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Rev Bras Ginecol Obstet. 2003;25(5):323-328
DOI 10.1590/S0100-72032003000500004
PURPOSE: to determine whether an elective cesarean section at the 38th week of gestation for HIV positive patients, in spite of decreasing vertical transmission, increases the risk of maternal death. METHODS: fifty-eight HIV-infected patients were studied and submitted to the complete ACTG 076 protocol (oral administration of zidovudine in the prenatal period associated with the intravenous form at delivery) followed by an elective cesarean section at the 38th week of gestation. The control group consisted of 226 noninfected women (the first four patients submitted to an elective cesarian section after each cesarian section in infected patient). The analyzed variables were: uterine atonia, puerperal fever, abdominal wall infection, urinary infection, endometritis, average blood loss, surgery time, and hospitalization time. Data were analyzed by the c² test (the Fisher test was used when there were less than 5 cases). The relative risk was calculated with the Epi-Info 6.0 program. RESULTS: results show that the elective cesarean section performed on HIV-positive patients, when compared to the control group, did not present a higher incidence of uterine atonia, puerperal fever, abdominal wall infection, urinary infection or endometritis. However, a greater average blood loss (2.26 relative risk) was recorded as well as an extended surgery time (3.32 relative risk). The HIV-infected patients remained less time in hospital than the noninfected control group (0.33 relative risk). CONCLUSION: we conclude that there was no increase in maternal morbidity after cesarean section as a means of interrupting gestation in the HIV-infected patients.
Summary
Rev Bras Ginecol Obstet. 2003;25(5):323-328
DOI 10.1590/S0100-72032003000500004
PURPOSE: to determine whether an elective cesarean section at the 38th week of gestation for HIV positive patients, in spite of decreasing vertical transmission, increases the risk of maternal death. METHODS: fifty-eight HIV-infected patients were studied and submitted to the complete ACTG 076 protocol (oral administration of zidovudine in the prenatal period associated with the intravenous form at delivery) followed by an elective cesarean section at the 38th week of gestation. The control group consisted of 226 noninfected women (the first four patients submitted to an elective cesarian section after each cesarian section in infected patient). The analyzed variables were: uterine atonia, puerperal fever, abdominal wall infection, urinary infection, endometritis, average blood loss, surgery time, and hospitalization time. Data were analyzed by the c² test (the Fisher test was used when there were less than 5 cases). The relative risk was calculated with the Epi-Info 6.0 program. RESULTS: results show that the elective cesarean section performed on HIV-positive patients, when compared to the control group, did not present a higher incidence of uterine atonia, puerperal fever, abdominal wall infection, urinary infection or endometritis. However, a greater average blood loss (2.26 relative risk) was recorded as well as an extended surgery time (3.32 relative risk). The HIV-infected patients remained less time in hospital than the noninfected control group (0.33 relative risk). CONCLUSION: we conclude that there was no increase in maternal morbidity after cesarean section as a means of interrupting gestation in the HIV-infected patients.
Summary
Rev Bras Ginecol Obstet. 2005;27(7):393-400
DOI 10.1590/S0100-72032005000700005
PURPOSE: to evaluate T cell proliferation and cytokine production in HIV-1-infected pregnant women and their impact on in vitro virus replication. METHODS: peripheral blood from 12 HIV-1-infected pregnant women and from their neonates was collected. As control, 10 samples from non-infected pregnants were also colleted. The CD4+ and CD8+ T cell counts were assayed by flow cytometry. Peripheral blood mononuclear cells (PBMC) and plasma were obtained by centrifugation with and without Ficoll-Hypaque gradient, respectively. The freshly purified PBMC were kept in cultures for seven days with PHA plus r-IL-2, and the lymphoproliferative response was assayed by Trypan blue dye exclusion. In some experiments we added anti-IL-10 monoclonal antibody. The plasma samples and supernatants from cell cultures were stored to determine both peripheral cytokine levels, by ELISA sandwich, and viral load, by RT-PCR. RESULTS: the results showed that the lymphoproliferative response was smaller in cultures obtained from HIV-1-infected women than in control cultures [4.2±0.37 vs 2.4±0.56 (x 10(6) cell/mL), p<0.005]. In both control and infected pregnant women who had low plasma viral load, the level of IL-10 was higher than in those with high viral replication (9.790±3.224 vs 1.256±350 pg/mL, p=0.002). The elevated TNF-alpha production detected in serum (7.200±2.440 pg/mL) and supernatants (21.350±15.230 pg/mL) was associated with higher plasma viral loads and vertical infection. The IL-10 blockade by anti-IL-10 antibodies augmented viral replication in the cell cultures. CONCLUSION: these results indicate that IL-10 production exerts a negative influence on virus replication, diminishing the probability of intrauterine HIV-1 infection.
Summary
Rev Bras Ginecol Obstet. 2005;27(7):393-400
DOI 10.1590/S0100-72032005000700005
PURPOSE: to evaluate T cell proliferation and cytokine production in HIV-1-infected pregnant women and their impact on in vitro virus replication. METHODS: peripheral blood from 12 HIV-1-infected pregnant women and from their neonates was collected. As control, 10 samples from non-infected pregnants were also colleted. The CD4+ and CD8+ T cell counts were assayed by flow cytometry. Peripheral blood mononuclear cells (PBMC) and plasma were obtained by centrifugation with and without Ficoll-Hypaque gradient, respectively. The freshly purified PBMC were kept in cultures for seven days with PHA plus r-IL-2, and the lymphoproliferative response was assayed by Trypan blue dye exclusion. In some experiments we added anti-IL-10 monoclonal antibody. The plasma samples and supernatants from cell cultures were stored to determine both peripheral cytokine levels, by ELISA sandwich, and viral load, by RT-PCR. RESULTS: the results showed that the lymphoproliferative response was smaller in cultures obtained from HIV-1-infected women than in control cultures [4.2±0.37 vs 2.4±0.56 (x 10(6) cell/mL), p<0.005]. In both control and infected pregnant women who had low plasma viral load, the level of IL-10 was higher than in those with high viral replication (9.790±3.224 vs 1.256±350 pg/mL, p=0.002). The elevated TNF-alpha production detected in serum (7.200±2.440 pg/mL) and supernatants (21.350±15.230 pg/mL) was associated with higher plasma viral loads and vertical infection. The IL-10 blockade by anti-IL-10 antibodies augmented viral replication in the cell cultures. CONCLUSION: these results indicate that IL-10 production exerts a negative influence on virus replication, diminishing the probability of intrauterine HIV-1 infection.
