Objective Human immunodeficiency virus (HIV) infection of the central nervous system (CNS) is frequently associated with intrathecal immunoglobulin synthesis and cerebrospinal fluid (CSF) pleocytosis, but little is known about the B‐cell response in the CSF of these patients. In this study, we investigated the relation between virus load and the frequency and phenotype of B cells in the CSF of HIV‐infected patients. Methods The distribution of T cells, B cells, short‐lived plasmablasts, and long‐lived plasma cells was analyzed by flow cytometry in CSF and peripheral blood of 33 patients with HIV infection compared with 12 patients with noninfectious CNS diseases. HIV RNA copy number in CSF and serum was quantified by kinetic polymerase chain reaction. Results B‐cell and plasmablast levels were increased in the CSF of HIV‐infected patients compared with patients with noninfectious CNS diseases. Whereas CSF B cells were found at similar frequency during early and late stages of HIV infection, plasmablasts were more prevalent in the CSF during early infection. Plasmablasts in the CSF correlated with intrathecal IgG synthesis and even stronger with HIV RNA copy numbers in CSF, in particular, in untreated, early HIV‐infected individuals. Initiation of antiviral treatment in therapy‐naive patients strongly decreased HIV copy numbers and plasmablasts in CSF. Interpretation Our findings demonstrate that HIV infection of the CNS triggers an early profound B‐cell response, with plasmablasts serving as the main virus‐related B‐cell subset in the CSF. Ann Neurol 2007

A pilot study was conducted to test the efficacy of a therapeutic group by telephone conference call for women with breast cancer. Sixty-six women with stage I or stage II breast cancer consented to participate in the study. Participants were randomly assigned to a usual psychosocial care or intervention group, using a permuted block method. Only 2 of 68 patients dropped out of the study, which included 27% African Americans. Assessments at 3 time periods (pretest, immediately after the intervention, and 3 months after the group ended) included evaluation of quality of life (QOL), mood, and immune function. ttests were performed to determine if differences on important variables existed at pretest. The intervention group had worse QOL and mood scores than did the control group on the pretests. A mixed-model repeated-measures procedure controlling for pretest differences was used to analyze data. A significant Group by Time interaction was found for spiritual well-being and mood. These differences were not in the expected direction. The intervention group showed improvement in QOL and mood during the intervention, but showed decompensation following the intervention. Conversely, the control group demonstrated stable or declining scores. This intervention is feasible and practical for women with breast cancer, especially African American participants. The puzzling results suggest several areas for future research, including a better conceptual fit with outcome measures, increasing dosage, and exploration of the value of emotional expression.

Adherence to zidovudine (ZDV) prophylaxis among 78 pregnant HIV-infected women was measured with 2 physiologic markers. Long-term adherence was measured with blood assays for macrocytosis, a clinical indicator of ZDV use; 53 women (67.9%) were adherent. Short-term adherence was measured with urine assays for ZDV; 48 women (61.5%) were adherent. Comparison of urine assay and interview data indicated that 29% had not taken the last dose that they reported. Participation in HIV support groups and disclosure to the participant's mother were associated with better adherence. These social network factors may enable HIV-infected pregnant women to cope more effectively with the multiple stressors they face and facilitate prenatal care.

ABSTRACT. Objective. To describe the extent of adherence to the recommended neonatal zidovudine (ZDV) regimen administered to infants who have been exposed to the human immunodeficiency virus (HIV) to prevent mother-to-child transmission of HIV and to determine which maternal factors are associated with compliance.Methods. HIV-infected women (n ‫؍‬ 87) who were participating in a larger study of perinatal transmission at 3 inner-city New York City hospitals were interviewed 2 to 6 weeks' postpartum to assess adherence to neonatal prophylaxis, social support, social network factors, and depression. In addition, plasma samples of 45 of their infants were assayed for ZDV levels.Results. A majority of women (71%) administered all of the prescribed 4 daily doses in the previous week, as measured by interview; self-reported adherence was not associated with any maternal characteristics. In contrast, poor adherence, as measured by lower infant ZDV plasma levels, was associated with asymptomatic HIV illness in the mother and having 2 or more other children; good adherence, as indicated by higher ZDV levels, was associated with the presence of a maternal social support network, disclosure of HIV infection, and mothers' adherence to their own ZDV regimens during pregnancy. In multivariate regression analyses, maternal asymptomatic status (␤ ‫؍‬ ؊0.40) was associated with lower infant ZDV levels, and maternal adherence during pregnancy (␤ ‫؍‬ 0.37) was associated with higher levels.Conclusions. Women who are HIV asymptomatic and lack a social support network are more likely not to comply with the recommended neonatal prophylactic regimen of antiretroviral therapy. Future studies should address the prenatal period and social network factors, such as disclosure of serostatus, and the custody of other children. Pediatrics 2002;110(3). URL: http://www. pediatrics.org/cgi/content/full/110/3/e35; adherence, mother-to-child transmission, zidovudine, perinatal HIV infection. Prophylactic treatment of all infected pregnant women and their infants with the 076 regimen was subsequently recommended by the US Public Health Service 2 and rapidly became the standard of care. A later study indicated reduced transmission rates in infants who were treated with ZDV within 48 hours of birth, even in the absence of maternal treatment. 3 The current prophylaxis for full-term HIV-exposed infants includes a 6-week course of oral ZDV 4 times daily in doses of 2 mg/kg body weight, initiated as soon as possible, and within 12 to 24 hours of delivery. 2 Understanding factors that are associated with adherence to neonatal prophylaxis has become increasingly important as greater proportions of HIV-exposed infants are being identified and treated as a result of more aggressive prenatal HIV testing policies 4 and recent advances in rapid HIV testing technology that could expedite the initiation of treatment for exposed neonates. 5 In August 1999, New York became the first state to legislate universal testing of women with undocumented HIV status or their...