Metabolic activation of 2′, 3′-Didehydro-3′-Deoxythymidine (D4T) in isolated maternal and fetal peripheral blood mononuclear cells at term gestation (original) (raw)
Related papers
American Journal of Obstetrics and Gynecology, 2005
Objective: Mother-to-child transmission of human immunodeficiency virus is the most common cause of pediatric human immunodeficiency virus in the United States; the Centers for Disease Control and Prevention recommendations endorse rapid human immunodeficiency virus testing for women with unknown viral status to quicken antiretroviral therapy. We compared the costeffectiveness of Oraquick (Orasure Technologies, Bethlehem, Pa) rapid testing versus enzymelinked immunosorbent assay testing for a low-risk population of Mexican American women who are in labor. Study design: Using decision analysis techniques, we tested 2 strategies: (1) testing with enzymelinked immunosorbent assay that was confirmed by Western blot and (2) testing with Oraquick rapid testing that was confirmed by Western blot. All seropositive parturients received zidovudine treatment in labor. The baseline assumptions were the incidence of human immunodeficiency virus in Mexican American mothers (0.05%), mother-to-child transmission with no treatment (25%), with treatment in labor (10%), sensitivity of enzyme-linked immunosorbent assay (98%), positive predictive value of enzyme-linked immunosorbent assay (10%), sensitivity/specificity of Oraquick rapid testing (99%/100%), positive predictive value of Oraquick rapid testing (83%-100%), sensitivity/specificity of Western blot (97%/99%), costs (enzyme-linked immunosorbent assay [$5], Oraquick rapid testing [$15], Western blot [$25], zidovudine treatment [$76] for 12 hours labor, neonatal treatment [$2.50], lifetime treatment of human immunodeficiency virus-affected child [$194,250]). Sensitivity analyses were done over a wide range of assumptions that included the costs of tests, the sensitivity of Oraquick rapid testing, the positive predictive value of enzymelinked immunosorbent assay and Oraquick rapid testing, and the costs of treatments. Results: Oraquick rapid testing was the preferred strategy at 98spentperhumanimmunodeficiencyvirus−negativechildversus98 spent per human immunodeficiency virus-negative child versus 98spentperhumanimmunodeficiencyvirus−negativechildversus491 for enzyme-linked immunosorbent assay testing. Much of the cost of the enzyme-linked immunosorbent assay strategy was due to the treatment of
Obstetrics & Gynecology, 2003
To estimate the incremental societal costs and effectiveness of a second human immunodeficiency virus (HIV) antibody test during the third trimester of pregnancy compared with no second test. We used a decision tree in this cost-effectiveness analysis to model outcomes among pregnant women in high-risk communities and nationwide who received an initial, negative HIV antibody test during the first trimester. The main outcome measure was discounted costs per year of infant life saved. In high-risk communities with estimated HIV incidence of 6.2 per 1000 person-years, a second HIV test compared with no second test would detect 192 infections in women, prevent approximately 37 infant infections, and save 655 infant life-years per 100,000 women tested. Net savings would be 5.2 million US dollars. Applied to an estimated national incidence of.17 per 1000 person-years, a second test would detect 5.3 infections in women, prevent 1.3 infant infections, and save 23.3 infant life-years per 100,000 women tested. Net costs would be 1.06 million US dollars, or 45,708 US dollars for each year of infant life saved. A second test would result in net savings in populations with HIV incidence of 1.2 per 1000 person-years or higher. Health care providers serving women in communities with an HIV incidence of 1 per 1000 person-years or higher should strongly consider implementing a second voluntary universal HIV test during the third trimester. Providers serving lower-risk communities should pilot second testing to assess community-specific costs.
Universal Rapid Human Immunodeficiency Virus Screening at Delivery: A Cost-Effectiveness Analysis
Infectious diseases in obstetrics and gynecology, 2018
To determine the cost-effectiveness of universal maternal HIV screening at time of delivery to decrease mother-to-child transmission (MTCT), by comparing the cost and quality-adjusted life years (QALYs) of universal rapid HIV screening at time of delivery to two current standards of care for prenatal HIV screening in the United States. We conducted a cost-effectiveness analysis to compare the cost and QALY of universal intrapartum rapid HIV screening with two current standards of care: (I) opt-out rapid HIV testing limited to patients without previous third-trimester screening and (II) opt-out rapid HIV testing limited to patients without any prenatal screening. We developed a decision-tree model and performed sensitivity analyses to estimate the impact of variances in QALY, estimated lifetime medical costs, HIV prevalence, and cumulative incidence. The incremental cost-effectiveness ratio for universal screening was $7,973.45/QALY. The results remained robust to sensitivity analysi...
Journal of the International Association of Physicians in AIDS Care, 2010
This study evaluated an obstetrical program using rapid HIV testing for the prevention of mother-to-child HIV transmission (MTCT) in Baja California, Mexico. Between 2003 and 2005, 45 women in labor and 17 prenatal care women were HIV infected. Among labor patients, 14 (31%) delivered by cesarean section compared with 17 (100%) prenatal care patients (P < .001). Intravenous maternal zidovudine (ZDV) and infant oral ZDV were more frequently administered in prenatal care compared to labor patients: 94% versus 33% (P < .001) and 100% versus 79% (P < .001), respectively. All prenatal care women received combination therapy. All 10 HIV-infected infants were in the labor group, resulting in a MTCT rate of 23% (95% confidence interval [CI] 9.5-34.8) compared to 0% (95% CI 0-1.8; P < .001) among the prenatal care group. Five (50%) of the HIV-infected infants had an AIDS diagnosis and 2 (20%) died within 18 months of birth. Women diagnosed during labor had a high HIV MTCT and poo...
Rational Testing of the HIV-Exposed Infant
PEDIATRICS, 2001
Objectives. The objectives of this study were 1) to evaluate testing regimens of human immunodeficiency virus (HIV)-exposed infants and 2) to determine optimal methods of follow-up by enzyme-linked immunosorbent assay (ELISA) testing. Methods. We reviewed the results from 742 HIV-exposed infants in the state of North Carolina; 2474 samples were tested for HIV by DNA polymerase chain reaction (PCR) at the University of North Carolina Retrovirology Core Laboratory. We then reviewed the utility and costs of ELISA testing of all HIV-exposed infants who were seen at the Duke University Pediatric Infectious Disease Clinic between January 1, 1993, and May 5, 1998. We used likelihood ratios to model probability of HIV infection given 3 negative DNA (PCR) tests and to provide recommendations on the use of ELISA follow-up. Results. The overall sensitivity of the DNA PCR was 87.1%, and its specificity was 99.9%. We evaluated 224 HIV-exposed infants who were seen at Duke University and who had at least 3 negative diagnostic tests using either DNA PCR tests or HIV blood cultures. All 178 infants who subsequently underwent ELISA testing ultimately demonstrated seroreversion. The Duke University Pediatric Infectious Disease Clinic transferred the care of 65 patients to primary care physicians before ELISA testing and retained the care of the remaining 159 patients. Children who remained in Duke's care were more likely to have documentation of seroreversion (158 of 159 vs 20 of 65). We reviewed costs of travel, physician appointment, and HIV antibody testing in a tertiary care setting. Given 3 negative PCR tests, the expected cost per case of HIV detected by a positive ELISA assay is $23.8 million. Conclusions. Documentation of seroreversion in this cohort was nearly complete in the multidisciplinary subspecialty clinic but not when such responsibility was left to the primary care physician. Given the low probability of disease in patients who have had 3 negative PCR tests, documentation of a negative ELISA may not be an appropriate use of medical resources. Pediatrics 2001;108(1).
Preventive Medicine, 2000
Thailand have demonstrated that a short course of zi-Key Words: HIV; perinatal transmission; prevention; dovudine therapy administered to human immunodefizidovudine; cost-effectiveness. ciency virus-infected women during late pregnancy and labor can substantially reduce the likelihood of INTRODUCTION perinatal transmission of HIV. This regimen is both less expensive and less effective than the full course Each year in the developing world more than 500,000 of therapy recommended for use in the United States infants are perinatally infected with HIV [1]. Therefore, by the U.S. Public Health Service (PHS). The objective the recent announcement by the Centers for Disease of the current study is to estimate the incremental cost-Control and Prevention of a 50% reduction in perinatal effectiveness of the full-course zidovudine regimen in transmission of HIV among Thai women treated with comparison to the short-course regimen that was a short course of the antiretroviral drug zidovudine tested in Thailand and to determine conditions under (ZDV) is welcome news [1,2]. which the PHS-recommended regimen produces a net HIV-infected pregnant women in the treatment arm savings in societal resource utilization, relative to the of this placebo-controlled study, undertaken in collaboshorter regimen.