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2. Robot-assisted gait training in patients with Parkinson's disease: Implications for clinical practice. A systematic review

Author

Carmignano, S, Fundaro, C, Bonaiuti, D, Calabro, R, Cassio, A, Mazzoli, D, Bizzarini, E, Campanini, I, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Gazzotti, V, Mazzoleni, D, Mazzucchelli, M, Melegari, C, Merlo, A, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Andrenelli, E, Carmignano S. M., Fundaro C., Bonaiuti D., Calabro R. S., Cassio A., Mazzoli D., Bizzarini E., Campanini I., Cerulli S., Chisari C., Colombo V., Dalise S., Gazzotti V., Mazzoleni D., Mazzucchelli M., Melegari C., Merlo A., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., Andrenelli E., Carmignano, S, Fundaro, C, Bonaiuti, D, Calabro, R, Cassio, A, Mazzoli, D, Bizzarini, E, Campanini, I, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Gazzotti, V, Mazzoleni, D, Mazzucchelli, M, Melegari, C, Merlo, A, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Andrenelli, E, Carmignano S. M., Fundaro C., Bonaiuti D., Calabro R. S., Cassio A., Mazzoli D., Bizzarini E., Campanini I., Cerulli S., Chisari C., Colombo V., Dalise S., Gazzotti V., Mazzoleni D., Mazzucchelli M., Melegari C., Merlo A., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., and Andrenelli E.

Abstract

BACKGROUND: Gait impairments are common disabling symptoms of Parkinson's disease (PD). Among the approaches for gait rehabilitation, interest in robotic devices has grown in recent years. However, the effectiveness compared to other interventions, the optimum amount of training, the type of device, and which patients might benefit most remains unclear. OBJECTIVE: To conduct a systematic review about the effects on gait of robot-assisted gait training (RAGT) in PD patients and to provide advice for clinical practice. METHODS: A search was performed on PubMed, Scopus, PEDro, Cochrane library, Web of science, and guideline databases, following PRISMA guidelines. We included English articles if they used a robotic system with details about the intervention, the parameters, and the outcome measures. We evaluated the level and quality of evidence. RESULTS: We included twenty papers out of 230 results: two systematic reviews, 9 randomized controlled trials, 4 uncontrolled studies, and 5 descriptive reports. Nine studies used an exoskeleton device and the remainders end-effector robots, with large variability in terms of subjects' disease-related disability. CONCLUSIONS: RAGT showed benefits on gait and no adverse events were recorded. However, it does not seem superior to other interventions, except in patients with more severe symptoms and advanced disease.

Published
2022

3. Gait robot-assisted rehabilitation in persons with spinal cord injury: A scoping review

Author

Stampacchia, G, Gazzotti, V, Olivieri, M, Andrenelli, E, Bonaiuti, D, Calabro, R, Carmignano, S, Cassio, A, Fundaro, C, Companini, I, Mazzoli, D, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Mazzoleni, D, Melegari, C, Merlo, A, Boldrini, P, Mazzoleni, S, Posteraro, F, Mazzucchelli, M, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bizzarrini, E, Stampacchia G., Gazzotti V., Olivieri M., Andrenelli E., Bonaiuti D., Calabro R. S., Carmignano S. M., Cassio A., Fundaro C., Companini I., Mazzoli D., Cerulli S., Chisari C., Colombo V., Dalise S., Mazzoleni D., Melegari C., Merlo A., Boldrini P., Mazzoleni S., Posteraro F., Mazzucchelli M., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., Bizzarrini E., Stampacchia, G, Gazzotti, V, Olivieri, M, Andrenelli, E, Bonaiuti, D, Calabro, R, Carmignano, S, Cassio, A, Fundaro, C, Companini, I, Mazzoli, D, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Mazzoleni, D, Melegari, C, Merlo, A, Boldrini, P, Mazzoleni, S, Posteraro, F, Mazzucchelli, M, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bizzarrini, E, Stampacchia G., Gazzotti V., Olivieri M., Andrenelli E., Bonaiuti D., Calabro R. S., Carmignano S. M., Cassio A., Fundaro C., Companini I., Mazzoli D., Cerulli S., Chisari C., Colombo V., Dalise S., Mazzoleni D., Melegari C., Merlo A., Boldrini P., Mazzoleni S., Posteraro F., Mazzucchelli M., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., and Bizzarrini E.

Abstract

BACKGROUND: Many robots are available for gait rehabilitation (BWSTRT and ORET) and their application in persons with SCI allowed an improvement of walking function.OBJECTIVE: The aim of the study is to compare the effects of different robotic exoskeletons gait training in persons with different SCI level and severity.METHODS: Sixty-two studies were included in this systematic review; the study quality was assessed according to GRADE and PEDro's scale.RESULTS: Quality assessment of included studies (n = 62) demonstrated a prevalence of evidence level 2; the quality of the studies was higher for BWSTRT (excellent and good) than for ORET (fair and good). Almost all persons recruited for BWSTRT had an incomplete SCI; both complete and incomplete SCI were recruited for ORET. The SCI lesion level in the persons recruited for BWSTRT are from cervical to sacral; mainly from thoracic to sacral for ORET; a high representation of AIS D lesion resulted both for BWSTRT (30%) and for ORET (45%). The walking performance, tested with 10MWT, 6MWT, TUG and WISCI, improved after exoskeleton training in persons with incomplete SCI lesions, when at least 20 sessions were applied. Persons with complete SCI lesions improved the dexterity in walking with exoskeleton, but did not recover independent walking function; symptoms such as spasticity, pain and cardiovascular endurance improved.CONCLUSION: Different exoskeletons are available for walking rehabilitation in persons with SCI. The choice about the kind of robotic gait training should be addressed on the basis of the lesion severity and the possible comorbidities.

Published
2022

4. Evidence-based improvement of gait in post-stroke patients following robot-assisted training: A systematic review

Author

Mazzucchelli, M, Mazzoleni, D, Campanini, I, Merlo, A, Mazzoli, D, Melegari, C, Colombo, V, Cerulli, S, Piscitelli, D, Perin, C, Andrenelli, E, Bizzarini, E, Calabro, R, Carmignano, S, Cassio, A, Chisari, C, Dalise, S, Fundaro, C, Gazzotti, V, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bonaiuti, D, Mazzucchelli M., Mazzoleni D., Campanini I., Merlo A., Mazzoli D., Melegari C., Colombo V., Cerulli S., Piscitelli D., Perin C., Andrenelli E., Bizzarini E., Calabro R. S., Carmignano S. M., Cassio A., Chisari C., Dalise S., Fundaro C., Gazzotti V., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., Bonaiuti D., Mazzucchelli, M, Mazzoleni, D, Campanini, I, Merlo, A, Mazzoli, D, Melegari, C, Colombo, V, Cerulli, S, Piscitelli, D, Perin, C, Andrenelli, E, Bizzarini, E, Calabro, R, Carmignano, S, Cassio, A, Chisari, C, Dalise, S, Fundaro, C, Gazzotti, V, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bonaiuti, D, Mazzucchelli M., Mazzoleni D., Campanini I., Merlo A., Mazzoli D., Melegari C., Colombo V., Cerulli S., Piscitelli D., Perin C., Andrenelli E., Bizzarini E., Calabro R. S., Carmignano S. M., Cassio A., Chisari C., Dalise S., Fundaro C., Gazzotti V., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., and Bonaiuti D.

Abstract

Background: The recovery of walking after stroke is a priority goal for recovering autonomy. In the last years robotic systems employed for Robotic Assisted Gait Training (RAGT) were developed. However, literature and clinical practice did not offer standardized RAGT protocol or pattern of evaluation scales. Objective: This systematic review aimed to summarize the available evidence on the use of RAGT in post-stroke, following the CICERONE Consensus indications. Methods: The literature search was conducted on PubMed, Cochrane Library and PEDro, including studies with the following criteria: 1) adult post-stroke survivors with gait disability in acute/subacute/chronic phase; 2) RAGT as intervention; 3) any comparators; 4) outcome regarding impairment, activity, and participation; 5) both primary studies and reviews. Results: Sixty-one articles were selected. Data about characteristics of patients, level of disability, robotic devices used, RAGT protocols, outcome measures, and level of evidence were extracted. Conclusion: It is possible to identify robotic devices that are more suitable for specific phase disease and level of disability, but we identified significant variability in dose and protocols. RAGT as an add-on treatment seemed to be prevalent. Further studies are needed to investigate the outcomes achieved as a function of RAGT doses delivered.

Published
2022

5. What does evidence tell us about the use of gait robotic devices in patients with multiple sclerosis? A comprehensive systematic review on functional outcomes and clinical recommendations

Author

Calabro, R, Cassio, A, Mazzoli, D, Andrenelli, E, Bizzarini, E, Campanini, I, Carmignano, S, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Fundaro, C, Gazzotti, V, Mazzoleni, D, Mazzucchelli, M, Melegari, C, Merlo, A, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Morone, G, Bonaiuti, D, Calabro R. S., Cassio A., Mazzoli D., Andrenelli E., Bizzarini E., Campanini I., Carmignano S. M., Cerulli S., Chisari C., Colombo V., Dalise S., Fundaro C., Gazzotti V., Mazzoleni D., Mazzucchelli M., Melegari C., Merlo A., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Petrarca M., Picelli A., Senatore M., Turchetti G., Morone G., Bonaiuti D., Calabro, R, Cassio, A, Mazzoli, D, Andrenelli, E, Bizzarini, E, Campanini, I, Carmignano, S, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Fundaro, C, Gazzotti, V, Mazzoleni, D, Mazzucchelli, M, Melegari, C, Merlo, A, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Morone, G, Bonaiuti, D, Calabro R. S., Cassio A., Mazzoli D., Andrenelli E., Bizzarini E., Campanini I., Carmignano S. M., Cerulli S., Chisari C., Colombo V., Dalise S., Fundaro C., Gazzotti V., Mazzoleni D., Mazzucchelli M., Melegari C., Merlo A., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Petrarca M., Picelli A., Senatore M., Turchetti G., Morone G., and Bonaiuti D.

Abstract

INTRODUCTION: There is growing evidence on the efficacy of gait robotic rehabilitation in patients with multiple sclerosis (MS), but most of the studies have focused on gait parameters. Moreover, clear indications on the clinical use of robotics still lack. As part of the CICERONE Italian Consensus on Robotic Rehabilitation, the aim of this systematic review was to investigate the existing evidence concerning the role of lower limb robotic rehabilitation in improving functional recovery in patients with MS. EVIDENCE ACQUISITION: We searched for and systematically reviewed evidence-based studies on gait robotic rehabilitation in MS, between January 1st, 2010 and December 31st, 2020, in the following databases: Cochrane Library, PEDro, PubMed and Google Scholar. The study quality was assessed by the 16-item assessment of multiple systematic reviews 2 (AMSTAR 2) and the 10-item PEDro scale for the other research studies. EVIDENCE SYNTHESIS: After an accurate screening, only 17 papers were included in the review, and most of them (13 RCT) had a level II evidence. Most of the studies used the Lokomat as a grounded robotic device, two investigated the efficacy of end-effectors and two powered exoskeletons. Generally speaking, robotic treatment has beneficial effects on gait speed, endurance and balance with comparable outcomes to those of conventional treatments. However, in more severe patients (EDSS >6), robotics leads to better functional outcomes. Notably, after gait training with robotics (especially when coupled to virtual reality) MS patients also reach better non-motor outcomes, including spasticity, fatigue, pain, psychological well-being and quality of life. Unfortunately, no clinical indications emerge on the treatment protocols. CONCLUSIONS: The present comprehensive systematic review highlights the potential beneficial role on functional outcomes of the lower limb robotic devices in people with MS. Future studies are warranted to evaluate the role of robot

Published
2021

6. robotic-assisted gait rehabilitation following stroke: A systematic review of current guidelines and practical clinical recommendations

Author

Calabro, R, Sorrentino, G, Cassio, A, Mazzoli, D, Andrenelli, E, Bizzarini, E, Campanini, I, Carmignano, S, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Fundaro, C, Gazzotti, V, Mazzoleni, D, Mazzucchelli, M, Melegari, C, Merlo, A, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bonaiuti, D, Calabro R. S., Sorrentino G., Cassio A., Mazzoli D., Andrenelli E., Bizzarini E., Campanini I., Carmignano S. M., Cerulli S., Chisari C., Colombo V., Dalise S., Fundaro C., Gazzotti V., Mazzoleni D., Mazzucchelli M., Melegari C., Merlo A., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., Bonaiuti D., Calabro, R, Sorrentino, G, Cassio, A, Mazzoli, D, Andrenelli, E, Bizzarini, E, Campanini, I, Carmignano, S, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Fundaro, C, Gazzotti, V, Mazzoleni, D, Mazzucchelli, M, Melegari, C, Merlo, A, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bonaiuti, D, Calabro R. S., Sorrentino G., Cassio A., Mazzoli D., Andrenelli E., Bizzarini E., Campanini I., Carmignano S. M., Cerulli S., Chisari C., Colombo V., Dalise S., Fundaro C., Gazzotti V., Mazzoleni D., Mazzucchelli M., Melegari C., Merlo A., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., and Bonaiuti D.

Abstract

Introduction: Stroke is the third leading cause of adult disability worldwide, and lower extremity motor impairment is one of the major determinants of long-term disability. although robotic therapy is becoming more and more utilized in research protocols for lower limb stroke rehabilitation, the gap between research evidence and its use in clinical practice is still significant. The aim of this study was to determine the scope, quality, and consistency of guidelines for robotic lower limb rehabilitation after stroke, in order to provide clinical recommendations. EVidEncE acQuisition: We systematically reviewed stroke rehabilitation guideline recommendations between January 1, 2010 and october 31, 2020. We explored electronic databases (n.=4), guideline repositories and professional rehabilitation networks (n.=12). two independent reviewers used the appraisal of Guidelines for research and Evaluation (aGrEE) ii instrument, and brief syntheses were used to evaluate and compare the different recommendations, considering only the most recent version. EVIDENCE SYNTHESIS: From the 1219 papers screened, ten eligible guidelines were identified from seven different regions/countries. Four of the included guidelines focused on stroke management, the other six on stroke rehabilitation. robotic rehabilitation is generally recommended to improve lower limb motor function, including gait and strength. unfortunately, there is still no consensus about the timing, frequency, training session duration and the exact characteristics of subjects who could benefit from robotics. conclusions: our systematic review shows that the introduction of robotic rehabilitation in standard treatment protocols seems to be the future of stroke rehabilitation. however, robot assisted gait training (raGt) for stroke needs to be improved with new solutions and in clinical practice guidelines, especially in terms of applicability.

Published
2021

11. Prognostic factors and survival in children with perinatal HIV-1 infection

Author

Tovo, P.A., Martino M. de, Gabiano, C., Cappello, N., D'Elia, R., Loy, A., Plebani, A., Zuccotti, G.V., Dallacasa, P., Ferraris, G., Caselli, D., Fundaro, C., D'Argenio, P., Galli, L., Principi, N., Stegagno, M., Ruga, E., and Palomba, E.

Subjects
HIV infection in children -- Prognosis
Published
1992

13. Combined antiretroviral therapy reduces hyperimmunoglobulinemia in HIV-1 infected children

Author

Chiappini, E, Galli, L, Tovo, PA, Gabiano, C, de Martino, M, Osimani, P, Cordiali, R, De Mattia, D, Manzioma, M, DI BARI, DANIELA COLOMBA, Ruggeri, M, Masi, M, Miniaci, A, Specchia, F, Ciccia, M, Lanari, M, Baldi, F, Battisti, L, Schumacher, R, Duse, M, Fiorino, C, Dessi, C, Pintor, C, Dedoni, M, Fenu, ML, CAVALLINI, RAFFAELLA, D'ANASTASIO, ELISABETTA, Merolla, F, Sticca, M, Pomero, G, Bezzi, T, Fiumana, E, Paganelli, S, Vierucci, A, Vitucci, P, CECCHI, MARIA TERESA, Cosso, D, Timitilli, A, Stronati, M, Plebani, A, PINZANI, ROBERTO, VIGANO', ALDO, Giacomet, V, Bianchi, R, SALVINI, FRANCESCO, Zuccotti, GV, Giovannini, M, Ferraris, G, Lipreri, R, Moretti, C, Cellini, M, Cano, MC, Palazzi, G, Guarino, A, Bruzzese, E, DE MARCO, GIUSEPPINA, Tarallo, L, TANCREDI, FERNANDO ANTONIO, Giaquinto, C, D'Elia, R, Rampon, O, Nogare, EDR, SANFILIPPO, ALESSIA, Romano, A, Saitta, M, Dodi, I, Barone, A, Maccabruni, A, Consolini, R, Legitimo, A, Magnani, C, Falconieri, P, Fundaro, C, Genovese, O, Salvucci, S, Casadei, AM, Gattinara, GC, Bernardi, S, PALMA, PASQUALE, Anzidei, G, Anzidei, M, Cerilli, S, Catania, S, Ajassa, C, Ganau, A, Cristiano, L, Mazza, A, Di Palma, A, Garetto, S, Riva, C, Scolfaro, C, Portelli, V, Rabusin, M, Pellegatta, A, Molesini, M, Chiappini, E, Galli, L, Tovo, PA, Gabiano, C, de Martino, M, Osimani, P, Cordiali, R, De Mattia, D, Manzioma, M, Di Bari, C, Ruggeri, M, Masi, M, Miniaci, A, Specchia, F, Ciccia, M, Lanari, M, Baldi, F, Battisti, L, Schumacher, R, Duse, M, Fiorino, C, Dessi, C, Pintor, C, Dedoni, M, Fenu, ML, Cavallini, R, Anastasio, E, Merolla, F, Sticca, M, Pomero, G, Bezzi, T, Fiumana, E, Paganelli, S, Vierucci, A, Vitucci, P, Cecchi, MT, Cosso, D, Timitilli, A, Stronati, M, Plebani, A, Pinzani, R, Vigano, A, Giacomet, V, Bianchi, R, Salvini, F, Zuccotti, GV, Giovannini, M, Ferraris, G, Lipreri, R, Moretti, C, Cellini, M, Cano, MC, Palazzi, G, Guarino, A, Bruzzese, E, De Marco, G, Tarallo, L, Tancredi, F, Giaquinto, C, D'Elia, R, Rampon, O, Nogare, EDR, Sanfilippo, A, Romano, A, Saitta, M, Dodi, I, Barone, A, Maccabruni, A, Consolini, R, Legitimo, A, Magnani, C, Falconieri, P, Fundaro, C, Genovese, O, Salvucci, S, Casadei, AM, Gattinara, GC, Bernardi, S, Palma, P, Anzidei, G, Anzidei, M, Cerilli, S, Catania, S, Ajassa, C, Ganau, A, Cristiano, L, Mazza, A, Di Palma, A, Garetto, S, Riva, C, Scolfaro, C, Portelli, V, Rabusin, M, Pellegatta, A, and Molesini, M

Subjects
Adult, medicine.medical_specialty, Adolescent, immunogiobulins, Immunology, immunoglobulins, combined antiretroviral therapy, Human immunodeficiency virus (HIV), HIV Infections, medicine.disease_cause, Gastroenterology, children, Hypergammaglobulinemia, Internal medicine, medicine, Humans, Immunology and Allergy, Child, Therapeutic regimen, biology, business.industry, Immunoglobulins, Intravenous, Infant, Normal population, hiv-1 infection, Settore MED/38, Antiretroviral therapy, HIV Reverse Transcriptase, Infectious Diseases, Child, Preschool, Intravenous IG, HIV-1, biology.protein, HIV-1 infection, Drug Evaluation, Reverse Transcriptase Inhibitors, Drug Therapy, Combination, Antibody, business, Viral load
Abstract

Objective: To evaluate the effect of combined antiretroviral therapy on serum immunoglobulin (Ig) levels in HIV-1 perinatally infected children.Methods: Data from 1250 children recorded by the Italian Register for HIV Infection in Children from 1985 to 2002 were analysed. Since Ig levels physiologically vary with age, differences at different age periods were evaluated as differences in z-scores calculated using means and standard deviations of normal population for each age period. Combined antiretroviral therapy has become widespread in Italy since 1996, thus differences in Ig z-scores between the periods 1985-1995 and 1996-2002 were analysed. Data according to type of therapeutic regimen were also analysed.Results: Between the two periods 1985-1995 and 1996-2002, significant (P < 0.0001) decreases in IgG (6.29 +/- 4.72 versus 4.44 +/- 4.33), IgM (9.25 +/- 13.32 versus 5.61 +/- 7.93), and IgA (10.25 +/- 15.68 versus 6.48 +/- 11.56) z-scores, together with a parallel significant (P < 0.0001) increase in CD4 T-lymphocyte percentages, were found. These decreases were confirmed regardless of whether the children were receiving intravenous Ig or not. Ig z-scores were significantly higher in children receiving mono-therapy than in those receiving double-combined therapy (IgG, P < 0.0001; IgM, P = 0.003; IgA, P = 0.031) and in the latter children than in those receiving three or more drugs (P < 0.0001 for all z-scores). Ig z-scores correlated inversely with CD4 T lymphocyte percentages and, directly, with viral loads.Conclusions: Our data show that in HIV-1 infected children combined antiretroviral therapy leads to reduction of hyperimmunoglobulinemia which parallels restoration of CD4 T-lymphocyte percentage and viral load decrease, which it turn probably reflects improved B-lymphocyte functions.(C) 2004 Lippincott Williams Wilkins.

Published
2004
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15. Duration of ruptured membranes and vertical transmission of HIV-1: a meta-analysis from 15 prospective cohort studies

Author

Bulterys, M. B., Fowler, M. G., Hanson, I. C., Lemay, M., Mayaux, M. J., Mofenson, L., Newell, M. -L., Peavy, H., Peckham, C., Read, J. S., Rother, C., Simpson, B. J., Van Dyke, R. B., Harris, D. R., Peavy, H. H., Easley, K., Khammy, A., Nugent, R. P., Mitchell, R., Owen, W., Van Dyke, R., Widmayer, S., Bardeguez, A., Hanson, C., Wiznia, A., Luzuriaga, K., Viscarello, R., Ho, D., Koup, R., Chen, I., Krogstad, P., Mullins, J., Wolinsky, S., Korber, B., Walker, B., Ammann, A., Clapp, S., Mcdonald, D., Lapointe, N., Boucher, M., Fauvel, M., Hankins, C., Samson, J., Newell, M. L., Peckham, C. S., Thorne, C. N., Giaquinto, C., Ruga, E., De Rossi, A., Truscia, D., Grosch-Worner, I., Schafer, A., Mok, J., Johnstone, F., Jiminez, J., de Alba, C., Garcia Rodriguez, M. C., Bates, I., de Josee, I., Hawkins, F., Martinez Zapico, R., Pena, J. M., Gonzalez Garcia, J., Arribas Lopez, J. R., Asensi-Botet, F., Otero, M. C., Peerez-Tamarit, D., Moya, A., Galbis, M. J., Scherpbier, H., Boer, K., Bohlin, A. B., Lindgren, S., Anzen, B., Belfrage, E., Lidin-Jansson, G., Levy, J., Barlow, P., Hainaut, M., Peltier, A., Ferrazin, A., De Maria, A., Gotta, C., Mur, A., Vinolas, M., Paya, A., Loepez-Vilchez, M. A., Coll, O., Fortuny, C., Boguna, J., Casellas Caro, M., Canet, Y., Pardi, G., Ravizza, M., Semprini, E., Castagna, C., Fiore, S., Guerra, B., Lanari, M., Bianchi, S., Bovicelli, L., Prati, E., Zanelli, S., Duse, M., Soresina, A., Scaravelli, G., Stegagno, M., De Santis, M., Muggiasca, M. L., Vigano, A., Spinillo, A., Ravagni Probizer, F., Bucceri, A., Rancilio, L., Taylor, G. P., Lyall, H., Penn, Z., Blott, M., Valerius, N. H., Martinelli, P., Buffolano, W., Tibaldi, C., Ziarati, N., Semprini, A., Della Torre, M., Parazzini, F., Dallacasa, P., Bianchi, U., Pachi, A., Mancuso, S., Villa, P., Conti, M., Principi, N., Muggiasca, M., Marchisio, P., Zara, C., Ravagni, F., Vignali, M., Rossi, G., Selvaggi, L., Greco, P., Vimercati, A., Massi, G., Innocenti, T., Fiscella, A., Sansone, M., Benedetto, C., Tadrist, B., Thevenieau, D., Gondry, J., Paulard, B., Alisy, C., Brault, D., Tordjeman, N., Mamou, J., Rozan, M., Colombani, D., Pincemaille, O., Salvetti, A., Chabanier, C., Hernandorena, X., Leroy, J., Schaal, J., Balde, P., Faucher, P., Lachassinne, E., Benoit, S., Douard, D., Hocke, C., Barjot, P., Brouard, J., Delattre, P., Stien, L., Audibert, F., Labrune, P., Vial, M., Mazy, F., Sitbon, D., Crenn-Hebert, C., Floch-Tudal, C., Akakpo, R., Daveau, C., Leblanc, A., Cesbron, P., Duval-Arnould, M., Huraux-Rendu, C., Lemerle, S., Touboul, C., Guerin, M., Maingueneau, C., Reynaud, I., Rousseau, T., Ercoil, V., Lanza, M., Denavit, M., Garnier, J., Lahsinat, K., Pia, P., Allouche, C., Nardou, M., Grall, F., May, A., Dallot, M., Lhuillier, P., Cecile, W., Mezin, R., Bech, A., Lobut, J., Algava, G., Chalvon Dermesay, A., Busuttil, R., Jacquemot, M., Bader-Meunier, B., Fridman, S., Codaccioni, X., Maxingue, F., Thomas, D., Alain, J., De Lumley, L., Tabaste, J., Bailly Salin, P., Seaume, H., Guichard, A., Kebaill, K., Roussouly, C., Botto, C., De Lanete, A., Wipff, P., Cravello, L., De Boisse, P., Leclaire, M., Michel, G., Crumiere, C., Lefevre, V., Le Lorier, B., Pauly, I., Robichez, B., Seguy, D., Delhinger, M., Rideau, F., Talon, P., Benos, P., Huret, C., Nicolas, J., Heller-Roussin, B., Saint-Leger, S., Delaporte, M., Hubert, C., De Sarcus, B., Karoubi, P., Mechinaud, F., Bertcrottiere, D., Bongain, A., Monpoux, F., De Gennes, C., Devianne, F., Nisand, I., Rousset, M., Mouchnino, G., Muray, J., Munzer, M., Quereux, C., Brossard, V., Clavier, B., Allemon, M., Rotten, D., Stephan, J., Varlet, M., Guyot, B., Narcy, P., Bardinet, F., De Caunes, F., Jeny, R., Robin, M., Raison Boulley, A., Savey, L., Berrebi, A., Tricoire, J., Borderon, J., Fignon, A., Guillot, F., Maria, B., Broyard, A., Chitrit, Y., Firtion, G., Mandelbrot, L., Lafay Pillet, M., Parat, S., Boissinot, C., Garec, N., Levine, M., Ottenwalter, A., Schaller, F., Vilmer, E., Courpotin, C., Brunner, C., Ciraru-Vigneron, N., Hatem-Gantzer, G., Fritel, X., Wallet, A., Bouille, J., Milliez, J., Bensaid Mrejen, D., Dermer, E., Noseda, G., Bardou, D., Cressaty, J., Francoual, C., Carlus Moncomble, C., Cohen, H., Blanche, S., Bastion, H., Benifla, J., Benkhatar, F., Berkane, N., Hervee, F., Ronzier, M., Mayaux, Mj., de Martino, M., Tovo, P. -A., Galli, L., Gabiano, C., Ferraris, G., Garetto, S., Palomba, E., Riva, C., Vierucci, A., de Luca, M., Farina, S., Fundaro, C., Genovese, O., Mereu, G., Forni, G. L., Casadei, A., Zuccotti, G. V., Riva, E., Cellini, M., Baraldi, C., Consolini, R., Palla, G., Ruggeri, M., Ciccimarra, F., Guarino, A., Osimani, P., Benaglia, G., Romano, A., De Mattia, D., Caselli, D., Boni, S., Dell'Erba, G., Bassanetti, F., Sticca, M., Timpano, C., Magnani, C., Salvatore, C., Lipreri, R., Tornaghi, R., Pinzani, R., Cecchi, M. T., Bezzi, T., Battisti, L., Bresciani, E., Castelli Gattinara, G., Nasi, C., Pellegatta, A., Mazza, A., Baldi, F., Altobelli, R., Deiana, M., Colnaghi, C., Tarallo, L., Tondo, U., Anastasio, E., Chiriaco, P. G., Ruggeri, C., Scott, G., Hutto, C., O'Sullivan, M., Malmsberry, A., Willoughby, A., Burns, D., Goedert, J., Landesman, S., Minkoff, H., Mendez, H., Holman, S., Rubinstein, A., Durako, S., Muenz, L., Goodwin, S., Bryson, Y., Dillon, M., Nielsen, K., Boyer, P., Liao, D., Keller, M., Deveikis, A., Nesheim, S., Lindsay, M., Lee, F., Nahmias, A., Sawyer, M., Vink, P., Farley, J., Alger, L., Abrams, E., Bamji, M., Lambert, G., Schoenbaum, E., Thomas, P., Weedon, J., Palumbo, P., Denny, T., Oleske, J., Bulterys, M., Simonds, R., Ethier-Ives, J., Rogers, M., Schluchter, M., Kutner, M., Kaplan, S., Kattan, M., Lipshultz, S., Mellins, R., Shearer, W., Sopko, G., Sloand, E., Wu, M., Kind, C., Nadal, D., Rudin, C., Siegrist, C. -A., Wyler, C. -A., Cheseaux, J. -J., Aebi, C., Gnehm, H., Schubiger, G., Klingler, J., Hunziker, U., Kuchler, H., Gianinazzi, M., Buhlmann, U., Biedermann, K., Lauper, U., Irion, O., Brunelli, A., Spoletini, G., Schreyer, A., Hosli, I., Saurenmann, E., Drack, G., Isenschmid, M., Poorbeik, M., Schupbach, J., Perrin, L., Erb, P., Joller, H., Kovacs, A., Stek, A., Chan, L., Khoury, M., Diaz, C., Pacheco-Acosta, E., Tuomala, R., Cooper, E., Mesthene, D., Pitt, J., Higgins, A., Moroso, G., Rich, K., Turpin, D., Cooper, N., Davenny, K., Thompson, B., Andiman, W., Simpson, J., THE INTERNATIONAL PERINATAL HIV, Group, Martinelli, Pasquale, Bulterys M.B., Fowler M.G., Hanson I.C., Lemay M., Mayaux M.J., Mofenson L., Newell M.-L., Peavy H., Peckham C., Read J.S., Rother C., Simpson B.J., Van Dyke R.B., Harris D.R., Peavy H.H., Easley K., Khammy A., Nugent R.P., Mitchell R., Owen W., Van Dyke R., Widmayer S., Bardeguez A., Hanson C., Wiznia A., Luzuriaga K., Viscarello R., Ho D., Koup R., Chen I., Krogstad P., Mullins J., Wolinsky S., Korber B., Walker B., Ammann A., Clapp S., McDonald D., Lapointe N., Boucher M., Fauvel M., Hankins C., Samson J., Newell M.L., Peckham C.S., Thorne C.N., Giaquinto C., Ruga E., De Rossi A., Truscia D., Grosch-Worner I., Schafer A., Mok J., Johnstone F., Jiminez J., de Alba C., Garcia Rodriguez M.C., Bates I., de Josee I., Hawkins F., Martinez Zapico R., Pena J.M., Gonzalez Garcia J., Arribas Lopez J.R., Asensi-Botet F., Otero M.C., Peerez-Tamarit D., Moya A., Galbis M.J., Scherpbier H., Boer K., Bohlin A.B., Lindgren S., Anzen B., Belfrage E., Lidin-Jansson G., Levy J., Barlow P., Hainaut M., Peltier A., Ferrazin A., De Maria A., Gotta C., Mur A., Vinolas M., Paya A., Loepez-Vilchez M.A., Coll O., Fortuny C., Boguna J., Casellas Caro M., Canet Y., Pardi G., Ravizza M., Semprini E., Castagna C., Fiore S., Guerra B., Lanari M., Bianchi S., Bovicelli L., Prati E., Zanelli S., Duse M., Soresina A., Scaravelli G., Stegagno M., De Santis M., Muggiasca M.L., Vigano A., Spinillo A., Ravagni Probizer F., Bucceri A., Rancilio L., Taylor G.P., Lyall H., Penn Z., Blott M., Valerius N.H., Martinelli P., Buffolano W., Tibaldi C., Ziarati N., Semprini A., Della Torre M., Parazzini F., Dallacasa P., Bianchi U., Pachi A., Mancuso S., Villa P., Conti M., Principi N., Muggiasca M., Marchisio P., Zara C., Ravagni F., Vignali M., Rossi G., Selvaggi L., Greco P., Vimercati A., Massi G., Innocenti T., Fiscella A., Sansone M., Benedetto C., Tadrist B., Thevenieau D., Gondry J., Paulard B., Alisy C., Brault D., Tordjeman N., Mamou J., Rozan M., Colombani D., Pincemaille O., Salvetti A., Chabanier C., Hernandorena X., Leroy J., Schaal J., Balde P., Faucher P., Lachassinne E., Benoit S., Douard D., Hocke C., Barjot P., Brouard J., Delattre P., Stien L., Audibert F., Labrune P., Vial M., Mazy F., Sitbon D., Crenn-Hebert C., Floch-Tudal C., Akakpo R., Daveau C., Leblanc A., Cesbron P., Duval-Arnould M., Huraux-Rendu C., Lemerle S., Touboul C., Guerin M., Maingueneau C., Reynaud I., Rousseau T., Ercoil V., Lanza M., Denavit M., Garnier J., Lahsinat K., Pia P., Allouche C., Nardou M., Grall F., May A., Dallot M., Lhuillier P., Cecile W., Mezin R., Bech A., Lobut J., Algava G., Chalvon Dermesay A., Busuttil R., Jacquemot M., Bader-Meunier B., Fridman S., Codaccioni X., Maxingue F., Thomas D., Alain J., De Lumley L., Tabaste J., Bailly Salin P., Seaume H., Guichard A., Kebaill K., Roussouly C., Botto C., De Lanete A., Wipff P., Cravello L., De Boisse P., Leclaire M., Michel G., Crumiere C., Lefevre V., Le Lorier B., Pauly I., Robichez B., Seguy D., Delhinger M., Rideau F., Talon P., Benos P., Huret C., Nicolas J., Heller-Roussin B., Saint-Leger S., Delaporte M., Hubert C., De Sarcus B., Karoubi P., Mechinaud F., Bertcrottiere D., Bongain A., Monpoux F., De Gennes C., Devianne F., Nisand I., Rousset M., Mouchnino G., Muray J., Munzer M., Quereux C., Brossard V., Clavier B., Allemon M., Rotten D., Stephan J., Varlet M., Guyot B., Narcy P., Bardinet F., De Caunes F., Jeny R., Robin M., Raison Boulley A., Savey L., Berrebi A., Tricoire J., Borderon J., Fignon A., Guillot F., Maria B., Broyard A., Chitrit Y., Firtion G., Mandelbrot L., Lafay Pillet M., Parat S., Boissinot C., Garec N., Levine M., Ottenwalter A., Schaller F., Vilmer E., Courpotin C., Brunner C., Ciraru-Vigneron N., Hatem-Gantzer G., Fritel X., Wallet A., Bouille J., Milliez J., Bensaid Mrejen D., Dermer E., Noseda G., Bardou D., Cressaty J., Francoual C., Carlus Moncomble C., Cohen H., Blanche S., Bastion H., Benifla J., Benkhatar F., Berkane N., Hervee F., Ronzier M., Mayaux MJ., de Martino M., Tovo P.-A., Galli L., Gabiano C., Ferraris G., Garetto S., Palomba E., Riva C., Vierucci A., de Luca M., Farina S., Fundaro C., Genovese O., Mereu G., Forni G.L., Casadei A., Zuccotti G.V., Riva E., Cellini M., Baraldi C., Consolini R., Palla G., Ruggeri M., Ciccimarra F., Guarino A., Osimani P., Benaglia G., Romano A., De Mattia D., Caselli D., Boni S., Dell'Erba G., Bassanetti F., Sticca M., Timpano C., Magnani C., Salvatore C., Lipreri R., Tornaghi R., Pinzani R., Cecchi M.T., Bezzi T., Battisti L., Bresciani E., Castelli Gattinara G., Nasi C., Pellegatta A., Mazza A., Baldi F., Altobelli R., Deiana M., Colnaghi C., Tarallo L., Tondo U., Anastasio E., Chiriaco P.G., Ruggeri C., Scott G., Hutto C., O'Sullivan M., Malmsberry A., Willoughby A., Burns D., Goedert J., Landesman S., Minkoff H., Mendez H., Holman S., Rubinstein A., Durako S., Muenz L., Goodwin S., Bryson Y., Dillon M., Nielsen K., Boyer P., Liao D., Keller M., Deveikis A., Nesheim S., Lindsay M., Lee F., Nahmias A., Sawyer M., Vink P., Farley J., Alger L., Abrams E., Bamji M., Lambert G., Schoenbaum E., Thomas P., Weedon J., Palumbo P., Denny T., Oleske J., Bulterys M., Simonds R., Ethier-Ives J., Rogers M., Schluchter M., Kutner M., Kaplan S., Kattan M., Lipshultz S., Mellins R., Shearer W., Sopko G., Sloand E., Wu M., Kind C., Nadal D., Rudin C., Siegrist C.-A., Wyler C.-A., Cheseaux J.-J., Aebi C., Gnehm H., Schubiger G., Klingler J., Hunziker U., Kuchler H., Gianinazzi M., Buhlmann U., Biedermann K., Lauper U., Irion O., Brunelli A., Spoletini G., Schreyer A., Hosli I., Saurenmann E., Drack G., Isenschmid M., Poorbeik M., Schupbach J., Perrin L., Erb P., Joller H., Kovacs A., Stek A., Chan L., Khoury M., Diaz C., Pacheco-Acosta E., Tuomala R., Cooper E., Mesthene D., Pitt J., Higgins A., Moroso G., Rich K., Turpin D., Cooper N., Davenny K., Thompson B., Andiman W., and Simpson J.

Subjects
Time Factors, Epidemiology, Infectious Disease Transmission, Prevention of perinatal transmission, Extraembryonic Membranes, Human immunodeficiency virus (HIV), HIV Infections, medicine.disease_cause, Cohort Studies, Pregnancy, Risk Factors, INFECTION, Vertical, Immunology and Allergy, HIV Infection, MOTHER-TO-CHILD, Pregnancy Complications, Infectious, Prospective cohort study, prevention of perinatal transmission, vertical transmission, obstetrics/gynaecology, epidemiology, Obstetrics, Transmission (medicine), Infectious, HUMAN-IMMUNODEFICIENCY-VIRUS, MOTHER-TO-CHILD, ZIDOVUDINE PROPHYLAXIS, RISK-FACTORS, TYPE-1, PREGNANCY, INFECTION, TRIAL, PREVENTION, Breast Feeding, Infectious Diseases, Meta-analysis, HUMAN-IMMUNODEFICIENCY-VIRUS, Vertical transmission, Regression Analysis, TRIAL, Female, Delivery, Obstetrics gynaecology, Human, medicine.medical_specialty, Time Factor, Ruptured membranes, Immunology, Regression Analysi, NO, ZIDOVUDINE PROPHYLAXIS, Extraembryonic Membrane, medicine, Humans, TYPE-1, business.industry, Risk Factor, Infant, Newborn, Infant, Obstetric, Delivery, Obstetric, Newborn, PREVENTION, Infectious Disease Transmission, Vertical, Pregnancy Complications, Obstetrics/gynaecology, RISK-FACTORS, Cohort Studie, business
Abstract

Objective: To test the a priori hypothesis that longer duration of ruptured membranes is associated with increased risk of vertical transmission of HIV. Design: The relationship between duration of ruptured membranes and vertical transmission of HIV was evaluated in an individual patient data meta-analysis. Methods: Eligible studies were prospective cohort studies including at least 100 mother-child pairs, from regions where HIV-infected women are counselled not to breastfeed. Analyses were restricted to vaginal deliveries and non-elective Cesarean sections; elective Cesarean section deliveries (those performed before onset of labour and before rupture of membranes) were excluded. Results: The primary analysis included 4721 deliveries with duration of ruptured membranes ≤ 24 h. After adjusting for other factors known to be associated with vertical transmission using logistic regression analysis to assess the strength of the relationship, the risk of vertical HIV transmission increased approximately 2% with an increase of 1 h in the duration of ruptured membranes [adjusted odds ratio, 1.02; 95% confidence interval, 1.01-1.04; for each 1 h increment]. There were no significant interactions of duration of ruptured membranes with study cohort or with any of the covariates, except maternal AIDS. Among women diagnosed with AIDS, the estimated probability of transmission increased from 8% to 31% with duration of ruptured membranes of 2 h and 24 h respectively (P < 0.01). Conclusions: These results support the importance of duration of ruptured membranes as a risk factor for vertical transmission of HIV and suggest that a diagnosis of AIDS in the mother at the time of delivery may potentiate the effect of duration of ruptured membranes. © 2001 Lippincott Williams & Wilkins.

Published
2001
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16. The Mode of Delivery and the Risk of Vertical Transmission of Human Immunodeficiency Virus Type 1 — A Meta-Analysis of 15 Prospective Cohort Studies

Author

Andiman, W., Boucher, M., Burns, D., Bryson, Y., Farley, J., Fowler, H., Gabiano, C., Galli, L., Hutto, C., Kind, C., Korber, B., Kovacs, A., Krogstad, P., Landesman, S., Lapointe, N., Lemay, M., Lew, J., Mandelbrot, L., Mayaux, Mj, Mellins, R., Minkoff, H., Mofenson, L., Nielsen, K., Newell, Ml, Pardi, G., Peavy, H., Peckham, C., Read, J., Rother, C., Rudin, C., Scott, G., Semprini, A., Shearer, W., Simonds, R., Simpson, B., Stek, A., Tovo, Pa, Tuomala, R., Dyke, R., Weedon, J., Martino, M., Lindsay, M., Belair, S., Chan, L., Harris, D., Kalish, L., Muenz, L., Nugent, R., Schluchter, M., Durako, S., Goodwin, S., Mitchell, R., Nourjah, P., Owen, W., Widmayer, S., Bardeguez, A., Hanson, C., Wiznia, A., Luzuriaga, K., Viscarello, R., Ho, D., Koup, R., Chen, I., Mullins, J., Wolinsky, S., Walker, B., Ammann, A., Clapp, S., Mcdonald, D., Fauvel, M., Hankins, C., Samson, J., Bailey, A., Giaquinto, C., Ruga, E., Rossi, A., Truscia, D., Grosch-Worner, I., Schafer, A., Mok, J., Johnstone, F., Jiminez, J., Alba, C., Garcia-Rodriguez, M., Bates, I., Jose, I., Hawkins, F., Zapico, Rm, Asensi-Botet, F., Otero, M., Perez-Tamarit, D., Moya, A., Galbis, M., Scherpbier, H., Boer, K., Bohlin, A., Lindgren, S., Ehrnst, A., Anzen, B., Belfrage, E., Levy, J., Alimenti, A., Barlow, P., Ferrazin, A., Maria, A., Gotta, C., Maritati, V., Mur, A., Rovira, M., Paya, A., Coll, O., Fortuny, C., Boguna, J., Caro, Mc, Canet, Y., Ravizza, M., Castagna, C., Fiore, S., Guerra, B., Lanari, M., Bianchi, S., Bovicelli, L., Prati, E., Duse, M., Soresina, A., Scaravelli, G., Santis, M., Muggiasca, M., Vigano, A., Marchisio, P., Iasci, A., Spinillo, A., Bucceri, A., Grossi, E., Rancilio, L., Della Torre, M., Dallacasa, P., Pachi, A., Principi, N., Zara, C., Vignali, M., Rossi, G., Selvaggi, L., Greco, P., Vimercati, A., Massi, G., Innocenti, T., Fiscella, A., Sansone, M., Benedetto, C., Tibaldi, C., Ziarati, N., Tadrist, B., Thevenicau, D., Gondry, J., Paulard, B., Alisy, C., Brault, D., Tordjeman, P., Mamou, J., Rozan, M., Colombani, D., Pincemaille, O., Salvetti, A., Chabanier, C., Hernandorena, X., Leroy, J., Schaal, J., Balde, P., Faucher, P., Lachassinne, E., Benoit, S., Douard, D., Hocke, C., Barjot, P., Brouard, J., Delattre, P., Stien, L., Audibert, F., Labrune, P., Vial, M., Mazy, F., Sitbon, D., Crenn-Hebert, C., Floch-Tudal, C., Akakpo, R., Daveau, C., Leblanc, A., Cesbron, P., Duval-Arnould, H., Huraux-Rendu, C., Lemerle, S., Touboul, C., Guerin, M., Maingueneau, C., Reynaud, I., Rousseau, T., Ercoil, V., Lanza, M., Denavit, M., Garnier, J., Lahsinat, K., Pia, R., Allouche, C., Nardou, M., Grall, F., May, A., Dallot, M., Lhuillier, P., Cecile, W., Mezin, R., Bech, A., Lobut, J., Algava, G., Dermesay, Ac, Busuttil, R., Jacquemot, M., Bader-Meunier, B., Fridman, S., Codaccioni, X., Maxingue, F., Thomas, D., Alain, J., Lumley, L., Tabaste, J., Salin, Pb, Seaume, H., Guichard, A., Kebaili, K., Roussouly, C., Botto, C., Lanete, A., Wipff, P., Cravello, L., Boisse, P., Leclaire, M., Michel, G., Crumiere, C., Lefevre, V., Le Lorier, B., Pauly, I., Robichez, B., Seguy, D., Dehlinger, M., Rideau, F., Talon, P., Benos, P., Huret, C., Nicolas, J., Heller-Roussin, B., Saint-Leger, S., Delaporte, M., Hubert, C., Sarcus, B., Karoubi, P., Mechinaud, F., Bertcrottiere, D., Bongain, A., Monpoux, F., Gennes, C., Devianne, F., Nisand, I., Rousset, M., Mouchnino, G., Muray, J., Munzer, M., Quereux, C., Brossard, V., Clavier, B., Allemon, M., Rotten, D., Stephan, J., Varlet, M., Guyot, B., Narey, P., Bardinet, F., Caunes, F., Jeny, R., Robin, M., Bouley, Ar, Savey, L., Berrebi, A., Tricoire, J., Borderon, J., Fignon, A., Guillot, F., Maria, B., Broyard, A., Chitrit, Y., Firtion, G., Pillet, Ml, Parat, S., Boissinot, C., Garec, N., Levine, M., Ottenwalter, A., Schaller, F., Vilmer, B., Courpotin, C., Brunner, C., Ciraru-Vigneron, N., Hatem-Gantzer, G., Xavier FRITEL, Wallet, A., Bouille, J., Milliez, J., Mrejen, Db, Dermer, E., Noseda, G., Bardou, D., Cressaty, J., Francoual, C., Moncomble, Cc, Cohen, H., Blanche, S., Bastion, H., Benifla, J., Benkhatar, F., Berkane, N., Herve, F., Ronzier, M., Ferraris, G., Rancillo, L., Tulisso, S., Scolfaro, C., Riva, C., Vierucci, A., Luca, M., Farina, S., Fundaro, C., Genovese, O., Mercu, G., Forni, G., Stegagno, M., Falconieri, P., Zuccotti, G., Riva, E., Cellini, M., Baraldi, C., Consolini, R., Palla, G., Ruggeri, M., Pignata, C., Guarino, A., Osimani, P., Metri, A., Antonellini, A., Benaglia, G., Romano, A., Mattia, D., Caselli, D., Boni, S., Erba, G., Bassanetti, F., Sticca, M., Timpano, C., Magnani, C., Salvatore, C., Gambaretto, G., Lipreri, R., Tornaghi, R., Pinzani, R., Cecchi, M., Bezzi, T., Battisti, L., Bresciani, E., Gattinara, G., Berrino, R., Pellegatta, A., Mazza, A., Baldi, F., Micheletti, E., Altobelli, R., Deiana, M., Colnaghi, C., Tarallo, L., Tondo, U., Anastasio, E., Chiriaco, P., Contardi, I., Ruggeri, C., Ibba, P., O Sullivan, M., Malmsberry, A., Willoughby, A., Goedert, J., Mendez, H., Holman, S., Rubinstein, A., Nesheim, S., Clark, S., Lee, F., Nahmias, A., Sawyer, M., Vink, P., Alger, L., Abrams, E., Bamji, M., Lambert, G., Schoenbaum, E., Thea, D., Thomas, P., Palumbo, P., Denny, T., Oleske, J., Orloff, S., Ethier-Ives, J., Rogers, M., Kutner, M., Kaplan, S., Kattan, M., Lipshultz, S., Sopko, G., Sloand, E., Wu, M., Nadal, D., Siegrist, Ca, Wyler, Ca, Cheseaux, Jj, Aebi, C., Gnehm, H., Schubiger, G., Klingler, J., Hunziker, U., Kuchler, H., Gianinazzi, M., Buhlmann, U., Biedermann, K., Lauper, U., Irion, O., Brunelli, A., Spoletini, G., Schreyer, A., Hosli, I., Saurenmann, E., Drack, G., Isenschmid, M., Poorbeik, M., Schupbach, J., Perrin, L., Erb, P., Joller, H., Dillon, M., Nielsen, R., Boyer, P., Liao, D., Keller, M., Deveikis, A., Khoury, M., Diaz, C., Pacheco-Acosta, E., Cooper, E., Mesthene, D., Pitt, J., Higgins, A., Moroso, G., Rich, K., Turpin, D., Cooper, N., Fowler, M., Smeriglio, V., Mckinlay, S., and Ellis, S.

Subjects
Male, medicine.medical_specialty, Multivariate analysis, Anti-HIV Agents, Birth weight, HIV Infections, Cohort Studies, Pregnancy, Risk Factors, medicine, Birth Weight, Humans, Rupture of membranes, Pregnancy Complications, Infectious, Prospective cohort study, Cesarean Section, Obstetrics, business.industry, Infant, Newborn, General Medicine, Odds ratio, Delivery, Obstetric, medicine.disease, Infectious Disease Transmission, Vertical, Confidence interval, Logistic Models, Multivariate Analysis, Immunology, HIV-1, Female, business, Zidovudine, Cohort study
Abstract

Background To evaluate the relation between elective cesarean section and vertical transmission of human immunodeficiency virus type 1 (HIV-1), we performed a meta-analysis using data on individual patients from 15 prospective cohort studies. Methods North American and European studies of at least 100 mother-child pairs were included in the meta-analysis. Uniform definitions of modes of delivery were used. Elective cesarean sections were defined as those performed before onset of labor and rupture of membranes. Multivariate logistic-regression analysis was used to adjust for other factors known to be associated with vertical transmission. Results The primary analysis included data on 8533 mother-child pairs. After adjustment for receipt of antiretroviral therapy, maternal stage of disease, and infant birth weight, the likelihood of vertical transmission of HIV-1 was decreased by approximately 50 percent with elective cesarean section, as compared with other modes of delivery (adjusted odds ratio, 0.43; 95 percent confidence interval, 0.33 to 0.56). The results were similar when the study population was limited to those with rupture of membranes shortly before delivery. The likelihood of transmission was reduced by approximately 87 percent with both elective cesarean section and receipt of antiretroviral therapy during the prenatal, intrapartum, and neonatal periods, as compared with other modes of delivery and the absence of therapy (adjusted odds ratio, 0.13; 95 percent confidence interval, 0.09 to 0.19). Among mother-child pairs receiving antiretroviral therapy during the prenatal, intrapartum, and neonatal periods, rates of vertical transmission were 2.0 percent among the 196 mothers who underwent elective cesarean section and 7.3 percent among the 1255 mothers with other modes of delivery. Conclusions The results of this meta-analysis suggest that elective cesarean section reduces the risk of transmission of HIV-1 from mother to child independently of the effects of treatment with zidovudine.

Published
1999
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17. Determinants of mother-to-infant human immunodeficiency virus 1 transmission before and after the introduction of zidovudine prophylaxis

Author

de Martino, M, Galli, L, Tovo, PA, Gabiano, C, Pezzotti, P, Wagner, TM, Rezza, G, Osimani, P, De Mattia, D, Di Bari, C, Ruggeri, M, Baldi, F, Ciccia, M, Lanari, M, Masi, M, Venturi, V, Battisti, L, Duse, M, Chiriaco, PG, Cavallini, R, Dessi, C, Pintor, C, Anastasio, E, SABATINO, GIOVANNI, Sticca, M, Pomero, G, Bezzi, T, Chiappini, E, De Luca, M, Gervaso, P, Cecchi, MT, Bassetti, D, Gotta, C, Rosso, R, Timitilli, A, Tondo, U, Mussini, P, Bricalli, D, BUCCERI, ANDREA, Ferraris, G, Giovannini, M, Mosca, F, Lipreri, R, Guarino, A, Plebani, A, Riva, E, RIVA, SILVIA, Vigano, A, Zuccotti, GV, Cellini, M, Buffolano, W, Tarallo, L, D'Elia, R, Giaquinto, C, Rampon, O, Dalle Nogare, ER, Romano, A, Caselli, D, Maccabruni, A, Consolini, R, Benaglia, G, Magnani, C, Anzidei, G, Pistilli, AMC, Gattinara, GC, Catania, S, Facente, C, Falconieri, P, Fundaro, C, Genovese, O, Rendeli, C, Bionda, S, Cristiano, L, Garetto, S, Riva, C, PALOMBA, ERIKA, Portelli, V, Mazza, A, SALVATORE, CLAUDIO, Pellegatta, A, Molesini, M, de Martino, M, Galli, L, Tovo, PA, Gabiano, C, Pezzotti, P, Wagner, TM, Rezza, G, Osimani, P, De Mattia, D, Di Bari, C, Ruggeri, M, Baldi, F, Ciccia, M, Lanari, M, Masi, M, Venturi, V, Battisti, L, Duse, M, Chiriaco, PG, Cavallini, R, Dessi, C, Pintor, C, Anastasio, E, Sabatino, G, Sticca, M, Pomero, G, Bezzi, T, Chiappini, E, De Luca, M, Gervaso, P, Cecchi, MT, Bassetti, D, Gotta, C, Rosso, R, Timitilli, A, Tondo, U, Mussini, P, Bricalli, D, Bucceri, A, Ferraris, G, Giovannini, M, Mosca, F, Lipreri, R, Guarino, A, Plebani, A, Riva, E, Riva, S, Vigano, A, Zuccotti, GV, Cellini, M, Buffolano, W, Tarallo, L, D'Elia, R, Giaquinto, C, Rampon, O, Dalle Nogare, ER, Romano, A, Caselli, D, Maccabruni, A, Consolini, R, Benaglia, G, Magnani, C, Anzidei, G, Pistilli, AMC, Gattinara, GC, Catania, S, Facente, C, Falconieri, P, Fundaro, C, Genovese, O, Rendeli, C, Bionda, S, Cristiano, L, Garetto, S, Riva, C, Palomba, E, Portelli, V, Mazza, A, Salvatore, C, Pellegatta, A, and Molesini, M

Subjects
immunodeficiency virus 1
Abstract

Background: Randomized controlled trials have demonstrated that zidovudine therapy decreases the mother-to-infant transmission of human immunodeficiency virus 1 (HIV-1). Data from large observational studies may provide further important findings on the effectiveness at the population level of combined treatments in decreasing transmission.Objective: To evaluate time trends in prophylactic interventions and the determinants of transmission both before and after the introduction of antiretroviral prophylaxis, and in treated and untreated mother-infant pairs after 1995.Design and Setting: Analysis of prospective data on 3770 children born to HIV-1-infected women between 1985 and 1999 and reported to the Italian Register for HIV Infection in Children.Main Outcome Measures: Logistic regression random effects models were used to estimate crude and adjusted odds ratios for several factors potentially influencing vertical transmission for 2periods-1985 through 1995 (January 1, 1985, through December 31,1995) and 1996 through 1999 (January 1, 1996, through December 31, 1999), and between treated and untreated children after 1995.Results: The transmission rate was 15.5% in the 19851995 period and 5.8% in the 1996-1999 period. By 1999, prophylactic interventions had greatly increased. Antiretroviral treatment (ART) usage was 89.9%, (55.1% combination ART) and the elective cesarean delivery rate was 81.3%. In multivariate analysis, only elective cesarean delivery was associated with a lower risk of mother-to-infant transmission before 1995. After 1995, nonbreastfeeding and receipt of ART were protective whereas elective cesarean delivery was not significantly protective in multivariate analysis. Transmission risk was reduced by 76% with an incomplete zidovudine regimen, 88% with a complete regimen, and 93% when the mother received combination ART. In the 1996-1999 period, the transmission rate for nonbreastfeeding mother-infant pairs was 8.6% with elective cesarean delivery, 4.4% with any ART, and 2.4% with these interventions combined.Conclusion: Prophylactic interventions, and in particular ART, reduced perinatal HIV-1 transmission at a population level in Italy.

Published
2004

18. Atazanavir and lopinavir profile in pregnant women with HIV: tolerability, activity and pregnancy outcomes in an observational national study

Author

Floridia, M., Ravizza, M., Masuelli, G., Giacomet, V., Martinelli, P., Degli Antoni, A., Spinillo, A., Fiscon, M., Francisci, D., Liuzzi, G., Pinnetti, C., Marconi, A. M., Tamburrini, E., Mori, F., Ortolani, P., dalle Nogare, E. R., Di Lorenzo, F., Sterrantino, G., Meli, M., Polemi, S., Nocentini, J., Baldini, M., Montorzi, G., Mazzetti, M., Rogasi, P., Borchi, B., Vichi, F., Del Pin, B., Pinter, E., Anzalone, E., Marocco, R., Mastroianni, C., Mercurio, V. S., Carocci, A., Grilli, E., Maccabruni, A., Zaramella, M., Mariani, B., Natalini Raponi, G., Guaraldi, Giovanni, Nardini, Giulia, Stentarelli, Chiara, Beghetto, Barbara, Degli Antoni, A. M., Molinari, A., Crisalli, M. P., Donisi, A., Piepoli, M., Cerri, V., Zuccotti, G., Fabiano, V., Placido, G., Vivarelli, A., Castelli, P., Savalli, F., Portelli, V., Sabbatini, F., Bernini, L., Grossi, P., Rizzi, L., Alberico, S., Maso, G., Airoud, M., Soppelsa, G., Meloni, A., Dedoni, M., Cuboni, C., Ortu, F., Piano, P., Citernesi, A., Bordoni Vicini, I., Luzi, K., Roccio, M., Vimercati, A., Miccolis, A., Bassi, E., Guerra, B., Cervi, F., Puccetti, C., Murano, P., Contoli, M., Capretti, M. G., Marsico, C., Faldella, G., Sansone, M., Agangi, A., Tibaldi, C., Trentini, L., Todros, T., Frisina, V., Cetin, I., Brambilla, T., Savasi, V., Personeni, C., Giaquinto, C., Rinaldi, R., Rubino, E., Bucceri, A., Matrone, R., Scaravelli, G., Fundaro, C., Genovese, O., Cafforio, C., Tozzi, V., Massetti, P., Casadei, A. M., Cavaliere, A. F., Finelli, V., Cellini, M., Castelli Gattinara, G., Dalzero, S., Sacchi, V., De Pirro, A., Polizzi, C., Mattei, A., Pirillo, M. F., Amici, R., Galluzzo, C. M., Donnini, S., Baroncelli, S., Regazzi, M., Villani, P., Cusato, M., Cerioli, A., De Martino, M., Mastroiacovo, P., Moroni, M., Parazzini, F., Vella, S., Floridia, M, Ravizza, M, Masuelli, G, Giacomet, V, Martinelli, Pasquale, Degli Antoni, A, Spinillo, A, Fiscon, M, Francisci, D, Liuzzi, G, Pinnetti, C, Marconi, Am, Tamburrini, E, on behalf of The Italian Group on Surveillance on Antiretroviral Treatment in, Pregnancy, Floridia, M1, Italian Group on Surveillance on Antiretroviral Treatment in, P. r. e. g. n. a. n. c. y., Marco Floridia, Marina Ravizza, Giulia Masuelli, Vania Giacomet, Pasquale Martinelli, Anna Degli Antoni, Arsenio Spinillo, Marta Fiscon, Daniela Francisci, Giuseppina Liuzzi, Carmela Pinnetti, Anna Maria Marconi, Enrica Tamburrini, on behalf of The Italian Group on Surveillance on Antiretroviral Treatment in Pregnancy [.., Capretti, M.G., Marsico, C., Faldella, G., and ].

Subjects
Pyridines, Pyridine, HIV Infections, Triglyceride, Lopinavir, Liver Function Tests, Pregnancy, HIV Infection, Pharmacology (medical), Viral, Pregnancy Complications, Infectious, triglycerides, pre-term delivery, medicine.diagnostic_test, Liver Function Test, Obstetrics, Medicine (all), Pregnancy Outcome, Infectious, virus diseases, HIV, pregnancy, RNA, Lipid, Viral Load, Lipids, Infectious Diseases, Tolerability, Oligopeptide, Population study, RNA, Viral, Female, medicine.symptom, bilirubin, Viral load, Oligopeptides, Human, medicine.drug, Microbiology (medical), Adult, medicine.medical_specialty, HIV RNA, Anti-HIV Agents, Atazanavir Sulfate, Infectious Disease, Bilirubin, Cholesterol, Pre-term delivery, Triglycerides, Pharmacology, cholesterol, Settore MED/17 - MALATTIE INFETTIVE, medicine, Humans, business.industry, Anti-HIV Agent, medicine.disease, Atazanavir, CD4 Lymphocyte Count, Pregnancy Complications, Immunology, Pregnancy Complications, Infectiou, business, Liver function tests, Weight gain
Abstract

BACKGROUND: Atazanavir and lopinavir represent the main HIV protease inhibitors recommended in pregnancy, but comparative data in pregnant women are limited. METHODS: Women from a national observational study, exposed in pregnancy to either atazanavir or lopinavir, were compared for glucose and lipid profiles, liver function tests, CD4 count, HIV RNA and main pregnancy outcomes. Statistical methods included univariate and multivariable analyses. RESULTS: The study population included 428 pregnancies (lopinavir, 322; atazanavir, 106). The lopinavir group was characterized by higher rates of HIV diagnosis in pregnancy and treatment indication for maternal health, lower CD4 counts, higher HIV RNA levels, less frequent antiretroviral treatment at conception and shorter duration of drug exposure during pregnancy. No differences in pregnancy outcomes, glucose metabolism and weight gain were observed. The two groups also showed in a multivariable analysis similar odds for detectable HIV RNA in the third trimester (adjusted OR 0.85, 95% CI 0.35-2.10, P = 0.730). Total lipid levels were significantly higher in the lopinavir group (median values in the third trimester 239 versus 221 mg/dL for total cholesterol and 226 versus 181 mg/dL for triglycerides; P < 0.001 for both comparisons) and bilirubin levels were significantly higher in the atazanavir group (1.53 versus 0.46 mg/dL, P < 0.001). CONCLUSIONS: In this observational study atazanavir and lopinavir showed similar safety and activity in pregnancy, with no differences in the main pregnancy outcomes. Atazanavir use was associated with a better lipid profile and with higher bilirubin levels. Overall, the study findings confirm that these two HIV protease inhibitors represent equally valid alternative options.

Published
2014

20. Body Mass Index and Weight Gain in Pregnant Women With HIV: A National Study in Italy

Author

Floridia, M., Ravizza, M., Masuelli, G., Dalzero, S., Pinnetti, C., Cetin, I., Meloni, A., Spinillo, A., Rubino, E., Francisci, D., Tamburrini, E., Mori, F., Ortolani, P., Dalle Nogare, E. R., Di Lorenzo, F., Sterrantino, G., Meli, M., Polemi, S., Nocentini, J., Baldini, M., Montorzi, G., Mazzetti, M., Rogasi, P., Borchi, B., Vichi, F., Pinter, E., Anzalone, E., Marocco, R., Mastroianni, Claudio Maria, Mercurio, V. S., Carocci, A., Grilli, E., Maccabruni, A., Zaramella, M., Mariani, B., Natalini Raponi, G., Guaraldi, G., Luzi, K., Nardini, G., Stentarelli, C., Degli Antoni, A. M., Molinari, A., Crisalli, M. P., Donisi, A., Piepoli, M., Cerri, V., Zuccotti, G., Giacomet, V., Fabiano, V., Placido, G., Vivarelli, A., Castelli, P., Savalli, F., Portelli, V., Sabbatini, F., Bernini, L., Alberico, S., Maso, G., Tropea, M., Dedoni, M., Cuboni, C., Ortu, F., Piano, P., Citernesi, A., Vicini, I., Roccio, M., Vimercati, A., Miccolis, A., Bassi, E., Guerra, B., Cervi, F., Puccetti, C., Murano, P., Contoli, M., Capretti, M. G., Marsico, C., Faldella, G., Sansone, M., Martinelli, P., Agangi, A., Tibaldi, C., Trentini, L., Todros, T., Garetto, S., Brambilla, T., Savasi, V., Crepaldi, A., Giaquinto, C., Fiscon, M., Rinaldi, R., Bucceri, A., Matrone, R., Scaravelli, G., Fundaro, C., Genovese, O., Cafforio, C., Liuzzi, G., Tozzi, V., Massetti, Anna Paola, Anceschi, M., Casadei, A. M., Cavaliere, A. F., Finelli, V., Cellini, M., Castelli Gattinara, G., Marconi, A. M., Sacchi, V., De Pirro, A., Polizzi, C., Mattei, A., Pirillo, M. F., Amici, R., Galluzzo, C. M., Donnini, S., Baroncelli, S., Villani, P., Cusato, M., Cerioli, A., De Martino, M., Mastroiacovo, P., Moroni, M., Parazzini, F., Vella, S., Floridia, M, Ravizza, M, Masuelli, G, Dalzero, S, Pinnetti, C, Cetin, I, Meloni, A, Spinillo, A, Rubino, E, Francisci, D, Tamburrini, E, Italian Group on Surveillance on Antiretroviral Treatment in, Pregnancy, Martinelli, Pasquale, Floridia M, Ravizza M, Masuelli G, Dalzero S, Pinnetti C, Cetin I, Meloni A, Spinillo A, Rubino E, Francisci D, Tamburrini E, Faldella G, Guerra B, and for the Italian Group on Surveillance on Antiretroviral Treatment in Pregnancy

Subjects
Microbiology (medical), medicine.medical_specialty, antiretroviral therapy, MEDLINE, Human immunodeficiency virus (HIV), HIV Infections, body mass index, medicine.disease_cause, Settore MED/17 - MALATTIE INFETTIVE, Body Mass Index, BMI, weight gain, HIV-1, Pregnancy, Medicine, Humans, HIV infection, pregnancy, Pregnancy Complications, Infectious, business.industry, Obstetrics, Cesarean Section, Infectious, Pregnancy Outcome, HIV, medicine.disease, Pregnancy Complications, Infectious Diseases, Italy, National study, Female, medicine.symptom, business, Weight gain, Body mass index
Abstract

Although most of the women (69.4%) had a normal BMI at start of pregnancy, only 37% had an adequate weight gain during pregnancy. Inadequate body weight gain was more common (44.8%) than excessive weight gain (18.2%), but 40% of overweight women and 50% of obese women had an excessive weight gain in pregnancy, with about 9% of the women in these categories gaining >18 kg during pregnancy (Table 1). Only 1.9% of the women had a vaginal delivery; elective and nonelective cesarean deliveries accounted for 81.3% and 16.7% of deliveries, respectively. Compared to underweight/normal women, overweight/obese women had similar occurrences of preterm delivery (23.4% vs 22.7%, P = .871), significantly lower rates of low birthweight (14.2% vs 24.2%, P = .007) and nonelective cesarean deliveries (11.7% vs 18.3%, P = .042), and a significantly higher occurrence of fasting plasma glucose >92 mg/dL at 20–28 weeks (12.1% vs 6.6%, P = .027), hypertension during pregnancy (6.4% vs 2.7%, P = .019), and gestational age–adjusted birthweight >90th percentile (15.5% vs 5.0%, P < .001). Complications of delivery, major birth defects, and HIV transmission were similar between the 2 groups (7.3% vs 7.6%, P = .881; 2.6% vs 3.5%, P = .589; and 0.8% vs 0.5%, P = .661, respectively). An inadequate weight gain during pregnancy was associated with an increased risk of nonelective cesarean delivery (OR, 1.589 [95% CI, 1.077–2.346], P = .020). Excessive weight gain during pregnancy was not associated with either hypertension (OR, 1.364 [95% CI, .537–3.465], P = .514) or 20–28 week glucose level of >92 mg/dL (OR, 0.841 [95% CI, .399–1.772], P = .648), but was significantly associated with birthweight >90th percentile (OR, 2.271 [95% CI, 1.229–4.195], P = .009), and appeared to be protective against low birthweight (OR, 0.544 [95% CI, .323–.918], P = .023) and birthweight

Published
2013

21. Birth defects in a national cohort of pregnant women with HIV infection in Italy, 2001-2011

Author

Floridia, M., Mastroiacovo, P., Tamburrini, E., Tibaldi, C., Todros, T., Crepaldi, A., Sansone, M., Fiscon, M., Liuzzi, G., Guerra, B., Vimercati, A., Vichi, F., Vicini, I., Pinnetti, C., Marconi, A. M., Ravizza, M., Mori, F., Ortolani, P., dalle Nogare, E. R., Di Lorenzo, F., Sterrantino, G., Meli, M., Polemi, S., Nocentini, J., Baldini, M., Montorzi, G., Mazzetti, M., Rogasi, P., Borchi, B., Pinter, E., Anzalone, E., Marocco, R., Mastroianni, C., Mercurio, V. S., Carocci, A., Grilli, E., Maccabruni, A., Zaramella, M., Mariani, B., Natalini Raponi, G., Guaraldi, G., Luzi, K., Nardini, G., Stentarelli, C., Degli Antoni, A. M., Molinari, A., Crisalli, M. P., Donisi, A., Piepoli, M., Cerri, V., Zuccotti, G., Giacomet, V., Fabiano, V., Coletto, S., Placido, G., Vivarelli, A., Castelli, P., Savalli, F., Portelli, V., Sabbatini, F., Francisci, D., Bernini, L., Alberico, S., Maso, G., Tropea, M., Meloni, A., Dedoni, M., Cuboni, C., Ortu, F., Piano, P., Citernesi, A., Spinillo, A., Roccio, M., Miccolis, A., Bassi, E., Cervi, F., Puccetti, C., Murano, P., Contoli, M., Capretti, M. G., Marsico, C., Faldella, G., Martinelli, P., Agangi, A., Trentini, L., Masuelli, G., Garetto, S., Cetin, I., Brambilla, T., Savasi, V., Giaquinto, C., Rinaldi, R., Rubino, E., Bucceri, A., Matrone, R., Scaravelli, G., Fundaro, C., Genovese, O., Cafforio, C., Tozzi, V., Massetti, P., Anceschi, M., Casadei, A. M., Cavaliere, A. F., Finelli, V., Cellini, M., Castelli Gattinara, G., Dalzero, S., Sacchi, V., De Pirro, A., Polizzi, C., Mattei, A., Pirillo, M. F., Amici, R., Galluzzo, C. M., Donnini, S., Baroncelli, S., Regazzi, M., Villani, P., Cusato, M., Cerioli, A., De Martino, M., Moroni, M., Parazzini, F., Vella, S., Floridia, M, Mastroiacovo, P, Tamburrini, E, Tibaldi, C, Todros, T, Crepaldi, A, Sansone, M, Fiscon, M, Liuzzi, G, Guerra, B, Vimercati, A, Vichi, F, Vicini, I, Pinnetti, C, Marconi, A, Ravizza, M, Martinelli, Pasquale, and The Italian Group on Surveillance on Antiretroviral Treatment in, Pregnancy

Subjects
Male, HIV Infections, transcriptase inhibitors, Cohort Studies, chemistry.chemical_compound, Pregnancy, Prevalence, Birth Weight, Young adult, Pregnancy Complications, Infectious, education.field_of_study, Obstetrics, Coinfection, Antiretroviral therapy, birth defects, efavirenz, HIV, non-nucleoside reverse transcriptase inhibitors, nucleoside reverse transcriptase inhibitors, pregnancy, protease inhibitors, women, Obstetrics and Gynecology, Abnormalities, Drug-Induced, Middle Aged, Italy, Maternal Exposure, Reverse Transcriptase Inhibitors, Female, Cohort study, Adult, medicine.medical_specialty, Efavirenz, Adolescent, Anti-HIV Agents, Birth weight, Population, Antiretroviral Therapy, Birth defects, HIV-1, Young Adult, Hepatitis B, Chronic, medicine, Humans, education, business.industry, Infant, Newborn, Odds ratio, Hepatitis C, Chronic, medicine.disease, Infectious Disease Transmission, Vertical, Surgery, Pregnancy Trimester, First, chemistry, business
Abstract

Objective We used data from a national study of pregnant women with HIV to evaluate the prevalence of congenital abnormalities in newborns from women with HIV infection. Design Observational study. Setting University and hospital clinics. Population Pregnant women with HIV exposed to antiretroviral treatment at any time during pregnancy. Methods The total prevalence of birth defects was assessed on live births, stillbirths, and elective terminations for fetal anomaly. The associations between potentially predictive variables and the occurrence of birth defects were expressed as odds ratios (ORs) with 95% confidence intervals (95% CIs) for exposed versus unexposed cases, calculated in univariate and multivariate logistic regression analyses. Main outcome measures Birth defects, defined according to the Antiretroviral Pregnancy Registry criteria. Results A total of 1257 pregnancies with exposure at any time to antiretroviral therapy were evaluated. Forty-two cases with major defects were observed. The total prevalence was 3.2% (95% CI 1.9–4.5) for exposure to any antiretroviral drug during the first trimester (23 cases with defects) and 3.4% (95% CI 1.9–4.9) for no antiretroviral exposure during the first trimester (19 cases). No associations were found between major birth defects and first-trimester exposure to any antiretroviral treatment (OR 0.94, 95% CI 0.51–1.75), main drug classes (nucleoside reverse transcriptase inhibitors, OR 0.95, 95% CI 0.51–1.76; non-nucleoside reverse transcriptase inhibitors, OR 1.20, 95% CI 0.56–2.55; protease inhibitors, OR 0.92, 95% CI 0.43–1.95), and individual drugs, including efavirenz (prevalence for efavirenz, 2.5%). Conclusions This study adds further support to the assumption that first-trimester exposure to antiretroviral treatment does not increase the risk of congenital abnormalities.

Published
2013

22. The mode of delivery and the risk of vertical transmission of human immunodeficiency virus type 1--a meta-analysis of 15 prospective cohort studies. The International Perinatal HIV Group

Author

Andiman W., Boucher M., Burns D., Bryson Y., Farley J., Fowler H., Gabiano C., Galli L., Hutto C., Kind C., Korber B., Kovacs A., Krogstad P., Landesman S., Lapointe N., Lemay M., Lew J., Mandelbrot L., Mayaux M.J., Mellins R., Minkoff H., Mofenson L., Nielsen K., Newell M.L., Pardi G., Peavy H., Peckham C., Read J., Rother C., Rudin C., Scott G., Semprini A., Shearer W., Simonds R., Simpson B., Stek A., Tovo P.A., Tuomala R., Van Dyke R., Weedon J., de Martino M., Lindsay M., Belair S., Chan L., Harris D., Kalish L., Muenz L., Nugent R., Schluchter M., Durako S., Goodwin S., Mitchell R., Nourjah P., Owen W., Widmayer S., Bardeguez A., Hanson C., Wiznia A., Luzuriaga K., Viscarello R., Ho D., Koup R., Chen I., Mullins J., Wolinsky S., Walker B., Ammann A., Clapp S., McDonald D., Fauvel M., Hankins C., Samson J., Bailey A., Giaquinto C., Ruga E., De Rossi A., Truscia D., Grosch Worner I., Schafer A., Mok J., Johnstone F., Jiminez J., de Alba C., Garcia Rodriguez M., Bates I., de Jose I., Hawkins F., Zapico R.M., Asensi Botet F., Otero M., Perez Tamarit D., Moya A., Galbis M., Scherpbier H., Boer K., Bohlin A., Lindgren S., Ehrnst A., Anzen B., Belfrage E., Levy J., Alimenti A., Barlow P., Ferrazin A., De Maria A., Gotta C., Maritati V., Mur A., Rovira M., Paya A., Coll O., Fortuny C., Boguna J., Caro M.C., Canet Y., Ravizza M., Castagna C., Fiore S., Guerra B., Lanari M., Bianchi S., Bovicelli L., Prati E., Duse M., Soresina A., Scaravelli G., De Santis M., Muggiasca M., Vigano A., Marchisio P., Iasci A., Spinillo A., Bucceri A., Grossi E., Rancilio L., Della Torre M., Dallacasa P., Pachi A., Principi N., Zara C., Vignali M., Rossi G., Selvaggi L., Greco P., Vimercati A., Massi G., Innocenti T., Fiscella A., Sansone M., Benedetto C., Tibaldi C., Ziarati N., Tadrist B., Thevenicau D., Gondry J., Paulard B., Alisy C., Brault D., Tordjeman P., Mamou J., Rozan M., Colombani D., Pincemaille O., Salvetti A., Chabanier C., Hernandorena X., Leroy J., Schaal J., Balde P., Faucher P., Lachassinne E., Benoit S., Douard D., Hocke C., Barjot P., Brouard J, Delattre P, Stien L, Audibert F, Labrune P, Vial M, Mazy F, Sitbon D, Crenn Hebert C, Floch Tudal C, Akakpo R, Daveau C, Leblanc A, Cesbron P, Duval Arnould H, Huraux Rendu C, Lemerle S, Touboul C, Guerin M, Maingueneau C, Reynaud I, Rousseau T, Ercoil V, Lanza M, Denavit M, Garnier J, Lahsinat K, Pia R, Allouche C, Nardou M, Grall F, May A, Dallot M, Lhuillier P, Cecile W, Mezin R, Balde P, Bech A, Lobut J, Algava G, Dermesay AC, Busuttil R, Jacquemot M, Bader Meunier B, Fridman S, Codaccioni X, Maxingue F, Thomas D, Alain J, De Lumley L, Tabaste J, Salin PB, Seaume H, Guichard A, Kebaili K, Roussouly C, Botto C, De Lanete A, Wipff P, Cravello L, De Boisse P, Leclaire M, Michel G, Crumiere C, Lefevre V, Le Lorier B, Pauly I, Robichez B, Seguy D, Dehlinger M, Rideau F, Talon P, Benos P, Huret C, Nicolas J, Heller Roussin B, Saint Leger S, Delaporte M, Hubert C, De Sarcus B, Karoubi P, Mechinaud F, Bertcrottiere D, Bongain A, Monpoux F, De Gennes C, Devianne F, Nisand I, Rousset M, Mouchnino G, Muray J, Munzer M, Quereux C, Brossard V, Clavier B, Allemon M, Rotten D, Stephan J, Varlet M, Guyot B, Narey P, Bardinet F, De Caunes F, Jeny R, Robin M, Bouley AR, Savey L, Berrebi A, Tricoire J, Borderon J, Fignon A, Guillot F, Maria B, Broyard A, Chitrit Y, Firtion G, Mandelbrot L, Pillet ML, Parat S, Boissinot C, Garec N, Levine M, Ottenwalter A, Schaller F, Vilmer B, Courpotin C, Brunner C, Ciraru Vigneron N, Hatem Gantzer G, Fritel X, Wallet A, Bouille J, Milliez J, Mrejen DB, Dermer E, Noseda G, Bardou D, Cressaty J, Francoual C, Moncomble CC, Cohen H, Blanche S, Bastion H, Benifla J, Benkhatar F, Berkane N, Herve F, Ronzier M, Mayaux MJ, de Martino M, Tovo PA, Galli L, Gabiano C, Ferraris G, Rancillo L, Bucceri A, Tulisso S, Scolfaro C, Riva C, Vierucci A, de Luca M, Farina S, Fundaro C, Genovese O, Mercu G, Forni G, Stegagno M, Falconieri P, Zuccotti G, Riva E, Cellini M, Baraldi C, Consolini R, Palla G, Ruggeri M, Osimani P, Metri A, Antonellini A, Benaglia G, Romano A, Dallacasa P, De Mattia D, Caselli D, Boni S, Dell'Erba G, Bassanetti F, Sticca M, Timpano C, Magnani C, Salvatore C, Gambaretto G, Lipreri R, Tornaghi R, Pinzani R, Cecchi M, Bezzi T, Battisti L, Bresciani E, Gattinara G, Berrino R, Pellegatta A, Mazza A, Baldi F, Micheletti E, Ruga E, Altobelli R, Deiana M, Colnaghi C, Tarallo L, Tondo U, Anastasio E, Duse M, Chiriaco P, Contardi I, Ruggeri C, Ibba P, Scott G, Hutto C, O'Sullivan M, Malmsberry A, Willoughby A, Burns D, Goedert J, Landesman S, Minkoff H, Mendez H, Holman S, Rubinstein A, Durako S, Muenz L, Goodwin S, Nesheim S, Lindsay M, Clark S, Lee F, Nahmias A, Sawyer M, Vink P, Farley J, Alger L, Abrams E, Bamji M, Lambert G, Schoenbaum E, Thea D, Thomas P, Weedon J, Palumbo P, Bardeguez A, Denny T, Oleske J, Simonds R, Orloff S, Ethier Ives J, Rogers M, Schluchter M, Kutner M, Kaplan S, Kattan M, Lipshultz S, Mellins R, Shearer W, Peavy H, Sopko G, Sloand E, Wu M, Kind C, Nadal D, Rudin C, Siegrist CA, Wyler CA, Cheseaux JJ, Aebi C, Gnehm H, Schubiger G, Klingler J, Hunziker U, Kuchler H, Gianinazzi M, Buhlmann U, Biedermann K, Lauper U, Irion O, Brunelli A, Spoletini G, Schreyer A, Hosli I, Saurenmann E, Drack G, Isenschmid M, Poorbeik M, Schupbach J, Perrin L, Erb P, Joller H, Bryson Y, Dillon M, Nielsen R, Boyer P, Liao D, Keller M, Deveikis A, Kovacs A, Stek A, Chan L, Rother C, Khoury M, Diaz C, Pacheco Acosta E, Tuomala R, Cooper E, Mesthene D, Pitt J, Higgins A, Moroso G, Rich K, Turpin D, Cooper N, Fowler M, Nugent R, Smeriglio V, McKinlay S, Kalish L, Ellis S, Andiman W, PIGNATA, CLAUDIO, GUARINO, ALFREDO, Andiman, W., Boucher, M., Burns, D., Bryson, Y., Farley, J., Fowler, H., Gabiano, C., Galli, L., Hutto, C., Kind, C., Korber, B., Kovacs, A., Krogstad, P., Landesman, S., Lapointe, N., Lemay, M., Lew, J., Mandelbrot, L., Mayaux, M. J., Mellins, R., Minkoff, H., Mofenson, L., Nielsen, K., Newell, M. L., Pardi, G., Peavy, H., Peckham, C., Read, J., Rother, C., Rudin, C., Scott, G., Semprini, A., Shearer, W., Simonds, R., Simpson, B., Stek, A., Tovo, P. A., Tuomala, R., Van Dyke, R., Weedon, J., de Martino, M., Lindsay, M., Belair, S., Chan, L., Harris, D., Kalish, L., Muenz, L., Nugent, R., Schluchter, M., Durako, S., Goodwin, S., Mitchell, R., Nourjah, P., Owen, W., Widmayer, S., Bardeguez, A., Hanson, C., Wiznia, A., Luzuriaga, K., Viscarello, R., Ho, D., Koup, R., Chen, I., Mullins, J., Wolinsky, S., Walker, B., Ammann, A., Clapp, S., Mcdonald, D., Fauvel, M., Hankins, C., Samson, J., Bailey, A., Giaquinto, C., Ruga, E., De Rossi, A., Truscia, D., Grosch Worner, I., Schafer, A., Mok, J., Johnstone, F., Jiminez, J., de Alba, C., Garcia Rodriguez, M., Bates, I., de Jose, I., Hawkins, F., Zapico, R. M., Asensi Botet, F., Otero, M., Perez Tamarit, D., Moya, A., Galbis, M., Scherpbier, H., Boer, K., Bohlin, A., Lindgren, S., Ehrnst, A., Anzen, B., Belfrage, E., Levy, J., Alimenti, A., Barlow, P., Ferrazin, A., De Maria, A., Gotta, C., Maritati, V., Mur, A., Rovira, M., Paya, A., Coll, O., Fortuny, C., Boguna, J., Caro, M. C., Canet, Y., Ravizza, M., Castagna, C., Fiore, S., Guerra, B., Lanari, M., Bianchi, S., Bovicelli, L., Prati, E., Duse, M., Soresina, A., Scaravelli, G., De Santis, M., Muggiasca, M., Vigano, A., Marchisio, P., Iasci, A., Spinillo, A., Bucceri, A., Grossi, E., Rancilio, L., Della Torre, M., Dallacasa, P., Pachi, A., Principi, N., Zara, C., Vignali, M., Rossi, G., Selvaggi, L., Greco, P., Vimercati, A., Massi, G., Innocenti, T., Fiscella, A., Sansone, M., Benedetto, C., Tibaldi, C., Ziarati, N., Tadrist, B., Thevenicau, D., Gondry, J., Paulard, B., Alisy, C., Brault, D., Tordjeman, P., Mamou, J., Rozan, M., Colombani, D., Pincemaille, O., Salvetti, A., Chabanier, C., Hernandorena, X., Leroy, J., Schaal, J., Balde, P., Faucher, P., Lachassinne, E., Benoit, S., Douard, D., Hocke, C., Barjot, P., Brouard, J, Delattre, P, Stien, L, Audibert, F, Labrune, P, Vial, M, Mazy, F, Sitbon, D, Crenn Hebert, C, Floch Tudal, C, Akakpo, R, Daveau, C, Leblanc, A, Cesbron, P, Duval Arnould, H, Huraux Rendu, C, Lemerle, S, Touboul, C, Guerin, M, Maingueneau, C, Reynaud, I, Rousseau, T, Ercoil, V, Lanza, M, Denavit, M, Garnier, J, Lahsinat, K, Pia, R, Allouche, C, Nardou, M, Grall, F, May, A, Dallot, M, Lhuillier, P, Cecile, W, Mezin, R, Balde, P, Bech, A, Lobut, J, Algava, G, Dermesay, Ac, Busuttil, R, Jacquemot, M, Bader Meunier, B, Fridman, S, Codaccioni, X, Maxingue, F, Thomas, D, Alain, J, De Lumley, L, Tabaste, J, Salin, Pb, Seaume, H, Guichard, A, Kebaili, K, Roussouly, C, Botto, C, De Lanete, A, Wipff, P, Cravello, L, De Boisse, P, Leclaire, M, Michel, G, Crumiere, C, Lefevre, V, Le Lorier, B, Pauly, I, Robichez, B, Seguy, D, Dehlinger, M, Rideau, F, Talon, P, Benos, P, Huret, C, Nicolas, J, Heller Roussin, B, Saint Leger, S, Delaporte, M, Hubert, C, De Sarcus, B, Karoubi, P, Mechinaud, F, Bertcrottiere, D, Bongain, A, Monpoux, F, De Gennes, C, Devianne, F, Nisand, I, Rousset, M, Mouchnino, G, Muray, J, Munzer, M, Quereux, C, Brossard, V, Clavier, B, Allemon, M, Rotten, D, Stephan, J, Varlet, M, Guyot, B, Narey, P, Bardinet, F, De Caunes, F, Jeny, R, Robin, M, Bouley, Ar, Savey, L, Berrebi, A, Tricoire, J, Borderon, J, Fignon, A, Guillot, F, Maria, B, Broyard, A, Chitrit, Y, Firtion, G, Mandelbrot, L, Pillet, Ml, Parat, S, Boissinot, C, Garec, N, Levine, M, Ottenwalter, A, Schaller, F, Vilmer, B, Courpotin, C, Brunner, C, Ciraru Vigneron, N, Hatem Gantzer, G, Fritel, X, Wallet, A, Bouille, J, Milliez, J, Mrejen, Db, Dermer, E, Noseda, G, Bardou, D, Cressaty, J, Francoual, C, Moncomble, Cc, Cohen, H, Blanche, S, Bastion, H, Benifla, J, Benkhatar, F, Berkane, N, Herve, F, Ronzier, M, Mayaux, Mj, de Martino, M, Tovo, Pa, Galli, L, Gabiano, C, Ferraris, G, Rancillo, L, Bucceri, A, Tulisso, S, Scolfaro, C, Riva, C, Vierucci, A, de Luca, M, Farina, S, Fundaro, C, Genovese, O, Mercu, G, Forni, G, Stegagno, M, Falconieri, P, Zuccotti, G, Riva, E, Cellini, M, Baraldi, C, Consolini, R, Palla, G, Ruggeri, M, Pignata, Claudio, Guarino, Alfredo, Osimani, P, Metri, A, Antonellini, A, Benaglia, G, Romano, A, Dallacasa, P, De Mattia, D, Caselli, D, Boni, S, Dell'Erba, G, Bassanetti, F, Sticca, M, Timpano, C, Magnani, C, Salvatore, C, Gambaretto, G, Lipreri, R, Tornaghi, R, Pinzani, R, Cecchi, M, Bezzi, T, Battisti, L, Bresciani, E, Gattinara, G, Berrino, R, Pellegatta, A, Mazza, A, Baldi, F, Micheletti, E, Ruga, E, Altobelli, R, Deiana, M, Colnaghi, C, Tarallo, L, Tondo, U, Anastasio, E, Duse, M, Chiriaco, P, Contardi, I, Ruggeri, C, Ibba, P, Scott, G, Hutto, C, O'Sullivan, M, Malmsberry, A, Willoughby, A, Burns, D, Goedert, J, Landesman, S, Minkoff, H, Mendez, H, Holman, S, Rubinstein, A, Durako, S, Muenz, L, Goodwin, S, Nesheim, S, Lindsay, M, Clark, S, Lee, F, Nahmias, A, Sawyer, M, Vink, P, Farley, J, Alger, L, Abrams, E, Bamji, M, Lambert, G, Schoenbaum, E, Thea, D, Thomas, P, Weedon, J, Palumbo, P, Bardeguez, A, Denny, T, Oleske, J, Simonds, R, Orloff, S, Ethier Ives, J, Rogers, M, Schluchter, M, Kutner, M, Kaplan, S, Kattan, M, Lipshultz, S, Mellins, R, Shearer, W, Peavy, H, Sopko, G, Sloand, E, Wu, M, Kind, C, Nadal, D, Rudin, C, Siegrist, Ca, Wyler, Ca, Cheseaux, Jj, Aebi, C, Gnehm, H, Schubiger, G, Klingler, J, Hunziker, U, Kuchler, H, Gianinazzi, M, Buhlmann, U, Biedermann, K, Lauper, U, Irion, O, Brunelli, A, Spoletini, G, Schreyer, A, Hosli, I, Saurenmann, E, Drack, G, Isenschmid, M, Poorbeik, M, Schupbach, J, Perrin, L, Erb, P, Joller, H, Bryson, Y, Dillon, M, Nielsen, R, Boyer, P, Liao, D, Keller, M, Deveikis, A, Kovacs, A, Stek, A, Chan, L, Rother, C, Khoury, M, Diaz, C, Pacheco Acosta, E, Tuomala, R, Cooper, E, Mesthene, D, Pitt, J, Higgins, A, Moroso, G, Rich, K, Turpin, D, Cooper, N, Fowler, M, Nugent, R, Smeriglio, V, Mckinlay, S, Kalish, L, Ellis, S, and Andiman, W

Abstract

To evaluate the relation between elective cesarean section and vertical transmission of human immunodeficiency virus type 1 (HIV-1), we performed a meta-analysis using data on individual patients from 15 prospective cohort studies. North American and European studies of at least 100 mother-child pairs were included in the meta-analysis. Uniform definitions of modes of delivery were used. Elective cesarean sections were defined as those performed before onset of labor and rupture of membranes. Multivariate logistic-regression analysis was used to adjust for other factors known to be associated with vertical transmission. The primary analysis included data on 8533 mother-child pairs. After adjustment for receipt of antiretroviral therapy, maternal stage of disease, and infant birth weight, the likelihood of vertical transmission of HIV-1 was decreased by approximately 50 percent with elective cesarean section, as compared with other modes of delivery (adjusted odds ratio, 0.43; 95 percent confidence interval, 0.33 to 0.56). The results were similar when the study population was limited to those with rupture of membranes shortly before delivery. The likelihood of transmission was reduced by approximately 87 percent with both elective cesarean section and receipt of antiretroviral therapy during the prenatal, intrapartum, and neonatal periods, as compared with other modes of delivery and the absence of therapy (adjusted odds ratio, 0.13; 95 percent confidence interval, 0.09 to 0.19). Among mother-child pairs receiving antiretroviral therapy during the prenatal, intrapartum, and neonatal periods, rates of vertical transmission were 2.0 percent among the 196 mothers who underwent elective cesarean section and 7.3 percent among the 1255 mothers with other modes of delivery. The results of this meta-analysis suggest that elective cesarean section reduces the risk of transmission of HIV-1 from mother to child independently of the effects of treatment with zidovudine.

Published
1999

23. Cancer rates after year 2000 significantly decrease in children with perinatal HIV infection: A study by the Italian Register for HIV Infection in Children

Author

Chiappini, E, Galli, L, Tovo, Pa, Gabiano, C, Lisi, C, Giaquinto, C, Rampon, O, Gattinara, Gc, De Marco, G, Osimani, P, Manzionna, M, Miniaci, A, Pintor, C, Rosso, R, Esposito, S, Viganò, A, Dodi, I, Maccabruni, A, Fundarò, C, de Martino, M, Osimani, P., Cordiali, R., De Mattia, D., Manzionna, M., Di Bari, C., Ruggeri, M., Masi, M., Miniaci, A., Specchia, F., Ciccia, M., Lanari, M., Baldi, F., Battisti, L., Fiorino, C., Dessı`, C., Pintor, C., Dedoni, M., Fenu, M. L., Cavallini, R., Anastasio, E., Merolla, F., Sticca, M., Pomero, G., Bezzi, Teresa Maria, Fiumana, Elisa, Bonsignori, F., Gervaso, P., Seini, E., Cecchi, M. T., Cosso, D., Timitilli, A., Stronati, M., Plebani, A., Pinzani, R., Bongianin, I., Vigano`, A., Giacomet, V., Erba, P., Salvini, F., Zuccotti, G. V., Giovannini, M., Ferraris, G., Lipreri, R., Moretti, C., Cellini, M., Cano, M. C., Paolucci, P., Bruzzese, E., De Marco, G., Tarallo, L., Tancredi, F., Pennazzato, M., Rampon, O., Dalle Nogare, E. R., Sanfilippo, A., Romano, A., Saitta, M., Dodi, I., Barone, A., Maccabruni, A., Consolini, R., Legitimo, A., Magnani, C., Falconieri, P., Fundaro`, C., Genovese, O., Panzanella, A., Casadei, A. M., Martino, A., Concato, C., Anzidei, G., Bove, G., Cerilli, S., Catania, S., Ajassa, C., Ganau, A., Cristiano, L., Mazza, A., Di Palma, A., Mignone, F., Riva, C., Scorfaro, C., Portelli, V., Rabusin, M., Pellegatta, A., Molesini, M., Chiappini, Elena, Galli, Luisa, Tovo, Pier-Angelo, Gabiano, Clara, Lisi, Catiuscia, Giaquinto, Carlo, Rampon, Osvalda, Gattinara, Guido Castelli, De Marco, Giulio, Osimani, Patrizia, Manzionna, Mariano, Miniaci, Angela, Pintor, Carlo, Rosso, Raffaella, Esposito, Susanna, Viganò, Alessandra, Dodi, Icilio, Maccabruni, Anna, Fundarò, Carlo, De Martino, Maurizio, Italian Register for HIV Infection in, Children, and Lanari, M.

Subjects
Registrie, Pediatrics, Cancer Research, Time Factors, HIV Infections, Antiretroviral Therapy, Highly Active, Neoplasms, HIV Infection, Registries, Sida, Child, biology, Incidence (epidemiology), Medicine (all), Incidence, Child, Preschool, Disease Progression, Humans, Infant, Infant, Newborn, Italy, Treatment Outcome, Oncology, symbols, Population study, Viral disease, Human, medicine.medical_specialty, cancer rates, HIV infection, children, Time Factor, Antiretroviral Therapy, symbols.namesake, Acquired immunodeficiency syndrome (AIDS), medicine, cancer, Highly Active, Poisson regression, Preschool, Settore MED/38 - Pediatria Generale e Specialistica, Perinatal HIV infection, business.industry, Cancer, Newborn, medicine.disease, biology.organism_classification, Italian Register for HIV infection in children, El Niño, Neoplasm, business
Abstract

Purpose To evaluate the impact of highly active antiretroviral therapy (HAART) on cancer incidence in HIV-infected children throughout a 20-year period. Patients and Methods An observational population study was conducted on 1,190 perinatally HIV-infected children enrolled onto the Italian Register for HIV Infection in Children from 1985 to 2004 and never lost to follow-up (total observation time, 10,037.66 years). Cancer rates were calculated in the pre-HAART (1985 to 1995), early HAART (1996 to 1999), and late HAART (2000 to 2004) periods and compared using Poisson regression adjusted for age. The proportion of HAART-treated children increased from 4.1% in 1996 to 60.4% in 1999 and to 81.5% in 2004. In the same time frame, the proportion of children receiving HAART for at least 2 years increased from 3.1% to 77.0%. Results Overall, 35 cancers occurred. Cancer rates were 4.49 (95% CI, 2.37 to 6.64), 4.09 (95% CI, 1.68 to 6.50), and 0.76 (95% CI, 0.00 to 1.80) per 1,000 children per year in 1985 to 1995, 1996 to 1999, and 2000 to 2004, respectively. Notably, there was no significant difference comparing the periods from 1985 to 1995 and 1996 to 1999 (P = .081). By contrast, cancer rates were significantly lower in the period from 2000 to 2004 than in 1996 to 1999 (P < .0001). Results were confirmed by separately analyzing data from children observed from birth (P = .418 for 1985 to 1995 v 1996 to 1999; P = .001 for 1996 to 1999 v 2000 to 2004). Conclusion Dramatically reduced cancer rates were observed only in the late HAART period in parallel to the increasing proportion of children receiving HAART therapy.

Published
2007

24. Virologic, immunologic, and clinical benefits from early combined antiretroviral therapy in infants with perinatal HIV-1 infection

Author

Chiappini, E., Galli, L., Atovo, P. i. e. r., Gabiano, C., Castelli Gattinara, G., Guarino, A., Baddato, R., Giaquinto, C., Lisi, C., de Martino, M., Osimani, P., Cordiali, R., De Mattia, D., Manzionna, M., Di Bari, C., Ruggeri, M., Masi, M., Miniaci, A., Specchia, F., Ciccia, M., Lanari, M., Baldi, F., Battisti, L., Fiorino, C., Dessı`, C., Pintor, C., Dedoni, M., Fenu, M. L., Cavallini, R., Anastasio, E., Merolla, F., Sticca, M., Pomero, G., Bezzi, Teresa Maria, Fiumana, Elisa, Bonsignori, F., Gervaso, P., Seini, E., Cecchi, M. T., Cosso, D., Timitilli, A., Stronati, M., Plebani, A., Pinzani, R., Bongianin, I., Vigano`, A., Giacomet, V., Erba, P., Salvini, F., Zuccotti, G. V., Giovannini, M., Ferraris, G., Lipreri, R., Moretti, C., Cellini, M., Cano, M. C., Paolucci, P., Bruzzese, E., De Marco, G., Tarallo, L., Tancredi, F., Pennazzato, M., Rampon, O., Dalle Nogare, E. R., Sanfilippo, A., Romano, A., Saitta, M., Dodi, I., Barone, A., Maccabruni, A., Consolini, R., Legitimo, A., Magnani, C., Falconieri, P., Fundaro`, C., Genovese, O., Panzanella, A., Casadei, A. M., Martino, A., Concato, C., Anzidei, G., Bove, G., Cerilli, S., Catania, S., Ajassa, C., Ganau, A., Cristiano, L., Mazza, A., Di Palma, A., Mignone, F., Riva, C., Scorfaro, C., Portelli, V., Rabusin, M., Pellegatta, A., Molesini, M., Chiappini, E, Galli, L, Tovo, Pa, Gabiano, C, Gattinara, Gc, Guarino, Alfredo, Baddato, R, Giaquinto, C, Lisi, C, and DE MARTINO, M.

Subjects
medicine.medical_specialty, Pediatrics, Anti-HIV Agents, medicine.medical_treatment, Immunology, combined antiretroviral therapy, CD4-CD8 Ratio, HIV Infections, HIV-1 infection, Asymptomatic, Drug Administration Schedule, Acquired immunodeficiency syndrome (AIDS), Immunopathology, Antiretroviral Therapy, Highly Active, Medicine, Immunology and Allergy, Humans, Sida, ART, infants, Chemotherapy, biology, business.industry, Age Factors, Infant, Viral Load, biology.organism_classification, medicine.disease, Infectious Disease Transmission, Vertical, Surgery, CD4 Lymphocyte Count, Infectious Diseases, Treatment Outcome, Child, Preschool, Lentivirus, Disease Progression, HIV-1, Viral disease, medicine.symptom, business, Epidemiologic Methods, Viral load
Abstract

Objective: To investigate the impact of early versus deferred combined antiretroviral treatment (ART) in asymptomatic or moderately symptomatic [Centers for Disease Control and Prevention (CDC) category N, A or B] infants with perinatal HIV-1 infection. Methods: A multi-centre nationwide case-control study was conducted. Data from 30 infants treated with combined ART with three or more drugs before 6 months of age were compared with data from 103 infants starting ART with three or more drugs after 6 months of age. The median follow-up time was 4.1 years (range, 1.0-6.5 years). Results: No difference was evident in the first available viral load and CD4 T-lymphocyte percentage between the two groups of children. Early-treated infants showed significantly lower viral loads than infants receiving deferred treatment at all the follow-up periods. A higher proportion of early-treated infants than infants receiving deferred treatment (73.3% versus 30.1%; P < 0.0001) reached an undetectable viral load. Higher CD4 T-lymphocyte percentages were found in early-treated infants at 13-24 (P < 0.0001), 25-36 (P < 0.0001), and 37-48 (P = 0.003) months of age. No early-treated infant versus 20 of 103 (19.4%) infants receiving deferred ART (P=0.02) showed a CD4 T-lymphocyte percentage of less than 15% at one time point during follow-up. No CDC category A, B or C clinical event occurred in early-treated infants over the follow-up period while 44 of 103 (42.7%) infants receiving deferred treatment presented a decline in the CDC category. Kaplan-Meier analyses revealed significant differences in CDC category A (P = 0.0002), B (P = 0.0003), and C (P = 0.0018) event-free survivals. Conclusion: The data suggest virologic, immunologic, and clinical benefits from early administration of ART.

Published
2006

25. Early triple therapy vs mono or dual therapy for children with perinatal HIV infection

Author

Chiappini, E, Galli, L, Gabiano, C, Tovo, Pa, de Martino, M, Osimani, P., Cordiali, R., De Mattia, D., Manzionna, M., Di Bari, C., Ruggeri, M., Masi, M., Miniaci, A., Specchia, F., Ciccia, M., Lanari, M., Baldi, F., Battisti, L., Fiorino, C., Dessı`, C., Pintor, C., Dedoni, M., Fenu, M. L., Cavallini, R., Anastasio, E., Merolla, F., Sticca, M., Pomero, G., Bezzi, Teresa Maria, Fiumana, Elisa, Bonsignori, F., Gervaso, P., Seini, E., Cecchi, M. T., Cosso, D., Timitilli, A., Stronati, M., Plebani, A., Pinzani, R., Bongianin, I., Vigano`, A., Giacomet, V., Erba, P., Salvini, F., Zuccotti, G. V., Giovannini, M., Ferraris, G., Lipreri, R., Moretti, C., Cellini, M., Cano, M. C., Paolucci, P., Bruzzese, E., De Marco, G., Tarallo, L., Tancredi, F., Pennazzato, M., Rampon, O., Dalle Nogare, E. R., Sanfilippo, A., Romano, A., Saitta, M., Dodi, I., Barone, A., Maccabruni, A., Consolini, R., Legitimo, A., Magnani, C., Falconieri, P., Fundaro`, C., Genovese, O., Panzanella, A., Casadei, A. M., Martino, A., Concato, C., Anzidei, G., Bove, G., Cerilli, S., Catania, S., Ajassa, C., Ganau, A., Cristiano, L., Mazza, A., Di Palma, A., Mignone, F., Riva, C., Scorfaro, C., Portelli, V., Rabusin, M., Pellegatta, A., Molesini, M., Chiappini E., Galli L., Gabiano C., Tovo P A., De Martino M., for the Italian Register for HIV Infection in Children: [.., Osimani P., Specchia F., Molesini M., and ]

Subjects
Perinatal HIV infection, Pediatrics, medicine.medical_specialty, HIV INFECTIONS, business.industry, Therapy, General Medicine, Virology, Perinatal hiv, medicine, INFANT, Dual therapy, business, MATERNAL-FETAL RELATIONS, DISEASE TRANSMISSION, ANTIHIV AGENTS
Abstract

The time at which antiretroviral therapy (ART) should be initiated in children with perinatal human immunodeficiencyvirus (HIV) infection remains controversial. In a cohort study, Berk et al1 reported clinical benefit from mono/dual ART started before 60 days of life in 10 children compared with treatment administered at 61 to 120 days of life in 16 children. The 23 children who received early triple ART were not investigated because none of them progressed to category C diagnosis by 3 years of age. We performed a similar analysis in a cohort study of a larger data set of children with a longer follow-up to evaluate the outcomes of early and very early triple ART.

Published
2006

26. Lower mother-to-child HIV-1 transmission in boys is independent of type of delivery and antiretroviral prophylaxis. The Italian register for HIV intection in children

Author

Galli, L., Puliti, D., Chiappini, E., Gabiano, C., Tovo, P. A., Pezzotti, P., de Martino, M., Osimani, P., Cordiali, R., De Mattia, D., Manzionna, M., Di Bari, C., Ruggeri, M., Masi, M., Miniaci, A., Specchia, F., Ciccia, M., Lanari, M., Baldi, F., Battisti, L., Fiorino, C., Dessı`, C., Pintor, C., Dedoni, M., Fenu, M. L., Cavallini, R., Anastasio, E., Merolla, F., Sticca, M., Pomero, G., Bezzi, Teresa Maria, Fiumana, Elisa, Bonsignori, F., Gervaso, P., Seini, E., Cecchi, M. T., Cosso, D., Timitilli, A., Stronati, M., Plebani, A., Pinzani, R., Bongianin, I., Vigano`, A., Giacomet, V., Erba, P., Salvini, F., Zuccotti, G. V., Giovannini, M., Ferraris, G., Lipreri, R., Moretti, C., Cellini, M., Cano, M. C., Paolucci, P., Bruzzese, E., De Marco, G., Tarallo, L., Tancredi, F., Pennazzato, M., Rampon, O., Dalle Nogare, E. R., Sanfilippo, A., Romano, A., Saitta, M., Dodi, I., Barone, A., Maccabruni, A., Consolini, R., Legitimo, A., Magnani, C., Falconieri, P., Fundaro`, C., Genovese, O., Panzanella, A., Casadei, A. M., Martino, A., Concato, C., Anzidei, G., Bove, G., Cerilli, S., Catania, S., Ajassa, C., Ganau, A., Cristiano, L., Mazza, A., Di Palma, A., Mignone, F., Riva, C., Scorfaro, C., Portelli, V., Rabusin, M., Pellegatta, A., and Molesini, M.

Subjects
infant's gender, vertical transmission, antiretroviral prophylaxis
Published
2005

27. Persistently high IgA serum levels are a marker of immunological or virological failure of combined antiretroviral therapy in children with perinatal HIV-1 infection

Author

Chiappini, E., Galli, L., Tovo, P. A., Gabiano, C., de Martino, M., Osimani, P., Cordiali, R., De Mattia, D., Manzionna, M., Di Bari, C., Ruggeri, M., Masi, M., Miniaci, A., Specchia, F., Ciccia, M., Lanari, M., Baldi, F., Battisti, L., Fiorino, C., Dessı`, C., Pintor, C., Dedoni, M., Fenu, M. L., Cavallini, R., Anastasio, E., Merolla, F., Sticca, M., Pomero, G., Bezzi, Teresa Maria, Fiumana, Elisa, Bonsignori, F., Gervaso, P., Seini, E., Cecchi, M. T., Cosso, D., Timitilli, A., Stronati, M., Plebani, A., Pinzani, R., Bongianin, I., Vigano`, A., Giacomet, V., Erba, P., Salvini, F., Zuccotti, G. V., Giovannini, M., Ferraris, G., Lipreri, R., Moretti, C., Cellini, M., Cano, M. C., Paolucci, P., Bruzzese, E., De Marco, G., Tarallo, L., Tancredi, F., Pennazzato, M., Rampon, O., Dalle Nogare, E. R., Sanfilippo, A., Romano, A., Saitta, M., Dodi, I., Barone, A., Maccabruni, A., Consolini, R., Legitimo, A., Magnani, C., Falconieri, P., Fundaro`, C., Genovese, O., Panzanella, A., Casadei, A. M., Martino, A., Concato, C., Anzidei, G., Bove, G., Cerilli, S., Catania, S., Ajassa, C., Ganau, A., Cristiano, L., Mazza, A., Di Palma, A., Mignone, F., Riva, C., Scorfaro, C., Portelli, V., Rabusin, M., Pellegatta, A., Molesini, M., Chiappini E., Galli L., Tovo PA., Gabiano C., de Martino M., Osimani P, Masi M., Specchia F., Molesini M., and The Italian Register for HIV Infection in Children

Subjects
Adolescent, Anti-HIV Agents, Immunology, HIV Infections, HIV-1 infection, Perinatal hiv, Antiretroviral Therapy, Highly Active, Clinical Studies, Immunology and Allergy, Medicine, Humans, Treatment Failure, Child, viremia, business.industry, combinedantiretroviral therapy, hyper-IgA, Infant, Newborn, Normal population, Infant, Viral Load, Antiretroviral therapy, Virological failure, Infectious Disease Transmission, Vertical, CD4 Lymphocyte Count, Immunoglobulin A, Child, Preschool, HIV-1, Drug Monitoring, business, Viral load, Biomarkers, Follow-Up Studies
Abstract

Summary Non-expensive and low-complexity surrogate markers for monitoring the response to combined antiretroviral therapy (combined-ART) are needed in poor-resource settings where routine assessment of CD4+ T-lymphocyte count and viral load can not be afforded. We longitudinally evaluated Ig serum levels in 234 HIV-1 infected children receiving combined-ART with ≥ 3 drugs. Since Ig levels physiologically vary with age, differences at different age periods were evaluated as differences in z-scores calculated using the mean and standard deviation of the normal population for each age period. Data from 17 (7·3%) children with immunological failure and from 54 (23·1%) children with virological failure of combined-ART were compared with data from not-failed children. At baseline children with immunological failure showed higher IgM z-scores (P = 0·042) than children without. After 3–12 months of therapy immunologically failed children displayed higher viral loads (P < 0·0001) and IgA (P = 0·043) z-scores than not-failed children. Similarly, at the same follow-up time, children with virological failure showed lower CD4+ T-lymphocyte percentages (P = 0·005) and higher IgA z-scores (P < 0·0001) than not-failed children. No difference in IgG or IgM z-scores was evidenced between failed and not-failed children after 3–12 months of therapy. In conclusion, IgA serum level is a cheap and low-complexity marker of immunological or virological failure of combined-ART which might be adopted in poor-resource settings.

Published
2005

32. Amoxicillin-induced nephritis and tubulitis in a child

Author

Ferrara, Pietro, D'Aleo, C. M., Rigante, Donato, Paoletti, F. P., Zannoni, Gian Franco, Venuti, L., Fundaro, C., Rendeli, Claudia, Salvaggio, E., Ferrara P., Rigante D. (ORCID:0000-0001-7032-7779), Zannoni G. (ORCID:0000-0003-1809-129X), Rendeli C. (ORCID:0000-0002-5948-1617), Ferrara, Pietro, D'Aleo, C. M., Rigante, Donato, Paoletti, F. P., Zannoni, Gian Franco, Venuti, L., Fundaro, C., Rendeli, Claudia, Salvaggio, E., Ferrara P., Rigante D. (ORCID:0000-0001-7032-7779), Zannoni G. (ORCID:0000-0003-1809-129X), and Rendeli C. (ORCID:0000-0002-5948-1617)

Abstract

The occurrence of interstitial nephritis in patients receiving antimicrobial therapy has frequently been reported in adults while it has rarely been described in children. We report the case of a patient treated with amoxicillin who presented hallucinations and serosanguineous blisters during treatment and developed renal failure a few days after discontinuation of the drug. On renal biopsy an interstitial nephritis with tubulitis was identified. Copyright © 2003 S. Karger AG, Basel.

Published
2003

34. HIV-I INFECTION IN PERINATALLY EXPOSED SIBLINGS AND TWINS

Author

Martino, M., Tovo, P. -A, Galli, L., Caselli, D., Gabiano, C., Mazzoni, P. L., Giacomelli, A., Duse, M., Fundaro, C., Masi, M., Cocchi, P., Loy, A., Paola Giovanna Marchisio, Zuccotti, G. V., Conte, A., Casteili Gattinara, G., Bardare, M., Ferraris, G., Ciccimarra, F., Rizzi, M., Sciotto, A., Forni, L., Consolini, R., Benaglia, G., Bresciani, E., and Cutillo, S.

Published
1991

38. Features of children perinatally infected with HIV-1 surviving longer than 5 years

Author

de Martino, M., primary, Tovo, P.-A., additional, Galli, L., additional, Gabiano, C., additional, Veglia, F., additional, Giaquinto, C., additional, Tulisso, S., additional, Loy, A., additional, Ferraris, G., additional, Zuccotti, G.V., additional, Schoeller, M.C., additional, Vierucci, A., additional, Marchisio, P., additional, Gattinara, G.C., additional, Caselli, D., additional, Dallacasa, P., additional, Fundaro, C., additional, Stegagno, M., additional, and Anzidei, G., additional

Published
1994
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43. HIV viral sequences in seronegative people at risk detected by in situhybridisation and polymerase chain reaction.

Author

Pezzella, M., Rossi, P., Lombardi, V., Gemelli, V., Costantini, R. Mariani, Mirolo, M., Fundaro, C., Moschese, V., and Wigzell, H.

Subjects
DIAGNOSIS of HIV infections, POLYMERASE chain reaction, IN situ hybridization
Abstract

Assesses the occurrence of infection with human immunodeficiency virus (HIV) among seronegative people in Rome, Italy. Confirmation of HIV genomic sequences using polymerase chain reaction technique; Detection of HIV retroviral sequences by in situ hybridization in peripheral blood mononuclear cells; Analysis of free antigen in the serum by antigen capture assay.

Published
1989
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44. EPIDEMIOLOGY, CLINICAL FEATURES, AND PROGNOSTIC FACTORS OF PAEDIATRIC HIV INFECTION

Author

Tovo, P. A., de Martino, M., Caramia), G., Armenio, L., Schettini, F., De Mattia, D., Chiodo, F., Masi, M., Trombacco, M. G., Zaniboni, M. G., Duse, Marzia, Vertua, G., Quarta, G., Cao, A., Dessi', C., Di Gregorio, F., Bezzi, T., Cocchi, P., Calabri, G., Vierucci, A., Galli, L., Boeri, E., Jannuzzi, C., Terragna, A., De Maria, A., Sanpietro, F., Barbanera, M., Bardare, M., Plebani, A., Giovannini, M., Magni, L. A., Marchisio, P., Tornaghi, R., Rossi, A., Esposito, L., Guarino, A., Romano, G., Viggiano, D., Zacchello, F., Giaquinto, C., Chieco Bianchi, L., Benaglia, G., Bertolini, P., Arico', M., Caselli, D., Bassanetti, F., Consolini, R., Antonellini, A., Magnani, C., Calvani, M., Falconieri, P., Segni, G., Fundaro', C., Gabiano, C., Palomba, E., Perugini, L., and Negro, F.

Subjects
Hepatitis, Pediatrics, medicine.medical_specialty, Pregnancy, business.industry, Vaginal delivery, Mortality rate, Secondary infection, General Medicine, medicine.disease, Substance abuse, Epidemiology, medicine, Lymphoid interstitial pneumonia, business
Abstract

486 children born to HIV-positive mothers, 57 children infected by blood products, and 1 child for whom the personal history was not available were studied. Perinatal infection had a more varied clinical picture and a worse outcome compared with infection acquired later in childhood. Severe secondary infections, neurological disorders, and hepatitis (but not lymphoid interstitial pneumonia) were linked to a high mortality rate in perinatally infected children, in whom an early onset of symptoms was also a bad prognostic factor. Perinatal HIV infection occurred in 32·6% of children born to seropositive mothers, with a higher transmission rate in children born by vaginal delivery and then breast-fed. Preterm delivery and low birthweight seemed to be related to drug abuse during pregnancy, not to intrauterine HIV infection. Girls had a higher rate of perinatal infection and, of those infected, had an increased mortality.

Published
1988
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