Evidence of Subclinical mtDNA Alterations in HIV-Infected Pregnant Women Receiving Combination Antiretroviral Therapy Compared to HIV-Negative Pregnant Women.

Introduction: Combination antiretroviral therapy (cART) can effectively prevent vertical transmission of HIV but there is potential risk of adverse maternal, foetal or infant effects. Specifically, the effect of cART use during pregnancy on mitochondrial DNA (mtDNA) content in HIV-positive (HIV+) women is unclear. We sought to characterize subclinical alterations in peripheral blood mtDNA levels in cART-treated HIV+ women during pregnancy and the postpartum period.

Evaluation of an emergency prevention program for mother to child transmission of HIV in British Columbia.

Introduction: The objective of this study was to evaluate a province-wide program designed to identify HIV infection accurately and to prevent mother to child transmission among high-risk pregnant women of unknown serostatus.

Methods: Between 2000 and 2007, 347 high-risk women were identified through the Prevention of Mother to Child Transmission (PMTCT) program implemented in 27 hospitals across British Columbia. Rates of HIV transmission and details of the implementation of prophylaxis kits were assessed.

Serious toxicity associated with continuous nevirapine-based HAART in pregnancy.

Objective: This study was designed to determine the safety of nevirapine (NVP)-based highly active antiretroviral therapy (HAART) in a cohort of HIV-positive pregnant women.

Design: This was a prospective cohort study of HIV-positive pregnant women.

Population And Setting: All HIV-positive women treated with HAART during pregnancy from January 1997 to February 2004 at the British Columbia (BC) Women's Hospital in Vancouver, BC, Canada.

Perinatal exposure to antiretroviral therapy is associated with increased blood mitochondrial DNA levels and decreased mitochondrial gene expression in infants.

Background: The effects of perinatal antiretroviral therapy (ART) on infant mitochondrial function are not well known. We compared blood mitochondrial DNA (mtDNA) levels and mtDNA gene expression (mtRNA) in human immunodeficiency virus (HIV)-uninfected, ART-exposed infants born to HIV-positive mothers with mtDNA levels and mtDNA gene expression in control infants born to uninfected women.

Methods: In this prospective cohort study, longitudinal mtDNA:nuclear DNA and mtRNA:beta-actin mRNA ratios were compared in blood samples obtained at various time points from birth to 8 months, using generalized estimating equation linear regression models.

Fertility intentions of women of reproductive age living with HIV in British Columbia, Canada.

Background: We undertook a study to examine the fertility intentions and reproductive health issues of women living with HIV in a broad-based sample in British Columbia, Canada.

Methods: Between November 2003 and December 2004, we invited women with HIV at all HIV clinics and AIDS service organizations in the province of British Columbia, Canada, to complete the survey instrument 'Contraceptive Decisions of HIV-positive Women'. Logistic regression analysis was conducted to calculate adjusted odds ratios to identify factors that may be significant predictors of the intention of women living with HIV to have children.

A prospective controlled study of neurodevelopment in HIV-uninfected children exposed to combination antiretroviral drugs in pregnancy.

Objective: Our intent was to investigate the neurodevelopment of HIV-uninfected children exposed to combination highly active antiretroviral therapy in pregnancy compared with children not exposed to highly active antiretroviral therapy but with similar socioeconomic backgrounds.

Patients And Methods: A prospective controlled cross-sectional study of the neurodevelopment of children exposed to highly active antiretroviral therapy versus those not exposed was performed by using the Bayley Scales of Infant Development and Vineland Adaptive Behavior Scales at 18 to 36 months of age. The highly active antiretroviral therapy-exposed children were born to HIV-infected women but were uninfected themselves.

Use of Sno Strip filter-paper wicks for collection of genital-tract samples allows reproducible determination of human immunodeficiency virus type 1 (HIV-1) RNA viral load with a commercial HIV-1 viral load assay.

To assess the reproducibility of measurements of cervical and vaginal human immunodeficiency virus (HIV) viral load, 92 duplicate cervical and 88 duplicate vaginal samples were collected from 13 HIV-infected women using Sno Strip filter-paper wicks. RNA was eluted from the strips, extracted, and assayed using a modified protocol for the Roche Cobas Amplicor HIV-1 Monitor assay. Pearson's correlation coefficient (R), coefficient of determination (D), and Bland-Altman plots (BA) were used to compare paired log10-transformed viral loads.

Psychometric assessment of the Multidimensional Quality of Life Questionnaire for Persons with HIV/AIDS (MQOL-HIV) in a sample of HIV-infected women.

Since the late 1980s, several HIV-specific quality of life instruments have been developed; however, little testing has been done in terms of their validity and reliability for HIV-infected women. The purpose of this study was to test the content validity, concurrent validity, internal consistency, and test-retest reliability of the Multidimensional Quality of Life Questionnaire for Persons with HIV/AIDS (MQOL-HIV) in a sample of 85 HIV-infected women. The MQOL-HIV is a 40-item scale comprised of 10 dimensions.

Age, adherence and injection drug use predict virological suppression among men and women enrolled in a population-based antiretroviral drug treatment programme.

Objectives: To characterize 1-year virological response to antiretroviral therapy and its determinants by sex.

Methods: This is a population-based analysis of antiretroviral therapy naive HIV-positive adult men and women. Factors associated with sex and with plasma HIV RNA viral load suppression to below 500 copies/ml were examined using non-parametric tests and logistic regression analyses.

Lactic acidemia in human immunodeficiency virus-uninfected infants exposed to perinatal antiretroviral therapy.

Objective: To investigate potential mitochondrial toxicity in HIV-uninfected infants exposed to highly active antiretroviral therapy (HAART) in utero and/or neonatal zidovudine.

Design: A prospective observational study performed in a tertiary referral center for HIV-infected women and their infants and children.

Methods: Plasma lactate was measured repeatedly during the first 6 months of life in a consecutive cohort of infants exposed to HAART in utero and/or neonatal zidovudine.

Genital tract and plasma human immunodeficiency virus viral load throughout the menstrual cycle in women who are infected with ovulatory human immunodeficiency virus.

Objective: The purpose of this study was to determine the vaginal, cervical, and plasma viral load through the menstrual cycle in women who are positive for human immunodeficiency virus.

Study Design: A prospective cohort study was performed on 14 women with ovulatory menstrual cycles who have human immunodeficiency virus. Duplicate cervical and vaginal viral load samples (n = 301) were taken at four stages (menstrual, follicular, periovulatory, and luteal) of two consecutive cycles.

Routine prenatal screening for HIV in a low-prevalence setting.

Background: The objectives of this study were to assess the effect of British Columbia's June 1994 guidelines for prenatal HIV screening on the rate of maternal-fetal HIV transmission and to estimate the cost-effectiveness of such screening.

Methods: The authors conducted a retrospective review of pregnancy and delivery statistics, HIV screening practices, laboratory testing volume, prenatal and labour management decisions of HIV-positive women, maternal-fetal transmission rates and associated costs.

Results: Over 1995 and 1996, 135,681 women were pregnant and 92,645 carried to term.

Human immunodeficiency virus infection in pregnancy.

The incidence and prevalence of human immunodeficiency virus (HIV) infection in women of child-bearing age continue to increase both internationally and in Canada. The care of HIV-infected pregnant women is complex, and multiple issues must be addressed, including the current and future health of the woman, minimization of the risk of maternal-infant HIV transmission, and maintenance of the well-being of the fetus and neonate. Vertical transmission of HIV can occur in utero, intrapartum and postpartum, but current evidence suggests that the majority of transmission occurs toward end of term, or during labour and delivery.

Bridging the Gender Gap in HIV Diagnosis and Care.

Since its emergence in 1981, the human immunodeficiency virus (HIV) has been viewed by the Western world as a disease that primarily affected men. Yet in mid 1996, the World Health Organization (WHO) estimated that globally 42% of the 21 million adults living with HIV infection were women. They also reported that the proportion of infected women continues to grow in developed and underdeveloped countries.

Eradication of methicillin-resistant Staphylococcus aureus from the lower respiratory tract of patients with cystic fibrosis.

Two of 95 patients followed in an adult cystic fibrosis clinic consistently grew methicillin-resistant Staphylococcus aureus (mrsa) on sputum culture. Sputum Gram stain consistently showed +4 polymorphonuclear leukocytes and +4 Gram-positive cocci in clusters. Both patients were co-infected with Pseudomonas aeruginosa and required multiple hospitalizations for treatment of pulmonary exacerbation, resulting in significant infection control concerns.

Xanthomonas maltophilia misidentified as Pseudomonas cepacia in cultures of sputum from patients with cystic fibrosis: a diagnostic pitfall with major clinical implications.

Pseudomonas cepacia infection in patients with cystic fibrosis (CF) has major significance in terms of infection control, psychosocial issues, and medical treatment. We describe three instances in which the diagnostic laboratory misidentified Xanthomonas maltophilia as P. cepacia in cultures of sputum from patients with CF.

The Oak Tree Centre: initiatives for HIV-infected women, children, youth and families.

The Oak Tree Centre (Women and Family HIV Care Project) is designed to address the needs of women, youth, children and families affected by HIV infection in British Columbia. It is a conjoint project of the Women's Health Centre and British Columbia's Children's Hospital. Community involvement and the participation of individuals living with HIV infection continue to be vital components of the project.

Histologically proven pressure sore-related osteomyelitis in the setting of negative technetium bone scans. Case report.

Pressure sores are common in patients with spinal cord injury, stroke or debilitating medical illness. Contiguous osteomyelitis is a well recognized complication of pressure ulcers, but remains a challenging diagnostic and management problem. Technetium bone scan is purported to be an extremely sensitive, although nonspecific diagnostic test for osteomyelitis.

Experience at a referral center for patients with suspected Lyme disease in an area of nonendemicity: first 65 patients.

A multidisciplinary referral center was established at a university hospital for prospectively assessing patients with possible Lyme disease. Borrelia burgdorferi is not known to be endemic in this region, but considerable anxiety about Lyme disease has developed among the general public. Sixty-five patients were referred for suspected Lyme borreliosis.

Case-control and vector studies of nosocomial acquisition of Pseudomonas cepacia in adult patients with cystic fibrosis.

Objective: To examine factors associated with nosocomial acquisition of Pseudomonas cepacia in adult patients with cystic fibrosis.

Design: A retrospective case-control study of 5 patients with nosocomial acquisition of P cepacia versus 20 matched controls who failed to develop P cepacia infection. Selective handwashing, air sampling, and respiratory equipment sampling also were performed.