Horizontal HIV transmission to children of HIV-uninfected mothers: A case series and review of the global literature

Trends of HIV/AIDS in Pregnant Women Presenting to a Tertiary Care Setting

INTRODUCTION

According to WHO, there are around 35 million adults living with HIV/AIDs worldwide. Of these, around 1.5 million are pregnant women. There is a high risk of vertical transmission of HIV infection. Preventing mother-to-child transmission of HIV infection is one of the foremost challenges in public health. This study was done to assess the rate of vertical transmission of HIV infection in pregnant women presenting to a tertiary care setting.  Methods: A retrospective analysis of 15 years of hospital data from 2008 to 2022 was conducted in the Mother and Child Health Care (MCH) Center, Pakistan Institute of Health Sciences, Islamabad. The demographic, clinical, and delivery outcomes of the mother were retrieved from hospital records. Data was analyzed in SPSS software, version 22.0 (IBM Corp., Armonk, NY).  Results: A total of 197 pregnant women with HIV/AIDS presented in 15 years. The mean age was 29.5 ± 6.4 years, and the majority was between 21 and 30 years 114 (57.6%). When HIV RNA load was assessed in study women, it was witnessed that 67 (34.1%) had undetectable load while 130 (65.8%) had detectable viral load. A significant linear trend of increase in rates of women with HIV in pregnancy was noted from 2008 (3.0%) to 2022 (15.7%). Vertical transmission of HIV was found in two (1.0%) of study cases.  Conclusion: The linear trend of increase in HIV in pregnancy was noted. The rate of vertical transmission was found to be 1%. It proves the role of Highly Active Antiretroviral Therapy (HAART) therapy in reducing the risk of HIV transmission from mothers to babies.

Preventing perinatal HIV acquisition; current gaps and future perspectives

PURPOSE OF REVIEW

Although current treatment could eradicate vertical transmission, in 2022, 130 000 infants acquired HIV globally. HIV suppression with antiretroviral therapy (ART) transforms survival for people living with HIV (PLWH), and prevents transmission, including vertical. International guidelines recommend lifelong ART for PLWH, consequently perinatal HIV acquisition reflects implementation gaps in the HIV care cascade. We summarize these gaps, exploring potential novel approaches and therapeutic innovations towards eliminating vertical HIV transmission.

RECENT FINDINGS

Multifactorial challenges continue to underpin gaps in the HIV care cascade, including accessibility, availability and sustainability of HIV testing, prevention and treatment, alongside stigma, gender-based violence and poverty. Long-acting ART may be important in preventing perinatal HIV acquisition, with early data demonstrating tolerability and efficacy of injectable ART throughout pregnancy, both as HIV treatment and prevention. Carefully selected long-acting broadly neutralizing antibodies (bNAbs) matching circulating, exposing viral envelope sequences have demonstrated safety, clinical trials are ongoing to demonstrate efficacy.

SUMMARY

Emerging clinical studies should prioritize pregnant/lactating people and infants to ensure such therapies are well tolerated and efficacious. Alongside therapeutic innovation, programmatic strategies must address social and economic challenges, ensuring sustainable HIV treatment/prevention programmes and facilitating global elimination of blood-borne viruses.

Unveiling the enigmatic roles of basophils in HIV infection: A narrative review

The intricate interplay between the human immunodeficiency virus (HIV) and the immune system has long been a focal point in understanding disease progression. Among the myriad of immune cells, basophils, often overshadowed, have recently emerged as pivotal contributors to the complex immunological landscape of HIV infection. This paper aims to provide a succinct overview of the enigmatic roles of basophils in HIV pathogenesis, elucidating their multifaceted functions and implications. Basophils, conventionally perceived as minor players in immune responses, exhibit active participation in HIV infection. Their activation triggered by viral antigens, cytokines, and immune complexes orchestrates a cascade of immune events, influencing immune modulation, cytokine release, and the activation of adaptive immune cells. Furthermore, basophils function as antigen-presenting cells, potentially impacting viral dissemination and immune dysregulation. Additionally, basophils serve as crucial regulators in HIV infection through cytokine secretion, notably interleukin (IL)-4, IL-13, and IL-3, influencing immune cell differentiation, polarization, and antibody production. Their interactions with various immune cells intricately shape the immune response against HIV, impacting disease progression and immune equilibrium. Moreover, harnessing basophils as potential vaccine targets or immune modulators represents a compelling avenue for future research. In conclusion, the emerging understanding of basophils' multifaceted involvement in HIV infection challenges prior perceptions and underscores their significance in shaping immune responses and disease outcomes. This abstraction highlights the need for continued research to unlock the full potential of basophils, paving the way for novel strategies in combatting HIV/AIDS.

Challenges in status disclosure and adherence to antiretroviral therapy in children living with HIV: An observational study

Background and Objectives

The advent of highly active antiretroviral therapy has increased the longevity in children living with HIV (CLHIV), which has brought forth new concerns related to status disclosure and adherence to treatment. Information regarding this is limited in Punjab; hence, this study was done to find the relation of disclosure with sociodemographic factors and the problems faced in adhering to antiretroviral therapy (ART) in this region.

Materials and Methods

An observational cross-sectional study was conducted on CLHIVs aged 18 months to 15 years visiting the ART center of a tertiary hospital from June to December 2021. Willing caregivers were approached with semistructured validated pretested questionnaire developed for the study.

Results

Ninety-eight caregivers of CLHIV were interviewed and 25% were found to be aware of their serostatus. Children between 5 and 12 years comprised the largest group (57%) and this was also the statistically significant age group in whom the status was not disclosed. Disclosure was more in children having single parents. The low economic status, rural background, and low education status of the caregivers were inversely related to disclosure. Sixty-five percent of the caregivers believed that the appropriate age for status disclosure should be 14-18 years. Adherence was optimal in 85% CLHIVs and distance was the foremost challenge.

Conclusion

The mean age for disclosure was found to be higher than the World Health Organization guidelines in this study; hence, there is a need to encourage caregivers for timely and systematic disclosure and motivate them for maintaining optimal adherence in CLHIV which is important for the success of ART program.

'I feel that I should decide on my own….': who should be involved in the decision-making process for adolescent involvement in HIV research?

INTRODUCTION

Efforts to improve health outcomes among adolescents and young adults living with HIV (ALHs) are hampered by limited adolescent engagement in HIV-related research. We sought to understand the views of adolescents, caregivers and healthcare workers (HCWs) about who should make decisions regarding ALHs' research participation.

METHODS

We conducted focus group discussions (FGDs) and in-depth interviews (IDIs) with ALHs (aged 14-24 years), caregivers of ALHs and HCWs from six HIV care clinics in Western Kenya. We used semi-structured guides to explore ALHs' involvement in research decisions. Transcripts were analysed using thematic analysis; perspectives were triangulated between groups.

RESULTS

We conducted 24 FGDs and 44 IDIs: 12 FGDs with ALHs, 12 with caregivers, and 44 IDIs with HCWs, involving 216 participants. HCWs often suggested that HIV research decision-making should involve caregivers and ALHs deciding together. In contrast, ALHs and parents generally thought decisions should be made individually, whether by HCWs/research teams (although this is likely ethically problematic), adolescents or caregivers. Caregiver and ALH preferences depended on ALHs' age, with younger ALHs requiring more support. A few caregivers felt that ALHs should consult with the research team/HCWs due to their greater knowledge of clinical care. ALHs emphasised that they should independently decide because they thought they had the right to do so and the capacity to consent. Poor communication and parental non-disclosure of HIV status influenced ALHs' views to exclude caregivers from decision-making. Regarding influences on research decision-making, ALHs were more willing to participate based on perceived contribution to science and less interested in participating in studies with potential risks, including loss of confidentiality.

DISCUSSION

While research teams and HCWs felt that adolescents and caregivers should jointly make research decisions, ALHs and caregivers generally felt individuals should make decisions. As ALHs sometimes find caregiver support lacking, improving family dynamics might enhance research engagement.

Mechanical transmission of dengue virus by Aedes aegypti may influence disease transmission dynamics during outbreaks

BACKGROUND

Dengue virus outbreaks are increasing in number and severity worldwide. Viral transmission is assumed to require a minimum time period of viral replication within the mosquito midgut. It is unknown if alternative transmission periods not requiring replication are possible.

METHODS

We used a mouse model of dengue virus transmission to investigate the potential of mechanical transmission of dengue virus. We investigated minimal viral titres necessary for development of symptoms in bitten mice and used resulting parameters to inform a new model of dengue virus transmission within a susceptible population.

FINDINGS

Naïve mice bitten by mosquitoes immediately after they took partial blood meals from dengue infected mice showed symptoms of dengue virus, followed by mortality. Incorporation of mechanical transmission into mathematical models of dengue virus transmission suggest that this supplemental transmission route could result in larger outbreaks which peak sooner.

INTERPRETATION

The potential of dengue transmission routes independent of midgut viral replication has implications for vector control strategies that target mosquito lifespan and suggest the possibility of similar mechanical transmission routes in other disease-carrying mosquitoes.

FUNDING

This study was funded by grants from the National Health Research Institutes, Taiwan (04D2-MMMOST02), the Human Frontier Science Program (RGP0033/2021), the National Institutes of Health (1R01AI143698-01A1, R01AI151004 and DP2AI152071) and the Ministry of Science and Technology, Taiwan (MOST104-2321-B-400-016).

Standardized Definitions of In Utero Human Immunodeficiency Virus and Antiretroviral Drug Exposure Among Children

In countries with high human immunodeficiency virus (HIV) prevalence, up to 30% of pregnant women are living with HIV, with fetal exposure to both HIV and antiretroviral therapy during pregnancy. In addition, pregnant women without HIV but at high risk of HIV acquisition are increasingly receiving HIV preexposure antiretroviral prophylaxis (PrEP). Investments are being made to establish and follow cohorts of children to evaluate the long-term effects of in utero HIV and antiretroviral exposure. Agreement on a key set of definitions for relevant exposures and outcomes is important both for interpreting individual study results and for comparisons across cohorts. Harmonized definitions of in utero HIV and antiretroviral drug (maternal treatment or PrEP) exposure will also facilitate improved classification of these exposures in future observational studies and clinical trials. The proposed definitions offer a uniform approach to facilitate the consistent description and estimation of effects of HIV and antiretroviral exposures on key child health outcomes.

Characterization of HIV-1 Epidemic in Kyrgyzstan

Kyrgyzstan has one of the highest rates of HIV-1 spread in Central Asia. In this study, we used molecular–epidemiological approaches to examine the HIV-1 epidemic in Kyrgyzstan. Samples were obtained from HIV-positive individuals who visited HIV/AIDS clinics. Partial pol gene sequences were used to identify HIV-1 subtypes and drug resistance mutations (DRMs) and to perform phylogenetic analysis. Genetic diversity and history reconstruction of the major HIV-1 subtypes were explored using BEAST. This study includes an analysis of 555 HIV-positive individuals. The study population was equally represented by men and women aged 1–72 years. Heterosexual transmission was the most frequent, followed by nosocomial infection. Men were more likely to acquire HIV-1 during injection drug use and while getting clinical services, while women were more likely to be infected through sexual contacts (p < 0.01). Heterosexual transmission was the more prevalent among individuals 25–49 years old; individuals over 49 years old were more likely to be persons who inject drugs (PWID). The major HIV-1 variants were CRF02_AG, CRF63_02A, and sub-subtype A6. Major DRMs were detected in 26.9% of the study individuals; 62.2% of those had DRMs to at least two antiretroviral (ARV) drug classes. Phylogenetic analysis revealed a well-defined structure of CRF02_AG, indicating locally evolving sub-epidemics. The lack of well-defined phylogenetic structure was observed for sub-subtype A6. The estimated origin date of CRF02_AG was January 1997; CRF63_02A, April 2004; and A6, June 1995. A rapid evolutionary dynamic of CRF02_AG and A6 among Kyrgyz population since the mid-1990s was observed. We observed the high levels of HIV-1 genetic diversity and drug resistance in the study population. Complex patterns of HIV-1 phylogenetics in Kyrgyzstan were found. This study highlights the importance of molecular–epidemiological analysis for HIV-1 surveillance and treatment implementation to reduce new HIV-1 infections.

HIV-1 Persistence in Children during Suppressive ART

There is a growing number of perinatally HIV-1-infected children worldwide who must maintain life-long ART. In early life, HIV-1 infection is established in an immunologically inexperienced environment in which maternal ART and immune dynamics during pregnancy play a role in reservoir establishment. Children that initiated early antiretroviral therapy (ART) and maintained long-term suppression of viremia have smaller and less diverse HIV reservoirs than adults, although their proviral landscape during ART is reported to be similar to that of adults. The ability of these early infected cells to persist long-term through clonal expansion poses a major barrier to finding a cure. Furthermore, the effects of life-long HIV persistence and ART are yet to be understood, but growing evidence suggests that these individuals are at an increased risk for developing non-AIDS-related comorbidities, which underscores the need for an HIV cure.

Central role of the placenta during viral infection: Immuno-competences and miRNA defensive responses

Pregnancy is a unique immunological condition in which an "immune-diplomatic" dialogue between trophoblasts and maternal immune cells is established to protect the fetus from rejection, to create a privileged environment in the uterus and to simultaneously be alert to any infectious challenge. The maternal-placental-fetal interface (MPFI) performs an essential role in this immunological defense. In this review, we will address the MPFI as an active immuno-mechanical barrier that protects against viral infections. We will describe the main viral infections affecting the placenta and trophoblasts and present their structure, mechanisms of immunocompetence and defensive responses to viral infections in pregnancy. In particular, we will analyze infection routes in the placenta and trophoblasts and the maternal-fetal outcomes in both. Finally, we will focus on the cellular targets of the antiviral microRNAs from the C19MC cluster, and their effects at both the intra- and extracellular level.