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Tymejczyk O, Deschamps MM, Rouzier V, McNairy ML, Peck RN, Malha L, Macius Y, Fitzgerald DW, Pape JW, Nash D. Estimated blood pressure trajectories and hypertension patterns among pregnant women living with HIV, Haiti, 2007-2017. J Clin Hypertens (Greenwich) 2022; 24:237-245. [PMID: 35129266 PMCID: PMC8925004 DOI: 10.1111/jch.14432] [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] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/27/2021] [Accepted: 12/30/2021] [Indexed: 01/17/2023]
Abstract
Hypertension in pregnancy is a key driver of mortality and morbidity among Haitian women. HIV infection and treatment may worsen hypertension and increase cardiovascular disease risk. The authors examined blood pressure and hypertension patterns among 1965 women (2306 pregnancies ending in live births) in a prevention of maternal-to-child transmission (PMTCT) program in Port-au-Prince, Haiti, between 2007 and 2017. Hypertension was defined as blood pressure ≥140/90 mm Hg on two consecutive visits. Latent class analysis assessed trajectories of mean arterial pressure (MAP) and multinomial ordinal logistic regression examined factors associated with higher trajectories. Between 2007-2009 and 2013-2016, hypertension at PMTCT entry increased from 1.3% to 3.8% (p = .005), while incidence at any time during PMTCT follow-up increased from 5.0 to 16.1 per 100 person-years (p < .001). Hypertension detected ≤20 weeks and > 20 weeks of gestation (possible gestational hypertension) increased from 1.1% to 3.5% (p = .003) and from 2.3% to 6.9% (p < .001), respectively. Five MAP trajectories ranged from low-stable to high-increasing. In multivariable analysis controlling for history of antiretroviral therapy, age, parity, and weight, program entry in more recent years was associated with greater odds of higher MAP trajectory (adjusted odds ratio for 2013-2016 vs. 2007-2009 = 3.1, 95% confidence interval: 1.7-5.6). The increasing prevalence and incidence of hypertension highlight a need for screening and management prior to PMTCT entry and during follow-up. In a population with limited access to chronic disease care, and where many deliveries occur outside of a clinical setting, the period of PMTCT follow-up represents an opportunity to diagnose and initiate management of preexisting and pregnancy-related hypertension.
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Affiliation(s)
- Olga Tymejczyk
- City University of New York Institute for Implementation Science in Population HealthNew YorkNew YorkUSA
| | - Marie Marcelle Deschamps
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Vanessa Rouzier
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
- Center for Global HealthDepartment of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Margaret L. McNairy
- Center for Global HealthDepartment of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Robert N. Peck
- Center for Global HealthDepartment of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
- Weill Bugando School of MedicineMwanzaTanzania
| | - Line Malha
- Division of Nephrology and HypertensionWeill Cornell MedicineNew YorkNew YorkUSA
| | - Youry Macius
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Daniel W. Fitzgerald
- Center for Global HealthDepartment of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Jean W. Pape
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
- Center for Global HealthDepartment of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Denis Nash
- City University of New York Institute for Implementation Science in Population HealthNew YorkNew YorkUSA
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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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Biadgo B, Ambachew S, Abebe M, Melku M. Gestational diabetes mellitus in HIV-infected pregnant women: A systematic review and meta-analysis. Diabetes Res Clin Pract 2019; 155:107800. [PMID: 31362053 DOI: 10.1016/j.diabres.2019.107800] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 07/20/2019] [Accepted: 07/23/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Impaired glucose metabolism during pregnancy can result in a significant adverse pregnancy-outcomes. Previous studies have reported the contribution of ART to the impaired glucose tolerance and gestational diabetes mellitus (GDM) in HIV-infected pregnant women. METHODS PRISMA guideline was followed for this systematic review and meta-analysis. The STATA version 11 was employed to compute the pooled prevalence of GDM using the random effect model and 95% confidence interval. Subgroup analysis was conducted by geographical regions. Visual inspection of the funnel plot and Egger's regression test statistic were used to show the publication bias. RESULTS A total of 13,517 articles were identified, of which 21 publications met the inclusion criteria. The pooled prevalence of GDM among HIV-infected pregnant women was 4.42% (95% CI: 3.48; 5.35). According to the subgroup analysis, the pooled prevalence of GDM among HIV-infected pregnant women was 7.1% (95%CI: 3.38; 10.76) in Asia, 5.83% (95% CI: 2.61; 9.04) in Europe, 3.58% (95% CI: 2.67; 4.50) in America and 3.19% (95% CI: -2.89; 9.27) in Africa. CONCLUSION The pooled prevalence of GDM among HIV-infected pregnant women is expectedly high. Therefore, early screening of HIV-infected pregnant women for GDM is vital to reduce its complications related to pregnancy. PROTOCOL REGISTRATION NUMBER International Prospective Register of Systematic Reviews CRD42018090735.
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Affiliation(s)
- Belete Biadgo
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Sintayehu Ambachew
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Molla Abebe
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Melku
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Premkumar A, Dude AM, Haddad LB, Yee LM. Combined antiretroviral therapy for HIV and the risk of hypertensive disorders of pregnancy: A systematic review. Pregnancy Hypertens 2019; 17:178-190. [PMID: 31487638 PMCID: PMC6733581 DOI: 10.1016/j.preghy.2019.05.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/18/2019] [Accepted: 05/17/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess if there is a relationship between use of combined antiretroviral therapy among pregnant women living with HIV and hypertensive disorders of pregnancy (HDP). DESIGN Due to the heterogeneity of study designs in the literature and the utilization of different outcome measures in regards to assessing the presence of HDP, a systematic review was performed. METHODS ClinicalTrials.gov and MEDLINE, via PubMed, EMBASE, Scopus, CINAHL, ProQuest Dissertations & Theses Global, EBSCOHost, DARE, and the Cochrane Library, were queried from January 1997 to October 2017. Studies were included if they reported HDP and focused on pregnant women living with HIV who used combined antiretroviral therapy. The Cochrane Collaboration's tool for assessment of risk of bias and the U.S. Preventive Services Task Force grading scale were used to assess the studies. RESULTS Of 1055 abstracts, 28 articles met inclusion criteria. The data are marked by multiple biases and poor study design. All studies demonstrate an increased risk of HDP among pregnant women living with HIV who used combined antiretroviral therapy when compared to seropositive pregnant women not using antiretroviral therapy. Three studies suggest protease inhibitors may be associated with a higher risk of HDP. CONCLUSION Despite all studies indicating a higher frequency of HDP among pregnant women living with HIV using combined antiretroviral therapy when compared with seropositive pregnant women not using antiretroviral therapy, the quality of the studies is mixed, necessitating further research.
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Affiliation(s)
- Ashish Premkumar
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, 250 E. Superior Street, Chicago, IL 60611, USA.
| | - Annie M Dude
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, 250 E. Superior Street, Chicago, IL 60611, USA
| | - Lisa B Haddad
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 49 Jesse Hill Jr Dr SE, Atlanta, GA 30303, USA
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, 250 E. Superior Street, Chicago, IL 60611, USA
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Easter SR, Eckert LO, Boghossian N, Spencer R, Oteng-Ntim E, Ioannou C, Patwardhan M, Harrison MS, Khalil A, Gravett M, Goldenberg R, McKelvey A, Gupta M, Pool V, Robson SC, Joshi J, Kochhar S, McElrath T. Fetal growth restriction: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2018; 35:6546-6554. [PMID: 29150060 PMCID: PMC5710982 DOI: 10.1016/j.vaccine.2017.01.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 01/13/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Sarah Rae Easter
- Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Linda O Eckert
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Nansi Boghossian
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Rebecca Spencer
- Consultant in Obstetrics, Institute for Women's Health, University College London, UK
| | | | - Christos Ioannou
- Consultant in Obstetrics and Fetal Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Manasi Patwardhan
- Division of Maternal-Fetal Medicine, Wayne State University, Detroit, MI, USA
| | - Margo S Harrison
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - Asma Khalil
- Consultant in Obstetrics and Subspecialist in Fetal Medicine, St George's University of London, London, UK
| | - Michael Gravett
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Robert Goldenberg
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - Alastair McKelvey
- Consultant in Obstetrics and Fetal Medicine, Norfolk and Norwich University Hospital, Norwich, UK
| | - Manish Gupta
- Consultant Obstetrician, Subspecialist in Maternal and Fetal Medicine, Barts Health NHS Trust, London, UK
| | - Vitali Pool
- Director of Scientific and Medical Affairs, Sanofi Pasteur, Swiftwater, PA, USA
| | - Stephen C Robson
- Professor of Fetal Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Jyoti Joshi
- Deputy Director of Immunization Technical Support Unit, Public Health Fund of India, New Delhi, India
| | - Sonali Kochhar
- Global Healthcare Consulting, New Delhi, India; Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tom McElrath
- Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Landolt NK, Achalapong J, Kosalaraksa P, Petdachai W, Ngampiyaskul C, Kerr S, Boonyanurak P, Ananworanich J, Bunupuradah T. Strategies to improve the uptake of effective contraception in perinatally HIV-infected adolescents. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30334-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ørbaek M, Thorsteinsson K, Helleberg M, Moseholm E, Katzenstein TL, Storgaard M, Johansen IS, Pedersen G, Weis N, Lebech AM. Assessment of mode of delivery and predictors of emergency caesarean section among women living with HIV in a matched-pair setting with women from the general population in Denmark, 2002-2014. HIV Med 2017; 18:736-747. [PMID: 28544321 DOI: 10.1111/hiv.12519] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We aimed to assess mode of delivery and predictors of emergency caesarean section (EmCS) in women living with HIV (WLWH) in a matched-pair setting with women from the general population (WGP) in Denmark. Further, we analysed birth plan in WLWH. METHODS All WLWH giving birth to live-born children from 2002 to 2014 were included in the study. Data were retrieved from medical records and national registries. WLWH were matched 1:5 by age, birth year, parity and ethnicity to WGP. Multivariate logistic regression was used to estimate predictors. RESULTS We included 389 WLWH and 1945 WGP in the study. At delivery, all WLWH were on antiretroviral therapy and 85.6% had HIV RNA <40 HIV-1 RNA copies/mL. Mean age was 32.7 years [95% confidence interval (CI) 32.1-33.2 years]. Mode of delivery differed significantly between WLWH and WGP [vaginal delivery, 33.4% versus 73.3%, respectively; elective caesarean section (ECS), 40.6% versus 9.7%, respectively; EmCS, 26% versus 17%, respectively; P < 0.0001]. Age > 40 years [adjusted odds ratio (aOR) 2.3; 95% CI 1.5-3.5], asphyxia (aOR 3.2; 95% CI 2.4-4.1), delivery during the evening and at night [aOR 2.3 (95% CI 1.7-3.0) and aOR 2.0 (95% CI 1.5-2.7), respectively], preterm delivery (aOR 3.8; 95% CI 2.6-5.6) and premature rupture of membranes (aOR 3.0; 95% CI 2.1-4.4) predicted EmCS. WLWH had a higher risk of EmCS compared with WGP [2002-2006, aOR 2.0 (95% CI 1.2-3.3); 2007-2008, aOR 2.9 (95% CI 1.4-5.9); 2009-2014, aOR 2.6 (95% CI 1.7-3.9)]. After 2007, more than half of WLWH planned to deliver vaginally. Prior caesarean section was associated with ECS (aOR 11.0; 95% CI 4.5-26.8). No mother-to-child transmission occurred. CONCLUSIONS Increasing numbers of WLWH deliver vaginally. Despite virological suppression, more WLWH plan and deliver by ECS than WGP. WLWH had a twofold higher risk of EmCS compared with WGP.
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Affiliation(s)
- M Ørbaek
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - K Thorsteinsson
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - M Helleberg
- Department of Infectious Diseases, The National University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - E Moseholm
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - T L Katzenstein
- Department of Infectious Diseases, The National University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - M Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark
| | - I S Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - G Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - N Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - A-M Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Pregnancy outcomes in HIV-positive women: a retrospective cohort study. Arch Gynecol Obstet 2017; 295:599-606. [PMID: 28097445 DOI: 10.1007/s00404-016-4271-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 12/09/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE In the United States, an estimated 8500 HIV (human immunodeficiency virus) positive women gave birth in 2014. This rate appears to be increasing annually. Our objective is to examine obstetrical outcomes of pregnancy among HIV-positive women. METHODS A population-based cohort study was conducted using the Nationwide Inpatient Sample database (2003-2011) from the United States. Pregnant HIV-positive women were identified and compared to pregnant women without HIV. Multivariate logistic regression was used to estimate the adjusted effect of HIV status on obstetrical and neonatal outcomes. RESULTS Among 7,772,999 births over the study period, 1997 were in HIV-positive women (an incidence of 25.7/100,000 births). HIV-infected patients had greater frequency of pre-existing diabetes and chronic hypertension, and use of cigarettes, drugs, and alcohol during pregnancy (p < 0.001). Upon adjustment for baseline characteristics, HIV-infected women had greater likelihood of antenatal complications: preterm premature rupture of membranes (OR 1.35, 95% CI 1.14-1.60) and urinary tract infections (OR 3.02, 95% CI 2.40-3.81). Delivery and postpartum complications were also increased among HIV-infected women: cesarean delivery (OR 3.06, 95% CI 2.79-3.36), postpartum sepsis (OR 8.05, 95% CI 5.44-11.90), venous thromboembolism (OR 2.21, 95% CI 1.46-3.33), blood transfusions (OR 3.67, 95% CI 3.01-4.49), postpartum infection (OR 3.00, 95% CI 2.37-3.80), and maternal mortality (OR 21.52, 95% CI 12.96-35.72). Neonates born to these mothers were at higher risk of prematurity and intrauterine growth restriction. CONCLUSION Pregnancy in HIV-infected women is associated with adverse maternal and newborn complications. Pregnant HIV-positive women should be followed in high-risk healthcare centers.
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Zash RM, Williams PL, Sibiude J, Lyall H, Kakkar F. Surveillance monitoring for safety of in utero antiretroviral therapy exposures: current strategies and challenges. Expert Opin Drug Saf 2016; 15:1501-1513. [PMID: 27552003 DOI: 10.1080/14740338.2016.1226281] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION The use of antiretroviral therapy (ART) in pregnancy to prevent vertical HIV transmission has been one of the most successful public health programs in the last decade. As a result, an unprecedented number of women are taking ART at conception and during pregnancy. Given few randomized studies evaluating safety of different ART regimens in pregnancy, ongoing drug safety surveillance is critical. Areas covered: This review aims to provide a rationale for ART drug safety surveillance, describe changing patterns of ART use and summarize current surveillance efforts in both low-resource and high-resource settings. Additionally, biostatistical approaches to and challenges in analysis of observational surveillance data are discussed. Expert opinion: The global landscape of ART use in pregnancy is rapidly increasing and evolving. Any increase in adverse effects of in-utero exposure to ART has the potential to reduce the impact of improvements in infant morbidity and mortality gained from decreased vertical HIV transmission. ART drug safety surveillance should therefore be a critical piece of programs to prevent mother to child transmission in both high- and low-resource settings. Current surveillance efforts could be strengthened with long-term follow-up of exposed children, pooling of data across cohorts and standardized approaches to analysis.
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Affiliation(s)
- Rebecca M Zash
- a Division of Infectious Diseases , Beth Israel Deaconess Medical Center , Boston , MA , USA.,b Department of Immunology and Infectious Diseases , Harvard T. H. Chan School of Public Health , Boston , MA , USA.,c Botswana Harvard AIDS Institute Partnership , Gaborone , Botswana
| | - Paige L Williams
- d Center for Biostatistics in AIDS Research , Departments of Biostatistics and Epidemiology, Harvard T. H. Chan School of Public Health
| | - Jeanne Sibiude
- e Groupe Hospitalier Cochin Port Royal , Université Paris Descartes , Paris , France.,f INSERM CESP 1018 , Le Kremlin Bicêtre , France
| | - Hermione Lyall
- g Consultant Paediatrician, Infectious Diseases , Imperial College Healthcare NHS Trust , London , UK
| | - Fatima Kakkar
- h Division of Infectious Diseases , Centre Hospitalier Universtaire Sainte-Justine, University of Montreal , Sainte-Justine , Canada
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