1
|
Short CES, Byrne L, Hagan-Bezgin A, Quinlan RA, Anderson J, Brook G, De Alwis O, de Ruiter A, Farrugia P, Fidler S, Hamlyn E, Hartley A, Murphy S, Noble H, Oomeer S, Roedling S, Rosenvinge M, Rubinstein L, Shah R, Singh S, Thorne E, Toby M, Wait B, Sarner L, Taylor GP. Pregnancy Management in HIV Viral Controllers: Twenty Years of Experience. Pathogens 2024; 13:308. [PMID: 38668263 PMCID: PMC11054990 DOI: 10.3390/pathogens13040308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/30/2024] [Accepted: 04/03/2024] [Indexed: 04/29/2024] Open
Abstract
(1) Background: The evidence base for the management of spontaneous viral controllers in pregnancy is lacking. We describe the management outcomes of pregnancies in a series of UK women with spontaneous HIV viral control (<100 copies/mL 2 occasions before or after pregnancy off ART). (2) Methods: A multi-centre, retrospective case series (1999-2021) comparing pre- and post-2012 when guidelines departed from zidovudine-monotherapy (ZDVm) as a first-line option. Demographic, virologic, obstetric and neonatal information were anonymised, collated and analysed in SPSS. (3) Results: A total of 49 live births were recorded in 29 women, 35 pre-2012 and 14 post. HIV infection was more commonly diagnosed in first reported pregnancy pre-2012 (15/35) compared to post (2/14), p = 0.10. Pre-2012 pregnancies were predominantly managed with ZDVm (28/35) with pre-labour caesarean section (PLCS) (24/35). Post-2012 4/14 received ZDVm and 10/14 triple ART, p = 0.002. Post-2012 mode of delivery was varied (5 vaginal, 6 PLCS and 3 emergency CS). No intrapartum ZDV infusions were given post-2012 compared to 11/35 deliveries pre-2012. During pregnancy, HIV was detected (> 50 copies/mL) in 14/49 pregnancies (29%) (median 92, range 51-6084). Neonatal ZDV post-exposure prophylaxis was recorded for 45/49 infants. No transmissions were reported. (4) Conclusion: UK practice has been influenced by the change in guidelines, but this has had little impact on CS rates.
Collapse
Affiliation(s)
- Charlotte-Eve S. Short
- Department of Infectious Disease, Imperial College London, London W2 1PG, UK
- Imperial College NIHR BRC, Imperial College London, London W2 1NY, UK
- Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Laura Byrne
- School of Medicine, St Georges, University of London, London SW17 0RE, UK
- St. George’s University Hospitals NHS Trust, London SW17 0RE, UK
| | - Aishah Hagan-Bezgin
- Department of Infectious Disease, Imperial College London, London W2 1PG, UK
- School of Medicine, University of Liverpool, Liverpool L69 3GE, UK
| | - Rachael A. Quinlan
- Department of Infectious Disease, Imperial College London, London W2 1PG, UK
- Imperial College NIHR BRC, Imperial College London, London W2 1NY, UK
| | - Jane Anderson
- Homerton Healthcare NHS Foundation Trust, London E9 6SR, UK
- London North West University Healthcare NHS Trust, Harrow HA1 3UJ, UK
| | - Gary Brook
- London North West University Healthcare NHS Trust, Harrow HA1 3UJ, UK
| | | | - Annemiek de Ruiter
- Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
- ViiV Healthcare, Brentford TW8 9GS, UK
| | - Pippa Farrugia
- Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Sarah Fidler
- Department of Infectious Disease, Imperial College London, London W2 1PG, UK
- Imperial College NIHR BRC, Imperial College London, London W2 1NY, UK
- Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Eleanor Hamlyn
- Royal Free London NHS Foundation Trust, London NW3 2QG, UK
| | - Anna Hartley
- Barts Health NHS Trust, London E1 1BB, UK
- Leeds University Teaching Hospital NHS Trust, Leeds LS1 3EX, UK
| | - Siobhan Murphy
- London North West University Healthcare NHS Trust, Harrow HA1 3UJ, UK
| | | | - Soonita Oomeer
- Imperial College Healthcare NHS Trust, London W2 1NY, UK
- Central and North West London NHS Foundation Trust, London NW1 3AX, UK
| | - Sherie Roedling
- Central and North West London NHS Foundation Trust, London NW1 3AX, UK
| | | | | | - Rimi Shah
- Royal Free London NHS Foundation Trust, London NW3 2QG, UK
| | | | - Elizabeth Thorne
- Department of Infectious Disease, Imperial College London, London W2 1PG, UK
- Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | | | - Brenton Wait
- Homerton Healthcare NHS Foundation Trust, London E9 6SR, UK
| | | | - Graham P. Taylor
- Department of Infectious Disease, Imperial College London, London W2 1PG, UK
- Imperial College NIHR BRC, Imperial College London, London W2 1NY, UK
- Imperial College Healthcare NHS Trust, London W2 1NY, UK
| |
Collapse
|
2
|
Short CES, Douglas M, Smith JH, Taylor GP. Preterm delivery risk in women initiating antiretroviral therapy to prevent HIV mother-to-child transmission. HIV Med 2013; 15:233-8. [DOI: 10.1111/hiv.12083] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2013] [Indexed: 11/29/2022]
Affiliation(s)
- C-ES Short
- Section of Infectious Diseases; Imperial College; London UK
- St Mary's Hospital; Imperial College Healthcare NHS Trust; London UK
| | - M Douglas
- St Mary's Hospital; Imperial College Healthcare NHS Trust; London UK
| | - JH Smith
- St Mary's Hospital; Imperial College Healthcare NHS Trust; London UK
| | - GP Taylor
- Section of Infectious Diseases; Imperial College; London UK
- St Mary's Hospital; Imperial College Healthcare NHS Trust; London UK
| |
Collapse
|
3
|
Newell ML, Huang S, Fiore S, Thorne C, Mandelbrot L, Sullivan JL, Maupin R, Delke I, Watts DH, Gelber RD, Cunningham CK. Characteristics and management of HIV-1-infected pregnant women enrolled in a randomised trial: differences between Europe and the USA. BMC Infect Dis 2007; 7:60. [PMID: 17584491 PMCID: PMC1913528 DOI: 10.1186/1471-2334-7-60] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Accepted: 06/20/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rates of mother-to-child transmission of HIV-1 (MTCT) have historically been lower in European than in American cohort studies, possibly due to differences in population characteristics. The Pediatric AIDS Clinical Trials Group Protocol (PACTG) 316 trial evaluated the effectiveness of the addition of intrapartum/neonatal nevirapine in reducing MTCT in women already receiving antiretroviral prophylaxis. Participation of large numbers of pregnant HIV-infected women from the US and Western Europe enrolling in the same clinical trial provided the opportunity to identify and explore differences in their characteristics and in the use of non-study interventions to reduce MTCT. METHODS In this secondary analysis, 1350 women were categorized according to enrollment in centres in the USA (n = 978) or in Europe (n = 372). Factors associated with receipt of highly active antiretroviral therapy and with elective caesarean delivery were identified with logistic regression. RESULTS In Europe, women enrolled were more likely to be white and those of black race were mainly born in Sub-Saharan Africa. Women in the US were younger and more likely to have previous pregnancies and miscarriages and a history of sexually transmitted infections. More than 90% of women did not report symptoms of their HIV infection; however, more women from the US had symptoms (8%), compared to women from Europe (4%). Women in the US were less likely to have HIV RNA levels <400 copies/ml at delivery than women enrolling in Europe, and more likely to receive highly active antiretroviral therapy, and to start therapy earlier in pregnancy. The elective caesarean delivery rate in Europe was 61%, significantly higher than that in the US (22%). Overall, 1.48% of infants were infected and there was no significant difference in the rate of transmission between Europe and the US despite the different approaches to treatment and delivery. CONCLUSION These findings confirm that there are important historical differences between the HIV-infected pregnant populations in Western Europe and the USA, both in terms of the characteristics of the women and their obstetric and therapeutic management. Although highly active antiretroviral therapy predominates in pregnancy in both settings now, population differences are likely to remain. TRIAL REGISTRATION NCT00000869.
Collapse
Affiliation(s)
- Marie-Louise Newell
- Centre of Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, UK
| | - Sharon Huang
- Centre for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, USA
| | - Simona Fiore
- Centre of Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, UK
| | - Claire Thorne
- Centre of Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, UK
| | - Laurent Mandelbrot
- Service de Gynecologie-Obstetrique, APHP Hopital Louis Mourier, F-75701 Colombes, Universite Diderot, Paris 7, and Inserm, U822, IFR69, F-94276, France
| | - John L Sullivan
- Department of Pediatrics and Molecular Medicine, University of Massachusetts Medical School, Worcester, USA
| | - Robert Maupin
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, New Orleans, USA
| | - Isaac Delke
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, USA
| | - D Heather Watts
- Pediatric, Adolescent, and Maternal AIDS Branch, National Institute of Child Health and Human Development, Bethesda, USA
| | - Richard D Gelber
- Centre for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, USA
| | | | | |
Collapse
|
4
|
Martin F, Navaratne L, Khan W, Sarner L, Mercey D, Anderson J, Noble H, Fakoya A, Hawkins DA, De Ruiter A, Taylor GP. Pregnant women with HIV infection can expect healthy survival: three-year follow-up. J Acquir Immune Defic Syndr 2006; 43:186-92. [PMID: 16940856 DOI: 10.1097/01.qai.0000233311.28602.4d] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To document postpartum disease-free survival of HIV-infected women taking antiretroviral therapy (ART) during pregnancy. METHODS Laboratory and clinical data were collected on all HIV-infected pregnant women delivering from 1998 to 2002 and followed up until September 2004 at 6 hospitals in London. Mothers were grouped according to receipt of zidovudine monotherapy (ZDVm), highly active antiretroviral therapy (HAART) given during and continued after pregnancy (cHAART), and short-term HAART given during pregnancy and discontinued on delivery (START). RESULTS Eight-five women took ZDVm, 155 took cHAART, and 71 took START. The mean follow-up for all mothers was 33 months, with a total of 847 person-years. At the first antenatal clinic (ANC) visit, 72% of women were in Centers for Disease Control and Prevention (CDC) stage A, 85% were treatment naive, and the ZDVm group had a median HIV viral load (VL) 10-fold less than those mothers who started HAART during pregnancy. At last follow-up, 1 patient had died and 6 (1.9%) had progressed to CDC stage C; 62% of all women, including a quarter of the ZDVm group, were receiving HAART for their own health; and 83% of all mothers had a VL <50 HIV RNA copies/mL of plasma regardless of whether they were on treatment or not. CONCLUSIONS The median-term postpartum prognosis of HIV-infected pregnant women with access to HAART is good. Exposure to short-course ZDVm or START during pregnancy did not jeopardize their response to subsequent therapy.
Collapse
|
5
|
Talaie H, Nava-Ocampo AA, Koren G. Antiretroviral treatment of maternal HIV infection. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2004; 50:865-8. [PMID: 15233367 PMCID: PMC2214614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
QUESTION One of my pregnant patients tested positive for human immunodeficiency virus. Will HIV therapy put her pregnancy outcome at risk? ANSWER The biggest risk is vertical transmission of HIV to her baby. She should be treated with combination therapy; triple therapy is required to reduce vertical transmission. Zidovudine is not teratogenic in humans, but information on other antiretroviral drugs is incomplete.
Collapse
|
6
|
Sharland M, Gibb DM, Tudor-Williams G. Advances in the prevention and treatment of paediatric HIV infection in the United Kingdom. Sex Transm Infect 2003; 79:53-5. [PMID: 12576615 PMCID: PMC1744598 DOI: 10.1136/sti.79.1.53] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- M Sharland
- Paediatric Infectious Diseases Unit, St George's Hospital, Blackshaw Road, London SW17 0QT, UK.
| | | | | |
Collapse
|
7
|
Bingham JS. The sins of the fathers--Africans with HIV infection in London; lessons for others? Int J STD AIDS 2002; 13 Suppl 2:42-4. [PMID: 12537726 DOI: 10.1258/095646202762226164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Many European countries have taken in immigrants from sub-Saharan Africa. The reasons for this are discussed and the particular problems experienced by HIV-infected Africans in London, and the approach to their care at St Thomas' Hospital, is delineated.
Collapse
Affiliation(s)
- J S Bingham
- Lydia Department, Guy's & St Thomas' Hospitals, London, UK.
| |
Collapse
|
8
|
Sharland M, Gibb DM, Tudor-Williams G. Advances in the prevention and treatment of paediatric HIV infection in the United Kingdom. Arch Dis Child 2002; 87:178-80. [PMID: 12193420 PMCID: PMC1719244 DOI: 10.1136/adc.87.3.178] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- M Sharland
- Paediatric Infectious Diseases Unit, St George's Hospital, Blackshaw Road, London SW17 0QT, UK.
| | | | | |
Collapse
|
9
|
Venerosi A, Calamandrei G, Alleva E. Animal models of anti-HIV drugs exposure during pregnancy: effects on neurobehavioral development. Prog Neuropsychopharmacol Biol Psychiatry 2002; 26:747-61. [PMID: 12188107 DOI: 10.1016/s0278-5846(01)00325-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In the last 10 years, zidovudine (AZT) has become the main prophylactic therapy against vertical HIV-1 transmission. AIDS Clinical Trials Group (ACTG) 076 have demonstrated that the administration of AZT to HIV-infected women during their third trimester of pregnancy, trough labor and given orally to babies for 6 weeks, reduced by two-thirds the rate of vertical infection. Although the rapid diffusion of this regimen into clinical practice together with the implementation of HIV counseling and testing practices have dramatically reduced the vertical transmission rate in the US and Western Europe, there is a growing concern on the adverse effects of antiretroviral therapy on the fetus and the newborn. In fact, even though shorter regimen therapies that are less complex and expensive to implement in poor countries have been demonstrated as effective as ACTG 076 regimen, the distribution of the risk of vertical transmission in the developing countries is still very high. Consequently, a large number of unborns will be a candidate to developmental exposure to antiretroviral agents. To date, data on the transplacental mutagenicity, carcinogenicity and mitochondrial dysfunction induced by developmental exposure to AZT have been reported in several animal models. Furthermore, one study reported severe yet few human cases of cardiomyopathy and neurological disease likely associated with mitochondrial dysfunction in uninfected infants of seropositive mothers perinatally exposed to AZT. For all of these reasons, many investigations have been focusing on the assessment of the potential adverse effects of nucleoside reverse transcriptase (RT) inhibitors (NRTI) administration during development. A survey of the main results derived from clinical and animal studies is reported here, focusing on those neurobehavioral studies that have been looking for specific and/or aspecific changes in the nervous system induced by NRTI exposure in utero.
Collapse
Affiliation(s)
- Aldina Venerosi
- Section of Behavioral Pathophysiology, Laboratorio di Fisiopatologia O.S., Istituto Superiore di Sanità, Rome, Italy.
| | | | | |
Collapse
|
10
|
Leyes M, Ciria L, Ruiz De Gopegui R, Sánchez E, Villalonga C, de La Peña A, Riera M, Salas A, Ribas A. [Prevention of vertical transmission of HIV-1 in Mallorca, Spain. Impact of antiretroviral therapy from 1995 to 2000]. Med Clin (Barc) 2002; 118:365-70. [PMID: 11940392 DOI: 10.1016/s0025-7753(02)72389-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Our objective was to evaluate the impact of antiretroviral therapy (ART) in the prevention of maternal-fetal HIV transmission in a population of HIV-infected pregnant women. PATIENTS AND METHOD We studied prospectively all HIV-infected pregnant women attended in our hospital from January 1995 to December 2000. We offered treatment with zidovudine (ZDV) alone or in combination according to women's requirements. RESULTS There were 98 mother-infant pairs and we studied 93 of them. The rate of vertical transmission was 1.4% when ART was started in pregnancy. Risk of HIV transmission was greater in mothers not being treated with ART during pregnancy (relative risk [RR]: 18; 95% confidence interval [CI]: 2.2-145.4), in mothers who only received ZDV at delivery and child vs those who received ART during pregnancy (RR: 16.4; 95% CI: 1.8-145.6) and in mothers who were active intravenous drug users (RR: 9.3; 95% CI: 2.2-38.5), with significant differences between vaginal delivery and caesarean section. CONCLUSIONS We observed a substantial benefit from ART, especially in the group of HIV-infected pregnant women who started treatment during pregnancy. Preventive interventions are needed.
Collapse
Affiliation(s)
- María Leyes
- Unidad de Enfermedades Infecciosas. Hospital Universitario de Son Dureta. Palma de Mallorca. Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
British HIV Association (BHIVA) guidelines for the treatment of HIV-infected adults with antiretroviral therapy. HIV Med 2001; 2:276-313. [PMID: 11737410 DOI: 10.1046/j.1464-2662.2001.00083.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
12
|
|
13
|
|
14
|
Sowell RL, Phillips KD, Seals BF, Misener TR, Rush C. HIV-infected women's experiences and beliefs related to AZT therapy during pregnancy. AIDS Patient Care STDS 2001; 15:201-9. [PMID: 11359662 DOI: 10.1089/10872910151133747] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To explore women's experiences and beliefs concerning zidovudine (AZT) therapy during pregnancy, short-answer and open-ended questions were asked of 322 human immunodeficiency virus (HIV)-infected women at increased risk for pregnancy. Specifically, we examined what women believed they had been told concerning AZT therapy during pregnancy by health care professionals and peers, experiences with taking AZT, how effective they believed AZT therapy to be, and if they would take AZT if they became pregnant. Women in the study were predominately African American (88%), single (79%), with a mean age of 32 years, and had annual incomes less than $10,000 (64%). Although 81.4% of the women had been told to take antiretrovirals, only 69.1% of the women were actually taking HIV-related medicines. Almost three-fourths of the women (70.8%) reported being told that taking AZT during pregnancy would reduce perinatal transmission. Women reported the most frequent reason for their stopping AZT was its side effects. When women who were not presently taking AZT were asked what would make them consider taking it, they most frequently said they would begin AZT if their health deteriorated or based on the advice of health care professionals. A small group of women said nothing would make them take AZT-type medications. More than one-half of the women said they felt AZT was effective in preventing perinatal HIV transmission. However, almost 20% of the women reported believing that their health care provider would not be positive about their taking AZT during pregnancy. Significant relationships were found between intent to take AZT if becoming pregnant and specific AZT-related beliefs and experiences.
Collapse
Affiliation(s)
- R L Sowell
- Department of Administrative and Clinical Nursing, College of Nursing, University of South Carolina, Columbia, South Carolina 29208, USA.
| | | | | | | | | |
Collapse
|
15
|
Brook MG, Taylor GP, Dale A, Lyall EG, Tomlinson D. Management of HIV and pregnancy in England's North Thames Region 1999: a survey of practice in 21 hospitals. HIV Med 2000; 1:143-7; discussion 148. [PMID: 11737341 DOI: 10.1046/j.1468-1293.2000.00023.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To ascertain current practices in the diagnosis and management of HIV and pregnancy in the North Thames Region. METHODS Postal survey using a self-completed questionnaire sent to the head of all of the Region's 34 units involved in the care of HIV. The survey asked questions on current policy around HIV and pregnancy in the HIV units and associated antenatal clinics and was linked to a case-note survey of pregnant, HIV-positive women in the last 2 years. RESULTS Over 50% of the responding antenatal units recommended the HIV test by March 1999. Most HIV units were offering a range of antiretroviral regimens in pregnancy, although a minority (33%) did not offer triple therapy. Elective Caesarean section was the recommended mode of delivery for most women (90%) irrespective of drug therapy or viral load. Most infants were being tested for HIV infection by a combination of PCR, viral culture and antibody testing to 18 months of age. All the infants (19) followed to 6 months of age in the case-note survey were PCR negative. Reporting rates to the National Survey of HIV in Pregnancy were high (87%) but poor for the Drug Exposure Register (33%). CONCLUSIONS Management of HIV and pregnancy in the North Thames units showed a large amount of consistency with regard to testing policies and management. However, there were a few units that did not offer therapy appropriate for advanced disease despite the recommendations of national bodies and a few units still did not recommend HIV testing to all women.
Collapse
Affiliation(s)
- M G Brook
- Department of Genitourinary/HIV Medicine, Patrick Clements Clinic, Central Middlesex Hospital, Acton Lane, London NW10 7NS, UK
| | | | | | | | | |
Collapse
|
16
|
Taylor GP, Lyall EG, Back D, Ward C, Tudor-Williams G. Pharmacological implications of lengthened in-utero exposure to nevirapine. Lancet 2000; 355:2134-5. [PMID: 10902630 DOI: 10.1016/s0140-6736(00)02383-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Given as a single dose to the mother during labour, nevirapine can protect the neonate from HIV-1 infection for up to 7 days. However, after maternal nevirapine therapy during pregnancy, neonatal plasma concentrations of nevirapine decline more rapidly, suggesting in-utero liver enzyme induction.
Collapse
|
17
|
Fiore S, Newell ML. Preventing perinatal transmission of HIV-1 infection. HOSPITAL MEDICINE (LONDON, ENGLAND : 1998) 2000; 61:315-8. [PMID: 10953736 DOI: 10.12968/hosp.2000.61.5.1329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
It is now known that with the use of antiretroviral prophylaxis with zidovudine, elective caesarean section delivery and refraining from breastfeeding the rate of mother-child transmission of HIV infection can be reduced to less than 2%.
Collapse
Affiliation(s)
- S Fiore
- Department of Epidemiology and Public Health, University College London
| | | |
Collapse
|
18
|
Abstract
Vertical transmission of HIV infection can take place in utero, during delivery and postnatally through breastfeeding, with about three-quarters of infections occurring around the time of delivery in non-breastfeeding populations. In Europe, in the absence of specific interventions, the vertical transmission rate was 15-20%. High maternal load is the major risk factor for both intra-uterine and intra-partum mother-to-child transmission. Prematurity is the most common adverse neonatal outcome associated with maternal HIV infection. Earlier diagnosis of paediatric HIV infection than previously available is now possible with virological tests, particularly HIV DNA polymerase chain reaction. An estimated one fifth of infected children will have been diagnosed with AIDS or have died by 12 months of age, rising to a third by 6 years of age. Surgical and therapeutic interventions are effective in reducing vertical transmission risk, in addition to the avoidance of breastfeeding. Caesarean section delivery before labour and before rupture of membranes approximately halves the risk of transmission, while prophylactic zidovudine therapy according to the ACTG076 regimen reduces transmission by up to two-thirds, transmission is reduced even further with both interventions. Trials of short-course zidovudine regimens show their effectiveness in reducing vertical transmission, in breastfeeding and non-breastfeeding populations. Nevirapine has been shown to be significantly more effective than short course zidovudine regimens in breastfeeding populations, but is still under evaluation in non-breastfeeding populations additionally receiving routine anti-retroviral prophylaxis. Reports of a small number of serious adverse events in uninfected children exposed in utero or neonatally to antiretroviral therapy need further investigation. Trials of vitamin A supplementation to reduce vertical transmission have had negative results, while the effectiveness of vaginal lavage and passive immune therapy in reducing vertical transmission remains uncertain.
Collapse
Affiliation(s)
- C Thorne
- Institute of Child Health, Department of Paediatric Epidemiology, 30 Guildford Street, London, UK
| | | |
Collapse
|
19
|
British HIV Association (BHIVA) guidelines for the treatment of HIV-infected adults with antiretroviral therapy. HIV Med 2000; 1:76-101. [PMID: 11737331 DOI: 10.1046/j.1468-1293.2000.00013.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
20
|
Mitchla Z, Sharland M. Current treatment options to prevent perinatal transmission of HIV. Expert Opin Pharmacother 2000; 1:239-48. [PMID: 11249545 DOI: 10.1517/14656566.1.2.239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Mother-to-infant transmission is the primary means by which young children become infected with HIV. WHO estimates approximately 1600 infants become infected with HIV every day. Recent advances in identifying the factors determining perinatal transmission have allowed interventions to be made to reduce mother-infant transmission. Paediatric AIDS Clinical Trials Group (PACTG) protocol 076, the pivotal vertical transmission study demonstrated that zidovudine (AZT) in pregnancy could reduce perinatal transmission of HIV-1 by 67%. This was confirmed by PACTG 185, in pregnant women with more advanced disease, which also demonstrated that viral load was the only independent factor determining vertical transmission rate (VTR). More recently, results from several short-course antiretroviral trials have brought new hope, that effective preventative interventions can be extended to developing countries. Although most studies have involved shorter versions of PACTG 076, the latest finding from HIVNET 012 demonstrated a significant reduction in VTR using a two-dose regimen of nevirapine (NVP). This intervention is the simplest, least expensive regimen so far with proven efficacy in diminishing mother-infant transmission. Non-pharmacological interventions have also been studied recently. The benefits of elective caesarean section (ELCS) have been clearly demonstrated in recent studies. These studies were carried out at a time when highly active antiviral therapies (HAART) were not available. There is still no information as to whether ELCS provides any added benefit for women on HAART with an undetectable HIV viral load. Prevention of breastfeeding can also further reduce VTR. This strategy is more applicable to resource-rich countries where access to formula feeds is not a problem. Options to prevent perinatal transmission must take into consideration the economic climate in which the intervention is to be made. In developed countries, effective intervention with perinatal AZT, ELCS and exclusive formula feeding has already reduced the VTR to around 1%. There is limited safety data currently available on the use of other antiretrovirals in pregnancy. A cautious approach to the use of HAART in pregnancy is recommended at present.
Collapse
Affiliation(s)
- Z Mitchla
- St. George's Hospital, Blackshaw Road, London, SW17 0QT, UK.
| | | |
Collapse
|
21
|
Taylor GP, Lyall EG, Tudor-Williams G, Regan L, Smith J. Labour care of women with HIV infection. Article did not highlight current guidelines. BMJ 1999; 319:381-2. [PMID: 10435971 PMCID: PMC1126999 DOI: 10.1136/bmj.319.7206.381a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|