CLINICAL OUTCOMES OF CHILDREN BORN TO HIV INFECTED WOMEN

艾滋病毒感染妇女所生子女的临床结果

基本信息

批准号：
6322362
负责人：
BARBARA Jean TURNER
金额：
$ 3.46万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
1992
资助国家：
美国
起止时间：
1992-09-29 至 2001-02-28
项目状态：
已结题

项目摘要

One of the greatest achievements to date in efforts to arrest the HIV epidemic was the dramatic success of the 076 clinical trial of antenatal and peripartum zidovudine (AZT) with brief AZT treatment of the child after, birth in reducing maternal-child HIV transmission (MCT). If used widely in clinical practice, this therapeutic intervention may greatly diminish the HIV epidemic among children, as most are infected by MCT. Yet our current NIDA-funded study of the influence of HIV-infected women's prenatal care and illicit drug use on the clinical outcomes of their children raises serious concerns about translating the 076 trial advance into clinical practice. Of 2,254 New York State (NYS) Medicaid-enrolled, HIV-infected women delivering singletons from 1985-90), 65% had too few prenatal visits according to an index adjusting for length of gestation. Untreated illicit drug user's had 60% higher odds of inadequate prenatal care than methadone-treated women. In this cohort, adequate prenatal care was associated with 50% lower odds of having a low birth weight infant. Our data also indicate that women using illicit drugs during pregnancy were more likely to have several characteristics such as advanced HIV- infection and smoking that we found to be associated with an increased risk of Ma. Unfortunately, drug users were under-represented in the 076 trials so the benefits and use of this potentially toxic therapy in this population remains an important question. In this continuation project, we propose to study prenatal care and birth outcomes for approximately 1700 NYS Medicaid-enrolled, HIV-infected parturient women in federal fiscal years (FFY) 1994-96 and to examine predictors of MCT for approximately 1100 of their infants delivered by mid-1996 and followed through FFY 1997. Data sources for this cohort include Medicaid claims-based research files and vital statistics records. As in our current project, we will conduct similar analyses in approximately 240 HIV-infected women and their children who are prospectively-followed at New York University (NYU), Bellevue Medical Center. Our research aims are: 1) To evaluate the impact of Medicaid initiatives to improve prenatal and HIV-related care on adequacy of prenatal care and birth outcomes among HIV-infected, drug-using women. 2) To assess the association of factors identified in aim #1 with receipt of antenatal AZT therapy. 3) To examine the effect of AZT on the risk of HIV infection among offspring of drug-using women. 4) To repeat aim #3 in the NYU/Bellevue cohort, supplementing these analyses with interview data regarding illicit drug use and maternal clinical and immune status factors not available for NYS Medicaid population. 5) To identify major birth defects among offspring of the NYS Medicaid cohort and to evaluate differences in rates of defects by maternal illicit drug use. This study unites the power of population-based research using Medicaid data with the specificity of analyses on a prospectively-followed cohort to extend our understanding of the use of attenuated AZT by women with a history of illicit drug use and the impact of AZT on transmission in actual clinical practice.

迄今为止为逮捕艾滋病毒而做出的最大成就之一流行病是产前076临床试验的巨大成功和Peripartum Zidovudine（AZT）对儿童进行了短暂的AZT治疗在减少母子HIV传播（MCT）的出生之后。如果使用在临床实践中，这种治疗性干预可能很大减少儿童的艾滋病毒流行，因为大多数人都被MCT感染。然而，我们目前关于NIDA资助的HIV感染妇女影响的研究产前护理和非法药物在其临床结果上使用孩子们对翻译076试验的严重担忧进入临床实践。纽约州（NYS）医疗补助注册的2,254个从1985 - 90年开始，艾滋病毒感染的妇女运送单例），有65％的人很少根据调整妊娠长度的索引，产前访问。未经治疗的非法吸毒者的产前几率不足60％比美沙酮治疗的妇女的护理。在这个队列中，足够的产前护理与低出生体重婴儿的几率低50％有关。我们的数据还表明，怀孕期间使用非法药物的妇女更有可能具有多种特征，例如晚期HIV- 我们发现与增加有关的感染和吸烟 MA的风险。不幸的是，吸毒者在076中的人数不足试验，因此这种潜在有毒疗法的好处和使用人口仍然是一个重要的问题。在这个延续项目中，我们建议研究产前护理和出生大约1700个纽约州医疗补助注册的艾滋病毒感染的结果 1994 - 96年联邦财政年度（FFY）的分离妇女 MCT的预测因子大约有1100名婴儿 1996年中，随后进行了1997年的FFY。该队列的数据源包括基于医疗补助索赔的研究文件和重要统计记录。与当前项目一样，我们将在大约有240名HIV感染的妇女及其子女 Bellevue Medical的纽约大学（纽约大学）中心。我们的研究目的是： 1）评估医疗补助计划的影响，以改善产前和艾滋病毒相关的护理对产前护理和出生结果的充分性感染了艾滋病毒，吸毒的妇女。 2）评估AIM＃1与收据中确定的因素的关联产前AZT治疗。 3）检查AZT对艾滋病毒感染风险的影响毒品妇女的后代。 4）在纽约州/贝尔维尤队列中重复目标3，补充这些分析有关非法药物使用和孕产妇的访谈数据的分析 NYS Medicaid不可用的临床和免疫状况因素人口。 5）确定纽约州医疗补助的后代之间的主要出生缺陷群体并评估孕产妇非法缺陷率的差异吸毒。这项研究结合了使用医疗补助的基于人群的研究的力量具有分析的特异性数据为了扩展我们对使用AZT的使用AZT的理解非法吸毒的历史以及AZT对传播的影响实际的临床实践。