Early invasive diagnostic techniques in pregnant women who are infected with the HIV: A multicenter case series
ABSTRACT Studies that mostly were conducted before the widespread use of combination antiretroviral treatments have reported that antenatal invasive procedures markedly increase the risk of human immunodeficiency virus vertical transmission. We aimed to evaluate the vertical transmission rate and other maternal and neonatal complications among women who were infected with human immunodeficiency virus who underwent antenatal invasive procedures during the second trimester of pregnancy and who were delivered after the advent of antiretroviral regimens.
We conducted a multicenter case series of women who were infected with human immunodeficiency virus who underwent amniocentesis or chorionic villus sampling or cordocentesis during the second trimester of pregnancy and who were delivered after January 1, 1997.
Sixty-three of 775 recruited women (8.1%) had performed early invasive diagnostic techniques . This rate has improved progressively from 4% in 1997 to 14%. Two of 60 viable infants (3.3%; 95% CI, 0.6%-10.1%) were infected with the human immunodeficiency virus. This rate did not differ significantly from the transmission rate that was observed in women who did not undergo antenatal invasive techniques (1.7%; P = .30).
The current risk of human immunodeficiency virus vertical transmission that is associated with early invasive diagnostic techniques is lower than previously reported.
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ABSTRACT: The desire to have children is more and more common in HIV serodiscordant couples. The Academic Medical Centre Amsterdam has developed a new treatment protocol for couples in whom the man is HIV positive. Semen is processed to obtain HIV-1 free spermatozoa. These spermatozoa are used for IUI treatment. Thus far, 20 serodiscordant couples underwent 76 IUI cycles. An insemination was performed in 50 cycles (66%). The insemination was cancelled in 26 cycles, because of too many follicles (risk for multiple pregnancy), weekend (no possibilities for virological testing), not enough spermatazoa after preparation, a positive HIV-1 RNA test and other reasons. 10 out of 20 women became pregnant (50%), 8 women were on-going pregnant. The clinical and ongoing pregnancy rate per started cycle was 13% and 11% respectively. 7 babies have thus far been born and none of the mothers or babies seroconverted within this study period. Larger numbers of patients are necessary to support the safety of this program.Nederlands tijdschrift voor geneeskunde 03/2005; 149(8):423-4.
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ABSTRACT: Anxiety and the willingness to undergo ART was assessed by the State-Trait Anxiety Inventory and by trade-off at increasing hypothetical HIV-1 transmission risks in fifty serodiscordant couples undergoing intrauterine inseminations as a risk-reduction strategy. Both men and women displayed high state anxiety levels, but despite their anxiety, women were prepared to take high risks to fulfill their desire for a child.Fertility and sterility 11/2007; 90(2):456-8. DOI:10.1016/j.fertnstert.2007.06.086 · 4.30 Impact Factor
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ABSTRACT: Data on the concentrations of didanosine (ddI) and tenofovir (TFV) in seminal plasma are sparse. Subtherapeutic drug concentrations within the lumen of the male genital tract may have implications for selection and transmission of drug-resistant HIV strains. On the other hand, sufficient penetration of these drugs into the male genital tract has potential toxic effects on the spermatozoa and their precursors. In the current study, the authors obtained paired semen and blood samples at variable time points after drug intake from 30 HIV-1-infected patients using a ddI (n = 15) or ddI + TFV (n = 15) containing an antiretroviral regimen. Didanosine and TFV concentrations were measured in seminal and blood plasma and semen quality was assessed. Both ddI and TFV penetrated well into seminal plasma. Whereas blood plasma ddI concentrations dropped to near or below the lower limit of quantification of 0.017 microg/mL 9 hours after drug intake, the ddI concentration in seminal plasma remained detectable during the whole dosing interval with a median of 0.20 and 0.21 microg/mL in the ddI and ddI + TFV groups, respectively. Tenofovir was detectable during the whole dosing interval in both blood and seminal plasma with a median concentration of 0.12 and 0.25 microg/mL, respectively, and a median seminal-to-blood-plasma ratio of 3.3. Semen quality was within the normal range according to the criteria of the World Health Organization, except for the percentage of progressively motile sperm, which was low in both groups of patients. The authors conclude that ddI and TFV penetrate well into seminal plasma and that the reduced sperm motility deserves further study.Therapeutic Drug Monitoring 11/2007; 29(5):566-70. DOI:10.1097/FTD.0b013e31811fef29 · 1.93 Impact Factor