Abstract in English:This report is based on the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, which was recently issued by the National Institutes of Health of the United States of America. Also known as the Adult Treatment Panel (ATP) III, this new report updates two earlier such reports on high cholesterol. While continuing to concentrate on treating patients with coronary heart disease, the new report advocates more intensive treatment in order to reduce low-density lipoprotein (LDL) cholesterol in specific groups of individuals, pays special attention to primary prevention among patients with multiple risk factors, and recognizes as a secondary prevention concern a cluster of heart disease risk factors known as "the metabolic syndrome." Other issues that the ATP III report covers include therapeutic lifestyle changes to reduce LDL, LDL-lowering drug therapy, and the management of specific dyslipidemias.
Abstract in English:In February 1994, a clinical trial by the Pediatrics AIDS Clinical Trials Group (PACTG 076) demonstrated, for the first time, that it was possible to reduce the risk of vertical transmission of human immunodeficiency virus type 1 (HIV-1) by nearly 70% by means of a triple therapeutic regimen: 1) oral zidovudine (ZDV) beginning anytime between the 14th and 34th week of gestation until the end of pregnancy; 2) intravenous ZDV during pregnancy, and 3) administration of oral ZDV to neonates during the first 6 weeks of life. Later, epidemiologic studies performed in the United States of America and France showed that this regimen drastically reduced perinatal transmission in clinical practice. Since then, important strides have been made, not only in terms of treatment (new drugs and highly effective therapeutic regimens) and diagnosis (tests that can measure the viral load), but also in terms of an increased understanding of the pathogenesis of perinatal transmission of HIV-1. This report contains: a) a review of special considerations to be kept in mind when administering antiretroviral agents to pregnant women; b) a current overview of the results of clinical and epidemiologic trials dealing with the prevention of perinatal transmission of HIV-1; c) a look at the use of tests for measuring HIV-1 RNA (viral load) during pregnancy; d) the most recent recommendations on the use of antiretroviral chemoprophylaxis and elective cesarean section for reducing perinatal viral transmission. These recommendations apply to the United States, and other countries may prefer to use different approaches.