Prevention of mother-to-child transmission of HIV in Denmark, 1994-2008

OBJECTIVES

The aim of this study was to describe trends in the management of pregnancies in HIV-infected women and their outcomes over a 14-year period in Denmark on a national basis.

METHODS

The study was a retrospective cohort study of all HIV-infected women in Denmark giving birth to one or more children between 1 June 1994 and 30 June 2008.

RESULTS

We identified 210 HIV-infected women with 255 pregnancies, ranging from 7 per year in 1995 to 39 per year in 2006. Thirty per cent of the women were Caucasian and 51% were Black African. Knowledge of HIV status before pregnancy increased from 8% (four of 49) in 1994-1999 to 80% (164 of 206) in 2000-2008. Only 29% (53 of 183) of the women chose to consult an infectious disease specialist when planning pregnancy, while 14% (27 of 199) received assistance with fertility. The proportion of women on antiretroviral therapy (ART) increased from 76% (37 of 49) in 1994-1999 to 98% (201 of 206) in 2000-2008. Vaginal deliveries ranged from 0 in 2003 to 35% of pregnancies in 2007. Mother-to-child transmission (MTCT) of HIV decreased from 10.4% in 1994-1999 to 0.5% in 2000-2008. All women giving birth to an HIV-positive child were diagnosed with HIV during or after delivery and did not receive prophylactic ART.

CONCLUSIONS

The annual number of HIV pregnancies increased fivefold during this 14-year period and substantial changes in pregnancy management were seen. No woman treated according to the national guidelines, i.e. ART before week 22, intravenous zidovudine (ZDV) during labour, neonatal ZDV for 4 to 6 weeks and no breastfeeding, transmitted HIV to her child.

[Atopy among children and adolescents in Copenhagen]

INTRODUCTION

Atopy is related to the presence of rhinitis and asthma, but our knowledge about its longitudinal predictors is limited.

METHODS

Data from a 6-yr follow-up study of a population sample of children and adolescents (n = 408), aged 7 to 17 yr. at enrollment, were analysed to investigate the prevalence and predictors of atopy. Case history, including allergic diseases and smoking habits, was elicited by interview and questionnaire. Skin prick test reactivity to common allergens, total serum IgE, airway responsiveness, and pulmonary function were measured.

RESULTS

The point prevalence of atopy increased from the first to the second survey, 26% and 44%, respectively; 23% of the participants were atopic only at the second survey. Sensitisation to house dust mites (HDM), grass, dogs, cats, and birch pollen increased significantly in both the males and the females. However, no gender differences in the prevalence of positive reactions were found at the first survey, whereas atopy to grass and HDM was significantly more prevalent in males than in females at the second survey. Analysis of the data solely on participants who were non-atopic at the first survey showed that exposure to maternal smoking (OR 2.0, CI 1.3-3.1; p = 0.002), increased serum IgE (OR 1.7, CI 1.2-2.3; p = 0.001), new asthma (OR 1.6, CI 1.2-2.7; p = 0.03), and new rhinitis (OR 2.1, CI 1.2-3.6; p = 0.01) were associated with an increased risk of a positive skin prick test at the second survey.

CONCLUSION

This longitudinal population study showed an increase in the point prevalence of atopy in Danish children and adolescents; and, furthermore, that exposure to maternal smoking during childhood, increased serum IgE, and new symptoms of asthma or rhinitis were associated with an increased risk of developing sensitisation to common aeroallergens in late adolescence.

Prevalence and predictors of rhinitis in Danish children and adolescents

BACKGROUND

The prevalence of self-reported symptoms of allergic rhinitis is increasing in many countries, but the reasons for this trend are not well understood. Data from a 6-year follow-up study of a population sample of children and adolescents (n=408), aged 7-17 years at enrolment in 1986, were analyzed to investigate the prevalence and predictors of self-reported rhinitis.

METHODS

Case history was used to assess the presence or absence of rhinitis (sneezing and running or blocked nose not associated with a cold), asthma, and eczema. Pulmonary function, skin prick test reactivity, and airway responsiveness to histamine were measured in all participants; a screening test for IgE antibodies to common allergens (Magic Lite SQ, Allergy Screen, ALK, Denmark) was performed in 237 (58%) of the participants.

RESULTS

The point prevalence of rhinitis increased from the first to the second survey, 14% and 22%, respectively; 54 (13%) of the subjects reported rhinitis only at the second survey (new rhinitis). Confining the analysis to participants without symptoms of rhinitis at the first survey showed that self-reported eczema (relative risk [RR] 2.3, 95% confidence interval [CI] 1.2-4.7), airway hyperresponsiveness (RR 2.5, CI 1.8-3.0), atopy to grass pollen (RR 2.6, CI 1.7-3.3), atopy to dog dander (RR 2.4, CI 1.6-3.3), and atopy to house-dust mite (RR 2.7, CI 1.4-5.2) at the first survey predicted an increased risk of the presence of rhinitis at the second survey. A positive Allergy Screen test at enrollment was associated with an increased risk of self-reported rhinitis at follow-up (RR 2.4, CI 1.4-3.4).

CONCLUSIONS

This longitudinal population study of children and adolescents showed an age-related increase in the point prevalence of self-reported rhinitis; furthermore, sensitization to common aeroallergens, airway hyperresponsiveness, and the presence of self-reported eczema were significantly associated with an increased risk of subsequent development of rhinitis.