HIV.

Mother-to-child transmission (MTCT) is almost entirely preventable with a combination of interventions--antiretroviral prophylaxis during pregnancy, intrapartum and neonatally, elective caesarean section and avoidance of breastfeeding. In resource-rich settings new paediatric human immuno-deficiency virus (HIV) infections have reached an all-time low due to broad application of these interventions, particularly the widespread use of highly active antiretroviral therapy and no breastfeeding. However, most HIV-infected pregnant women live in developing countries where <10% of them have access to preventative interventions.

Pregnancy outcomes in HIV-infected and uninfected women in rural and urban South Africa.

Objective: To describe pregnancy outcomes among clade C HIV-infected and uninfected women in South Africa.

Design: A longitudinal cohort study.

Methods: Pregnant women attending 9 rural/urban antenatal clinics were prospectively recruited and followed up.

Women's groups' perceptions of maternal health issues in rural Malawi.

Background: Improvements in preventive and care-seeking behaviours to reduce maternal mortality in rural Africa depend on the knowledge and attitudes of women and communities. Surveys have indicated a poor awareness of maternal health problems by individual women. We report the perceptions of women's groups to such issues in the rural Mchinji district of Malawi.

Increased CD154 expression in uninfected infants born to HIV-positive mothers exposed to antiretroviral prophylaxis.

Although prevention of mother-to-child HIV transmission by antiretroviral drugs has been shown to be effective, the short- and long-term effects of treatment are not well known. Several reports suggest that antiretroviral drugs act not only by inhibiting viral replication, but also by improving antiviral immunity. In particular, treatment with nucleoside analogs was found to increase CD40 ligand (CD40L; CD154) levels, an inducible molecule expressed on activated T lymphocytes.

Within and between race differences in lymphocyte, CD4+, CD8+ and neutrophil levels in HIV-uninfected children with or without HIV exposure in Europe and Uganda.

Background: Racial immuno-haematological differences have been reported in children but to date have not been well quantified.

Aim: To investigate differences in haemato-immunological markers over age between children born and living in Europe and Uganda.

Subjects: HIV-uninfected children living in Uganda (n = 1633) with cross-sectional data.

Vaccines to prevent transmission of HIV-1 via breastmilk: scientific and logistical priorities.

Mother-to-child transmission (MTCT) of HIV-1 is the major mode of paediatric infection. The rapidly increasing incidence of MTCT worldwide has resulted in an urgent need for preventive strategies. Antiretroviral regimens can prevent intrapartum HIV transmission; however, these regimens do not prevent HIV transmission through breastfeeding.

CD4 cell response to antiretroviral therapy in children with vertically acquired HIV infection: is it associated with age at initiation?

Background: Considerable uncertainty remains as to whether early initiation of antiretroviral therapy (ART) in children with vertically acquired human immunodeficiency virus (HIV) infection increases the benefit in terms of immunological response.

Methods: The association between immunological outcome and early initiation of and/or more-potent ART was investigated, using age-standardized z scores for CD4 cell counts (hereafter, "CD4 z scores"), in 131 HIV-infected children enrolled in the European Collaborative Study, a birth cohort study.

Results: Median age at initiation of the most-potent ART was 4 years (range, 0.

Monitoring the scale-up of antiretroviral therapy programmes: methods to estimate coverage.

This paper reviews the data sources and methods used to estimate the number of people on, and coverage of, antiretroviral therapy (ART) programmes in low- and middle-income countries and to monitor the progress towards the "3 by 5" target set by WHO and UNAIDS. We include a review of the data sources used to estimate the coverage of ART programmes as well as the efforts made to avoid double counting and over-reporting. The methods used to estimate the number of people in need of ART are described and expanded with estimates of treatment needs for children, both for ART and for cotrimoxazole prophylaxis.

Prevention of mother-to-child transmission of HIV infection: Ukraine experience to date.

Background: Despite the availability of effective interventions for the prevention of mother-to-child transmission (PMTCT), questions remain regarding implementation of programmes in settings with limited resources. This article sets out to describe the first 2 years of the implementation of the national PMTCT programme in Ukraine.

Methods: National data sources and data from a cohort of pregnant HIV-infected women delivering in 13 centres in Ukraine since 2000 were analysed.

Vertically acquired paediatric coinfection with HIV and hepatitis C virus.

Both HIV and hepatitis C virus (HCV) can be transmitted from mother to child during pregnancy and delivery. Vertical transmission of HIV and HCV separately is most likely from HIV/HCV-coinfected mothers; however, transmission of both infections is less frequent. The effect of HCV coinfection on HIV-related disease remains unclear; whereas most studies indicate no effect, recent results suggest HCV in adults accelerates HIV progression.

Antiretroviral therapy-associated modulation of Th1 and Th2 immune responses in HIV-infected pregnant women.

A successful pregnancy is characterised by an increase in Th2 cytokines and suppression of Th1 cytokine production. A Th1 to Th2 cytokine shift is also observed in the disease progression of HIV infection. Highly active antiretroviral therapy (HAART) suppresses HIV viremia, increases CD4+ cell counts and counteracts the Th1 to Th2 shift.

Accuracy of HCV-RNA PCR tests for diagnosis or exclusion of vertically acquired HCV infection.

The aim of the study was to estimate the sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and likelihood ratios for HCV-RNA PCR tests for the early diagnosis or exclusion of HCV infection in vertically exposed children. Data were included for children with confirmed HCV infection status from a European multi-center study. Confirmation was dependent on antibody status at or beyond 18 months, the 'gold standard' measure of infection status against which the use of qualitative HCV-RNA PCR tests was assessed.

Managing mother-to-child transmission of HIV infection in developed-country settings.

This article reviews current understanding of the management of mother-to-child transmission of HIV-1 infection in the context of developed-country settings. The advent of highly active antiretroviral therapy has facilitated the virtual elimination of mother-to-child transmission of HIV infection in developed countries, reducing transmission rates to approximately 1-2%. This review describes the epidemiology of HIV infection among women of child-bearing age and the risk factors, timing and mechanisms of mother-to-child transmission, followed by a discussion of the identification of pregnant HIV-infected women and their therapeutic and obstetric management.

Does exposure to antiretroviral therapy affect growth in the first 18 months of life in uninfected children born to HIV-infected women?

Uninfected children born to HIV-infected women are exposed antenatally to antiretroviral therapy, but it is uncertain whether this affects growth in early life. We analyzed weight, height, and occipitofrontal circumference (OFC) in 1912 children from a cohort study: 1304 had no or monotherapy exposure and 608 had combination therapy exposure. The mean z-score for birth weight or OFC did not differ by exposure category in 1513 term children or in 78 born at <34 weeks; the 266 born from 34 to 36 weeks were heavier if exposed to combination therapy.

Is there a difference in the efficacy of peripartum antiretroviral regimens in reducing mother-to-child transmission of HIV in Africa?

Background: Peripartum antiretroviral regimens have been shown to prevent mother-to-child transmission of HIV (MTCT) in randomized clinical trials; however, direct comparison of published results is impossible given methodological and population differences.

Objective: To directly compare the efficacy of different antiretroviral regimens in reducing the risk of 6-week MTCT rate in African breastfeeding populations.

Methods: Pooled analysis including all mother-infant pairs from any relevant trial: West African ZDV-placebo trials, Petra ZDV+3TC [two regimens A (pre/intra/post-partum) and B (intra/post-partum), placebo from Uganda and Tanzania], SAINT (NVP and Petra arm B), HIVNET012 (NVP, ultra short ZDV pp) and the Vitamin A trial (as placebo arm in South Africa).

Current issues in the prevention of mother-to-child transmission of HIV-1 infection.

Worldwide every year approximately 750,000 children become infected with HIV, mostly through mother-to-child transmission (MTCT). Without specific interventions, the rate of MTCT is approximately 15-20%, with prolonged breastfeeding doubling the rate to 35-40%. Current approaches to intervention to reduce the risk of MTCT focus mainly on antiretroviral prophylaxis during pregnancy, labour and in the early neonatal period, but in some settings also on delivery procedures and avoidance of breastfeeding.

The management of HCV infected pregnant women and their children European paediatric HCV network.

Background/aims: As evidence accumulates relating to mother-to-child (vertical) transmission of hepatitis C virus (HCV), it is timely to draw up guidelines for the clinical management of HCV infected pregnant women and their children.

Methods: A review of evidence from the European Paediatric HCV Network (EPHN) prospective study of HCV infected women and their children and other published studies. Meeting of EPHN clinical experts to reach a consensus on recommendations for management.

Growth in the first 5 years of life is unaffected in children with perinatally-acquired hepatitis C infection.

Objectives: To identify the effect of vertical hepatitis C virus (HCV) infection or exposure on growth in childhood.

Study Design: Children (n=1203) born to HCV-infected mothers were followed up from birth prospectively in centers of the European Paediatric Hepatitis C virus Network. Z-scores compared height- and weight-for-age in HCV-infected and -uninfected children, adjusting for other factors using linear regression.

Treatment options for the prevention of mother-to-child transmission of HIV.

Vertically acquired HIV infection has been virtually eliminated in developed countries through the use of highly active antiretroviral therapy (HAART), reducing mother-to-child transmission rates to below 1 to 2%. However, with the increasing use of HAART, particularly when initiated before or during early pregnancy, safety and toxicity issues for both women and infants have gained significance. In less developed countries, the effectiveness of simpler and less costly antiretroviral strategies has been shown to be acceptable; however, the high prevalence of resistance associated with the use of monotherapy, in particular single dose nevirapine, has meant increasing attention focused on the use of combination therapy in these countries.

Excluding hepatitis C virus (HCV) infection by serology in young infants of HCV-infected mothers.

Aim: To identify the age at which HCV infection can be accurately excluded by serology in young children born to HCV-infected mothers and to determine an appropriate schedule of antibody testing, most informative to clinical practice.

Methods: Children born to HCV-infected mothers were followed in centres of the European Paediatric HCV Network. Turnbull survival analysis techniques were used to estimate the age at which HCV-uninfected children will lose maternally acquired HCV antibodies.