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Women at Barcelona: Some abstracts on Treatment
Marge Berer. RHM August 2002 Reposted courtesy of GENDER-AIDS ([email protected])
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Marge Berer, UK Editor of Reproductive Health Matters, has compiled the following list of useful research abstracts pertaining to HIV-positive women as presented at the Barcelona Conference. This list will be augmented in due course, and will be published on the RHM website and in the November 2002 RHM journal.
1. Martin FAZ et al. Long term clinical outcome of anti-retroviral therapy (ART) naive and experienced HIV-1 positive pregnant women. Abstract MoPeC3526. AIDS 2002, Barcelona. July
Prior to effective ART, a more rapid clinical progression after pregnancy has been observed. Data on the long term outcome of HIV infection in women who received ARV therapy during pregnancy are scarce. To determine clinical and immunological outcome in HIV-positive women who commence therapy before or during pregnancy, a prospective cohort study of 49 women delivering at an inner city maternity unit between 1996 and 2000 was carried out with follow-up of at least 12 months. Outcome measures were changes in CD4 counts, HIV viral load, morbidity and mortality. Mean follow-up was 154 weeks. Morbidity is low following pregnancy in the HAART era. Pregnant HIV-positive women who first received monotherapy during pregnancy subsequently responded well to triple therapy following pregnancy. In our cohort, with 350 patient-years, clinical progression was minimal and mortality nil.
2. Zvandasara P et al. Anaemia and associated mortality among HIV-positive post-natal women in Zimbabwe. Abstract TuPeC4782. AIDS 2002, Barcelona. July.
Anaemia due to pregnancy and HIV in post-natal women and risk of earlier death, Harare In developed countries, anaemia is common during HIV and significantly associated with earlier death. This form of anaemia results from changes in cytokine production, blunted erythropoietin (EPO) response, and anti-retroviral use, especially zidovudine. Treatment with recombinant EPO improves this anaemia and survival; iron supplementation does not improve the anaemia and has been hypothesised to hasten progression of disease. In developing countries, anaemia is especially common among pregnant women, usually due to iron deficiency resulting from poor diet and blood loss, malaria, and parasitic infection.
This study investigated whether anaemia (likely to be due both to pregnancy and HIV) among HIV-positive women participating in the ZVITAMBO trial in Zimbabwe was a risk factor for early mortality. Between October 1998 and January 2000, 8206 women were enrolled in the trial within 96 hours of delivery, randomised to receive vitamin A or placebo, and tested for HIV and haemoglobin (Hb); CD4 count was also measured in HIV-positve women. Women with Hb <8 g/dl were referred to the study physician and followed up at six weeks, and then three-monthly for a median of 12.0 (9.4-15.6) months. At delivery, 2669 (32.6%) women were HIV-positive. Anaemia (Hb<11 g/dl) was more common among HIV-positive than HIV-negative women (42.4% vs. 24.8%). Vitamin A did not affect mortality at 12 months post-partum; analysis is underway to determine impact on survival time. After adjusting for parity and CD4, women with Hb <7 g/dl and 7<11 g/dl were 4.1 and 1.7 times respectively more likely to die. This study demonstrates that anaemia is a risk factor for earlier death among HIV-positive women of reproductive age in a developing country setting. Analysis is underway to determine the impact of prescribed iron treatment on Hb and mortality, and will have implications for treatment options. [1]
3. Li M et al. The effect of oestrogen on human vaginal susceptibility to HIV-1 infection. Abstract WePeA5740. AIDS 2002, Barcelona. July.
Could topical vaginal oestrogen treatment increase women's resistance to HIV infection? The human vaginal epithelium is well-supplied with HIV-receptive Langerhans cells, overlain by a stratified squamous epithelium. This epithelium is oestrogen-dependent, being thickest at around the time of ovulation, and thinnest just before menstruation. Vaginal biopsies were obtained from pre-and post-menopausal women undergoing vaginal reconstructive surgery, with or without prior oestrogen replacement therapy. The thickness of epithelium and the distribution of Langerhans cells was assessed histologically and immunocytochemically. Pre-operative oestrogen treatment increased the thickness of the vaginal epithelium in post-menopausal women, but had no apparent effect on the number and distribution of Langerhans cells. Vaginal biopsies from pre-menopausal women are currently being investigated. In all mammals, the vaginal epithelium is at its thickest, and is most keratinised or cornified at the time of the ovulatory peak of oestrogen secretion. This may have evolved as a natural defence against sexually transmitted infections. Humans are the only species that frequently has intercourse other than at the time of ovulation, perhaps making us particularly susceptible to STD/HIV infection. Oestrogen treatment of Rhesus monkeys whose ovaries have been removed greatly increases their resistance to vaginal SIV infection. This raises the possibility that topical vaginal oestrogen treatment could increase a woman's resistance to HIV infection.
For further information, contact:
Marge Berer, UK Editor Reproductive Health Matters
E-mail: [email protected]
Elsevier website: www.elsevier.com/locate/rhm
RHM website: www.rhmjournal.org.uk
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