Biomedical subjects

Steven Nesheim

Publications and source records attributed to Steven Nesheim.

5 recordsLinked to original sources

PubMed2006

Dyslipidemia among perinatally HIV-infected children enrolled in the PACTS-HOPE cohort, 1999-2004: a longitudinal analysis.

BACKGROUND: Protease inhibitor (PI)-containing regimens have led to improved survival among HIV-infected children. However, adverse effects, including dyslipidemia, may put children at risk for cardiovascular disease. METHODS: Serum cholesterol and triglyceride levels were recorded on perinatally HIV-infected children participating in the PACTS-HOPE cohort (1999-2004). Hypercholesterolemia (HC) was defined as cholesterol > or =200 mg/dL and hypertriglyceridemia (HT) as triglycerides >or =150 mg/dL. HC and HT were modeled over time using generalized estimating equations. RESULTS: For 178 children, 47% met criteria for HC and 67% for HT at least once during the study period. In generalized estimating equation models, PI use, undetectable viral load, and immunologic category 3 were independent predictors of HC. HT was significantly associated with PI use and body mass index (BMI) > or =90th percentile for age and gender. Among children on PI-containing regimens, HC was significantly associated with multiple PIs and undetectable viral load; HT was predicted by body mass index > or =90th percentile and ritonavir use. The prevalence of clinical lipodystrophy was 5.6% (10/178). CONCLUSIONS: Children on PI-containing regimens have a higher risk of both HC and HT. Lipid levels should be measured regularly in children on antiretroviral treatment. Interventions such as diet, exercise, or lipid-lowering drug therapy may benefit some children.

Adolescent↗

PubMed2005

Temporal trends in HIV Type 1 incidence among inner-city childbearing women in Atlanta: use of the IgG-capture BED-enzyme immunoassay.

Recently, we developed an immunoglobulin G (IgG)-capture BED-enzyme immunoassay (BED-CEIA) to identify recent HIV-1 infections. We estimated HIV-1 incidence among inner-city pregnant women in Atlanta, Georgia (1991-1998) using this assay. The annual cumulative incidence was estimated at 2.4/1000 (95% CI = 2.0-2.9). Incidence declined from 3.1/1000 in 1991-1994 to 1.4/1000 in 1995-1998 (risk ratio = 2.3, 95% CI = 1.5-3.4). Women with recent HIV-1 infection more often reported a previous negative antibody test (p = 0.018) and sexual relations with men other than the father during the past year (p = 0.046). Fewer seroconverters in 1995-1998 used crack cocaine than in the earlier time period. A high but declining HIV-1 incidence was found among inner-city pregnant women in Atlanta.

Adolescent↗

PubMed2004

Rapid HIV-1 testing during labor: a multicenter study.

CONTEXT: Timely testing of women in labor with undocumented human immunodeficiency virus (HIV) status could enable immediate provision of antiretroviral prophylaxis. OBJECTIVES: To determine the feasibility and acceptance of rapid HIV testing among women in labor and to assess rapid HIV assay performance. DESIGN, SETTING, AND PATIENTS: The Mother-Infant Rapid Intervention At Delivery (MIRIAD) study implemented 24-hour counseling and voluntary rapid HIV testing for women in labor at 16 US hospitals from November 16, 2001, through November 15, 2003. A rapid HIV-1 antibody test for whole blood was used. MAIN OUTCOME MEASURES: Acceptance of HIV testing; sensitivity, specificity, and predictive value of the rapid test; time from blood collection to patient notification of results. RESULTS: There were 91,707 visits to the labor and delivery units in the study, 7381 of which were by eligible women without documentation of HIV testing. Of these, 5744 (78%) women were approached for rapid HIV testing and 4849 (84%) consented. HIV-1 test results were positive for 34 women (prevalence = 7/1000). Sensitivity and specificity of the rapid test were 100% and 99.9%, respectively; positive predictive value was 90% compared with 76% for enzyme immunoassay (EIA). Factors independently associated with higher test acceptance included younger age, being black or Hispanic, gestational age less than 32 weeks, and having had no prenatal care. Lower acceptance was associated with being admitted between 4 pm and midnight, particularly on Friday nights, but this may be explained in part by fewer available personnel. Median time from blood collection to patient notification of result was 66 minutes (interquartile range, 45-120 minutes), compared with 28 hours for EIA (P<.001). CONCLUSIONS: Rapid HIV testing is feasible and delivers accurate and timely test results for women in labor. It provides HIV-positive women prompt access to intrapartum and neonatal antiretroviral prophylaxis, proven to reduce perinatal HIV transmission, and may be particularly applicable to higher-risk populations.

AIDS Serodiagnosis↗

PubMed2003

Quantitative RNA testing for diagnosis of HIV-infected infants.

Quantitative HIV RNA testing was used for diagnosis in 156 HIV-exposed non-breast-fed infants at less than 6 months of age (54 infected, 102 uninfected) enrolled in the Perinatal AIDS Collaborative Transmission Study. Sensitivity was 29% in the first week, 79% at 8 to 28 days of age, and >90% at 29 days of age and thereafter; specificity was 100% in all periods, except at 29 to 60 days of age, when specificity was 93%. Neither sensitivity nor specificity was significantly affected by maternal or infant zidovudine (ZDV) treatment, even though infant viral loads were lower during the first 6 weeks in infants who received perinatal ZDV prophylaxis ( p=.005). Paired analysis of DNA and RNA measurements revealed no advantage for either test. Quantitative RNA testing can be used for diagnosis in HIV-exposed infants, recognizing the chance for a false-positive test result. It may be most useful as a confirmatory test in infants with another positive diagnostic test result.

Anti-HIV Agents↗

PubMed2003

The challenges of informed consent for rapid HIV testing in labor.

BACKGROUND: Although increasing attention has been focused on the adequacy of the informed consent process for participation in research studies, there has been little systematic evaluation of the process, particularly when consent is obtained in the labor and delivery setting. The Mother Infant Rapid Intervention at Delivery (MIRIAD) study is an ongoing multisite study initiated by the Centers for Disease Control and Prevention (CDC) designed to evaluate the feasibility of offering 24-hour counseling and voluntary rapid HIV testing and antriretroviral therapy when indicated to women with unknown HIV status who are in labor. METHODS: To address concerns about obtaining informed consent from women in labor, we have completed focus groups, conducted a pilot of the informed consent process among women in labor, developed flip-charts to enhance comprehension, and plan an ongoing evaluation of the informed consent process throughout the course of the MIRIAD study. RESULTS: In the pilot study, approximately 70% of women were able to state in their own words the purpose and benefits of the research study. Substantially fewer women (25%) were able to state one or more risks of the study. CONCLUSIONS: We hope that the MIRIAD study will make a valuable contribution by defining best approaches for informed consent and will provide guidance when it is necessary to obtain consent from laboring women for crucial interventions.

AIDS Serodiagnosis↗