with HIV should be carried out by specialist centers.

Fetal cardiac biometry and function in HIV-infected pregnant women exposed to HAART therapy.

Previous studies have suggested that antiretroviral therapy in human immunodeficiency virus (HIV)-infected pregnant women can cause alterations in cardiac structure and function in fetuses or children, although the results are not very clear. The aim of this study is to assess whether or not these alterations are present in the heart of fetuses of HIV-infected pregnant women, undergoing treatment with highly active antiretroviral therapy (HAART). We performed a prospective study on 29 consecutive HIV-positive pregnant women treated with HAART and 70 consecutive HIV-negative pregnant women as controls. Fetal cardiac biometry and function was evaluated by echocardiography at 30-32 weeks of gestation. Fetal biometry, estimated fetal weight and umbilical artery Doppler were also measured. We found E/A tricuspid ratio values slightly increased (0.84 vs 0.80, p = 0.03) and diastolic length shortened (49.7 vs 51.7%, p = 0.03) in the HIV-infected group. The rest of the biometric and functional cardiac parameters were not different between both groups. There were no cases of vertical transmission of HIV infection. In HIV-infected pregnant women treated with HAART, no significant changes are showed in fetal cardiac parameters.