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Cardenas MC, Farnan S, Hamel BL, Mejia Plazas MC, Sintim-Aboagye E, Littlefield DR, Behl S, Punia S, Enninga EAL, Johnson E, Temesgen Z, Theiler R, Gray CM, Chakraborty R. Prevention of the Vertical Transmission of HIV; A Recap of the Journey so Far. Viruses 2023; 15:v15040849. [PMID: 37112830 PMCID: PMC10142818 DOI: 10.3390/v15040849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
In 1989, one in four (25%) infants born to women living with HIV were infected; by the age of 2 years, there was 25% mortality among them due to HIV. These and other pieces of data prompted the development of interventions to offset vertical transmission, including the landmark Pediatric AIDS Clinical Trial Group Study (PACTG 076) in 1994. This study reported a 67.5% reduction in perinatal HIV transmission with prophylactic antenatal, intrapartum, and postnatal zidovudine. Numerous studies since then have provided compelling evidence to further optimize interventions, such that annual transmission rates of 0% are now reported by many health departments in the US and elimination has been validated in several countries around the world. Despite this success, the elimination of HIV’s vertical transmission on the global scale remains a work in progress, limited by socioeconomic factors such as the prohibitive cost of antiretrovirals. Here, we review some of the key trials underpinning the development of guidelines in the US as well as globally, and discuss the evidence through a historic lens.
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Affiliation(s)
- Maria Camila Cardenas
- Pediatric Residency Program, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Sheila Farnan
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Benjamin L. Hamel
- Pediatric Residency Program, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Maria Camila Mejia Plazas
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Pediatric Residency Program, Nicklaus Children’s Hospital, 3100 SW 62nd Ave, Miami, FL 33155, USA
| | - Elise Sintim-Aboagye
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Dawn R. Littlefield
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Supriya Behl
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Sohan Punia
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Elizabeth Ann L Enninga
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 33155, USA
| | - Erica Johnson
- Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Zelalem Temesgen
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55905, USA
| | - Regan Theiler
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 33155, USA
| | - Clive M. Gray
- Division of Molecular Biology and Human Genetics, Biomedical Research Institute, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7600, South Africa
| | - Rana Chakraborty
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Correspondence: ; Tel.: +1-507-293-9531
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Aleshire K, Bazzi R. Management Strategies in Perinatal HIV. Infect Dis (Lond) 2022. [DOI: 10.5772/intechopen.105451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Current management of perinatal HIV infections and exposures involves the administration of antiretroviral therapy to both the pregnant mother and to her child after delivery. Striving to achieve safe and effective medication management is key in preventing new pediatric HIV infections. Maternal HIV testing and subsequent monitoring can help to identify fetal HIV exposures during pregnancy, maternal nonadherence, insufficient treatment regimens, and otherwise undiscovered exposures during the delivery process. There are several well-constructed guidelines that offer expert references for healthcare providers. This chapter will summarize current recommendations from the United States, with a brief insight into select international guidelines. Although available guidelines provide a structured framework for the healthcare team, there has recently been a significant drive to advance current perinatal management and outcomes.
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Hussen R, Zenebe WA, Mamo TT, Shaka MF. Determinants of HIV infection among children born from mothers on prevention of mother to child transmission programme of HIV in southern Ethiopia: a case-control study. BMJ Open 2022; 12:e048491. [PMID: 35131814 PMCID: PMC8823216 DOI: 10.1136/bmjopen-2020-048491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study was aimed to identify determinants of HIV infection among children born from mothers on the prevention of mother to child transmission (PMTCT) programme in Southern Ethiopia. It was designed to explore the main contributors to the considerable transmission rate of HIV from mother to child. SETTING AND DESIGN A multicentre facility-based unmatched case-control study was conducted using 27 health facilities providing PMTCT service in Southern Ethiopia. PARTICIPANTS Out of 307 (62 cases and 245 controls) expected to participate in this study, a total of 290 mother-child pairs of 58 cases and 232 controls have completed the interview. Cases were children born to mothers on PMTCT programme and with DNA PCR or antibody HIV positive test result at ≤24 months of age. Controls were children born to mothers on PMTCT programme and with DNA PCR or antibody HIV negative test result at ≤24 months of age. RESULT Data were collected from the mother and record and analysed using SPSS V.20. Logistic regression analysis was done for statistical association and the significance of association was declared at a p value of <0.05. Rural residence (adjusted OR (AOR): 4.15, 95% CI: (1.57 to 10.97)), knowing serostatus during current pregnancy (AOR: 5.11, 95% CI: (1.33 to 19.69)), home delivery (AOR: 6.00, 95% CI: (2.310 to 15.593)), poor partner involvement (AOR: 5.95, 95% CI: 1.91 to 18.53)), poor adherence, late enrolment of the child for ARV prophylaxis (AOR: 4.89, 95% CI: 1.34 to 17.88)), mixed breastfeeding practice (AOR: 10.36, 95% CI: (3.10 to 34.60)) and failure to be on cotrimoxazole therapy (AOR: 7.56, 95% CI: 2.07 to 27.61)) were factors significantly associated with MTCT. CONCLUSION The finding implies that more needs to be done on rural residents, strengthening screening for HIV before pregnancy, encouraging male involvement, early enrolment of child for ARV prophylaxis, avoiding mixed breast feeding and putting newborn on cotrimoxazole therapy.
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Affiliation(s)
- Rehima Hussen
- School of Public Health, Dilla University College of Health Sciences, Dilla, Ethiopia
| | - Wagaye Alemu Zenebe
- School of Public Health, Dilla University College of Health Sciences, Dilla, Ethiopia
| | - Tizalegn Tesfaye Mamo
- School of Public Health, Dilla University College of Health Sciences, Dilla, Ethiopia
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Knapp KM. Prevention of Mother-to-Child Human Immunodeficiency Virus Transmission in Resource-Limited Countries. Pediatr Clin North Am 2022; 69:1-18. [PMID: 34794668 DOI: 10.1016/j.pcl.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The first pediatric AIDS cases were reported in 1982. A decade later, the World Health Organization estimated there were more than 500,000 pediatric AIDS cases resulting from mother-to-child transmission, 90% of which were in sub-Saharan Africa. Although the rate of new infections globally has been cut in half since the peak of the pandemic, human immunodeficiency virus (HIV) remains a public health threat, and rates of new infections continue to increase in some regions. Mother-to-child transmission of HIV has now been virtually eliminated in many parts of the world but remains an issue in resource-limited countries.
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Affiliation(s)
- Katherine M Knapp
- Department of Infectious Diseases, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 600, Memphis, TN 38105, USA.
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Cerveny L, Murthi P, Staud F. HIV in pregnancy: Mother-to-child transmission, pharmacotherapy, and toxicity. Biochim Biophys Acta Mol Basis Dis 2021; 1867:166206. [PMID: 34197912 DOI: 10.1016/j.bbadis.2021.166206] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/18/2021] [Accepted: 06/11/2021] [Indexed: 12/15/2022]
Abstract
An estimated 1.3 million pregnant women were living with HIV in 2018. HIV infection is associated with adverse pregnancy outcomes and all HIV-positive pregnant women, regardless of their clinical stage, should receive a combination of antiretroviral drugs to suppress maternal viral load and prevent vertical fetal infection. Although antiretroviral treatment in pregnant women has undoubtedly minimized mother-to-child transmission of HIV, several uncertainties remain. For example, while pregnancy is accompanied by changes in pharmacokinetic parameters, relevant data from clinical studies are lacking. Similarly, long-term adverse effects of exposure to antiretrovirals on fetuses have not been studied in detail. Here, we review current knowledge on HIV effects on the placenta and developing fetus, recommended antiretroviral regimens, and pharmacokinetic considerations with particular focus on placental transport. We also discuss recent advances in antiretroviral research and potential effects of antiretroviral treatment on placental/fetal development and programming.
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Affiliation(s)
- Lukas Cerveny
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Padma Murthi
- Department of Medicine, School of Clinical Sciences, and Department of Pharmacology, Monash Biomedicine Discovery Institute Monash University, Clayton, Victoria, Australia; Hudson Institute of Medical Research, The Ritchie Centre, Clayton, Victoria, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
| | - Frantisek Staud
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic.
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Gatta LA, Hughes BL. Premature Rupture of Membranes with Concurrent Viral Infection. Obstet Gynecol Clin North Am 2021; 47:605-623. [PMID: 33121648 DOI: 10.1016/j.ogc.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Treatment of viral infections is geared toward ameliorating maternal symptoms and minimizing perinatal transmission. Multidisciplinary teams often are required to manage sequelae due to viral diseases in patients with preterm premature rupture of membranes (PPROM). although data are scarce regarding the antepartum management of common viruses in PPROM, essential principles may be extrapolated from national guidelines and studies in gravid patients. The well-established risks of prematurity are weighed against the often unclear risks of vertical transmission.
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Affiliation(s)
- Luke A Gatta
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Duke University Hospital, 2608 Erwin Road, Durham, NC 27705-4597, USA.
| | - Brenna L Hughes
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Duke University Hospital, 2608 Erwin Road, Durham, NC 27705-4597, USA
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Chilaka VN, Konje JC. HIV in pregnancy - An update. Eur J Obstet Gynecol Reprod Biol 2020; 256:484-491. [PMID: 33246666 PMCID: PMC7659513 DOI: 10.1016/j.ejogrb.2020.11.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 11/16/2022]
Abstract
Human immunodeficiency virus (HIV) is an infection with a global prevalence and currently no cure or vaccine. Women living with HIV who become pregnant or who acquire the virus during pregnancy are at risk of both maternal and perinatal morbidity and mortality mainly if the virus is poorly controlled. Furthermore, there is a risk of vertical transmission to the fetus during pregnancy labour and postpartum through breastfeeding. Appropriate management must be instituted to reduce the consequences of HIV in pregnancy, ideally starting with preconception counselling and planning pregnancies when the viral load is minimum. During pregnancy, an appropriate combined anti-retroviral (cART) medication is mandatory with very close monitoring of the viral load, cluster of differentiation 4 (CD4) cell counts, blood counts, liver and kidney function tests. Planning delivery should not be different in women on cART and suppressed viral loads. However, special care must be taken to limit vertical transmission in those who present late and in whom viral load is unknown or not controlled at the time of delivery. Breastfeeding remains a potential source of infection for the baby and is being discouraged in high-income countries for women living with HIV; however, in low-income countries, the recommendation is exclusive breastfeeding. If breastfeeding must happen, it is best when viral load is suppressed, and cART continued until weaning. Serodiscordant couples present unique problems, and their management should begin with the planning of pregnancy. Emphasis should be on taking steps to prevent HIV transmission to the negative partner and vertical transmission to the new-born.
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Affiliation(s)
- Victor N Chilaka
- Women's Wellness Research Center, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar.
| | - Justin C Konje
- Weill Cornell Medicine, Doha, Qatar; Sidra Medicine, Doha, Qatar; University of Leicester, UK
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Abstract
Preterm birth occurs in approximately 10% of all births in the United States and is a major contributor to perinatal morbidity and mortality (). Prelabor rupture of membranes (PROM) that occurs preterm complicates approximately 2-3% of all pregnancies in the United States, representing a significant proportion of preterm births, whereas term PROM occurs in approximately 8% of pregnancies (). The optimal approach to assessment and treatment of women with term and preterm PROM remains challenging. Management decisions depend on gestational age and evaluation of the relative risks of delivery versus the risks (eg, infection, abruptio placentae, and umbilical cord accident) of expectant management when pregnancy is allowed to progress to a later gestational age. The purpose of this document is to review the current understanding of this condition and to provide management guidelines that have been validated by appropriately conducted outcome-based research when available. Additional guidelines on the basis of consensus and expert opinion also are presented. This Practice Bulletin is updated to include information about diagnosis of PROM, expectant management of PROM at term, and timing of delivery for patients with preterm PROM between 34 0/7 weeks of gestation and 36 6/7 weeks of gestation.
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Gilleece DY, Tariq DS, Bamford DA, Bhagani DS, Byrne DL, Clarke DE, Clayden MP, Lyall DH, Metcalfe DR, Palfreeman DA, Rubinstein DL, Sonecha MS, Thorley DL, Tookey DP, Tosswill MJ, Utting MD, Welch DS, Wright MA. British HIV Association guidelines for the management of HIV in pregnancy and postpartum 2018. HIV Med 2020; 20 Suppl 3:s2-s85. [PMID: 30869192 DOI: 10.1111/hiv.12720] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Dr Yvonne Gilleece
- Honorary Clinical Senior Lecturer and Consultant Physician in HIV and Genitourinary Medicine, Brighton and Sussex University Hospitals NHS Trust
| | - Dr Shema Tariq
- Postdoctoral Clinical Research Fellow, University College London, and Honorary Consultant Physician in HIV, Central and North West London NHS Foundation Trust
| | - Dr Alasdair Bamford
- Consultant in Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London
| | - Dr Sanjay Bhagani
- Consultant Physician in Infectious Diseases, Royal Free Hospital NHS Trust, London
| | - Dr Laura Byrne
- Locum Consultant in HIV Medicine, St George's University Hospitals NHS Foundation Trust, London
| | - Dr Emily Clarke
- Consultant in Genitourinary Medicine, Royal Liverpool and Broadgreen University Hospitals NHS Trust
| | - Ms Polly Clayden
- UK Community Advisory Board representative/HIV treatment advocates network
| | - Dr Hermione Lyall
- Clinical Director for Children's Services and Consultant Paediatrician in Infectious Diseases, Imperial College Healthcare NHS Trust, London
| | | | - Dr Adrian Palfreeman
- Consultant in Genitourinary Medicine, University Hospitals of Leicester NHS Trust
| | - Dr Luciana Rubinstein
- Consultant in Genitourinary Medicine, London North West Healthcare University NHS Trust, London
| | - Ms Sonali Sonecha
- Lead Directorate Pharmacist HIV/GUM, Chelsea and Westminster Healthcare NHS Foundation Trust, London
| | | | - Dr Pat Tookey
- Honorary Senior Lecturer and Co-Investigator National Study of HIV in Pregnancy and Childhood, UCL Great Ormond Street Institute of Child Health, London
| | | | - Mr David Utting
- Consultant Obstetrician and Gynaecologist, Brighton and Sussex University Hospitals NHS Trust
| | - Dr Steven Welch
- Consultant in Paediatric Infectious Diseases, Heart of England NHS Foundation Trust, Birmingham
| | - Ms Alison Wright
- Consultant Obstetrician and Gynaecologist, Royal Free Hospitals NHS Foundation Trust, London
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Loh M, Thoon KC, Mathur M, Kathirvel R. Management of HIV-positive pregnant women: a Singapore experience. Singapore Med J 2020; 62:599-603. [PMID: 32241070 DOI: 10.11622/smedj.2020048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Perinatal transmission remains one of the important causes of the transmission of the human immunodeficiency virus (HIV). Over the years, with better knowledge and awareness of HIV, the perinatal transmission rate has been significantly reduced. We previously reported on the pregnancy outcomes of HIV-positive mothers from 1997 to 2007 in our institution. This paper aims to review standards of care of HIV-positive pregnant women since then. METHODS A retrospective study reviewed 84 HIV-positive women who delivered in a tertiary centre from January 2008 to December 2015. Patient demographics and antenatal, intrapartum, postnatal and immediate neonatal data were analysed. RESULTS There were a total of 97 deliveries with 98 neonates. 12 women delivered more than once and there was one set of twins. Mean maternal age at diagnosis of HIV was 27.8 years. Of the study population, 63.1% of women were non-Singaporeans. 56 women were known to have HIV on presentation and 90.7% were on antiretroviral therapy during pregnancy. 88.7% of the women received intrapartum intravenous zidovudine, and 93.1% of women with detectable and 58.7% with undetectable viral load underwent Caesarean sections. All neonates were HIV-negative. CONCLUSION Having high standards of care for HIV-positive women has successfully reduced our perinatal transmission rate to zero.
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Affiliation(s)
- Michelle Loh
- Department of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, Singapore
| | - Koh Cheng Thoon
- Paediatrics Infectious Disease, Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore,Duke-NUS Medical School, Singapore,NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Manisha Mathur
- Department of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, Singapore,Duke-NUS Medical School, Singapore,NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Rajeswari Kathirvel
- Department of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, Singapore,Duke-NUS Medical School, Singapore,NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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İnkaya AÇ, Örgül G, Halis N, Alp Ş, Kara A, Özyüncü Ö, Yurdakok M, Ünal S, Beksaç MS. Perinatal outcomes of twenty-five human immunodeficiency virus-infected pregnant women: Hacettepe University experience. J Turk Ger Gynecol Assoc 2019; 21:180-186. [PMID: 31564083 PMCID: PMC7495123 DOI: 10.4274/jtgga.galenos.2019.2019.0033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: To evaluate perinatal outcomes in human immunodeficiency virus (HIV) infected pregnant women in Turkey. Material and Methods: Maternal characteristics, pregnancy complications, laboratory findings including HIV load, CD4 cell count, CD4/CD8 ratio, neonatal features and final HIV status of the baby were retrospectively analyzed. Results: The sample included 26 singleton pregnancies, from 25 HIV-infected women. The ethnicities were Turkish (n=18), East European (n=4), Asian (n=2) and African (n=2). The majority (76.9%) was aware of their HIV status before becoming pregnant. Four cases (15.3%) were diagnosed during pregnancy and two (7.8%) at the onset of labor. The results for median HIV viral load, CD4 count, and CD4/CD8 ratio at birth were 20 copies/mL (0-34 587), 577/mm3 (115-977), and 0.7 (0.1-1.9), respectively. The HIV viral load rate was 5.5% in eighteen women taking anti-retroviral treatment. The rates of gestational diabetes mellitus, gestational hypertension, intrauterine growth restriction, and preterm delivery were 3.8%, 3.8%, 7.6%, and 8% (numbers are 1;1;2;2), respectively. The mean gestational week at birth was 38 weeks and mean birthweight is 2972±329 g. Two babies were congenitally infected with HIV (infection rate of 8.3%). There was one needle-related accident during surgery. Conclusion: Timely diagnosis of HIV infection during pregnancy is important for preventing mother to child transmission. HIV infected women may give birth to HIV negative babies with the help of a multidisciplinary team, composed of perinatology, infectious diseases, and pediatrics specialists.
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Affiliation(s)
- Ahmet Çağkan İnkaya
- Department of Infection Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gökçen Örgül
- Department of Obstetrics and Gynecology, Division of Perinatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nurhayat Halis
- Department of Obstetrics and Gynecology, Division of Perinatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Şehnaz Alp
- Department of Infection Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ateş Kara
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Özgür Özyüncü
- Department of Obstetrics and Gynecology, Division of Perinatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Murat Yurdakok
- Department of Child Health and Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Serhat Ünal
- Department of Infection Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - M. Sinan Beksaç
- Department of Obstetrics and Gynecology, Division of Perinatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Petraro P, Madzorera I, Duggan CP, Spiegelman D, Manji K, Kisenge R, Kupka R, Fawzi WW. Mid-arm muscle area and anthropometry predict low birth weight and poor pregnancy outcomes in Tanzanian women with HIV. BMC Pregnancy Childbirth 2018; 18:500. [PMID: 30558577 PMCID: PMC6296154 DOI: 10.1186/s12884-018-2136-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 12/04/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND An observational study was conducted to examine the role of maternal anthropometry, including mid-arm muscle area (MAMA) and others, as risk factors for low birth weight (LBW), small for gestational age (SGA) and preterm births in human immunodeficiency virus (HIV) infected pregnant women. HIV-positive women (N = 2369), between 12 and 32 weeks gestation were followed through delivery in Tanzania, from 2003 to 2008. Participants were women enrolled in a randomized, double-blind, placebo-controlled, clinical trial who delivered live births. METHODS Binomial regression analysis was used to evaluate the association of maternal nutritional indicators of MAMA, mid-upper arm circumference (MUAC), body mass index (BMI) and maternal weight with LBW, SGA and preterm in multivariate analysis. RESULTS Higher MAMA was associated with a 32% lower risk of LBW compared to lower measurements (RR = 0.68, 95% CI = 0.50-0.94). Similar protective associations were noted for higher BMI (RR = 0.58, 95% CI = 0.42-0.79); maternal weight (RR = 0.50, 95% CI = 0.36-0.69) and MUAC (RR = 0.62, 95% CI = 0.45-0.86). Higher MAMA was also associated with lower risk of SGA (RR = 0.78, 95% CI = 0.68-0.90) and marginally associated with preterm (RR = 0.85, 95% CI = 0.69-1.04). Beneficial associations of MUAC, BMI and maternal weight with SGA and preterm were also observed. CONCLUSION MAMA performs comparably to MUAC, maternal weight and BMI, as a predictor of LBW and SGA in HIV-infected women. The possible role of MAMA and other indicators in screening HIV positive women at risk of adverse pregnancy outcomes should be investigated.
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Affiliation(s)
- Paul Petraro
- Department of Nutrition, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1102, Boston, MA 02115 USA
| | - Isabel Madzorera
- Department of Nutrition, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1102, Boston, MA 02115 USA
| | - Christopher P. Duggan
- Department of Nutrition, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1102, Boston, MA 02115 USA
- Division of Gastroenterology and Nutrition, Children’s Hospital Boston, Boston, MA USA
| | - Donna Spiegelman
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA 02115 USA
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA 02115 USA
| | - Karim Manji
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Rodrick Kisenge
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Roland Kupka
- Department of Nutrition, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1102, Boston, MA 02115 USA
- UNICEF Headquarters, New York, NY USA
| | - Wafaie W. Fawzi
- Department of Nutrition, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1102, Boston, MA 02115 USA
- Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA 02115 USA
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Abstract
Preterm delivery occurs in approximately 12% of all births in the United States and is a major factor that contributes to perinatal morbidity and mortality (1, 2). Preterm prelabor rupture of membranes (also referred to as premature rupture of membranes) (PROM) complicates approximately 3% of all pregnancies in the United States (3). The optimal approach to clinical assessment and treatment of women with term and preterm PROM remains controversial. Management hinges on knowledge of gestational age and evaluation of the relative risks of delivery versus the risks of expectant management (eg, infection, abruptio placentae, and umbilical cord accident). The purpose of this document is to review the current understanding of this condition and to provide management guidelines that have been validated by appropriately conducted outcome-based research when available. Additional guidelines on the basis of consensus and expert opinion also are presented.
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14
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Sam-Agudu NA, Isah C, Fan-Osuala C, Erekaha S, Ramadhani HO, Anaba U, Adeyemi OA, Manji-Obadiah G, Lee D, Cornelius LJ, Charurat M. Correlates of facility delivery for rural HIV-positive pregnant women enrolled in the MoMent Nigeria prospective cohort study. BMC Pregnancy Childbirth 2017; 17:227. [PMID: 28705148 PMCID: PMC5512933 DOI: 10.1186/s12884-017-1417-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 07/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low rates of maternal healthcare service utilization, including facility delivery, may impede progress in the prevention of mother-to-child transmission of HIV (PMTCT) and in reducing maternal and infant mortality. The MoMent (Mother Mentor) study investigated the impact of structured peer support on early infant diagnosis presentation and postpartum maternal retention in PMTCT care in rural Nigeria. This paper describes baseline characteristics and correlates of facility delivery among MoMent study participants. METHODS HIV-positive pregnant women were recruited at 20 rural Primary Healthcare Centers matched by antenatal care clinic volume, client HIV prevalence, and PMTCT service staffing. Baseline and delivery data were collected by participant interviews and medical record abstraction. Multivariate logistic regression with generalized estimating equation analysis was used to evaluate for correlates of facility delivery including exposure to structured (closely supervised Mentor Mother, intervention) vs unstructured (routine, control) peer support. RESULTS Of 497 women enrolled, 352 (71%) were between 21 and 30 years old, 319 (64%) were Christian, 245 (49%) had received secondary or higher education, 402 (81%) were multigravidae and 299 (60%) newly HIV-diagnosed. Delivery data was available for 445 (90%) participants, and 276 (62%) of these women delivered at a health facility. Facility delivery did not differ by type of peer support; however, it was positively associated with secondary or greater education (aOR 1.9, CI 1.1-3.2) and Christian affiliation (OR 1.4, CI 1.0-2.0) and negatively associated with primigravidity (OR 0.5; 0.3-0.9) and new HIV diagnosis (OR 0.6, CI 0.4-0.9). CONCLUSIONS Primary-level or lesser-educated HIV-infected pregnant women and those newly-diagnosed and primigravid should be prioritized for interventions to improve facility delivery rates and ultimately, healthy outcomes. Incremental gains in facility delivery from structured peer support appear limited, however the impact of duration of pre-delivery support needs further investigation. Religious influences on facility delivery and on general maternal healthcare service utilization need to be further explored. TRIAL REGISTRATION ClinicalTrials.gov number NCT01936753 , registered September 2013.
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Affiliation(s)
- Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Plot 252 Herbert McCaulay Way, Abuja, Nigeria. .,Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA. .,Clinical Department, Institute of Human Virology Nigeria, Abuja, Nigeria.
| | - Christopher Isah
- International Research Center of Excellence, Institute of Human Virology Nigeria, Plot 252 Herbert McCaulay Way, Abuja, Nigeria
| | - Chinenye Fan-Osuala
- International Research Center of Excellence, Institute of Human Virology Nigeria, Plot 252 Herbert McCaulay Way, Abuja, Nigeria
| | - Salome Erekaha
- International Research Center of Excellence, Institute of Human Virology Nigeria, Plot 252 Herbert McCaulay Way, Abuja, Nigeria
| | - Habib O Ramadhani
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Udochisom Anaba
- International Research Center of Excellence, Institute of Human Virology Nigeria, Plot 252 Herbert McCaulay Way, Abuja, Nigeria
| | - Olusegun A Adeyemi
- Clinical Department, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Grace Manji-Obadiah
- International Research Center of Excellence, Institute of Human Virology Nigeria, Plot 252 Herbert McCaulay Way, Abuja, Nigeria
| | - Daniel Lee
- University of Maryland School of Medicine, Baltimore, USA
| | - Llewellyn J Cornelius
- School of Social Work and College of Public Health, University of Georgia Athens, Athens, USA
| | - Manhattan Charurat
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
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Abstract
Preterm delivery occurs in approximately 12% of all births in the United States and is a major factor that contributes to perinatal morbidity and mortality (1, 2). Preterm premature rupture of membranes (PROM) complicates approximately 3% of all pregnancies in the United States (3). The optimal approach to clinical assessment and treatment of women with term and preterm PROM remains controversial. Management hinges on knowledge of gestational age and evaluation of the relative risks of delivery versus the risks of expectant management (eg, infection, abruptio placentae, and umbilical cord accident). The purpose of this document is to review the current understanding of this condition and to provide management guidelines that have been validated by appropriately conducted outcome-based research when available. Additional guidelines on the basis of consensus and expert opinion also are presented.
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Eleje GU, Edokwe ES, Ikechebelu JI, Onubogu CU, Ugochukwu EF, Okam PC, Ibekwe AM. Mother-to-child transmission of human immunodeficiency virus (HIV) among HIV-infected pregnant women on highly active anti-retroviral therapy with premature rupture of membranes at term. J Matern Fetal Neonatal Med 2017; 31:184-190. [PMID: 28064549 DOI: 10.1080/14767058.2017.1279600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine mother-to-child transmission (MTCT) rate and associated risk factors of human immune-deficiency virus (HIV) among HIV-infected pregnant women with term premature rupture of membranes (PROM) in comparison with those without PROM at term. MATERIALS AND METHODS All optimally managed HIV-positive pregnant women of Nnamdi Azikiwe University Teaching Hospital, on highly active anti-retroviral therapy (HAART) who had PROM at term were enrolled. Maternal HIV-1 viral load was not assessed. Follow up was for a minimum of 18 months for evidence of HIV infection. RESULTS Of the 121 women with PROM at term, 46 (38.0%) were HIV sero-positive, 22/46 (47.8%) of which had their babies followed up till 18 months. The mean latency period was 10.5 ± 5.3 h in PROM group. Apart from duration of PROM (OR = 0.01; 95%CI = 0.00-0.13; p < 0.001), there were no differences in risk factors seen between cases and controls (p > 0.05). Of the 22 (47.8%) babies followed-up in the PROM group and 13 in non-PROM group, none tested positive to HIV, given an MTCT rate of 0%. CONCLUSIONS MTCT rate was 0% following term PROM and in women without PROM. Since maternal HIV-1 viral load was not assessed, we need to be critical while interpreting the findings.
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Affiliation(s)
- George Uchenna Eleje
- a Effective Care Research Unit, Department of Obstetrics and Gynecology , Nnamdi Azikiwe University , Nnewi , Nigeria.,b Department of Obstetrics and Gynecology , Nnamdi Azikiwe University Teaching Hospital , Nnewi , Nigeria
| | - Emeka Stephen Edokwe
- c Paediatrics Infectious Disease and Neonatology Unit , Nnamdi Azikiwe University Teaching Hospital , Nnewi , Nigeria.,d PMTCT Unit , Nnamdi Azikiwe University Teaching Hospital , Nnewi , Nigeria
| | - Joseph Ifeanyichukwu Ikechebelu
- a Effective Care Research Unit, Department of Obstetrics and Gynecology , Nnamdi Azikiwe University , Nnewi , Nigeria.,b Department of Obstetrics and Gynecology , Nnamdi Azikiwe University Teaching Hospital , Nnewi , Nigeria.,d PMTCT Unit , Nnamdi Azikiwe University Teaching Hospital , Nnewi , Nigeria
| | - Chinyere Ukamaka Onubogu
- c Paediatrics Infectious Disease and Neonatology Unit , Nnamdi Azikiwe University Teaching Hospital , Nnewi , Nigeria.,d PMTCT Unit , Nnamdi Azikiwe University Teaching Hospital , Nnewi , Nigeria
| | - Ebele Francesca Ugochukwu
- c Paediatrics Infectious Disease and Neonatology Unit , Nnamdi Azikiwe University Teaching Hospital , Nnewi , Nigeria.,d PMTCT Unit , Nnamdi Azikiwe University Teaching Hospital , Nnewi , Nigeria
| | | | - Adaobi Maryann Ibekwe
- e Antenatal Care Unit , Nnamdi Azikiwe University Teaching Hospital , Nnewi , Nigeria
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17
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Raffe SF, Savage C, Perry LA, Patel A, Keith T, Howell R, Bradley R, Bomont R, Fidler K, Gilleece Y. The management of HIV in pregnancy: A 10-year experience. Eur J Obstet Gynecol Reprod Biol 2017; 210:310-313. [PMID: 28110176 DOI: 10.1016/j.ejogrb.2016.12.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 11/19/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The package of care to reduce HIV mother to child transmission (MTCT) has evolved significantly since trials of ante and intrapartum antiretroviral therapy (ART) in 1994. In the UK MTCT rate has fallen from 25.6% in the 1990s to 0.46%. We review the management of HIV in pregnancy in Brighton in the context of evolving guidelines. STUDY DESIGN HIV, obstetric and neonatal notes of all HIV positive women, pregnant between 2003 and 2014, were reviewed. RESULTS 97 pregnancies in 75 women were identified, resulting in 79 live births. Antenatal HIV diagnosis was made in 22 (28%). The proportion of pregnancies in those with known HIV at conception increased over the time period. At conception 58 (60%) were on ART, 33 (57%) of who continued on their original regimen. 34 (35%) initiated ART following conception: 14 known to be HIV positive, 20 diagnosed during pregnancy. Two did not start ART (1 due to miscarriage, 1 as diagnosed post-delivery) and in three cases ART history was unavailable due to transfer to alternative centres. ART was initiated on average at 22 weeks gestation (range 6-34). 4(5%) received Zidovudine (AZT) monotherapy, all before 2006. Choice of combination ART (cART) varied with time reflecting changing guidelines. Prior to 2008 an AZT containing regimen was used in 83% versus 8% after. Planned mode of delivery was documented in 73: 30(41%) planned a normal vaginal delivery (NVD), 43(59%) a caesarean section (CS). The viral load (VL) was <50copies/mL in 58(76%) at 36 weeks and 64(84%) at delivery. 90% with a detectable VL at 36 weeks delivered via CS. 100% received neonatal post-exposure prophylaxis (PEP): 68(88%) AZT monotherapy, 9(12%) cART. 84% initiated PEP within four hours. 90% completed 28days. 8(10%) babies experienced side effects. In the 10-year review period, one infant (1.3%) was diagnosed HIV positive. Both mother and infant received care in accordance with guidelines, including neonatal PEP within 4hours. CONCLUSION Care of the HIV positive pregnant woman in Brighton has been successful with overall transmission consistent with that seen nationally. Despite effective preventative strategies MTCT remains a risk and women should be counselled accordingly.
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Affiliation(s)
- Sonia F Raffe
- Brighton and Sussex University Hospitals NHS Trust, Brighton, England, UK.
| | - Charlotte Savage
- Brighton and Sussex University Hospitals NHS Trust, Brighton, England, UK
| | - Louisa A Perry
- Brighton and Sussex University Hospitals NHS Trust, Brighton, England, UK
| | - Amie Patel
- Brighton and Sussex University Hospitals NHS Trust, Brighton, England, UK
| | - Tricia Keith
- Brighton and Sussex University Hospitals NHS Trust, Brighton, England, UK
| | - Richard Howell
- Brighton and Sussex University Hospitals NHS Trust, Brighton, England, UK
| | - Robert Bradley
- Brighton and Sussex University Hospitals NHS Trust, Brighton, England, UK
| | - Rob Bomont
- Brighton and Sussex University Hospitals NHS Trust, Brighton, England, UK
| | - Katy Fidler
- Brighton and Sussex University Hospitals NHS Trust, Brighton, England, UK
| | - Yvonne Gilleece
- Brighton and Sussex University Hospitals NHS Trust, Brighton, England, UK
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18
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Special Problems in Women Who Have HIV Disease. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00101-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Lingen-Stallard A, Furber C, Lavender T. Testing HIV positive in pregnancy: A phenomenological study of women's experiences. Midwifery 2016; 35:31-8. [PMID: 27060398 DOI: 10.1016/j.midw.2016.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/21/2015] [Accepted: 02/07/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE globally women receive HIV testing in pregnancy; however, limited information is available on their experiences of this potentially life-changing event. This study aims to explore women's experiences of receiving a positive HIV test result following antenatal screening. DESIGN a qualitative, phenomenological approach. SETTING two public National Health Service (NHS) hospitals and HIV support organisations. PARTICIPANTS a purposive sampling strategy was used. Thirteen black African women with a positive HIV result, in England, participated. METHODS data were collected using in-depth semi-structured interviews. An interpretive phenomenological approach to data analysis was used. FINDINGS the emergent phenomenon was transition and transformation of 'being,' as women accepted HIV as part of their lives. Paired themes support the phenomenon: shock and disbelief; anger and turmoil; stigma and confidentiality issues; acceptance and resilience. Women had extreme reactions to their positive HIV diagnosis, compounded by the cultural belief that they would die. Initial disbelief of the unexpected result developed into sadness at the loss of their old self. Turmoil was evident, as women considered termination of pregnancy, self-harm and suicide. Women felt isolated from others and relationship breakdowns often occurred. Most reported the pervasiveness of stigma, and how this was managed alongside living with HIV. Coping strategies included keeping HIV 'secret' and making their child(ren) the prime focus of life. Growing resilience was apparent with time. KEY CONCLUSIONS this study gives midwives unique understanding of the complexities and major implications for women who tested positive for HIV. Women's experiences resonated with processes of bereavement, providing useful insight into a transitional and transformational period, during which appropriate support can be targeted. IMPLICATIONS midwives are crucial in improving the experience of women when they test HIV positive and to do this they need to be appropriately trained. Midwives need to acknowledge the social and psychological impact of HIV and pathways should be developed to support early referral for appropriate support.
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Affiliation(s)
- Andrew Lingen-Stallard
- School of Nursing and Midwifery, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M139PL, United Kingdom
| | - Christine Furber
- School of Nursing and Midwifery, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M139PL, United Kingdom
| | - Tina Lavender
- School of Nursing and Midwifery, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M139PL, United Kingdom.
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20
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Ngwej DT, Mukuku O, Mudekereza R, Karaj E, Odimba EBF, Luboya ON, Kakoma JBS, Wembonyama SO. [Study of risk factors for HIV transmission from mother to child in the strategy «option A» in Lubumbashi, Democratic Republic of Congo]. Pan Afr Med J 2015; 22:18. [PMID: 26600917 PMCID: PMC4646444 DOI: 10.11604/pamj.2015.22.18.7480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 08/31/2015] [Indexed: 02/05/2023] Open
Affiliation(s)
| | - Olivier Mukuku
- Département de Pédiatrie, Faculté de Médecine, Université de Lubumbashi, RD Congo
| | | | | | | | - Oscar Numbi Luboya
- Département de Pédiatrie, Faculté de Médecine, Université de Lubumbashi, RD Congo
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21
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de Ruiter A, Taylor GP, Clayden P, Dhar J, Gandhi K, Gilleece Y, Harding K, Hay P, Kennedy J, Low-Beer N, Lyall H, Palfreeman A, O'Shea S, Tookey P, Tosswill J, Welch S, Wilkins E. British HIV Association guidelines for the management of HIV infection in pregnant women 2012 (2014 interim review). HIV Med 2015; 15 Suppl 4:1-77. [PMID: 25604045 DOI: 10.1111/hiv.12185] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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22
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Peters H, Byrne L, De Ruiter A, Francis K, Harding K, Taylor GP, Tookey PA, Townsend CL. Duration of ruptured membranes and mother-to-child HIV transmission: a prospective population-based surveillance study. BJOG 2015; 123:975-81. [PMID: 26011825 DOI: 10.1111/1471-0528.13442] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the association between duration of rupture of membranes (ROM) and mother-to-child HIV transmission (MTCT) rates in the era of combination antiretroviral therapy (cART). DESIGN The National Study of HIV in Pregnancy and Childhood (NSHPC) undertakes comprehensive population-based surveillance of HIV in pregnant women and children. SETTING UK and Ireland. POPULATION A cohort of 2398 singleton pregnancies delivered vaginally, or by emergency caesarean section, in women on cART in pregnancy during the period 2007-2012 with information on duration of ROM; HIV infection status was available for 1898 infants. METHODS Descriptive analysis of NSHPC data. MAIN OUTCOME MEASURES Rates of MTCT. RESULTS In 2116 pregnancies delivered at term, the median duration of ROM was 3 hours 30 minutes (interquartile range, IQR 1-8 hours). The overall MTCT rate for women delivering at term with duration of ROM ≥4 hours was 0.64% compared with 0.34% for ROM <4 hours, with no significant difference between the groups (OR 1.90, 95% CI 0.45-7.97). In women delivering at term with a viral load of <50 copies/ml, there was no evidence of a difference in MTCT rates with duration of ROM ≥4 hours, compared with <4 hours (0.14% for ≥4 hours versus 0.12% for <4 hour; OR 1.14, 95% CI 0.07-18.27). Among infants born preterm with infection status available, there were no transmissions in 163 deliveries where the maternal viral load was <50 copies/ml. CONCLUSIONS No association was found between duration of ROM and MTCT in women taking cART. TWEETABLE ABSTRACT Rupture of membranes of more than 4 hours is not associated with MTCT of HIV in women on effective ART delivering at term.
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Affiliation(s)
- H Peters
- Population, Policy and Practice Programme, UCL Institute of Child Health, University College London, London, UK
| | - L Byrne
- Population, Policy and Practice Programme, UCL Institute of Child Health, University College London, London, UK
| | - A De Ruiter
- Guys & St Thomas' NHS Foundation Trust, London, UK
| | - K Francis
- Population, Policy and Practice Programme, UCL Institute of Child Health, University College London, London, UK
| | - K Harding
- Guys & St Thomas' NHS Foundation Trust, London, UK
| | - G P Taylor
- Imperial College Healthcare NHS Trust, London, UK
| | - P A Tookey
- Population, Policy and Practice Programme, UCL Institute of Child Health, University College London, London, UK
| | - C L Townsend
- Population, Policy and Practice Programme, UCL Institute of Child Health, University College London, London, UK
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Ocheke AN, Agaba PA, Imade GE, Silas OA, Ajetunmobi OI, Echejoh G, Ekere C, Sendht A, Bitrus J, Agaba EI, Sagay AS. Chorioamnionitis in pregnancy: a comparative study of HIV-positive and HIV-negative parturients. Int J STD AIDS 2015; 27:296-304. [PMID: 25887063 DOI: 10.1177/0956462415580887] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/16/2015] [Indexed: 11/15/2022]
Abstract
Chorioamnionitis is an important risk factor for vertical transmission of HIV/AIDS. We compared the prevalence and correlates of histologic chorioamnionitis (HCA) in HIV-positive and HIV-negative pregnant women. HIV-positive and -negative parturients were interviewed, examined and had their placentas examined histologically for chorioamnionitis. Data regarding HIV were also retrieved from their hospital records. A total of 298 parturients (150 HIV positive and 148 HIV negative) were enrolled. The two groups were similar in socio-demographic and obstetric parameters except for age. The prevalence of HCA was 57.1% in HIV-positive women and 61.6% in HIV-negative women (p = 0.43). HCA staging was associated with the number of intrapartum vaginal examinations in HIV-positive subjects and nulliparity in HIV-negative subjects. The number of intrapartum vaginal examinations and coitus in the week prior to delivery significantly affected the grade of HCA in HIV-negative subjects. The prevalence of HCA in both HIV-positive and HIV-negative is high. Most variables did not affect the occurrence of HCA in both groups studied except number of intrapartum examinations, coitus in the preceding one week and nulliparity, which were related to severity of the disease.
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Affiliation(s)
- Amaka N Ocheke
- Department of Obstetrics and Gynaecology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Patricia A Agaba
- Department of Family Medicine, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Godwin E Imade
- Department of Obstetrics and Gynaecology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Olugbenga A Silas
- Department of Histopathology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Olanrewaju I Ajetunmobi
- Department of Histopathology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Godwins Echejoh
- Department of Histopathology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Clement Ekere
- Department of Obstetrics and Gynaecology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Ayuba Sendht
- Department of Obstetrics and Gynaecology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - James Bitrus
- Department of Obstetrics and Gynaecology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Emmanuel I Agaba
- Department of Medicine, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Atiene S Sagay
- Department of Obstetrics and Gynaecology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
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Kinuthia J, Kohler P, Okanda J, Otieno G, Odhiambo F, John-Stewart G. A community-based assessment of correlates of facility delivery among HIV-infected women in western Kenya. BMC Pregnancy Childbirth 2015; 15:46. [PMID: 25885458 PMCID: PMC4344995 DOI: 10.1186/s12884-015-0467-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 02/03/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childbirth at health facilities is an important strategy to reduce maternal morbidity and mortality, improve fetal outcomes, and reduce mother-to-child transmission of HIV. Although access to antenatal care in Kenya is high (>90%), less than half of births occur at health facilities. This analysis aims to assess correlates of facility delivery among recently pregnant HIV-infected women participating in a community-based survey, and to determine whether these correlates were unique when compared to HIV-uninfected women from the same region. METHODS Women residing in the Kenya Medical Research Institute/Centers for Disease Control and Prevention Health and Demographic Surveillance System, and who had delivered an infant in the previous year were visited at home in 2011. Consenting mothers answered a questionnaire assessing demographics, place of delivery, utilization of prevention of mother-to-child HIV transmission (PMTCT) services, and stigma indicators. Known HIV-positive women were purposively oversampled. Chi-square tests of proportions and multivariate logistic regression, stratified by HIV status, were performed to assess correlates of facility delivery. RESULTS Overall, 101 (46.8%) HIV-infected and 127 (39.9%) HIV-uninfected women delivered at health facilities. Among HIV-infected women, cost (42.8%), distance (18.8%) and fear of harsh treatment (15.2%) were primary disincentives for facility delivery; 2.9% noted fear of HIV testing was a disincentive. HIV-infected women who delivered at facilities had higher education (p = 0.04) and socioeconomic status (p < 0.005), initiated antenatal care (ANC) earlier (4.9 vs. 5.4 months, p = 0.016), were more likely to know partner's HIV status (p = 0.016), report satisfaction with delivery care (p = 0.001) and use antiretrovirals (87.1% vs. 77.4%, p = 0.063) compared to those with non-facility delivery. Stigma indicators were not associated with delivery location. Similar cofactors of facility delivery were noted among uninfected women. CONCLUSIONS Utilization of facility delivery remains low in Kenya and poses a challenge to elimination of infant HIV and reduction of peripartum mortality. Cost, distance, and harsh treatment were cited as barriers and these need to be addressed programmatically. HIV-infected women with lower socioeconomic status and those who present late to ANC should be prioritized for interventions to increase facility delivery. Partner involvement may increase use of maternity services and could be enhanced by couples counseling.
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Affiliation(s)
- John Kinuthia
- Department of Research and Programs/Department of Reproductive Health Kenyatta National Hospital, Nairobi, Kenya.
| | - Pamela Kohler
- Global Health and Psychosocial and Community Health, University of Washington, Seattle, WA, USA.
| | - John Okanda
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
| | - George Otieno
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
| | - Frank Odhiambo
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
| | - Grace John-Stewart
- Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, WA, USA.
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Dramatic decline in substance use by HIV-infected pregnant women in the United States from 1990 to 2012. AIDS 2015; 29:117-23. [PMID: 25562496 DOI: 10.1097/qad.0000000000000503] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We aimed to describe temporal changes in substance use among HIV-infected pregnant women in the United States from 1990 to 2012. DESIGN Data came from two prospective cohort studies (Women and Infants Transmission Study and Surveillance Monitoring for Antiretroviral Therapy Toxicities Study). METHODS Women were classified as using a substance during pregnancy if they self-reported use or had a positive biological sample. To account for correlation between repeated pregnancies by the same woman, generalized estimating equation models were used to test for temporal trends and evaluate predictors of substance use. RESULTS Over the 23-year period, substance use among the 5451 HIV-infected pregnant women sharply declined; 82% of women reported substance use during pregnancy in 1990, compared with 23% in 2012. Use of each substance decreased significantly (P < 0.001 for each substance) in an approximately linear fashion, until reaching a plateau in 2006. Multivariable models showed substance use was inversely associated with receiving antiretroviral therapy. Among the subset of 824 women with multiple pregnancies under observation, women who used a substance in their previous pregnancy were at elevated risk of substance use during their next pregnancy (risk ratio, 5.71; 95% confidence interval, 4.63-7.05). CONCLUSION A substantial decrease in substance use during pregnancy was observed between 1990 and 2012 in two large US cohorts of HIV-infected women. Substance use prevalence in these cohorts became similar to that of pregnant women in the general US population by the mid-2000s, suggesting that the observed decrease may be due to an epidemiological transition of the HIV epidemic among women in the United States.
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26
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Frange P, Blanche S. VIH et transmission mère–enfant. Presse Med 2014; 43:691-7. [DOI: 10.1016/j.lpm.2014.02.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 02/05/2014] [Indexed: 11/28/2022] Open
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Park JW, Yang TW, Kim YK, Choi BM, Kim HJ, Park DW. Ten years of experience in the prevention of mother-to-child human immunodeficiency virus transmission in a university teaching hospital. KOREAN JOURNAL OF PEDIATRICS 2014; 57:117-24. [PMID: 24778693 PMCID: PMC4000757 DOI: 10.3345/kjp.2014.57.3.117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 10/24/2013] [Accepted: 11/15/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE Administration of antiretroviral drugs to mothers and infants significantly decreases mother-to-child human immunodeficiency virus (HIV) transmission; cesarean sections and discouraging breastfeeding further decreases this risk. The present study confirmed the HIV status of babies born to mothers infected with HIV and describes the characteristics of babies and mothers who received preventive treatment. METHODS This study retrospectively analyzed medical records of nine infants and their mothers positive for HIV who gave birth at Korea University Ansan Hospital, between June 1, 2003, and May 31, 2013. Maternal parameters, including HIV diagnosis date, CD4+ count, and HIV ribonucleic acid (RNA) copy number, were analyzed. Infant growth and development, HIV RNA copy number, and HIV antigen/antibody test results were analyzed. RESULTS Eight HIV-positive mothers delivered nine babies; all the infants received antiretroviral therapy. Three (37.5%) and five mothers (62.5%) were administered single- and multidrug therapy, respectively. Intravenous zidovudine was administered to four infants (50%) at birth. Breastfeeding was discouraged for all the infants. All the infants were negative for HIV, although two were lost to follow-up. Third trimester maternal viral copy numbers were less than 1,000 copies/mL with a median CD4+ count of 325/µL (92-729/µL). Among the nine infants, two were preterm (22.2%) and three had low birth weights (33.3%). CONCLUSION This study concludes that prophylactic antiretroviral therapy, scheduled cesarean section, and prohibition of breastfeeding considerably decrease mother-to-child HIV transmission. Because the number of infants infected via mother-to-child transmission may be increasing, studies in additional regions using more variables are necessary.
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Affiliation(s)
- Jung-Weon Park
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Tae-Whan Yang
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Yun-Kyung Kim
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Byung-Min Choi
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Hai-Joong Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Dae-Won Park
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
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Ngwende S, Gombe NT, Midzi S, Tshimanga M, Shambira G, Chadambuka A. Factors associated with HIV infection among children born to mothers on the prevention of mother to child transmission programme at Chitungwiza Hospital, Zimbabwe, 2008. BMC Public Health 2013; 13:1181. [PMID: 24330311 PMCID: PMC3878665 DOI: 10.1186/1471-2458-13-1181] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 12/10/2013] [Indexed: 11/10/2022] Open
Abstract
Background Zimbabwe is one of the five countries worst affected by the HIV/AIDS pandemic with HIV infection contributing increasingly to childhood morbidity and mortality. Among the children born to HIV positive mothers participating in the PMTCT programme, 25% tested positive to HIV. We investigated factors associated with HIV infection among children born to mothers on the PMTCT programme. Methods A 1:1 unmatched case–control study was conducted at Chitungwiza Hospital, Zimbabwe, 2008. A case was defined as a child who tested HIV positive, born to a mother who had been on PMTCT programme. A control was a HIV negative child born to a mother who had been on PMTCT programme. An interviewer-administered questionnaire was used to collect data on demographic characteristics, risk factors associated with HIV infection and immunization status. Results A total of 120 mothers were interviewed. Independent risk factors associated with HIV infection among children included maternal CD4 count of less than 200 during pregnancy [aOR = 7.1, 95% CI (2.6-17)], mixed feeding [aOR = 29, 95% CI (4.2-208)], being hospitalized since birth [aOR = 2.9, 95% CI (1.2-4.8)] whilst being exclusively breast fed for less than 6 months [aOR = 0.1 (95% CI 0.03-0.4)] was protective. Conclusions HIV infection among children increased if the mother’s CD4 count was ≤200 cells/μL and if the child was exposed to mixed feeding. Breastfeeding exclusively for less than six months was protective. We recommended exclusive breast feeding period for the first six months and stop breast feeding after 6 months if affordable, sustainable and safe.
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Affiliation(s)
| | - Notion T Gombe
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe.
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Abstract
Preterm delivery occurs in approximately 12% of all births in the United States and is a major factor that contributes to perinatal morbidity and mortality (). Preterm premature rupture of membranes (PROM) complicates approximately 3% of all pregnancies in the United States (). The optimal approach to clinical assessment and treatment of women with term and preterm PROM remains controversial. Management hinges on knowledge of gestational age and evaluation of the relative risks of delivery versus the risks of expectant management (eg, infection, abruptio placentae, and umbilical cord accident). The purpose of this document is to review the current understanding of this condition and to provide management guidelines that have been validated by appropriately conducted outcome-based research when available. Additional guidelines on the basis of consensus and expert opinion also are presented.
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Briand N, Jasseron C, Sibiude J, Azria E, Pollet J, Hammou Y, Warszawski J, Mandelbrot L. Cesarean section for HIV-infected women in the combination antiretroviral therapies era, 2000-2010. Am J Obstet Gynecol 2013; 209:335.e1-335.e12. [PMID: 23791563 DOI: 10.1016/j.ajog.2013.06.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 05/05/2013] [Accepted: 06/12/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Elective cesarean section (CS) is a proven method to prevent mother-to-child transmission (MTCT), but is no longer recommended for women with antiretroviral therapy resulting in a low viral load (VL): <400 copies/mL in French and <1000 copies/mL in US guidelines. We sought to describe mode of delivery practices in human immunodeficiency virus (HIV)-infected women and their association with MTCT and postpartum complications. STUDY DESIGN All deliveries from HIV-1-infected women in the French Perinatal Cohort (Agence Nationale de Recherches sur le Sida/Enquête Périnatale Française) 2000 through 2010 (N = 8977) were analyzed, with additional details for 2005 through 2010 (n = 4717). RESULTS Vaginal deliveries increased from 25% in 2000 to 53% in 2010. Over 2005 through 2010, 4300 women had VL before delivery <400 copies/mL; among them only 49.3% delivered vaginally, 22.0% had nonelective CS, and 28.7% had elective CS. Elective CS were performed for scarred uterus in 45.4%, other obstetrical indications in 37.1%, and solely because of HIV in 15.7%. Of the 417 women with VL ≥400 copies/mL, 48.9% had elective CS as recommended, 25.9% had nonelective CS, and 25.2% had vaginal delivery. The MTCT rate did not differ according to the mode of delivery in term deliveries (≥37 gestational weeks) in 2000 through 2010: 0.3% after both vaginal delivery and elective CS with VL <50 copies/mL, 4.0% vs 5.3%, respectively, with VL ≥10,000 copies/mL. In case of preterm delivery, MTCT rates tended to be higher with vaginal delivery. Postpartum complications were more frequent following CS than vaginal deliveries (6.5% vs 2.9, P < .01). CONCLUSION Our findings suggest that HIV-infected women on antiretroviral therapy with low VL can safely opt for vaginal delivery in the absence of obstetrical risk factors.
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Affiliation(s)
- Nelly Briand
- Inserm, Center for Research in Epidemiology and Population Health U1018, Le Kremlin-Bicêtre, France; Université Paris-Sud, Le Kremlin-Bicêtre, France
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King CC, Ellington SR, Kourtis AP. The role of co-infections in mother-to-child transmission of HIV. Curr HIV Res 2013; 11:10-23. [PMID: 23305198 PMCID: PMC4411038 DOI: 10.2174/1570162x11311010003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 12/11/2012] [Accepted: 12/14/2012] [Indexed: 01/27/2023]
Abstract
In HIV-infected women, co-infections that target the placenta, fetal membranes, genital tract, and breast tissue, as well as systemic maternal and infant infections, have been shown to increase the risk for mother-to-child transmission of HIV (MTCT). Active co-infection stimulates the release of cytokines and inflammatory agents that enhance HIV replication locally or systemically and increase tissue permeability, which weakens natural defenses to MTCT. Many maternal or infant co-infections can affect MTCT of HIV, and particular ones, such as genital tract infection with herpes simplex virus, or systemic infections such as hepatitis B, can have substantial epidemiologic impact on MTCT. Screening and treatment for co-infections that can make infants susceptible to MTCT in utero, peripartum, or postpartum can help reduce the incidence of HIV infection among infants and improve the health of mothers and infants worldwide.
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Affiliation(s)
- Caroline C King
- Division of Reproductive Health, NCCDPHP, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS-K34, Atlanta, GA 30341, USA.
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Cotter AM, Brookfield KF, Duthely LM, Gonzalez Quintero VH, Potter JE, O'Sullivan MJ. Duration of membrane rupture and risk of perinatal transmission of HIV-1 in the era of combination antiretroviral therapy. Am J Obstet Gynecol 2012; 207:482.e1-5. [PMID: 23103331 DOI: 10.1016/j.ajog.2012.10.862] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 09/13/2012] [Accepted: 10/10/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The objective of the study was to determine whether the duration of membrane rupture of 4 or more hours is a significant risk factor for perinatal transmission of human immunodeficiency virus (HIV) in the era of combination antiretroviral therapy (ART). STUDY DESIGN This was a prospective cohort study of 717 HIV-infected pregnant women-infant pairs with a delivery viral load available who received prenatal care and delivered at our institution during the interval 1996-2008. RESULTS The cohort comprised 707 women receiving ART who delivered during this interval. The perinatal transmission rate was 1% in women with membranes ruptured for less than 4 hours and 1.9% when ruptured for 4 or more hours. For 493 women with a delivery viral load less than 1000 copies/mL receiving combination ART in pregnancy, there were no cases of perinatal transmission identified up to 25 hours of membrane rupture. Logistic regression demonstrated only a viral load above 10,000 copies/mL as an independent risk factor for perinatal transmission. CONCLUSION Duration of membrane rupture of 4 or more hours is not a risk factor for perinatal transmission of HIV in women with a viral load less than 1000 copies/mL receiving combination ART.
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11.0 References. HIV Med 2012. [DOI: 10.1111/j.1468-1293.2012.1030_12.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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7.0 Obstetric management. HIV Med 2012. [DOI: 10.1111/j.1468-1293.2012.1030_8.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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4.0 Screening and monitoring of HIV-positive pregnant women. HIV Med 2012. [DOI: 10.1111/j.1468-1293.2012.1030_5.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Taylor GP, Clayden P, Dhar J, Gandhi K, Gilleece Y, Harding K, Hay P, Kennedy J, Low-Beer N, Lyall H, Palfreeman A, Tookey P, Welch S, Wilkins E, de Ruiter A. British HIV Association guidelines for the management of HIV infection in pregnant women 2012. HIV Med 2012. [DOI: 10.1111/j.1468-1293.2012.01030.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- GP Taylor
- Communicable Diseases; Section of Infectious Diseases; Imperial College London; UK
| | - P Clayden
- UK Community Advisory Board representative/HIV treatment advocates network; London; UK
| | - J Dhar
- Genitourinary Medicine; University Hospitals of Leicester NHS Trust; Leicester; UK
| | - K Gandhi
- Heart of England NHS Foundation Trust; Birmingham; UK
| | | | - K Harding
- Guy's and St Thomas′ Hospital NHS Foundation Trust; London; UK
| | - P Hay
- St George's Healthcare NHS Trust; London; UK
| | - J Kennedy
- Homerton University Hospital NHS Foundation Trust; London; UK
| | - N Low-Beer
- Chelsea and Westminster Hospital NHS Foundation Trust; London; UK
| | - H Lyall
- Imperial College Healthcare NHS Trust; London; UK
| | - A Palfreeman
- Genitourinary Medicine; University Hospitals of Leicester NHS Trust; Leicester; UK
| | - P Tookey
- UCL Institute of Child Health; London; UK
| | - S Welch
- Paediatric Infectious Diseases; Heart of England NHS Foundation Trust; Birmingham; UK
| | - E Wilkins
- Infectious Diseases and Director of the HIV Research Unit; North Manchester General Hospital; Manchester; UK
| | - A de Ruiter
- Genitourinary Medicine; Guy's and St Thomas' NHS Foundation Trust; London; UK
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Mark S, Murphy KE, Read S, Bitnun A, Yudin MH. HIV mother-to-child transmission, mode of delivery, and duration of rupture of membranes: experience in the current era. Infect Dis Obstet Gynecol 2012; 2012:267969. [PMID: 22690108 PMCID: PMC3368362 DOI: 10.1155/2012/267969] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 03/24/2012] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate whether the length of time of rupture of membranes (ROM) in optimally managed HIV-positive women on highly active antiretroviral therapy (HAART) with low viral loads (VL) is predictive of the risk of mother to child transmission (MTCT) of the human immunodeficiency virus (HIV). STUDY METHODS A retrospective case series of all HIV-positive women who delivered at two academic tertiary centers in Toronto, Canada from January 2000 to November 2010 was completed. RESULTS Two hundred and ten HIV-positive women with viral loads <1,000 copies/ml delivered during the study period. VL was undetectable (<50 copies/mL) for the majority of the women (167, 80%), and <1,000 copies/mL for all women. Mode of delivery was vaginal in 107 (51%) and cesarean in 103 (49%). The median length of time of ROM was 0.63 hours (range 0 to 77.87 hours) for the entire group and 2.56 hours (range 0 to 53.90 hours) for those who had a vaginal birth. Among women with undetectable VL, 90 (54%) had a vaginal birth and 77 (46%) had a cesarean birth. Among the women in this cohort there were no cases of MTCT of HIV. CONCLUSIONS There was no association between duration of ROM or mode of delivery and MTCT in this cohort of 210 virally suppressed HIV-positive pregnant women.
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Affiliation(s)
- Siobhan Mark
- Department of Obstetrics and Gynecology, University of Toronto, 92 College Street, Toronto, ON, Canada M5G 1L4.
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Kinuthia J, Kiarie JN, Farquhar C, Richardson BA, Nduati R, Mbori-Ngacha D, John-Stewart G. Uptake of prevention of mother to child transmission interventions in Kenya: health systems are more influential than stigma. J Int AIDS Soc 2011; 14:61. [PMID: 22204313 PMCID: PMC3313883 DOI: 10.1186/1758-2652-14-61] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 12/28/2011] [Indexed: 12/02/2022] Open
Abstract
Background We set out to determine the relative roles of stigma versus health systems in non-uptake of prevention of mother to child transmission (PMTCT) of HIV-1 interventions: we conducted cross-sectional assessment of all consenting mothers accompanying infants for six-week immunizations. Methods Between September 2008 and March 2009, mothers at six maternal and child health clinics in Kenya's Nairobi and Nyanza provinces were interviewed regarding PMTCT intervention uptake during recent pregnancy. Stigma was ascertained using a previously published standardized questionnaire and infant HIV-1 status determined by HIV-1 polymerase chain reaction. Results Among 2663 mothers, 2453 (92.1%) reported antenatal HIV-1 testing. Untested mothers were more likely to have less than secondary education (85.2% vs. 74.9%, p = 0.001), be from Nyanza (47.1% vs. 32.2%, p < 0.001) and have lower socio-economic status. Among 318 HIV-1-infected mothers, 90% reported use of maternal or infant antiretrovirals. Facility delivery was less common among HIV-1-infected mothers (69% vs. 76%, p = 0.009) and was associated with antiretroviral use (p < 0.001). Although internal or external stigma indicators were reported by between 12% and 59% of women, stigma was not associated with lower HIV-1 testing or infant HIV-1 infection rates; internal stigma was associated with modestly decreased antiretroviral uptake. Health system factors contributed to about 60% of non-testing among mothers who attended antenatal clinics and to missed opportunities in offering antiretrovirals and utilization of facility delivery. Eight percent of six-week-old HIV-1-exposed infants were HIV-1 infected. Conclusions Antenatal HIV-1 testing and antiretroviral uptake was high (both more than 90%) and infant HIV-1 infection risk was low, reflecting high PMTCT coverage. Investment in health systems to deliver HIV-1 testing and antiretrovirals can effectively prevent infant HIV-1 infection despite substantial HIV-1 stigma.
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Affiliation(s)
- John Kinuthia
- Department of Obstetrics and Gynaecology, Kenyatta National Hospital/University of Nairobi, Kenya.
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Cavarelli M, Scarlatti G. Human immunodeficiency virus type 1 mother-to-child transmission and prevention: successes and controversies. J Intern Med 2011; 270:561-79. [PMID: 21929711 DOI: 10.1111/j.1365-2796.2011.02458.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The World Health Organization (WHO) and United Nations Programme on HIV/AIDS (UNAIDS) estimated that an additional 370 000 new human immunodeficiency virus type 1 (HIV-1) infections occurred in children in 2009, mainly through mother-to-child transmission (MTCT). Intrapartum transmission contributes to approximately 20-25% of infections, in utero transmission to 5-10% and postnatal transmission to an additional 10-15% of cases. MTCT accounts for only a few hundred infected newborns in those countries in which services are established for voluntary counselling and testing of pregnant women, and a supply of antiretroviral drugs is available throughout pregnancy with recommendations for elective Caesarean section and avoidance of breastfeeding. The single-dose nevirapine regimen has provided the momentum to initiate MTCT programmes in many resource-limited countries; however, regimens using a combination of antiretroviral drugs are needed also to effectively reduce transmission via breastfeeding.
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Affiliation(s)
- M Cavarelli
- Unit of Viral Evolution and Transmission, DITID, San Raffaele Scientific Institute, Milan, Italy
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Ellington SR, King CC, Kourtis AP. Host factors that influence mother-to-child transmission of HIV-1: genetics, coinfections, behavior and nutrition. Future Virol 2011; 6:1451-1469. [PMID: 29348780 DOI: 10.2217/fvl.11.119] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Mother-to-child transmission (MTCT) is the most important mode of HIV-1 acquisition among infants and children and it can occur in utero, intrapartum and postnatally through breastfeeding. Great progress has been made in preventing MTCT through use of antiretroviral regimens during gestation, labor/delivery and breastfeeding. The mechanisms of MTCT, however, are multifactorial and remain incompletely understood. This review focuses on select host factors affecting MTCT, in particular genetic factors, coexisting infections, behavioral factors and nutrition. Whereas much emphasis has been placed on decreasing maternal HIV-1 viral load, an important determinant of MTCT, through use of antiretroviral agents, complementary focus on overall maternal health is often neglected. By addressing coinfections in mothers and infants, improving the mother's nutritional status and modifying risky behaviors and practices, not only is maternal and child health improved, but a direct benefit in reducing MTCT can be derived. The study of genetic variations in susceptibility to HIV-1 infection is rapidly evolving, and the future is likely to bring revolutionary changes in HIV-1 prevention by enhancing natural resistance to infection and by individually tailoring pharmacologic regimens.
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Affiliation(s)
- Sascha R Ellington
- Division of Reproductive Health, National Center for Chronic Disease Prevention & Health Promotion, CDC, 4770 Buford Highway, NE, MS K34, Atlanta, GA 30341, USA
| | - Caroline C King
- Division of Reproductive Health, National Center for Chronic Disease Prevention & Health Promotion, CDC, 4770 Buford Highway, NE, MS K34, Atlanta, GA 30341, USA
| | - Athena P Kourtis
- Division of Reproductive Health, National Center for Chronic Disease Prevention & Health Promotion, CDC, 4770 Buford Highway, NE, MS K34, Atlanta, GA 30341, USA
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Mukherjee K. Cost-effectiveness of Childbirth Strategies for Prevention of Mother-to-child Transmission of HIV Among Mothers Receiving Nevirapine in India. Indian J Community Med 2011; 35:29-33. [PMID: 20606916 PMCID: PMC2888364 DOI: 10.4103/0970-0218.62550] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Accepted: 10/10/2009] [Indexed: 12/02/2022] Open
Abstract
Background: Mother-to-child transmission of HIV is an important mode of spread of HIV in India. With strategies like caesarian section and nevirapine therapy, this spread has been reduced. However, they have costs attached. In this context, this paper attempts to compare the cost-effectiveness of alternative childbirth strategies among HIV-positive mothers receiving nevirapine. Materials and Methods: Using sentinel surveillance data from three districts in Tamil Nadu, a model was created to test the cost-effectiveness of vaginal delivery against elective caesarian section among mothers receiving nevirapine. Sensitivity analysis was applied to evaluate cost per HIV infection prevented. Results: Vaginal delivery is not only cheaper in HIV-infected mothers receiving nevirapine but also cost-effective as compared to elective caesarian section. The incremental cost for preventing an additional HIV infection through caesarian section was Rs. 76,000. Sensitivity analysis reveals that the findings are robust over a range of HIV transmission probabilities, 0.04-0.14 for vaginal delivery and 0.00-0.02 for caesarian section. Conclusions: From a clinical perspective, the findings suggest that pregnant HIV-infected women receiving nevirapine should consider the benefits of a cheaper and safer vaginal delivery. From an economic perspective, the findings support the strategy of vaginal delivery in mothers receiving nevirapine.
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Affiliation(s)
- Kanchan Mukherjee
- Centre for Health Policy, Planning and Management School of Health Systems Studies, Tata Institute of Social Sciences, Deonar, Mumbai - 400 088, Maharashtra, India
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Siegfried N, van der Merwe L, Brocklehurst P, Sint TT. Antiretrovirals for reducing the risk of mother-to-child transmission of HIV infection. Cochrane Database Syst Rev 2011:CD003510. [PMID: 21735394 DOI: 10.1002/14651858.cd003510.pub3] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Antiretroviral drugs reduce viral replication and can reduce mother-to-child transmission of HIV either by lowering plasma viral load in pregnant women or through post-exposure prophylaxis in their newborns. In rich countries, highly active antiretroviral therapy (HAART) which usually comprises three drugs, has reduced the mother-to-child transmission rates to around 1-2%, but HAART is not always available in low- and middle-income countries. In these countries, various simpler and less costly antiretroviral regimens have been offered to pregnant women or to their newborn babies, or to both. OBJECTIVES To determine whether, and to what extent, antiretroviral regimens aimed at decreasing the risk of mother-to-child transmission of HIV infection achieve a clinically useful decrease in transmission risk, and what effect these interventions have on maternal and infant mortality and morbidity. SEARCH STRATEGY We sought to identify all relevant studies regardless of language or publication status by searching the Cochrane HIV/AIDS Review Group Trials Register, The Cochrane Library, MEDLINE, EMBASE and AIDSearch and relevant conference abstracts. We also contacted research organizations and experts in the field for unpublished and ongoing studies. The original review search strategy was conducted in 2002 and updated in 2006 and again in 2009. SELECTION CRITERIA Randomised controlled trials of any antiretroviral regimen aimed at decreasing the risk of mother-to-child transmission of HIV infection compared with placebo or no treatment, or compared with another antiretroviral regimen. DATA COLLECTION AND ANALYSIS Two authors independently selected relevant studies, extracted data and assessed trial quality. For the primary outcomes, we used survival analysis to estimate the probability of infants being infected with HIV (the observed proportion) at various specific time-points and calculated efficacy at a specific time as the relative reduction in the proportion infected. Efficacy, at a specific time, is defined as the preventive fraction in the exposed group compared to the reference group, which is the relative reduction in the proportion infected: 1-(Re/Rf). For those studies where efficacy and hence confidence intervals were not calculated, we calculated the approximate confidence intervals for the efficacy using recommended methods. For analysis of results that are not based on survival analyses we present the relative risk for each trial outcome based on the number randomised. No meta-analysis was conducted as no trial assessed identical drug regimens. MAIN RESULTS Twenty-five trials including 18,901 participants with a median trial sample size of 627 ranging from 50 to 1,844 participants were included in this update. Twenty-two trials randomised mothers (18 pre-natally and four in labour) and followed up their infants, and three trials randomised infants. The first trial began in April 1991 and assessed zidovudine (ZDV) versus placebo and since then, the type, dosage and duration of drugs to be compared has been modified in each subsequent trial. We present the results stratified by regimen and type of feeding.Antiretrovirals versus placebo In breastfeeding populations, three trials found that:ZDV given to mothers from 36 to 38 weeks gestation, during labour and for 7 days after delivery significantly reduced HIV infection at 4-8 weeks (Efficacy 32.00%; 95% CI 1.50 to 62.50), 3 to 4 months (Efficacy 33.07%; 95% CI 5.57 to 60.57), 6 months (Efficacy 34.55%; 95% CI 9.05 to 60.05), 12 months (Efficacy 34.31%; 95% CI 9.30 to 59.32) and 18 months (Efficacy 29.74%; 95% CI 2.73 to 56.75).ZDV given to mothers from 36 weeks gestation and during labour significantly reduced HIV infection at 4 to 8 weeks (Efficacy 43.78%; 95% CI 8.78 to 78.78) and 3 to 4 months (Efficacy 36.95%; 95% CI 2.94 to 70.96) but not at birth.ZDV plus lamivudine (3TC) given to mothers from 36 weeks gestation, during labour and for 7 days after delivery and to babies for the first 7 days after birth (PETRA 'regimen A') significantly reduced HIV infection (Efficacy 62.75%; 95% CI 40.76 to 84.74) and a combined endpoint of HIV infection or death (Efficacy 62.75 [, ]61.00%; 95% CI 40.76 to 84.74) at 4 to 8 weeks but these effects were not sustained at 18 months.ZDV plus 3TC given to mothers from the start of labour until 7 days after delivery and to babies for the first 7 days after birth (PETRA 'regimen B') significantly reduced HIV infection (Efficacy 41.83%; 95% CI 12.82 to 70.84) and HIV infection or death at 4 to 8 weeks (Efficacy 35.91%; 95% CI 8.41 to 63.41) but the effects were not sustained at 18 months.ZDV plus 3TC given to mothers during labour only (PETRA 'regimen C') with no treatment to babies did not reduce the risk of HIV infection at either 4 to 8 weeks or 18 months.In non-breastfeeding populations, three trials found that:ZDV given to mothers from 14 to 34 weeks gestation and during labour and to babies for the first 6 weeks after birth significantly reduced HIV infection in babies at 18 months (Efficacy 66.22%; 95% CI 33.94 to 98.50).ZDV given to mothers from 36 weeks gestation and during labour with no treatment to babies ('Thai-CDC regimen') significantly reduced HIV infection at 4 to 8 weeks (Efficacy 50.26%; 95% CI 13.80 to 86.72) but not at birthZDV given to mothers from 38 weeks gestation and during labour with no treatment to babies did not influence HIV transmission at 6 months.Longer versus shorter regimens using the same antiretrovirals One trial in a breastfeeding population found that:ZDV given to mothers during labour and to their babies for the first 3 days after birth compared with ZDV given to mothers from 36 weeks and during labour (similar to 'Thai-CDC') resulted in HIV infection rates that were not significantly different at birth, 4-8 weeks, 3 to 4 months, 6 months and 12 months.Three trials in non-breastfeeding populations found that:ZDV given to mothers from 28 weeks gestation during labour and to infants for the first 3 days after birth compared with ZDV given to mothers from 35 weeks gestation through labour and to infants from birth to 6 weeks significantly reduced HIV infection rate at 6 months (Efficacy 45.35 %; 95% CI 1.39 to 89.31) but compared with the same regimen ZDV given to mothers from 28 weeks gestation through labour and to infants from birth to 6 weeks did not result in a statistically significant difference in HIV infection at 6 months. ZDV given to mothers from 35 weeks gestation during labour and to infants for the first 3 days after birth was considered ineffective for reducing transmission rates and this regimen was discontinued.An antenatal/intrapartum course of ZDV used for a median of 76 days compared with an antenatal/intrapartum ZDV regimen used for a median 28 days with no treatment to babies in either group did not result in HIV infection rates that were significantly different at birth and at 3 to 4 months.In a programme where mothers were routinely receiving ZDV in the third trimester of pregnancy and babies were receiving one week of ZDV therapy, a single dose of nevirapine (NVP) given to mothers in labour and to their babies soon after birth compared with a single dose of NVP given to mothers only resulted in HIV infection rates that were not significantly different at birth and 6 months. However the reduction in risk of HIV infection or death at 6 months was marginally significant (Efficacy 45.00%; 95% CI -4.00 to 94.00).Antiretroviral regimens using different drugs and durations of treatmentIn breastfeeding populations, three trials found that:A single dose of NVP given to mothers at the onset of labour plus a single dose of NVP given to their babies immediately after birth ('HIVNET 012 regimen') compared with ZDV given to mothers during labour and to their babies for a week after birth resulted in lower HIV infection rates at 4-8 weeks (Efficacy 41.00%; 95% CI 11.84 to 70.16), 3-4 months (Efficacy 38.91%; 95% CI 11.24 to 66.58), 12 months (Efficacy 35.98 [9.25, 62.71]36.00%; 95% CI 8.56 to 63.44) and 18 months (Efficacy 39.15%; 95% CI 13.81 to 64.49). In addition, the NVP regimen significantly reduced the risk of HIV infection or death at 4-8 weeks (Efficacy 41.74%; 95% CI 14.30 to 69.18), 3 to 4 months (Efficacy 40.00%; 95% CI 14.34 to 65.66), 12 months (Efficacy 32.17%; 95% CI 8.51 to 55.83) and 18 months (Efficacy 32.57 [9.93, 55.21]33.00%; 95% CI 9.93 to 55.21).The 'HIVNET 012 regimen' plus ZDV given to babies for 1 week after birth compared with the 'HIVNET 012 regimen' alone did not result in a statistically significant difference in HIV infection at 4 to 8 weeks.A single dose of NVP given to babies immediately after birth plus ZDV given to babies for 1 week after birth compared with a single dose of NVP given to babies only significantly reduced the HIV infection rate at 4 to 8 weeks (Efficacy 36.79%; 95% CI 3.57 to 70.01).Five trials in non-breastfeeding populations found that:In a population in which mothers were receiving 'standard' antiretroviral for HIV infection a single dose of NVP given to mothers in labour plus a single dose of NVP given to babies immediately after birth ('HIVNET 012 regimen') compared with placebo did not result in a statistically significant difference in HIV infection rates at birth and at 4 to 8 weeks.The 'Thai CDC regimen' compared with the 'HIVNET 012 regimen' did not result in a significant difference in HIV infection at 4 to 8 weeks.A single dose of NVP given to babies immediately after birth compared to ZDV given to babies for the first 6 weeks after birth did not result in a significant difference in HIV infection rates at 4-8 weeks and 3 to 4 months. (ABSTRACT TRUNCATED)
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Affiliation(s)
- Nandi Siegfried
- Department of Public Health and Primary Health Care, University of Cape Town, Cape Town, South Africa
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Purohit V, Rapaka RS, Schnur P, Shurtleff D. Potential impact of drugs of abuse on mother-to-child transmission (MTCT) of HIV in the era of highly active antiretroviral therapy (HAART). Life Sci 2011; 88:909-16. [DOI: 10.1016/j.lfs.2011.03.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 03/19/2011] [Indexed: 11/16/2022]
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Van Dyke RB. Mother-to-child transmission of HIV-1 in the era prior to the availability of combination antiretroviral therapy: the role of drugs of abuse. Life Sci 2011; 88:922-5. [PMID: 21439978 DOI: 10.1016/j.lfs.2011.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 02/22/2011] [Accepted: 03/03/2011] [Indexed: 10/18/2022]
Abstract
Since the use of combination antiretroviral therapy (HAART) to treat pregnant women, the rate of mother-to-child transmission (MTCT) of HIV in the United States has dropped dramatically to less than 2%. With this, the principal determinants of the risk of transmission are the maternal viral load and her use of antiretroviral therapy (ART). However, in the pre-HAART era, the MTCT ranged from 12 to 45% and was influenced by a variety of risk factors for transmission including no ART during pregnancy or delivery, advanced maternal HIV infection (high viral load, low CD4 count, and AIDS diagnosis), prolonged rupture of membranes, first-born of twins, prematurity/low birth weight, chorioamnionitis, vaginal delivery or non-elective Cesarean section, and maternal drug use. Several studies in the pre-HAART era found maternal illicit drug use to be an independent predictor of MTCT. Reasons for this association may be both behavioral and biological. Drug use is associated with poor adherence to ART and medical care. Opioids enhance infection of macrophages by HIV.
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Affiliation(s)
- Russell B Van Dyke
- Tulane University Health Sciences, New Orleans, LA 70112, United States.
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Cook JA. Associations between use of crack cocaine and HIV-1 disease progression: research findings and implications for mother-to-infant transmission. Life Sci 2011; 88:931-9. [PMID: 21219914 DOI: 10.1016/j.lfs.2011.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2010] [Revised: 10/08/2010] [Accepted: 12/23/2010] [Indexed: 10/18/2022]
Abstract
Recent in vitro and in vivo research has suggested that cocaine has a direct effect on the pathogenesis of AIDS. These findings are confirmed by epidemiological studies linking the use of injected, inhaled, and smoked (crack) cocaine and indicators of HIV disease progression, even among adherent users of highly active antiretroviral therapy. Recent studies of vertical HIV transmission suggest that cocaine use may play a role in mother-to-child infection via alteration of maternal immune responses, enhanced viral replication in maternal immune cells, or alterations in the immune systems of neonates or infants. The purpose of this article is to review research conducted over the past several decades on associations between use of cocaine and HIV disease progression, especially among HIV+ women, and to explore its potential relevance for understanding mother-to-infant transmission of HIV.
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Affiliation(s)
- Judith A Cook
- Department of Psychiatry, University of Illinois at Chicago, United States.
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Legardy-Williams JK, Jamieson DJ, Read JS. Prevention of mother-to-child transmission of HIV-1: the role of cesarean delivery. Clin Perinatol 2010; 37:777-85, ix. [PMID: 21078450 DOI: 10.1016/j.clp.2010.08.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The risk of mother-to-child transmission (MTCT) of HIV can be reduced through cesarean delivery prior to the onset of labor and prior to rupture of the membranes (elective cesarean delivery [ECD]). As a result of this evidence, the American College of Obstetricians and Gynecologists and the Department of Health and Human Services Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission developed guidelines recommending ECD for HIV-infected women with plasma viral loads of more than 1000 copies/mL. Since the release of the recommendations, an increase in ECD has been seen among HIV-infected women in the United States. This article discusses the evidence on efficacy of ECD, current recommendations in the United States, and risks and morbidity related to ECD. Although the benefit of ECD in preventing MTCT of HIV is substantial, some questions remain. Specifically, the benefit of ECD for women with very low viral loads or for women using combination antiretroviral regimens is unclear, as is the timeframe after onset of labor or rupture of membranes within which ECD will still confer preventive benefits.
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Affiliation(s)
- Jennifer K Legardy-Williams
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341, USA.
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Abstract
More than 400,000 children were infected with (HIV-1) worldwide in 2008, or more than 1000 children per day. Mother-to-child transmission (MTCT) of HIV-1 is the most important mode of HIV acquisition in infants and children. MTCT of HIV-1 can occur in utero, intrapartum, and postnatally through breastfeeding. Great progress has been made in preventing such transmission, through the use of antiretroviral prophylactic regimens to the mother during gestation and labor and delivery and to either mother or infant during breast feeding. The timing and mechanisms of transmission, however, are multifactorial and remain incompletely understood. This article summarizes what is known about the pathogenetic mechanisms and routes of MTCT of HIV-1, and includes virologic, immunologic, genetic, and mucosal aspects of transmission.
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Mepham SO, Bland RM, Newell ML. Prevention of mother-to-child transmission of HIV in resource-rich and -poor settings. BJOG 2010; 118:202-18. [DOI: 10.1111/j.1471-0528.2010.02733.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mother-to-child transmission (MTCT) of HIV and drugs of abuse in post-highly active antiretroviral therapy (HAART) era. J Neuroimmune Pharmacol 2010; 5:507-15. [PMID: 20838913 DOI: 10.1007/s11481-010-9242-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 08/19/2010] [Indexed: 10/19/2022]
Abstract
In the pre-highly active antiretroviral therapy (HAART) era, prenatal "vertical" mother-to-child transmission (MTCT) of HIV was about 25% and exposure of pregnant mothers to drugs of abuse (illicit drugs and tobacco smoking) was a significant contributory factor of MTCT. However, with the introduction of HAART, the rate of MTCT of HIV has decreased to less that 2%. But, it is estimated that currently about 5.1% of pregnant women use illicit drugs and 16.4% smoke tobacco. The residual prevalence of MTCT is of concern and may be related to this continued prevalence of substance use among pregnant mothers. In this report, we review and present evidence that supports the hypothesis that drugs of abuse do have the potential to increase MTCT of HIV in the presence of HAART. Exposure to drugs of abuse during pregnancy may increase MTCT of HIV through a variety of mechanisms that are addressed in detail including possible damage to the placenta, induction of preterm birth, and increasing maternal plasma viral load though a variety of putative mechanisms such as: (a) promoting HIV replication in monocyte/macrophages; (b) increasing the expression of CCR5 receptors; (c) decreasing the expression of CCR5 receptor ligands; (d) increasing the expression of CXCR4 receptors; (e) increasing the expression of DC-SIGN; (f) impairing the efficacy of HAART through drug-drug interaction; and (g) promoting HIV mutation and replication through non-adherence to HAART.
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Why are some babies still being infected with HIV in the UK? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2010. [PMID: 20204755 DOI: 10.1007/978-1-4419-0981-7_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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