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Biomedical subjects

M L Newell

Publications and source records attributed to M L Newell.

At least 37 records · Page 2Linked to original sources
PubMed2000

Variable use of therapeutic interventions for children with human immunodeficiency virus type 1 infection in Europe.

UNLABELLED: Although a range of antiretroviral drugs are available for use in children, the appropriate paediatric regimen remains unclear. In a survey to investigate policies and practices relating to the therapeutic management of children infected by the human immunodeficiency virus (HIV), a postal questionnaire was sent to a named paediatrician in 70 major HIV centres in 13 European countries in early 1998. A total of 64 paediatricians (91%) responded. Pneumocystis carinii pneumonia prophylaxis was found to be routine in all centres, although considerable variation existed regarding the time of starting and stopping therapy. Prophylaxis for fungal infections and recurrent bacterial infections was common, with cytomegalovirus prophylaxis being less frequent. Although most centres (89%) used all five currently available nucleoside analogues (ziduvodine, lamivudine, stavudine, didanosine, zalcitabine), there was considerable variability regarding the availability of protease inhibitors. Most respondents delayed initiation of antiretroviral therapy until evidence of disease progression was apparent. The initial prescription of 38% of clinicians was triple therapy and that of 57% prescribed double therapy. Policies varied regarding the modification to regimens in response to disease progression and emergence of side effects and drug resistance. Clinical practice was informed by a number of sources, including centre-specific and national guidelines. Most respondents affirmed the need for European guidelines. CONCLUSION: Approaches to the therapeutic management of paediatric human immunodeficiency virus infection differ across Europe.

Antiviral Agents↗
PubMed2000

Epidemiology of HIV infection in the newborn.

Vertical transmission of HIV infection can take place in utero, during delivery and postnatally through breastfeeding, with about three-quarters of infections occurring around the time of delivery in non-breastfeeding populations. In Europe, in the absence of specific interventions, the vertical transmission rate was 15-20%. High maternal load is the major risk factor for both intra-uterine and intra-partum mother-to-child transmission. Prematurity is the most common adverse neonatal outcome associated with maternal HIV infection. Earlier diagnosis of paediatric HIV infection than previously available is now possible with virological tests, particularly HIV DNA polymerase chain reaction. An estimated one fifth of infected children will have been diagnosed with AIDS or have died by 12 months of age, rising to a third by 6 years of age. Surgical and therapeutic interventions are effective in reducing vertical transmission risk, in addition to the avoidance of breastfeeding. Caesarean section delivery before labour and before rupture of membranes approximately halves the risk of transmission, while prophylactic zidovudine therapy according to the ACTG076 regimen reduces transmission by up to two-thirds, transmission is reduced even further with both interventions. Trials of short-course zidovudine regimens show their effectiveness in reducing vertical transmission, in breastfeeding and non-breastfeeding populations. Nevirapine has been shown to be significantly more effective than short course zidovudine regimens in breastfeeding populations, but is still under evaluation in non-breastfeeding populations additionally receiving routine anti-retroviral prophylaxis. Reports of a small number of serious adverse events in uninfected children exposed in utero or neonatally to antiretroviral therapy need further investigation. Trials of vitamin A supplementation to reduce vertical transmission have had negative results, while the effectiveness of vaginal lavage and passive immune therapy in reducing vertical transmission remains uncertain.

Adult↗
PubMed2000

Disclosure of diagnosis and planning for the future in HIV-affected families in Europe.

Information relating to disclosure of infection status in families affected by HIV and the existence of plans for the future social care of children with infected parents was collected as part of a larger survey on clinical and psychosocial service use of these families. Parents and alternative carers of HIV-affected children in follow-up in 10 paediatric centres from seven European countries were surveyed. A total of 182 questionnaires were returned: most (73%) were completed by parents, of whom 92% were HIV-infected. Of the 226 children cared for by the respondents, most (62%) were HIV-infected. Disclosure of both the child's and the parent's infection status was rare and found to be associated with child's age in both cases. Infected children living with their parents were less likely to know their diagnosis than those living in alternative care. Uninfected parents and carers were significantly more likely to want professional help with disclosing to an infected child than infected parents. Infected parents also face difficult decisions regarding the issue of who will care for their children when they are unable to. Half of the infected parents had made long-term plans for their children's future social care. European parents were more likely to have made such plans than those from elsewhere (mainly Africa) and parents with plans had known about their HIV infection for significantly longer than those without. Increasing numbers of vertically infected children are reaching adolescence as a result of improvements in the management of paediatric HIV infection. As both disclosure and planning for the future social care of HIV-affected children have been found to be strongly associated with child's age, the changing epidemiology of paediatric HIV highlights the need for more information on these issues in order to support families more effectively.

Adolescent↗
PubMed2000

Persistence rate and progression of vertically acquired hepatitis C infection. European Paediatric Hepatitis C Virus Infection.

Data were collected from 104 infected children who were followed up from birth for a mean of 49 (range, 6-153) months in 22 European centers, to outline the natural history of perinatal hepatitis C virus (HCV) infection. Fifty-four children were persistently HCV RNA positive, 44 were occasionally positive, and 6 never had detectable viremia. At least 90% of the children had evidence of ongoing infection at the latest analysis. Eighteen children became HCV RNA negative at their last assessments, but 40% of these had high alanine aminotransferase (ALT) concentrations. Infection was asymptomatic in all but 2 children, who developed hepatomegaly. Mean ALT concentrations decreased substantially after the first 2 years of life; 14 children had persistently normal ALT values. Signs of minimal to moderate inflammation were noted in all 20 patients who underwent liver biopsy. Perinatal HCV infection is usually asymptomatic in the first years of life, but the virus persists in most children, even in the absence of elevated ALT activity.

Adult↗
PubMed2000

Prevention of mother-to-child transmission of HIV in developing countries: recommendations for practice. The Ghent International Working Group on Mother-To-Child Transmission of HIV.

OBJECTIVES: Different approaches to prevent mother-to-child transmission of HIV are being evaluated in developing countries. The first trials using a short regimen of zidovudine have been successful in Thailand, Côte d'Ivoire and Burkina Faso. International and local strategies are now being considered. The Ghent International Working Group on Mother-to-Child Transmission of HIV developed public health policy options to integrate these interventions into basic and maternal and child health (MCH) services. METHODS: The following tasks were undertaken: a critical review of randomized trials; an international pooled analysis of late postnatal transmission of HIV through breastfeeding; a review of the cost-effectiveness and cost-benefit of antiretroviral prophylaxis; a feasibility assessment of preventive strategies, including a postal survey on HIV voluntary counselling and testing (VCT) of pregnant women; the identification of requirements and research priorities for prenatal, obstetric and paediatric care. These projects provided the background for a three-day workshop in Ghent, Belgium, in November 1997. Conclusions were further refined, based on 1998 research findings. RESULTS: A summary of relevant evidence and ten public health recommendations are reported. VCT for pregnant women, a short regimen of zidovudine together with alternatives to breastfeeding currently represent the best option to reduce vertical transmission in most developing countries. The primary goal of the integrated package supporting these interventions is to alleviate overall maternal and infant morbidity and mortality. CONCLUSION: Prevention of mother-to-child transmission of HIV should now be considered for integration into basic health and MCH services of selected countries, with the involvement of governments and donor agencies.

Anti-HIV Agents↗
PubMed2000

Preventing perinatal transmission of HIV-1 infection.

It is now known that with the use of antiretroviral prophylaxis with zidovudine, elective caesarean section delivery and refraining from breastfeeding the rate of mother-child transmission of HIV infection can be reduced to less than 2%.

Adolescent↗
PubMed1999

European paediatric hepatitis C virus network. Antenatal hepatitis C virus screening and management of infected women and their children: policies in Europe.

UNLABELLED: A postal survey of 31 European centres was conducted to document current practices regarding screening and management of hepatitis C virus (HCV)-infected pregnant women and their children. Antenatal HCV prevalence was low. Universal antenatal screening programmes were in place in ten centres, selective screening occurred in ten other centres, two did not specify the type of policy, and there was no screening programme in nine centres. Numbers of HCV-infected children were low. Breastfeeding was recommended for infants of infected mothers in ten centres, discouraged in ten centres, in three centres women were merely informed of the risks, and there were no guidelines in eight centres. Polymerase chain reaction was available in all centres. In 17 centres children born to HCV-infected women were seen every 3 months for at least the 1st year. CONCLUSION: The optimum antenatal hepatitis C virus screening approach and the appropriateness of breastfeeding recommendations are unclear and this survey highlights the lack of uniformity in current practice.

Academic Medical Centers↗
PubMed1999

Mother-to-infant transmission of hepatitis C virus.

The rate of mother-to-infant transmission of hepatitis C virus (HCV) is approximately 5%, but is higher when the mother is co-infected with HIV Vertical transmission is restricted to infants whose mothers are viraemic. The risk of transmission increases with increasing maternal viral load but a specific cut-off value predicting infection cannot be defined. There is no specific HCV genotype which is preferentially transmitted. The mode of delivery (caesarean versus vaginal) does not appear to influence the rate of transmission, but firm evidence is lacking. There is no evidence to suggest an increased risk of HCV transmission through breast feeding. Pregnancy is not contra-indicated in HCV-infected women. Without drugs to treat established infections in mothers and infants and interventions to prevent vertical transmission, routine HCV screening is not recommended in pregnant women.

Female↗
PubMed1999

Hepatitis C in children.

Mother-to-child, or vertical transmission, of hepatitis C virus is now the dominant mode of acquisition of infection for children. The rate of transmission is low in women who are not also HIV-positive. Whether the mode of delivery is associated with transmission remains questionable; breast-feeding does not appear to be a source of infection. The detection of hepatitis C virus RNA using the polymerase chain reaction is a sensitive method for the early diagnosis of infection in perinatally exposed infants, but false positive results can occur. The natural history of hepatitis C virus infection in children is not well defined, but chronic infection is common in most cases. The disease progression is slower than in adults. Therapeutic trials (not placebo controlled) in a small number of children suggested a sustained response to interferon treatment in only a minority of cases. The option of combination therapy with ribavirin looks promising and needs evaluation.

Journal Article↗
PubMed1999

Antenatal screening for hepatitis B infection and syphilis in the UK.

OBJECTIVES: To assess antenatal hepatitis B and syphilis screening policies in the UK. DESIGN: Postal questionnaire survey. SETTING: One hundred and ninety-two obstetric units and 116 Public Health directorates. MAIN OUTCOME MEASURES: Antenatal screening policy and line of responsibility for ensuring vaccine uptake in hepatitis B virus exposed children. RESULTS: Replies were received from 140 (73%) obstetric centres and 99 (85%) Public Health directors. Forty per cent of obstetric centres now offer hepatitis B virus tests to all pregnant women, and nearly one-quarter (24.1%) of all births in the UK in 1996 occurred in centres with a universal testing policy. The prevalence of chronic hepatitis B virus ranged from 0.3 to 17.5 per 1000 deliveries. Universal antenatal screening for serological evidence of syphilis was the norm, but five obstetric centres respondents and three Public Health directors were considering its discontinuation. In the nine London centres, syphilis prevalence was 2.06 per 1000 pregnant women, compared with 0.24 per 1000 elsewhere. Responses from Public Health directors indicated the nonspecific nature of the antenatal care contract. Responsibility for hepatitis B virus vaccination of the newly born infant rests with the hospital paediatrician, with transfer of responsibility to the community usually occurring through a discharge letter. Only two areas had a monitoring system to ensure full hepatitis B virus vaccination coverage of exposed infants. CONCLUSIONS: If antenatal screening policies are to be equitable there is a need for a clear national policy, and systems need to be established to monitor local policy and practice.

Female↗
PubMed1999

British HIV Association guidelines for prescribing antiretroviral therapy in pregnancy (1998).

The aim of antiretroviral therapy in pregnancy is to deliver a healthy uninfected child to a healthy mother, without prejudicing the future treatment opportunities of the mother. The use of zidovudine monotherapy rapidly became standard practice once it had been shown to reduce by 67% mother to child transmission in women with CD4+ lymphocyte counts above 200 x 10(6)/l. High rates of transmission are seen when maternal disease is advanced (high viral load, low CD4+ lymphocyte counts) despite zidovudine. In these women highly active antiretroviral therapy gives the best prospect for prolonged health and it is anticipated that reducing plasma viral load below the limits of detection will further reduce transmission rates. However, safety data for antiretroviral therapy in pregnancy are limited and each additional treatment exposes a significant proportion of uninfected infants to potential long term hazards. Where maternal therapy is not indicated and the sole objective of treatment is to reduce mother to child transmission, recent data suggest that short course zidovudine (especially in conjunction with prelabour caesarean section) is a reasonable option. This may minimise the emergence of viruses with reduced sensitivity to zidovudine and preserve maternal options for later therapy.

Anti-HIV Agents↗