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Objective – to characterize the clinic and the immune status state in children with HIV infection, taking into account the presence of congenital CMVI.Methods. A clinical and laboratory examination of 91 children with HIV infection with congenital CMVI (20; group I) and without it (71; group II) was carried out. Results. The anamnestic risk groups for congenital CMVI on the part of the mother included age over 30 years (55%), drug use (75%), chronic metroendometritis (85%), colpitis (55%), features of HIV status (secondary disease stage 4 — in 20%, CD4-lymphocyte count 0,5 х 109/l or less in 85%, HIV blood viral load 50 cop./ml or more in 80%), pregnancy pathology (threat of miscarriage — in 50%, developmental delay fetus — in 65%), lack of chemoprophylaxis for vertical transmission of HIV (55%). The clinical criteria for diagnosing of congenital CMVI in newborns included prematurity (40%), congenital malformations (45%), intrauterine growth retardation (65%), jaundice syndrome (50%), and perinatal CNS damage (80%). Children with congenital CMVI at the age of three months developed multiple organ pathology — lymphadenopathy (80%), hepatomegaly (65%), splenomegaly (40%), underweight (75%), pneumonia (60%), hepatitis (30%), pancreatitis (15%), enterocolitis (20%), nephritis (25%), carditis (20%), encephalitis (15%), chorioretinitis (20%), anemia (60%), thrombocytopenia (15%). A severe immunodeficiency state with a predominant violation of the T-cell link was revealed. A high titer of CMV was found in biological materials, IgG antibodies in the blood.Conclusion. The use of clinical and laboratory criteria makes it possible to timely diagnose congenital CMVI in children with HIV infection and prescribe complex therapy.
Objective – to characterize the clinic and the immune status state in children with HIV infection, taking into account the presence of congenital CMVI.Methods. A clinical and laboratory examination of 91 children with HIV infection with congenital CMVI (20; group I) and without it (71; group II) was carried out. Results. The anamnestic risk groups for congenital CMVI on the part of the mother included age over 30 years (55%), drug use (75%), chronic metroendometritis (85%), colpitis (55%), features of HIV status (secondary disease stage 4 — in 20%, CD4-lymphocyte count 0,5 х 109/l or less in 85%, HIV blood viral load 50 cop./ml or more in 80%), pregnancy pathology (threat of miscarriage — in 50%, developmental delay fetus — in 65%), lack of chemoprophylaxis for vertical transmission of HIV (55%). The clinical criteria for diagnosing of congenital CMVI in newborns included prematurity (40%), congenital malformations (45%), intrauterine growth retardation (65%), jaundice syndrome (50%), and perinatal CNS damage (80%). Children with congenital CMVI at the age of three months developed multiple organ pathology — lymphadenopathy (80%), hepatomegaly (65%), splenomegaly (40%), underweight (75%), pneumonia (60%), hepatitis (30%), pancreatitis (15%), enterocolitis (20%), nephritis (25%), carditis (20%), encephalitis (15%), chorioretinitis (20%), anemia (60%), thrombocytopenia (15%). A severe immunodeficiency state with a predominant violation of the T-cell link was revealed. A high titer of CMV was found in biological materials, IgG antibodies in the blood.Conclusion. The use of clinical and laboratory criteria makes it possible to timely diagnose congenital CMVI in children with HIV infection and prescribe complex therapy.
The aim. To study the features of the course of the neonatal period in children, perinatally exposed to HIV, who receive an enhanced regimen of chemoprophylaxis of HIV mother-to-child transmission.Patients and methods. A retrospective longitudinal cohort study of mother – child pairs for the period from 2017 to 2019 was carried out. The clinical observation group included HIV-positive women with a high risk of vertical transmission of the immunodeficiency virus (n = 213) and their newborn children (n = 214), who were prescribed an enhanced chemoprophylaxis regimen of HIV transmission from mother to child. Results. According to the results of the study of HIV-positive mothers we revealed a high prevalence of secondary diseases and a high per partum viremia – 1700 (222–18342) copies/ml. 35.9 % of children were born prematurely, 27.5 % – had low birth weight by gestational age. In newborns, diseases of the respiratory (24.3 %) and nervous (17.2 %) systems prevailed. 17.2 % of children developed intrauterine infection; HIV RNA was detected in 3.7 %. Congenital malformations were observed in 7.4 % of children. Symptoms of enteropathy were noted in 24.7 % of newborns. A decrease in red blood counts was found in all children by the 28th day of life (pw < 0.001).Conclusion. The study confirms the need for increased attention and improvement of approaches to medical support of children who were perinatally exposed to high risk of vertical HIV infection.
In order to assess the socio-demographic and behavioral characteristics of HIV-infected pregnant women in the Voronezh region, which increase the risks of perinatal HIV infection, an analysis was carried out for the period 2017–2021. The materials were official statistics and personalized data from the registers and surveillance maps of the Voronezh Regional Clinical Center for AIDS Prevention and Control. There was an increase in positive results (per 1000 tests) during screening examinations of pregnant women, with a stable proportion (34 %) over the past 5 years among those who gave birth to HIV-positive people identified for the first time when registering for pregnancy. In the cohort of HIV-infected women, an accumulation of persons with parenteral infection, escaping from medical supervision due to behavioral characteristics, was revealed. It was found that among the reasons why women are not registered for pregnancy, there is a high proportion of officially unemployed (72.5 %), insufficient level of education and awareness about HIV. Compared with the general population of pregnant women in the region, the proportion of late registration for pregnancy among HIV-infected pregnant women is 17 times higher, and the proportion of births among women who are not registered for pregnancy is 8,2 times higher. The detection of HIV in women at a late stage or after childbirth is also caused by the material benefits of the status of a single mother (63.1 % are not married), which additionally leads to the absence of an HIV examination of the child's father. With a statistically small number of births in HIV-infected women in the region, these reasons led to the implementation of vertical HIV transmission in 5.9 % of newborns in 2021
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