Incidence and prevalence of human immunodeficiency virus infection in a prenatal population undergoing routine voluntary human immunodeficiency virus screening, July 1987 to June 1990

Article Abstract:

To learn more about the incidence of infection with human immunodeficiency virus (HIV) among women seeking prenatal care, and about the relationship between infection rates and risk behavior, a study was conducted involving 22,364 patients who registered for care at one institution in Atlanta, Georgia over a three-year period. This number represented those who consented to be tested for HIV antibody out of a larger group of 23,432 women who received prenatal care (a 95 percent acceptance rate). In two of the study years, patients received counseling concerning HIV before testing. Patients completed questionnaires designed to assess their level of risk for infection before testing and afterwards if the results were positive. Results showed that 113 women tested positive, for a prevalence of 5 per 1,000. The yearly cumulative incidence of infection was 3.5 per 1,000 in 1987 and 1988, and 5.3 per 1,000 in 1989 and 1990. All infections, with one exception, were asymptomatic. While seronegative and seropositive women were similar with respect to race, marital status, and educational level, the age distribution of the two groups differed. A greater proportion of women aged 21 to 25 were seropositive compared with other age groups. Self-reported risk behavior increased from 1987 to 1990 (9.4 percent in the earlier years, 15.2 percent in the later years). An increase in the use of 'crack' cocaine was noted during the study period. Ten of the 57 seropositive women whose pregnancies were eligible for abortion elected to undergo that procedure. The rate of HIV infection in this group is more than three times higher than the estimates provided by the Centers for Disease Control. The increase in incidence appears related to the reported increase in risk behavior. Almost three fourths of the seropositive women had reported that they were not at risk, which casts doubt on the value of targeted screening programs. Other research has shown a poor correlation between infection status and targeted screening. The results also indicate that most infected women will not select abortion to prevent transmission of the infection to their infants. (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects, HIV infection, HIV infections, Georgia, HIV seroprevalence

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Cost-effectiveness of prenatal testing for Chlamydia trachomatis

Article Abstract:

The cost-effectiveness of programs to screen pregnant women for infection with Chlamydia trachomatis was assessed. This microorganism is more similar to bacteria than viruses and can cause various diseases, including serious infections in the newborn and genital infections, which may result in infertility in men and women. Screening for C. trachomatis would be cost-effective only under certain conditions. Testing for antigen, an element of the microorganism that can provoke an immune response, would be cost-effective if the price of the test was less than $6.30 or the prevalence (number of cases) of the disease in a given population was more than six percent. However, direct antigen testing is only predictive in 51 percent of cases. Culturing, or attempts to grow C. trachomatis, would only be cost-effective if the disease prevalence was more than 14.8 percent. If the cost of the direct antigen test was less than $3.90 or the disease prevalence more than 8.7 percent, direct antigen testing confirmed by culturing would be cost-effective. If direct antigen testing cost $8.00 per test and culturing cost $25.00, the additional costs of screening all pregnant women by direct antigen testing, confirmed by culturing would be $2.09 per woman. These findings suggest that screening all pregnant women for C. trachomatis is not cost-effective, but additional costs would be modest if direct antigen testing was implemented. (Consumer Summary produced by Reliance Medical Information, Inc.)

Sexually transmitted diseases, Finance, Diagnosis, Sexually transmitted disease diagnosis, Medical screening, Health screening, Chlamydia trachomatis

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Successful pregnancy in association with Zollinger-Ellison syndrome

Article Abstract:

Chronic and severe vomiting during pregnancy may be a symptom of disease such as the Zollinger-Ellison syndrome. The case of a woman who was diagnosed with Zollinger-Ellison syndrome in her third pregnancy is discussed. Zollinger-Ellison syndrome is caused by the development of non-beta-cell islet cell tumors in the pancreas, duodenum, or stomach. The tumors produce gastric acid that causes severe ulceration, vomiting, and diarrhea. The woman experienced chronic vomiting and stomach pain in her first pregnancy and was treated with ranitidine and antacids. Two years later, during her second pregnancy, she was found to have several ulcers and high gastrin levels. After the birth of her third healthy child, the woman was found to have an inoperable tumor of the pancreas and liver. She is well and is being treated with omeprazole.

Case studies, Zollinger-Ellison syndrome

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