HIV in pregnancy - An update

Coincidental discovery of HIV and pregnancy positive status in primary healthcare facilities

BACKGROUND

 HIV-positive and pregnancy diagnosis is a traumatic, shocking, and distressing experience for women. Adoption of routine HIV counselling and testing in the antenatal programme aimed to increase the uptake and the early diagnosis of HIV among pregnant women to prevent maternal HIV transmission to unborn babies and neonates.

OBJECTIVES

 The study aimed to explore the psychological reaction of women coincidentally discovering their HIV-positive status and pregnancy while seeking medical care in primary healthcare facilities in the Tshwane district.

METHOD

 Descriptive phenomenology involving a semi-structured in-depth interview was used to collect data. The sample was purposively selected. Twenty-eight women participated in the research project. Face-to-face in-depth audio recorded interviews were used to gain a full understanding of the experiences and feelings of the participants.

RESULTS

 Reason for the uptake of pregnancy and HIV testing, reactions upon discovering HIV and pregnancy-positive status, emotions arising from the pregnancy and HIV-positive diagnosis, understanding HIV infection in pregnancy, and transitions to acceptance and coping with the HIV-positive diagnosis were themes that emerged from this study.

CONCLUSION

 It is crucial that responsible healthcare workers consider this psychological imbalance during their offering of antenatal and postnatal care services so that the pregnant women living with HIV can accept and cope with the situation.Contribution: This study accounts to support other studies that offer intense counselling for women coincidentally discovering their positive HIV status and pregnancy. It is important to remedy the acceptance of the situation and to promote HIV prevention and family planning for women of childbearing age.

Knowledge of HIV transmission during pregnancy among women of reproductive age in Ghana

INTRODUCTION

Human immunodeficiency virus (HIV) remains a significant health challenge affecting many people including those from sub-Saharan Africa (SSA). Even though HIV can be transmitted through various means, mother-to-child transmission (MTCT) remains the major route of transmission in children under the age of five. This study examined the correlates of knowledge of HIV transmission during pregnancy among reproductive-age women in Ghana.

METHODS

Data for this study were obtained from the 2014 Ghana Demographic and Health Survey. The sample consisted of 9,106 women aged 15 to 49 years. We conducted both descriptive and multivariable logistic regression analyses to determine the prevalence and factors associated with knowledge of HIV transmission during pregnancy. The results were presented using frequencies, percentages, and adjusted odds ratios (aOR) with their corresponding 95% confidence intervals (CI).

RESULTS

Approximately, 69.41% of women of reproductive age knew of HIV transmission during pregnancy. Women who had two (aOR = 1.32, 95% CI [1.01, 1.72]) or three (aOR = 1.37, 95% CI [1.07, 1.76]) births were more knowledgeable of HIV transmission during pregnancy. Women who read the newspaper (aOR = 1.56, 95% CI [1.31, 1.86]), listened to the radio (aOR = 1.23, 95% CI [1.05, 1.45]), lived in rural areas (aOR = 1.30, 95% CI [1.09, 1.54]) or ever been tested for HIV (aOR = 1.20, 95% CI [1.05, 1.37]) were more likely to be knowledgeable of HIV transmission during pregnancy than their counterparts in the reference categories. Compared to those in the Western Region, women in the Upper East (aOR = 0.45, 95% CI [0.32, 0.63]), Upper West (aOR = 0.54, 95% CI [0.35, 0.85]), Ashanti (aOR = 0.75, 95% CI [0.58, 0.97]) and Greater Accra Regions (aOR = 0.74, 95% CI [0.56, 0.98]) were less knowledgeable of HIV transmission during pregnancy.

CONCLUSIONS

The study highlights a gap in the knowledge of HIV transmission during pregnancy among women in Ghana. Continuous public education is required to educate women on HIV transmission from mothers to their children during pregnancy and how this may be interrupted. Such programs should involve the use of the media and take into consideration the demographic and geographic characteristics highlighted as determinants in this study. This will ultimately contribute to the reduction of MTCT of HIV in Ghana.

Fetal Clinical and Paraclinical Outcomes in HIV-Positive Pregnant Women

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.

A validated method for simultaneous quantification of four antiretrovirals in dried blood spot and plasma using LC-MS/MS: Application to efavirenz therapeutic drug monitoring in pregnant patients

INTRODUCTION

The specific physiological background induced by pregnancy leads to significant changes in maternal pharmacokinetics, suggesting potential variability in plasma concentrations of antiretrovirals. Pregnant HIV patients exposed to subtherapeutic doses, particularly in the last trimester of the pregnancy, have higher chances to transmit the infection to their children. Therefore, the therapeutic drug monitoring of antiretrovirals in HIV pregnant patients would be of great value.

OBJECTIVES

This study aimed to develop and validate a sensitive liquid chromatograph tandem mass spectrometry (LC-MS/MS) method for simultaneous quantification of efavirenz, raltegravir, atazanavir, and ritonavir in dried blood spots (DBS) and plasma.

DESIGN AND METHODS

The analytes were extracted from the DBS punch and plasma with a mixture of methanol:zinc sulfate 200 mM (50:50, v/v) and 100 % methanol, respectively. For the chromatographic separation a Shim-pack® C18, 4.6 mm × 150 mm, 5 μm column was used. Detection was performed in a 3200-QTRAP® mass spectrometer, with a run time of 6 min.

RESULTS

The assay was linear in the range of 15-1,000 ng/mL for raltegravir, 50-10,000 ng/mL for both atazanavir and ritonavir, 50-5,000 ng/mL for efavirenz. Precision and accuracy at these concentrations were less than 15 % for all analytes. Raltegravir, atazanavir, and ritonavir were stable for seven days at 23 °C and 40 °C, whereas efavirenz was stable for twenty-four hours at the same conditions.

CONCLUSIONS

The method was successfully applied to quantify efavirenz in DBS samples obtained from HIV-1 infected pregnant volunteers under antiretroviral therapy. The concentrations of efavirenz in DBS and plasma were comparable according to Passing-Bablok regression and Bland-Altman analysis.

Revolutionizing HIV-1 Viral Load Monitoring in India: The Potential of Dried Blood Spot Analysis for Expanding Access and Improving Care

India continues to grapple with a significant burden of HIV infections. Despite notable progress in prevention and treatment efforts, multiple challenges, such as high-risk populations, inadequate testing facilities, and limited access to healthcare in remote areas, persist. Though the Government of India offers HIV-1 plasma viral load testing at various medical centers, aiding treatment decisions and monitoring antiretroviral therapy effectiveness, enhancing care for individuals living with HIV under the National AIDS Control Program (NACP), the nation's large population and diverse demographics further complicate its outreach and response. Hence, strategic interventions and alternative methods of testing remain crucial to curbing HIV transmission and improving the quality of life for those affected. Dried blood spot (DBS) sampling has emerged as a convenient and cost-effective alternative for HIV-1 viral load testing, revolutionizing the landscape of diagnostic and monitoring strategies for HIV infection. Though the plasma-based viral load remains the gold standard for monitoring HIV-1, DBS-based HIV-1 viral load testing holds immense promise for improving access to care, particularly in resource-limited settings where traditional plasma-based methods may be logistically challenging. DBS entails the collection of a small volume of blood onto filter paper, followed by drying and storage. This approach offers numerous advantages, including simplified sample collection, transportation, and storage, reducing the need for cold-chain logistics. Recent studies have demonstrated the feasibility and accuracy of DBS-based HIV-1 viral load testing, revealing a strong correlation between DBS and plasma measurements. Its implementation can enhance the early detection of treatment failure, guide therapeutic decisions, and ultimately contribute to better clinical outcomes for HIV-infected individuals. Hence, this review explores the principles, advancements, feasibility, and implications of DBS-based HIV-1 viral load testing.

Impact of Protease Inhibitor-Based Highly Active Antiretroviral Therapy on Fetal Subcutaneous Fat Tissue in HIV-Pregnant Women in a Middle-Income Country

BACKGROUND

HIV infection continues to be a global public health challenge, affecting approximately 1.7 million reproductive-aged women. Protease inhibitor-based highly active antiretroviral therapy (PI-HAART) has significantly reduced the risk of vertical transmission of HIV from mother to child. Nevertheless, concerns linger regarding the long-term effects, particularly on body composition, notably subcutaneous fat tissue (SFT). Although HIV-associated lipodystrophy syndrome (LS) has been well documented in adults and older children, its impact on fetuses exposed to PI-HAART remains underexplored. This study aims to evaluate SFT in the fetuses of HIV-pregnant women exposed to PI-HAART, assessing the potential clinical implications.

METHODS

We conducted a comparative study between HIV-pregnant women receiving PI-HAART and an HIV-negative control group. Fetometry measurements were obtained via 3D ultrasound. SFT in the fetal arm and thigh segments was assessed. Data were analyzed using lineal multivariate regression and receiver-operating characteristics (ROC)-curve analysis.

RESULTS

Fetuses exposed to PI-HAART exhibited a significant reduction in subcutaneous fat, particularly in the proximal third-middle union of the femur (coefficient: -2.588, p = 0.042). This reduction was correlated with lower newborn serum glucose levels (65.7 vs. 56.1, p = 0.007; coefficient: -1.277, p = 0.045).

CONCLUSIONS

Our study sheds light on the connection between PI-HAART, fetal subcutaneous fat, and neonatal health. These findings might reveal the long-lasting effects of PI-HAART on newborns and children's well-being. Our results emphasize the need for a more balanced approach to managing pregnant women with HIV in developing countries and open new venues for research on the impact of intrauterine PI-HAART exposure on energy metabolism and fetal programming.

Can newborn infants with positive HIV soon after birth be diagnosed with intrauterine infection?

BACKGROUND

Mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) can occur intrauterine, intrapartum, and postpartum. Currently, infants with confirmed positive results in virological tests before 48 h of age are defined as having intrauterine infection.

AIM

We herein review the literature that identifies emerging challenges in diagnosing intrauterine HIV infection to rethink the current diagnostic criteria.

FINDINGS

A number of reports have shown that some infants who were diagnosed with intrauterine HIV infection after birth became negative for HIV in the subsequent follow-ups, including negative HIV antibodies at the age of 12-18 months. Such "clearance" of HIV was attributed to various reasons: neonatal antiretroviral treatment (ART), false positivity, strong host immune response, or unknown factors in maternal breast milk.

DISCUSSIONS

Positive HIV tests in newborn infants shortly after birth do not necessarily indicate HIV infection, because maternal HIV can enter fetal circulation intrapartum due to the repetitive, strong uterine contractions. The infants are therefore exposed to, but may not yet be infected with HIV at that time. The current diagnostic criteria cannot differentiate HIV exposure from HIV infection, leading to so-called "challenges in diagnosing intrauterine HIV infection". Those infants diagnosed with intrauterine infection who cleared HIV later were less likely to have been truly infected with HIV, but more likely to have been exposed to HIV. Moreover, we suggest that the determination of HIV antibody titers in infants' serial serum samples can provide valuable information to distinguish intrapartum exposure from intrauterine infection.

HIV/Tuberculosis Coinfection in Pregnancy and the Postpartum Period

The convergence of Human Immunodeficiency Virus (HIV) and tuberculosis (TB) represents a considerable global public health challenge. The concurrent infection of HIV and TB in pregnant women not only intensifies the transmission of HIV from mother to fetus but also engenders adverse outcomes for maternal health, pregnancy, and infant well-being, necessitating the implementation of integrated strategies to effectively address and manage both diseases. In this article, we review the pathophysiology, clinical presentation, treatment, and management of HIV/TB coinfection during pregnancy, the postpartum period, and lactation and highlight the differences compared to the general population.

Women's voices: the lived experience of HIV-positive women in the postpartum period at the University of Gondar comprehensive specialized referral hospital, Ethiopia: a phenomenological study

BACKGROUND

Pregnancy and the postpartum period are incredibly challenging for women living with the Human Immune Deficiency Virus (HIV) due to the multidimensional influence of HIV infection. These women experience the challenges of navigating pregnancy and motherhood while living with HIV. It is poorly understood how women living with HIV (WLWH) experience pregnancy and postpartum. Therefore, the current study aimed to explore the lived experience of pregnancy and postpartum among women living with HIV.

METHODS

A phenomenological qualitative study design was employed. A semi-structured, interview guide was used to conduct in-depth interviews with HIV-positive postpartum women from April to May 2022. All interviews were recorded using a voice recorder and note was taken. The collected data were transcribed and translated into English for analysis. Inductive thematic analysis was applied to analyze the data.

RESULTS

Six main themes about the lived experience of women living with HIV were identified: (1) Fear and distress related to maternal and child Health, (2) HIV status self-disclosure dilemma, (3) Courage and commitment of HIV-positive women to prevent HIV, (4) Challenges faced and coping mechanisms used by HIV-positive women, (5) Health care providers and HIV-positive women interaction, and (6) Solution from their voices.

CONCLUSION

HIV infection also has a multidimensional impact on women's life during pregnancy and postpartum. The findings of this study improve our understanding of the lived experience of HIV-positive women while pregnant and in the postpartum period. These women's descriptions showed that they have been experiencing various challenges that are not often addressed in antenatal clinics, such as distress and uncertainties related to vertical transmission of HIV. These women need specialized support and all-encompassing care to have a healthy pregnancy and postpartum period. Moreover, it is essential to understand the circumstances of women's lives, their relationships with others, and their decision-making processes. Healthcare professionals and other responsible bodies working with women living with HIV should encourage and support these mothers to appraise and maintain their commitment to protecting their children from acquiring HIV infection and maintaining their Health to the maximum to raise their children.

Understanding clinical outcome measures reported in HIV pregnancy studies involving antiretroviral-naive and antiretroviral-experienced women

HIV infection is a clinically significant public health disease and contributes to increased risk of maternal and fetal morbidity and mortality. HIV pregnancy studies use outcome measures as metrics to show how people with HIV feel, function, or survive. These endpoints are crucial for tracking the evolution of HIV illness over time, assessing the effectiveness of antiretroviral therapy (ART), and comparing outcomes across studies. Although the need for ideal outcome measures is widely acknowledged, selecting acceptable outcome measures for these HIV pregnancy studies can be challenging. We discuss the many outcome measures that have been implemented over time to assess HIV in pregnancy studies, their benefits, and drawbacks. Finally, we offer suggestions for improving the reporting of outcome measures in HIV in pregnancy studies. Medical professionals can best care for pregnant women living with HIV receiving ART by having a thorough understanding of these outcome metrics.

Prevalence of human immunodeficiency virus (HIV) among pregnant women in Nigeria: a systematic review and meta-analysis

OBJECTIVE

To estimate prevalence of HIV infection in Nigeria and to examine variations by geopolitical zones and study characteristics to inform policy, practice and research.

METHODS

We conducted a comprehensive search of bibliographic databases including PubMed, CINAHL, PsycINFO, Global Health, Academic Search Elite and Allied and Complementary Medicine Database (AMED) and grey sources for studies published between 1 January 2008 and 31 December 2019. Studies reporting prevalence estimates of HIV among pregnant women in Nigeria using a diagnostic test were included. Primary outcome was proportion (%) of pregnant women living with HIV infection. A review protocol was developed and registered (PROSPERO 2019 CRD42019107037).

RESULTS

Twenty-three studies involving 72 728 pregnant women were included. Ten studies were of high quality and the remaining were of moderate quality. Twenty-one studies used two or more diagnostic tests to identify women living with HIV. Overall pooled prevalence of HIV among pregnant women was 7.22% (95% CI 5.64 to 9.21). Studies showed high degree of heterogeneity (I² =97.2%) and evidence of publication bias (p=0.728). Pooled prevalence for most individual geopolitical zones showed substantial variations compared with overall prevalence. North-Central (6.84%, 95% CI 4.73 to 9.79) and South-West zones (6.27%, 95% CI 4.75 to 8.24) had lower prevalence whereas South-East zone (17.04%, 95% CI 9.01 to 29.86) had higher prevalence.

CONCLUSIONS

While robust national prevalence studies are sparse in Nigeria, our findings suggest 7 in every 100 pregnant women are likely to have HIV infection. These figures are consistent with reported prevalence rates in sub-Saharan African region. WHO has indicated much higher prevalence in Nigeria compared with our findings. This discrepancy could potentially be attributed to varied methodological approaches and regional focus of studies included in our review. The magnitude of the issue highlights the need for targeted efforts from local, national and international stakeholders for prevention, diagnosis, management and treatment.

HIV is still a major public health problem among pregnant women attending ANC in Referral Hospitals of the Amhara Regional State, Ethiopia: a cross sectional study

BACKGROUND

The burden of HIV is disproportionately higher among women of reproductive age contributing more than half of the global share. The situation in Ethiopia is not exceptional. The present study was done to determine the proportion of HIV among pregnant women in Amhara Regional State, Ethiopia.

METHOD

Institutions-based cross-sectional study was conducted from October 2020 to December 2020. Systematic random sampling technique was used to select 538 study participants from pregnant women who had ANC follow-up in Referral Hospitals of the Amhara Regional State. Data on socio-demographic, clinical, obstetric, behavioral as well as psychosocial characteristics were gathered using an interviewer administered structured and standardized instruments. The data was entered into Epi-Data Manager V4.6.0.0 and exported to STATA version 14 for data analyses. Descriptive statics were computed to summarize the participant's characteristics. Bi-variable and multivariable logistic regression analyses were conducted to identify the association between dependent and independent variables. Independent variables with a p-value of less than 0.05 were considered to be statistically significant at 95% confidence level (CI).

RESULTS

The proportion of HIV infection among pregnant women was 8.68% (95% CI: 6.5, 11.4). Completing secondary school education (Adjusted Odds Ratio (AOR = 0.15; 95% CI: 0.04-0.53), graduated from college (AOR = 0.03; 95% CI: 0.01-0.22), and family monthly income greater than 8001 ETB (1 USD = 56 ETB) (AOR = 0.19; 95% CI: 0.04-0.87) were protective factors associated with maternal HIV. On the other hand, history of previous abortion (AOR = 7.73; 95% CI: 3.33-17.95) and positive syphilis status (AOR = 10.28; 95% CI: 2.80-37.62) were risk factors associated with maternal HIV status.

CONCLUSION

The proportion of HIV infection among pregnant women was found to be high. Advanced level of education, relatively higher monthly income, history of abortion and previous syphilis status were associated factors with HIV status. Strengthening women's formal education; empowering women in all spheres of life (especially improving their economic standing that prevents women from engaging in risky sexual practices); educating women about HIV transmission methods and HIV prevention and control strategies using behavior change intervention strategy prepared for women to reduce their vulnerability; advocating for the use of family planning to reduce unsafe abortions and syphilis; as well as regular screening and testing for syphilis are recommended.

Pregnancy outcomes and pharmacokinetics in pregnant women living with HIV exposed to long‐acting cabotegravir and rilpivirine in clinical trials

BACKGROUND

Limited data exist on pregnant women living with HIV exposed to cabotegravir + rilpivirine (CAB + RPV). Outcomes in pregnant participants exposed to CAB + RPV, and pharmacokinetic washout data in those exposed to CAB + RPV long-acting (LA) with live births, are presented.

METHODS

Women exposed to one or more doses of CAB + RPV (oral/LA) from ViiV Healthcare-sponsored phase 2b/3/3b clinical trials and the compassionate use programme who became pregnant were included. Upon pregnancy in the trial programme, CAB + RPV was discontinued, an alternative antiretroviral regimen was initiated, and quarterly pharmacokinetic sampling for 52 weeks post-last injection was obtained. CAB + RPV continuation or alternative antiretroviral regimen initiation was decided by pregnant compassionate use programme participants and their treating physicians.

RESULTS

As of 31 March 2021, 25 pregnancies following CAB + RPV exposure at conception were reported (five oral, 20 LA), including four who conceived during pharmacokinetic washout following treatment discontinuation. There were eight elective abortions, six miscarriages (five in first trimester), one ectopic pregnancy, and 10 live births (one oral, nine LA), including one infant born with congenital ptosis. Among participants exposed to CAB + RPV LA at conception with live births, plasma CAB and RPV washout concentrations during pregnancy were within the range of those observed in non-pregnant women.

CONCLUSION

In this first analysis of pregnancy outcomes following CAB + RPV exposure at conception, 10 live births, including one with congenital anomaly, were reported. Plasma CAB and RPV washout concentrations during pregnancy were within the range of those in non-pregnant women. Pregnancy surveillance within ViiV Healthcare-sponsored clinical trials is ongoing, with dedicated pregnancy studies planned.

Burden, clinical presentation and risk factors of advanced HIV disease in pregnant Mozambican women

Background

Information on the frequency and clinical features of advanced HIV disease (AHD) in pregnancy and its effects on maternal and perinatal outcomes is limited. The objective of this study was to describe the prevalence and clinical presentation of AHD in pregnancy, and to assess the impact of AHD in maternal and perinatal outcomes in Mozambican pregnant women.

Methods

This is a prospective and retrospective cohort study including HIV-infected pregnant women who attended the antenatal care (ANC) clinic at the Manhiça District Hospital between 2015 and 2020. Women were followed up for 36 months. Levels of CD4 + cell count were determined to assess AHD immune-suppressive changes. Risk factors for AHD were analyzed and the immune-suppressive changes over time and the effect of AHD on pregnancy outcomes were assessed.

Results

A total of 2458 HIV-infected pregnant women were enrolled. The prevalence of AHD at first ANC visit was 14.2% (349/2458). Among women with AHD at enrolment, 76.2% (260/341) were on antiretroviral therapy (ART). The proportion of women with AHD increased with age reaching 20.5% in those older than 35 years of age (p < 0.001). Tuberculosis was the only opportunistic infection diagnosed in women with AHD [4.9% (17/349)]. There was a trend for increased CD4 + cell count in women without AHD during the follow up period; however, in women with AHD the CD4 + cell count remained below 200 cells/mm³ (p < 0.001). Forty-two out of 2458 (1.7%) of the women were severely immunosuppressed (CD4 + cell count < 50 cells/mm3). No significant differences were detected between women with and without AHD in the frequency of maternal mortality, preterm birth, low birth weight and neonatal HIV infection.

Conclusions

After more than two decades of roll out of ART in Mozambique, over 14% and nearly 2% of HIV-infected pregnant women present at first ANC clinic visit with AHD and severe immunosuppression, respectively. Prompt HIV diagnosis in women of childbearing age, effective linkage to HIV care with an optimal ART regimen and close monitoring after ART initiation may contribute to reduce this burden and improve maternal and child survival.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-05090-3.

Effects of HIV Infection on Pregnancy Outcomes Among Women Attending Antenatal Care in Referral Hospitals of the Amhara Regional State, Ethiopia: A Prospective Cohort Study

Background

Human immunodeficiency virus (HIV) has remained to be a significant public health problem worldwide mainly affecting women. Despite a 2 to 3 times higher risk of adverse pregnancy outcomes, around 2 million HIV positive women give birth each year globally. However, there is a dearth of evidences in Ethiopia about the effect of maternal HIV infection on pregnancy outcomes where adverse birth outcomes are still a significant health problem. This study is, therefore, aimed to examine the effect of HIV on the risk of adverse pregnancy outcomes in Amhara Regional State, Ethiopia.

Methods

A prospective cohort study was conducted among 704 pregnant women (352 women with HIV and 352 women without HIV infection). Systematic random sampling technique was employed to select the study participants. Data on socio-demographic, obstetric, clinical, as well as behavioral and psychosocial characteristics were collected using a validated tool. Data on the outcome variables were also collected following delivery. Modified Poisson regression was employed to estimate the relative risk (RR) of HIV on low birth weight (LBW), preterm birth, and still birth at 95% confidence level. Attributable fraction (AF) was used to report the impact of HIV infection on pregnancy outcomes.

Results

Of the total 704 pregnant women enrolled for the study, 96.3% (678) completed the study. The mean age of the study participants was 30.8 (SD ± 5.4) for HIV positive and 27 (SD ± 5.4) for HIV negative women. The cumulative incidence of low birth weight, preterm birth, and stillbirth were 21.4%, 9.4%, and 4.1%, respectively. The incidence of LBW was 24.7% among HIV positive and 17.8% among HIV negative women. The incidence of preterm birth was 10.7% among HIV positive and 7.9% among HIV negative women. And the incidence of stillbirth was 3.7% and 4.6% among HIV positive and those HIV negative women. New-borns from women with HIV infection had a higher risk of low birth weight and preterm birth than those HIV negative women (Adjusted Relative Risk (ARR) = 1.47; 95% CI: 1.06–2.03) and (ARR = 1.74; 95% CI: 1.08–2.79), respectively. The attributable risk of HIV on low birth weight was 32% (Attributable Fraction (AF) = 32%, 95% CI: 23–46%), and 43% (AF = 43%, 95% CI: 23–46%) for preterm birth.

Conclusion

Maternal HIV infection increased the risk of low birth weight and preterm birth. This implies due attention is required while providing maternal health services primarily antenatal care and delivery services. These services should be aimed at reducing adverse pregnancy outcomes with more attention given to women with HIV infection. Moreover, reinforcement of HIV prevention intervention strategies should be considered at all levels.

The co-occurrence of the SAVA syndemic, depression and anxiety as barriers to antiretroviral therapy adherence among sub-Saharan Africa population groups: A scoping review protocol

Introduction

The scale-up of access to antiretroviral therapy has transformed HIV from an acute, terminal disease to a manageable chronic illness. Yet, sustaining high levels of antiretroviral therapy adherence remain a challenge, especially in the sub-Saharan Africa region which is disproportionately affected by HIV. This protocol proposes a scoping review to explore literature reporting on the antiretroviral therapy adherence levels among people who experience substance abuse and violence (SAVA) syndemics, as well as mood disorders such as anxiety and depression among people living with HIV in sub-Saharan Africa.

Methods and analysis

This proposed scoping review will follow Arksey and O’Malley’s methodological framework for conducting scoping reviews as refined by Levac et al. The review will follow the Joanna Briggs Institute’s manual for conducting scoping reviews. Literature searches will be conducted using six databases: Academic search complete; APA PsycArticles; CINAHL; MEDLINE; SocINDEX and Web of science. Title screening will see the “Participant, Concept, Context” framework applied to identify relevant literature and will not include the appraisal of search results. Data charting will follow an adapted version of Trico and colleagues’ PRISMA-ScR and results will be mapped descriptively and in tabular format. Furthermore, results will be discussed within the syndemics model of health, and summarised as a biosocial conceptual model.

Ethics and dissemination

The study will make use of secondary data that are readily available to the public and will not require ethical approval. We intend to publish our results in a peer-reviewed journal and disseminate our findings at relevant conferences and seminars.

Prevalence of the Human Immunodeficiency Virus and associated factors in pregnant women in the state of Pará

OBJECTIVES

to analyze the prevalence of the Human Immunodeficiency Virus and the associated factors in pregnant women in the state of Pará.

METHODS

retrospective, analytical, quantitative study with a sample of 332 medical records of HIV-positive pregnant women hospitalized at the Referral Maternity Hospital in the state of Pará between 2010 and 2019. Bivariate and multivariate statistical analysis were performed with the variables collected.

RESULTS

the average prevalence in the period was 2.39% and the Metropolitan Region concentrated 66.87% of cases. There was a strong relationship between the number of antenatal consultations and lack of knowledge of serological status (p value equal to 0.01E-17) variables, and a correlation between the education and number of antenatal consultations variables.

CONCLUSIONS

the increase in the infection rate during the study period revealed the need to intensify health actions, early diagnosis and strategies to improve adherence to antiretroviral treatment for maternal viral suppression and reduction of the risk of vertical transmission, contributing to improve public policies.

Prevalência do Vírus da Imunodeficiência Humana e fatores associados em gestantes no estado do Pará

RESUMO Objetivos: analisar a prevalência do Vírus da Imunodeficiência Humana e os fatores associados em gestantes no estado do Pará. Métodos: estudo analítico, quantitativo e retrospectivo com a amostra de 332 prontuários de gestantes HIV positivas internadas na Maternidade de Referência do estado do Pará, no período de 2010 a 2019. Com as variáveis coletadas, procedeu-se a análise estatística bivariada e multivariada. Resultados: a média de prevalência no período foi de 2,39% e a Região Metropolitana concentrou 66,87% dos casos. Houve forte relação entre as variáveis número de consultas pré-natais e desconhecimento do status sorológico (p valor igual a 0,01E-17) e correlação entre as variáveis escolaridade com o número de consultas pré-natais. Conclusões: o aumento da taxa de infecção no período estudado revelou a necessidade de intensificar as ações de saúde, o diagnóstico precoce e as estratégias para a melhoria da adesão ao tratamento antirretroviral para supressão viral materna e redução do risco de transmissão vertical, contribuindo para aprimorar as políticas públicas.