Providing Care for HIV-infected Woman Amneris E. Luque, MD SMH AIDS Center Medical Director 2002/07/01
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2 Providing Care for HIV-infected Woman Amneris E. Luque, MD SMH AIDS Center Medical Director 2002/07/01
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4 / (%) 100, (18) (63) (18) (1) 1 / 40 (<1) 5 * 10,780 (100) 9.3 *
5 : 9.3 N=10, _ <5 /100,000 <5 cases * PR 21.3 VI MA NH RI CT NJ DE MD DC * * * *
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7 HIV
8 HIV HIV
9 HIV HIV
10 % 10,000 23% 2% 1%
11 HIV HIV
12 CD4
13 (37%) (15%) (13%)
14
15
16
17 HIV
18 (d4t) (ddi)
19 HIV EE AUC 19% EE AUC 37% EE) EE EE
20 :
21 40-60%
22 Amneris E. Luque, Lisa M. Demeter, Heng Li and Richard C. Reichman
23 HIV HIV HPV HIV 204
24 (n=16) :
25 : : Cervex-Brush HPV DNA
26 HIV-1 RNA HPV DNA DIGENE : (LR HPV): HPV 6, 11, 42, 43, 44 : (HR HPV): HPV 16, 18, 31, 33, 35, 45, 51, 52, 57 HPV : VLP ELISA
27 HIV-1 RNA 10,000 HPV Luque AE, Demeter LM and Reichman RC. JID 179:1405-9, 1999
28 HIV-1 RNA > 10,000 copies/ml (P = ) HPV (P = < 0.001) Luque AE, Demeter LM and Reichman RC. JID 179:1405-9, 1999
29 (Pap smear) (n=191) 123 (64%) normal 31 (16%) ASCUS 25 (13%) LGSIL 7 (4%) HGSIL 3 (2%) dysplasia nos
30 HIV : 104 (51%) HIV 37 (18%) NRTI 2 61 (30%) NRTI 2 + PI 6 (3%) NRTI 2 + NNRTI
31 Median CD4 count (cells/ml) Median HIV-1 RNA (copies/ml) ,056 11, ,667 Normal Pap smear 50 (69%) 22 (31%) 58 (76%) * 18 (24%) Abnormal Pap smear 18 (51%) 17 (49%) 16 (53%) 14 (47%) HPV DNA - 42 (63%) 25 (37%) 46 (77%) ** 14 (23%) HPV DNA + 24 (62%) 15 (38%) 16 (50%) 16 (50%)
32 % P< % 47% HIV HIV % l Luque. 8th CROI; 2001; Chicago. Abstract 724.
33 80 78% 80% P< % HPV DNA+ 20% HPV DNA Luque. 8th CROI; 2001; Chicago. Abstract 724.
34 HIV HIV (P = 0.03, OR: 0.17, 95% CI: )
35 HIV HPV DNA P = <0.01, OR: 0.07, 95% CI; HIV RNA CD4
36 32 (SHCS) 416 Weisser M, Rudin C, et al. J Acqu Imm Def Hum Ret 1998;17:
37 ( )
38 PCR HIV 10 HIV
39 HIV HIV
40
41 HIV
42
43
44 14-34 AZT 500 mg/ 1 AZT 2mg/Kg 1mg/Kg 8-12 AZT 2 mg/kg 6
45 HIV ACTG 076 HIV 14 AZT
46 AZT AZT
47 ZDV PCR N (%) 95% CI 423(45) 26 (6) ( ) 50(5.3) 5 (10) ( ) (9.2) 8 (9.3) ( ) 3 38 (4) 7 ( ( ) 237 (25) 63 (26.6) Wade N, Birkhead G et al NEJM 1998:
48 AZT AZT 48 HIV
49 PACTG HIV HIV ZDV 2 mg /Kg ZDV 2 mg/kg ZDV 8.3% ZDV 500mg/ % 1mg/kg/hr 6 ( 67.5%) ZDV 300 mg 2 / 36 ZDV 300 mg / ZDV 300 mg ZDV 9.2% 18.6% ( 51%) ZDV 300 mg ( ) ZDV 15.7% / 25% ( 37%) 1999 ZDV 300 mg ZDV 4 mg/kg / / x 7 NVP 2 mg/kg NVP 200 mg ZDV 25% NVP 13% ( 47%NVP)
50 HIVNET NVP 200 mg 72 NVP ZDV NVP ZDV 47% Guay LA, Musoke P, Fleming T et al Lancet 199;354:
51 NVP % 46% K103 Y181C Eshelman S, et al Abstract th CROI Feb 4-8, Chicago
52 PACTG NVP 200 mg mg/kg HIV 41% 3 28% ZDV + 3TC 21-24% ZDV 2% NVP
53 PACTG 316 HIV (1.5%) HIV (50% ) Dorenbaum A, et al Abstract LB7. 8th CROI Feb 4-8, Chicago
54 PACTG 316 NVP ZDV 23% ZDV + 3TC 28% PI 41% Dorenbaum A, et al Abstract LB7. 8th CROI Feb 4-8, Chicago
55 HIV ( )
56 (< 2 ) CD4 < 200 ( ) John GC et al. JID 2001: 183:
57 ( 2 ) HIV RNA > 43,000 John GC et al. JID 2001: 183:
58 15 (5 1 ) 8,533 HIV 4,675 ZDV 7,840 The International Perinatal HIV group.nejm 1999: 340:977-87
59 HIV
60 HIV
61 HIV -AETC NRC
10 2 2 10 6.5 78 1 65 / 30 / - 2 -
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CDC MMWR Recommendations and Reports September 30, 2005 / Vol 54 / No. RR-9 Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure
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