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Iordache MD, Meca DC, Cirstoiu MM. Fetal Clinical and Paraclinical Outcomes in HIV-Positive Pregnant Women. Cureus 2024; 16:e59568. [PMID: 38826912 PMCID: PMC11144293 DOI: 10.7759/cureus.59568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 06/04/2024] Open
Abstract
Background Adverse pregnancy outcomes in women with human immunodeficiency virus (HIV) infection remain significantly increased. Untreated maternal infection primarily leads to fetal complications, such as intrauterine growth restriction, stillbirth, or preterm birth. Concerning both maternal and fetal complications that can appear in pregnancy associated with HIV infection, the purpose of the study was to determine fetal and maternal demographic characteristics and the correlation between blood count parameters and poor fetal prognosis. Methods We conducted a quantitative study utilizing document review as the data collection method. This study encompassed a cohort of nine HIV-positive pregnant women who delivered at the Obstetrics and Gynecology Department of the University Emergency Hospital in Bucharest from January 1, 2021, to December 31, 2023. A comparative cohort of nine healthy pregnant women who delivered during the same period in the same facility was selected using stratified random sampling. We examined maternal and fetal demographic parameters and neonatal outcomes, reporting them to paraclinical laboratory data. Results The incidence of pregnancy-related HIV infections was 0.16%. The mean age of patients in the selected group was 29.88 ± 5.53. There was no statistically significant correlation between maternal clinical and paraclinical parameters in the HIV-positive and HIV-negative groups. Although there was a slightly negative difference in the fetal weight at birth, the 1-min APGAR (appearance, pulse, grimace, activity, and respiration) score, and the intrauterine growth restriction between the two groups, there was a statistically significant association between admission to the neonatal intensive care unit (NICU) and the neonates from HIV-positive pregnancies. In our study, we observed preterm deliveries in 22.22% of cases, and we did not record any stillbirths. The 1-min APGAR score was correlated with the value of leukocytes in peripheral blood. Vertical transmission was established to be 11.11% independent of maternal blood count parameters. Conclusion HIV infection during pregnancy leads to a higher risk of admission to the NICU. Fetal leukocytosis is indicative of a lower 1-min APGAR score. The primary emphasis of therapeutic intervention during pregnancy should center on vigilant monitoring of maternal viral load and the timely administration of antiretroviral therapy to enhance fetal outcomes.
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Affiliation(s)
- Madalina Daniela Iordache
- Department of Obstetrics and Gynaecology, University Emergency Hospital Bucharest, Doctoral School of Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Daniela Catalina Meca
- Department of Obstetrics and Gynaecology, University Emergency Hospital Bucharest, Doctoral School of Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Monica Mihaela Cirstoiu
- Department of Obstetrics and Gynaecology, University Emergency Hospital Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
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Lumaca A, Galli L, de Martino M, Chiappini E. Paediatric HIV-1 infection: updated strategies of prevention mother-to-child transmission. J Chemother 2018; 30:193-202. [PMID: 29595094 DOI: 10.1080/1120009x.2018.1451030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION HIV-1 epidemiology is changing and prevention of mother-to-child transmission (PMTCT) strategies have been continuously optimized over time. However, the correct management of infected women during pregnancy is crucial for PMTCT and cases of vertical transmission continue to occur. OBJECTIVE To review the most recent evidence regarding the prevention of MTCT in resource-rich and resource-limited settings, focalizing on new possible approaches. RESULTS New issues regard the optimal antiretroviral therapy regimen for pregnant women with good immunological control, the use of intrapartum zidovudine (ZDV) in pregnant women with low viral load, the optimization of prophylaxis in the settings where breastfeeding is recommended and use of combined neonatal prophylaxis (CNP) in infants at high-risk for MTCT. Complete viral control, in recent years, has been achieved in most infected pregnant women, has led to change the recommended mode of delivery, since vaginal birth has become a safe option and is now largely recommended. Recent data reported a large use of CNP in preterm infants: this practice may be dangerous, due to the lack of safety data, and its efficacy and effectiveness is unproven. CONCLUSION Data are accumulating on efficacy, effectiveness and safety of different PMTCT strategies in various possible clinical scenarios, however further researches are needed in order to optimize the management of infants at extremely low risk for MTCT as well as in those presenting with high risk for infection.
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Affiliation(s)
- Alessandra Lumaca
- a Department of Health Sciences , Meyer University Hospital, University of Florence , Florence , Italy
| | - Luisa Galli
- a Department of Health Sciences , Meyer University Hospital, University of Florence , Florence , Italy
| | - Maurizio de Martino
- a Department of Health Sciences , Meyer University Hospital, University of Florence , Florence , Italy
| | - Elena Chiappini
- a Department of Health Sciences , Meyer University Hospital, University of Florence , Florence , Italy
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Sharma U, Gupta P, Singhal M, Singh S, Gupta S, Venkatesh S, Rai A, Husain M. Comparative genetic variability in HIV-1 subtype C nef gene in early age groups of infants. J Med Virol 2017; 89:1606-1619. [PMID: 28370302 DOI: 10.1002/jmv.24820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 03/24/2017] [Indexed: 11/06/2022]
Abstract
Targeting properties of vertically transmitted viruses in early infancy is important to understand disease progression. To investigate genotypic characteristics of transmitted viruses, blood samples were obtained from infants aged 6 weeks-18 months, categorized in two age groups, acute (<6 months) and early (>6-18 months). Nef having an important role in pathogenesis was selected to explore the viral characteristics. A total of 57 PCR positive samples, amplified by nef gene were sequenced. Analysis showed that 50 sequences belonged to subtype C. In one sequence of acute age group, a long insertion of 10 residues (AAERMRRAEP) in variable region and a 13 residues deletion (ATNNADCAWLEAQ) around proteolytic cleavage region of gene in another sequence was observed. Insertions were also observed in sequences of early age group, however, they ranged from two to eight residues only. In one sequence of early age group, 3/4 arginines at positions 19, 21, 22 of arginine cluster were mutated to glutamine, alanine, and glutamine, respectively. Entropy analysis of two age groups revealed presence of several residues with statistically significant differences in their variability. Among these, 15 (R18,R23,R24; A66,L68,Q71; E74,E77,E78; V87,M92; R119, P144, E167, and C176) belonged to functional motifs, out of which, 12 were in acute age group, suggesting that variability was greater in this group. Prediction of HLA binding peptide motif revealed that epitope LTFGWCFKL was present in >80% study sequences. This epitope was also present in maximum number of HLA types circulating in India and vaccine candidate sequences, suggesting that it may be helpful in designing an epitope-based vaccine.
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Affiliation(s)
- Uma Sharma
- Molecular Virology Laboratory, Department of Biotechnology, Jamia Millia Islamia, New Delhi, India.,National Centre for Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Poonam Gupta
- Molecular Virology Laboratory, Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Megha Singhal
- National Centre for Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Supriya Singh
- National Centre for Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Sunil Gupta
- National Centre for Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Srinivas Venkatesh
- National Centre for Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Arvind Rai
- National Centre for Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Mohammad Husain
- Molecular Virology Laboratory, Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
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Ismail AQT. Does placental MDSC-mediated modulation of arginine levels help protect the foetus from auxotrophic pathogens? J Matern Fetal Neonatal Med 2017; 31:1667-1669. [DOI: 10.1080/14767058.2017.1319935] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Nkwo PO. Prevention of mother to child transmission of human immunodeficiency virus: the nigerian perspective. Ann Med Health Sci Res 2012; 2:56-65. [PMID: 23209993 PMCID: PMC3507117 DOI: 10.4103/2141-9248.96940] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Despite the proven effectiveness of the prevention of mother to child transmission (PMTCT) of human immunodeficiency virus (HIV) program, Nigeria currently has the highest burden of vertical transmission of HIV in the world due to poor coverage of the PMTCT program partly as a result of poor knowledge of PMTCT interventions amongst healthcare providers in the country. This paper aims at making information on PMTCT interventions more readily available to healthcare providers in developing countries. The internet was searched using Google and Google scholar. In addition, relevant electronic journals from the Universities library including PubMed and Scirus, Medline, Cochrane library, and World Health Organization (WHO)'s Hinari were used. There was paucity of published work on PMCT from Nigeria. Most of the information concerning PMCT in Nigeria was obtained from technical reports from the Federal Ministry of Health and WHO. It is expected that this article will help in improving healthcare providers' knowledge of PMTCT interventions and thus help in the urgently needed rapid scale-up of PMTCT services in Nigeria.
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Affiliation(s)
- PO Nkwo
- Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Enugu, Nigeria
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Ahmad N. Molecular mechanisms of HIV-1 mother-to-child transmission and infection in neonatal target cells. Life Sci 2010; 88:980-6. [PMID: 20888841 DOI: 10.1016/j.lfs.2010.09.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 09/02/2010] [Accepted: 09/16/2010] [Indexed: 11/25/2022]
Abstract
HIV-1 mother-to-child transmission (MTCT) occurs mainly at three stages, including prepartum, intrapartum and postpartum. Several maternal factors, including low CD4+ lymphocyte counts, high viral load, immune response, advanced disease status, smoking and abusing drugs have been implicated in an increased risk of HIV-1 MTCT. While use of antiretroviral therapy (ART) during pregnancy has significantly reduced the rate of MTCT, selective transmission of ART resistant mutants has been reported. Based on HIV-1 sequence comparison, the maternal HIV-1 minor genotypes with R5 phenotypes are predominantly transmitted to their infants and initially maintained in the infants with the same properties. Several HIV-1 structural, regulatory and accessory genes were highly conserved following MTCT. In addition, HIV-1 sequences from non-transmitting mothers are less heterogeneous compared with transmitting mothers, suggesting that a higher level of viral heterogeneity influences MTCT. Analysis of the immunologically relevant epitopes showed that variants evolved to escape the immune response that influenced HIV-1 MTCT. Several cytotoxic T-lymphocyte (CTL) epitopes were identified in various HIV-1 genes that were conserved in HIV-1 mother-infant sequences, suggesting a role in MTCT. We have shown that HIV-1 replicates more efficiently in neonatal T-lymphocytes and monocytes/macrophages compared with adult cells, and this differential replication is influenced at the level of HIV-1 gene expression, which was due to differential expression of host factors, including transcriptional activators, signal transducers and cytokines in neonatal than adult cells. In addition, HIV-1 integration occurs in more actively transcribed genes in neonatal compared with adult cells, which may influence HIV-1 gene expression. The increased HIV-1 gene expression and replication in neonatal target cells contribute to a higher viral load and more rapid disease progression in neonates/infants than adults. These findings may identify targets, viral and host, for developing strategies for HIV-1 prevention and treatment.
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Affiliation(s)
- Nafees Ahmad
- Department of Immunobiology, College of Medicine, University of Arizona, Tucson, AZ, United States.
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Habib NA, Daltveit AK, Bergsjø P, Shao J, Oneko O, Lie RT. Maternal HIV status and pregnancy outcomes in northeastern Tanzania: a registry-based study. BJOG 2008; 115:616-24. [DOI: 10.1111/j.1471-0528.2008.01672.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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