摘要:

Background:HIV-1 transmission through breastfeeding is a global problem and has been associated with poor maternal micronutrient status.Methods:A total of 1078 HIV-infected pregnant women from Tanzania were randomly assigned to vitamin A or multivitamins excluding A from approximately 20 weeks’ gestation and throughout lactation.Results:Multivitamins excluding A had no effect on the total risk of HIV-1 transmission (RR 1.04, 95% CI 0.82–1.32,P= 0.76). Vitamin A increased the risk of transmission (RR 1.38, 95% CI 1.09–1.76,P= 0.009). Multivitamins were associated with non-statistically significant reductions in transmission through breastfeeding, and mortality by 24 months among those alive and not infected at 6 weeks. Multivitamins significantly reduced breastfeeding transmission in infants of mothers with low baseline lymphocyte counts (RR 0.37; 95% CI 0.16–0.85,P= 0.02) compared with infants of mothers with higher counts (RR 0.99, 95% CI 0.68–1.45,P= 0.97;P-for-interaction 0.03). Multivitamins also protected against transmission among mothers with a high erythrocyte sedimentation rate (P-for-interaction 0.06), low hemoglobin (P-for-interaction 0.06), and low birthweight babies (P-for-interaction 0.04). Multivitamins reduced death and prolonged HIV-free survival significantly among children born to women with low maternal immunological or nutritional status. Vitamin A alone increased breastfeeding transmission but had no effect on mortality by 24 months.Conclusion:Vitamin A increased the risk of HIV-1 transmission. Multivitamin (B, C, and E) supplementation of breastfeeding mothers reduced child mortality and HIV-1 transmission through breastfeeding among immunologically and nutritionally compromised women. The provision of these supplements to HIV-infected lactating women should be considered.

ISSN:0269-9370    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Objective:To assess the repercussion of late diagnosis of HIV infection on AIDS incidence in the era of highly active antiretroviral therapy.Design:Analysis of AIDS surveillance data.Setting:Spain.Patients:AIDS cases reported from 1994 though 2000.Main outcome measures:Late testers were defined as persons who had a first positive HIV test in the month of or immediately preceding AIDS diagnosis. Their incidence trend was compared against that for the remaining cases, and the influence of demographic factors evaluated.Results:Of 30 778 AIDS cases, 8499 (28%) were late testers, and of these, 1061 (12%) died within 3 months of diagnosis of HIV infection. From 1995 to 2000, AIDS diagnoses declined by 36% among late testers versus 67% for the remainder (P< 0.001). The percentage of late testers increased from 24% in 1994–1996 to 35% in 1998–2000 (P< 0.001). Among the 7825 AIDS cases diagnosed in 1998–2000, late testing was independently associated (P< 0.01) with male sex, age over 44 years, residence in provinces with a lower AIDS incidence, foreign origin, and no record of injecting drug use or prison stay.Conclusions:A growing proportion of AIDS cases involves late diagnosis of HIV infection. Persons who are unaware of their HIV infection cannot benefit from antiretroviral therapy and, hence, early diagnosis would strengthen the impact of such therapy and so reduce AIDS incidence.

ISSN:0269-9370    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Objectives:To examine HIV-positive patients’ reports of whether HIV care providers ever talked with them about practicing safer sex and disclosing seropositive status to sex partners.Design:Cross-sectional survey (1998–1999) of HIV-positive men and women sampled randomly at six public HIV clinics in California.Methods:Participants were interviewed and asked whether applicable clinic providers (physician, physician assistant, nurse practitioner, nurse, social worker, health educator, psychologist, psychiatrist) ever talked with them about safer sex or disclosure. Responses were analyzed by clinic site, HIV medical status (viral load), demographic, and behavioral variables (unprotected intercourse, non-disclosure).Results:The sample (n = 839) included heterosexual men (n = 127), men who have sex with men (MSM; n = 607), and women (n = 105). Thirty-nine percent were white, 36% Hispanic, 17% black, and 8% other/mixed ethnicity. Overall, 71% reported that an applicable provider had talked with them at least once about safer sex (range across clinics, 52–94%); 50% reported discussion of disclosure (range across clinics, 31–78%). Discussion of safer sex was more prevalent with physicians than with other clinic staff. In multivariate analyses, in addition to significant clinic differences, MSM (versus heterosexual men) and whites (versus blacks or Hispanics) were less likely to receive prevention messages on these topics. Patients’ behaviors (unsafe sex, non-disclosure) and HIV medical status were not independently associated with provider communication.Conclusions:HIV clinics differed substantially in the percentage of patients who reported that they received prevention messages from clinic staff. Care providers should assess and overcome barriers to providing prevention messages to patients.

ISSN:0269-9370    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0269-9370    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0269-9370    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0269-9370    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0269-9370    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0269-9370    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0269-9370    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0269-9370    

出版商:OVID    

年代:2002

数据来源: OVID