1
|
Saint‐Lary L, Lacroix I, Leroy V, Sommet A. Integrase inhibitor drugs during pregnancy and congenital anomalies: A case/non-case study from the global pharmacovigilance database VigiBase®. Pharmacol Res Perspect 2024; 12:e1247. [PMID: 39086081 PMCID: PMC11291555 DOI: 10.1002/prp2.1247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/18/2024] [Accepted: 07/04/2024] [Indexed: 08/02/2024] Open
Abstract
In 2018, a significant neural tube defects (NTD) signal was reported after pre-conceptional exposure to dolutegravir, but was not confirmed in further analysis. Since 2019, dolutegravir-based regimen, an integrase inhibitor (INI), is recommended by WHO as the most-effective first-line therapy in all patients living with HIV. To explore the potential INI-related teratogenic effect, we searched disproportionate signals between exposure to INI-class drugs and congenital anomalies, compared to non-INI drugs, using the international pharmacovigilance database, VigiBase®. We selected all the reports registered in VigiBase® between 01/01/2007 and 30/03/2021 on any antiretroviral drug-related fetal or neonatal adverse drug reactions, declared either in children (<2 years) exposed in utero or in pregnant women (12-50 years). A case/non-case study was conducted to detected signals between congenital anomalies and prenatal exposure to any INI-class drug, compared to non-INI drugs, by estimating adjusted reporting odds ratios (aROR) with 95% confidence intervals (95%CI). We identified 2521 unique reports, among which 664 (26.3%) were related to INI-class use. Overall, 520 congenital anomalies were cited from 327 unique reports, of whom 31.0% were INI-related. Compared to non-INI drugs, no significant disproportionate reporting signal between prenatal exposure to INI-class drugs and congenital anomalies was found (aROR 1.13; 95% CI:0.85-1.51). However, specific significant signals were reported for raltegravir/elvitegravir/dolutegravir drug exposure and urinary malformations (aROR 2.43; 95%CI:1.08-5.43), digestive malformations (aROR 3.09; 95%CI:1.22-7.84), and NTDs (aROR 3.02; 95%CI:1.09-8.37). Although specific congenital anomalies signals associated with raltegravir/elvitegravir/dolutegravir exposure were notified, causal relationship needs to be further investigated in prospective studies.
Collapse
Affiliation(s)
- Laura Saint‐Lary
- CERPOP, Inserm, Université de Toulouse, Université Paul Sabatier IIIToulouseFrance
| | - Isabelle Lacroix
- CERPOP, Inserm, Université de Toulouse, Université Paul Sabatier IIIToulouseFrance
- Service de Pharmacologie Clinique, CHU de ToulouseUniversité Toulouse 3ToulouseFrance
| | - Valériane Leroy
- CERPOP, Inserm, Université de Toulouse, Université Paul Sabatier IIIToulouseFrance
| | - Agnès Sommet
- CERPOP, Inserm, Université de Toulouse, Université Paul Sabatier IIIToulouseFrance
- Service de Pharmacologie Clinique, CHU de ToulouseUniversité Toulouse 3ToulouseFrance
| |
Collapse
|
2
|
Todorović Z, Dragović G, Lukić R. Pharmacokinetic and toxicological considerations affecting antiretroviral drug dosing in pregnant women. Expert Opin Drug Metab Toxicol 2024; 20:419-437. [PMID: 38738389 DOI: 10.1080/17425255.2024.2353762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 05/07/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION To prevent mother-to-child transmission (PMTCT) of the human immunodeficiency virus (HIV) during pregnancy, the appropriate dosing regimens of antiretroviral (ARV) drugs need to be determined. Reliable data about pharmacokinetic (PK) characteristics of ARVs from randomized clinical trials (RCTs) are lacking, and post-marketing observational studies may offer valuable, but sometimes insufficient data, especially in pregnant people living with HIV (PLWHIV). This review article is focused PK and toxicological considerations affecting ARV dosing in pregnant PLWHIV. AREAS COVERED In our search, we included studies focused on PKs of ARVs in pregnancy available on PubMed, abstracts from recent global conferences and data from modeling studies. There are no significant changes in PKs of nucleoside/nucleotide reverse transcriptase inhibitors and non-nucleoside reverse transcriptase inhibitors throughout pregnancy. In contrast, the PKs of PIs and INSTIs are more variable, especially in the second and third trimesters. EXPERT OPINION Pregnant women are left out of RCTs. To the greatest extent possible, future research should include pregnant persons in RCTs, including PK studies, strictly considering maternal and fetal safety. Alternative innovative approaches/models need to be developed to obtain reliable data about rational pharmacotherapy of ARVs in the effective PMTCT of HIV, with maximum safety.
Collapse
Affiliation(s)
- Zoran Todorović
- Faculty of Medicine, Department of Pharmacology, Clinical Pharmacology and Toxicology, University of Belgrade, Belgrade, Serbia
| | - Gordana Dragović
- Faculty of Medicine, Department of Pharmacology, Clinical Pharmacology and Toxicology, University of Belgrade, Belgrade, Serbia
| | - Relja Lukić
- Faculty of Medicine, Obstetrics and Gynaecology Clinic GAK "Narodni Front", University of Belgrade, Belgrade, Serbia
| |
Collapse
|
3
|
Chen J, Liu D, Zeng L, Jia ZJ, Cheng G, Xiao X, Zhang L. Disease burden and risk factors of children aged 0-14 years in China: a retrospective study on data from the Global Burden of Disease Study 2019. BMJ Open 2024; 14:e076013. [PMID: 38816057 PMCID: PMC11138299 DOI: 10.1136/bmjopen-2023-076013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 01/11/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVES This study aimed to analyse the current status, trends and risk factors of disease burden from 1990 to 2019 among Chinese children. DESIGN AND PARTICIPANTS It was a retrospective study on data from the Global Burden of Disease Study 2019 (GBD 2019). Data of disease burden and risk factors were extracted from the GBD 2019. Children were divided into two groups of <5 and 5-14 years. Data were analysed using GBD results query tool, Excel and Pareto analysis. PRIMARY OUTCOME MEASURES Disability-Adjusted Life Years (DALYs) and deaths. RESULTS The overall disease burden for both children <5 years and those aged 5-14 years significantly decreased from 1990 to 2019. For children aged <5 years, in 2019, the leading cause of deaths and DALYs were 'neonatal disorders', and the top risk factor was 'low birth weight'. Compared with data of 1990, the ranking of causes of deaths and DALYs in 2019 saw the most significant increase for 'HIV/AIDS and sexually transmitted infections' and 'skin and subcutaneous diseases' respectively. Conversely, the ranking of deaths/DALYs causes that dropped most significantly was 'nutritional deficiencies'. For children aged 5-14, in 2019, the leading deaths and DALYs causes were 'unintentional injuries' and 'mental disorders' respectively. The top risk factors were 'alcohol use' and 'short gestation', respectively. The ranking of deaths and DALYs causes rose most significantly were 'HIV/AIDS and sexually transmitted infections' and 'neonatal disorders', respectively. Conversely, the ranking of deaths causes that dropped most significantly were 'other infectious diseases', 'enteric infections' and 'nutritional deficiencies'. For DALYs, the causes that dropped most significantly in ranking were 'other infectious diseases'. CONCLUSIONS The disease burden of children has significantly changed from 1990 to 2019, with notable differences between children aged <5 and 5-14 years. To optimise the allocation of health resources, it is necessary to adjust management strategies based on the latest disease burden.
Collapse
Affiliation(s)
- Jingjing Chen
- Department of Pharmacy, West China Second University Hospital/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Dan Liu
- Department of Pharmacy, West China Second University Hospital/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Linan Zeng
- Department of Pharmacy, West China Second University Hospital/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Zhi-Jun Jia
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
- Department of Pharmacy, West China Second University Hospital/Evidence-Based Pharmacy Center, West China Second University Hospital/West China School of Pharmacy, Sichuan University, Chengdu, Sichuan, China
| | - Guo Cheng
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
- Department of Pediatrics, West China Second University Hospital/Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Xue Xiao
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lingli Zhang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
- Department of Pharmacy, West China Second University Hospital/Evidence-Based Pharmacy Center, West China Second University Hospital/Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
4
|
Brittain K, Brown K, Phillips T, Zerbe A, Pellowski J, Remien RH, Mellins CA, Abrams EJ, Myer L. Why do Integrated Maternal HIV and Infant Healthcare Services work? A Secondary Analysis of a Randomised Controlled Trial in South Africa. AIDS Behav 2023; 27:3831-3843. [PMID: 37306847 PMCID: PMC10598190 DOI: 10.1007/s10461-023-04097-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 06/13/2023]
Abstract
In a randomised trial, we found that integrated maternal HIV and infant health services through the end of breastfeeding were significantly associated with the primary outcome of engagement in HIV care and viral suppression at 12 months postpartum, compared to the standard of care. Here, we quantitatively explore potential psychosocial modifiers and mediators of this association. Our findings suggest that the intervention was significantly more effective among women experiencing an unintended pregnancy but did not improve outcomes among women reporting risky alcohol use. Although not statistically significant, our results suggest that the intervention may also be more effective among women experiencing higher levels of poverty and HIV-related stigma. We observed no definitive mediator of the intervention effect, but women allocated to integrated services reported better relationships with their healthcare providers through 12 months postpartum. These findings point to high-risk groups that may benefit the most from integrated care, as well as groups for whom these benefits are hampered and that warrant further attention in intervention development and evaluation.
Collapse
Affiliation(s)
- Kirsty Brittain
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa.
| | - Karryn Brown
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
| | - Tamsin Phillips
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
| | - Allison Zerbe
- Mailman School of Public Health, ICAP at Columbia University, Columbia University, New York, NY, USA
| | - Jennifer Pellowski
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, RI, USA
- International Health Institute, Brown University School of Public Health, Providence, RI, USA
| | - Robert H Remien
- New York State Psychiatric Institute, HIV Center for Clinical & Behavioral Studies, Columbia University, New York, NY, USA
| | - Claude A Mellins
- New York State Psychiatric Institute, HIV Center for Clinical & Behavioral Studies, Columbia University, New York, NY, USA
| | - Elaine J Abrams
- Mailman School of Public Health, ICAP at Columbia University, Columbia University, New York, NY, USA
- Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
| |
Collapse
|
5
|
Tan Y, Wu S, Yan Y, Zou S, Feng L, Guo W, Wu M, Luo M, Liang K. Adverse pregnancy outcomes associated with antiretroviral therapy initiated before pregnancy and during pregnancy: a retrospective study in Hubei province, China. Front Med (Lausanne) 2023; 10:1158962. [PMID: 37275371 PMCID: PMC10232830 DOI: 10.3389/fmed.2023.1158962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 05/03/2023] [Indexed: 06/07/2023] Open
Abstract
Background Antiretroviral therapy (ART) initiation before pregnancy was reported to have an increased risk of adverse pregnancy outcomes (APOs) than ART initiation during pregnancy. However, the risks of APOs associated with different ART regimens initiated before or during pregnancy remain unknown. Methods Pregnant women living with HIV (PWLHIV) from Hubei Province, China, were retrospectively enrolled between January 1, 2004, and December 31, 2021. The trends of ART initiation time and application of different ART regimens were evaluated over time, separately. Using no ART exposure before and during pregnancy as control, the risks of APOs associated with protease inhibitor (PI) based regimens and non-nucleoside reverse transcriptase inhibitors (NNRTIs) based regimens initiated before pregnancy were analyzed; and the risks of APOs associated with PI-based regimens, NNRTIs based regimens and zidovudine (AZT) monotherapy initiated during pregnancy were analyzed. APOs, including low birthweight (LBW), stillbirth, preterm birth (PTB) and early miscarriage, were reviewed. Results Among 781 PWLHIV including 1,010 pregnancies, 522 pregnancies (51.7%) were exposed to ART before or during pregnancy. Of them, the proportion of ART initiation before pregnancy per year increased from around 20% in the early period to more than 60% after 2019. Efavirenz (EFV)-nucleoside reverse transcriptase inhibitors (NRTIs) (32.2%), LPV/r-NRTIs (31.2%), and nevirapine (NVP)-NRTIs (27.4%) were the most commonly used regimens, and the proportion of LPV/r-NRTIs used per year has increased to around 50.0% in recent years. LPV/r-NRTIs was associated with higher risks of LBW whether initiated before pregnancy [adjusted OR (aOR) = 2.59, 95%CI 1.04-6.45, p = 0.041] or during pregnancy (aOR = 2.19, 95%CI 1.03-4.67, p = 0.041), compared with no exposure to ART before and during pregnancy. However, no matter initiated before or during pregnancy, LPV/r-NRTIs had no significantly increased risks of stillbirth, PTB and early miscarriage, and EFV /NVP-NRTIs and AZT monotherapy had no significantly increased risks of LBW, stillbirth, PTB and early miscarriage when compared with no exposure to ART before and during pregnancy. Conclusion Our data suggests that LPV/r-NRTIs has been widely used among PWLHIV in recent years. However, the potential risk of LBW should be continuously monitored among PWLHIV whether LPV/r-NRTIs is initiated before or during pregnancy.
Collapse
Affiliation(s)
- Yuting Tan
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
- Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, China
| | - Songjie Wu
- Department of Nosocomial Infection Management, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yajun Yan
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shi Zou
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ling Feng
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Guo
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Pathology, School of Basic Medical Sciences, Wuhan University, Wuhan, China
| | - Mengmeng Wu
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
- Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, China
| | - Mingqi Luo
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ke Liang
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
- Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, China
- Department of Nosocomial Infection Management, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Engineering Center for Infectious Disease Prevention, Control and Treatment, Wuhan, China
| |
Collapse
|
6
|
Bukkems VE, Finkenflügel RN, Grintjes K, Marneef M, de Haan M, Mielitz I, van Hulzen A, Rokx C, van Leeuwen E, Nellen JF, Burger DM, Colbers A. Exploring the Breastfeeding Desires and Decision-Making of Women Living with HIV in the Netherlands: Implications for Perinatal HIV Management in Developed Countries. Breastfeed Med 2023; 18:356-361. [PMID: 37083439 PMCID: PMC10254968 DOI: 10.1089/bfm.2023.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Introduction: Guidelines in high-income countries recommend women living with human immunodeficiency virus (HIV) to formula feed their newborns, because the possibility of mother-to-child-transmission of HIV during breastfeeding cannot be ruled out. It is an ongoing debate if the possible transmission risk outweighs the medical, cultural, psychological, and social importance of breastfeeding in women stable on current first-line suppressive antiretroviral regimens. The study aim was to explore breastfeeding desires and decision-making of immigrant and nonimmigrant women living with HIV in the Netherlands. Method: A questionnaire was administered orally or online to 82 women living with HIV in the Netherlands. The breastfeeding desires of the participants were collected as categorical data, and breastfeeding decision-making and willingness to adhere to additional monitoring were collected on a 5-point Likert scale. Categorical data were presented as proportions, and Likert scale data were presented in Likert scale bar plots. Results: Seventy-one percent of the participants expressed a desire to breastfeed in the future. The most important factors influencing decision-making to breastfeed were the chance of transmission of HIV to the infant and the advice by the doctor or nurse practitioner. Of the participants, 42% expressed their interest in breastfeeding with a <1/100 transmission risk. More than half of the participants expressed their interest to breastfeed with additional monitoring. Conclusions: A substantial proportion of the women living with HIV in the Netherlands has a desire to breastfeed, of which the majority are willing to adhere to additional monitoring to do so.
Collapse
Affiliation(s)
- Vera E. Bukkems
- Department of Pharmacy, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Karin Grintjes
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Manon Marneef
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Martine de Haan
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Astrid van Hulzen
- Department of Internal Medicine, Isala Hospital, Zwolle, the Netherlands
| | - Casper Rokx
- Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, the Netherlands
| | - Elisabeth van Leeuwen
- Department of Obstetrics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jeannine F. Nellen
- Division of Infectious Diseases, Tropical Medicine and AIDS, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - David M. Burger
- Department of Pharmacy, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Angela Colbers
- Department of Pharmacy, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, the Netherlands
| |
Collapse
|
7
|
Ibrahim A, Warton FL, Fry S, Cotton MF, Jacobson SW, Jacobson JL, Molteno CD, Little F, van der Kouwe AJW, Laughton B, Meintjes EM, Holmes MJ. Maternal ART throughout gestation prevents caudate volume reductions in neonates who are HIV exposed but uninfected. Front Neurosci 2023; 17:1085589. [PMID: 36968507 PMCID: PMC10035579 DOI: 10.3389/fnins.2023.1085589] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/25/2023] [Indexed: 03/12/2023] Open
Abstract
IntroductionSuccessful programmes for prevention of vertical HIV transmission have reduced the risk of infant HIV infection in South Africa from 8% in 2008 to below 1% in 2018/2019, resulting in an increasing population of children exposed to HIV perinatally but who are uninfected (HEU). However, the long-term effects of HIV and antiretroviral treatment (ART) exposure on the developing brain are not well understood. Whereas children who are HEU perform better than their HIV-infected counterparts, they demonstrate greater neurodevelopmental delay than children who are HIV unexposed and uninfected (HUU), especially in resource-poor settings. Here we investigate subcortical volumetric differences related to HIV and ART exposure in neonates.MethodsWe included 120 infants (59 girls; 79 HEU) born to healthy women with and without HIV infection in Cape Town, South Africa, where HIV sero-prevalence approaches 30%. Of the 79 HEU infants, 40 were exposed to ART throughout gestation (i.e., mothers initiated ART pre conception; HEU-pre), and 39 were exposed to ART for part of gestation (i.e., mothers initiated ART post conception; HEU-post). Post-conception mothers had a mean (± SD) gestational age (GA) of 15.4 (± 5.7) weeks at ART initiation. Mothers with HIV received standard care fixed drug combination ART (Tenofovir/Efavirenz/Emtricitabine). Infants were imaged unsedated on a 3T Skyra (Siemens, Erlangen, Germany) at mean GA equivalent of 41.5 (± 1.0) weeks. Selected regions (caudate, putamen, pallidum, thalamus, cerebellar hemispheres and vermis, and corpus callosum) were manually traced on T1-weighted images using Freeview.ResultsHEU neonates had smaller left putamen volumes than HUU [β (SE) = −90.3 (45.3), p = 0.05] and caudate volume reductions that depended on ART exposure duration in utero. While the HEU-pre group demonstrated no caudate volume reductions compared to HUU, the HEU-post group had smaller caudate volumes bilaterally [β (SE) = −145.5 (45.1), p = 0.002, and −135.7 (49.7), p = 0.008 for left and right caudate, respectively].DiscussionThese findings from the first postnatal month suggest that maternal ART throughout gestation is protective to the caudate nuclei. In contrast, left putamens were smaller across all HEU newborns, despite maternal ART.
Collapse
Affiliation(s)
- Abdulmumin Ibrahim
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Fleur L. Warton
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- *Correspondence: Fleur L. Warton,
| | - Samantha Fry
- Department of Paediatrics and Child Health and Tygerberg Children’s Hospital, Faculty of Medicine and Health Sciences, Family Centre for Research with Ubuntu, Stellenbosch University, Stellenbosch, South Africa
| | - Mark F. Cotton
- Department of Paediatrics and Child Health and Tygerberg Children’s Hospital, Faculty of Medicine and Health Sciences, Family Centre for Research with Ubuntu, Stellenbosch University, Stellenbosch, South Africa
| | - Sandra W. Jacobson
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - Joseph L. Jacobson
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - Christopher D. Molteno
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Francesca Little
- Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
| | - Andre J. W. van der Kouwe
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Cape Town, South Africa
- A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States
- Department of Radiology, Harvard Medical School, Boston, MA, United States
| | - Barbara Laughton
- Department of Paediatrics and Child Health and Tygerberg Children’s Hospital, Faculty of Medicine and Health Sciences, Family Centre for Research with Ubuntu, Stellenbosch University, Stellenbosch, South Africa
| | - Ernesta M. Meintjes
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa
- Ernesta M. Meintjes,
| | - Martha J. Holmes
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
8
|
Mwanza J, Kawonga M, Kumwenda A, Gray GE, Mutale W, Doherty T. Health system response to preventing mother-to-child transmission of HIV policy changes in Zambia: a health system dynamics analysis of primary health care facilities. Glob Health Action 2022; 15:2126269. [PMID: 36239946 PMCID: PMC9578454 DOI: 10.1080/16549716.2022.2126269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Zambia is focusing on attaining HIV epidemic control by 2021, including eliminating Mother to Child Transmission (eMTCT) of HIV. However, there is little evidence to understand frontline healthcare workers’ experience with the policy changes and the readiness of different health system elements to contribute to this goal. Objective To understand frontline healthcare workers’ experience of preventing mother-to-child transmission (PMTCT) of human immunodeficiency (HIV) policy changes and to explore the health system readiness to respond to rapid changes in PMTCT policy by using the health system dynamic framework. Method We conducted a qualitative study in which 35 frontline healthcare workers were selected and interviewed using a snowball sampling technique. All transcripts were analysed through thematic content analysis and deductive coding. Themes were derived and presented according to the health system dynamics framework. Results Among the ten elements of the health system dynamics framework, service delivery, context, and resources (i.e. infrastructure and supplies, knowledge and information, human resource, and finance) were critical in implementing the continuously evolving PMTCT policies. Furthermore, due to the fragmented primary health care platform in Zambia, non-governmental organisations (NGOs) were instrumental in ensuring that the PMTCT programme met the demand and requirements of the general population. Frontline healthcare workers who participated in the study described inequity in access to ART services due to the service delivery model employed in the selected study sites. Conclusion The study highlights challenges when policies are implemented without consideration for the readiness, context, and capacity in which the policy is implemented. We offer lessons that can inform implementation of universal health coverage of antiretroviral therapy (ART), a strategy many countries have adopted, despite weak health systems.
Collapse
Affiliation(s)
- Jonathan Mwanza
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Mary Kawonga
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Department of Community Health, Charlotte Maxeke Johannesburg Academic Hospital Johannesburg, Johannesburg, South Africa
| | - Andrew Kumwenda
- Department of Obstetrics and Gynaecology, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Glenda E Gray
- Office of the President, South Africa Medical Research Council, Cape Town, South Africa
| | - Wilbroad Mutale
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Tanya Doherty
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Health Systems Research Unit, South Africa Medical Research Council, Cape Town, South Africa
| |
Collapse
|
9
|
Alsulami S, Alotaibi SN, Damfu N, Aljefri DM, Altayib HA, Alharbi M. Efficacy and Safety of Bictegravir-Based Regimen in Pregnant Women Living with HIV: A Case Report. J Int Assoc Provid AIDS Care 2022; 21:23259582221146110. [PMID: 36529886 PMCID: PMC9772963 DOI: 10.1177/23259582221146110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Bictegravir (BIC) is included in international guidelines as the first line of therapy for patients living with Human Immunodeficiency Virus (HIV), either as initial therapy or as a replacement for patients with prior antiretroviral therapy (ART). Due to limited efficacy and safety data, BIC is currently not recommended during pregnancy. Data on the safety and efficacy of BIC during pregnancy were unavailable at the time of drug approval. In our case, BIC/TAF/FTC was effective in suppressing viral load (VL) in pregnancy, and there were no reported safety issues for the mother or the baby.
Collapse
Affiliation(s)
- Shaimaa Alsulami
- Department of Pharmaceutical Care Services, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia,Shaimaa Alsulami, Department of Pharmaceutical Care Services, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia.
| | - Sultan N. Alotaibi
- Department of Pharmaceutical Care Services, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Nader Damfu
- Department of Infection Prevention and Control, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Doaa M. Aljefri
- Department of Pharmaceutical Care Services, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | | | - Maher Alharbi
- Department of Infectious Diseases, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia,Department of Infection Prevention and Control, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia,King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| |
Collapse
|
10
|
Rendell S, Schmidt H, Neergaard R, Nkwihoreze H, Barbati Z, Short WR, Rana AI, Sheth AN, Scott RK, Sethi S, Momplaisir FM. Integrating ART adherence support technologies in the care of pregnant and postpartum people with HIV: a qualitative study. Implement Sci Commun 2022; 3:85. [PMID: 35918738 PMCID: PMC9344442 DOI: 10.1186/s43058-022-00331-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background We have a limited understanding on how to best integrate technologies to support antiretroviral therapy (ART) adherence in routine HIV care. Methods We conducted semi-structured interviews with multidisciplinary providers caring for pregnant and postpartum people with HIV and asked providers about their perspectives on utilizing adherence support technologies such as text messages, video check-ins with providers or automated with facial recognition for directly-observed-therapy, signaling pill bottle, and signaling pill to support ART adherence. Each approach generated an adherence report. The interview instrument was guided by the Consolidated Framework for Implementation Research and included questions on the implementation climate, barriers, and facilitators to the clinical integration of the adherence approach and strategies that could be used to maximize this integration. The order of adherence support technologies was randomized to minimize bias. We used a modified grounded theory to develop the coding structure and two coders applied the codebook to the transcripts after establishing strong inter-rater reliability with 20% of interviews (kappa = 0.82). Results Between March and December 2020, we conducted 26 in-depth, semi-structured interviews with providers who weighed several factors when considering each approach, including the approach’s effect on patient-provider interaction in and outside of the clinic visit, timing for and duration of the approach’s utility, threat of disclosing status, and added burden to providers (e.g., needing to act on generated information) or to patients (e.g., needing to hide the signaling pills, responding to text messages). Providers’ most preferred approach was text-messages, and the least preferred was the signaling pill. Barriers to acceptability varied by approach and included perceived surveillance, violation of privacy, added time demand for providers, potential inaccuracy of the adherence data generated, and negative impact on the patient-provider relationship, particularly if the approach was perceived as coercive. Payers anticipated regulatory hurdles with unfamiliar approaches, particularly the signaling pill and signaling pill bottle. Facilitators included strengthened therapeutic alliance, predictable reminder mechanisms, and options for customization according to patient preference. Conclusions Our study elucidates barriers and facilitators to integrating technology-based adherence support approaches in clinical care to support adherence of pregnant and postpartum people with HIV.
Collapse
|
11
|
From Undetectable Equals Untransmittable (U=U) to Breastfeeding: Is the Jump Short? Infect Dis Rep 2022; 14:220-227. [PMID: 35447879 PMCID: PMC9030015 DOI: 10.3390/idr14020027] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Vertical transmission of HIV infection may occur during pregnancy, at childbirth or through breastfeeding. Recommendations on the safety of breastfeeding of HIV-infected women on effective antiretroviral treatment are not univocal among international guidelines (WHO 2010, EACS 2017, DHHS 2017), leaving space for variability at the patient’s level. Methods: We collected clinical, laboratory and outcome data from 13 HIV-infected pregnant women who, between March 2017 and June 2021, elected to breastfeed their children against specific medical advice. All mothers were on antiretroviral therapy with darunavir or raltegravir plus emtricitabine/tenofovir disoproxil and remained HIV-RNA undetectable and >400 cells/mmc CD4+ lymphocytes during pregnancy and breastfeeding. Prophylactic antiretroviral therapy (zidovudine for 4 weeks) was started immediately after birth in all newborns. The mean duration of breastfeeding was 5.4 months. Newborns were tested for HIV-RNA multiple times: at birth, 1, 3, and 6 months after birth, and 1, 3 and 6 months after the end of breastfeeding. Results: None of the infants were infected by HIV. Conclusions: Our experience, gathered in the setting of freedom of choice on the patient’s side, while insufficient to address the eventual safety of breastfeeding in HIV-infected mothers since the represented cohort is numerically irrelevant, supports the extension of the U=U (Undetectable Equals Untransmittable) paradigm to this setting. Since breastfeeding is often requested by women with HIV planning pregnancy, more extensive comparative studies should be performed.
Collapse
|
12
|
Vianna CA, Dupont C, Selleret L, Canestri A, Levy R, Hamid RH. Comparison of in vitro fertilization cycles in couples with human immunodeficiency virus type 1 infection versus noninfected couples through a retrospective matched case-control study. F S Rep 2021; 2:376-385. [PMID: 34934977 PMCID: PMC8655394 DOI: 10.1016/j.xfre.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/18/2021] [Accepted: 04/26/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To compare in vitro fertilization (IVF) outcomes in couples in which at least one partner is human immunodeficiency virus (HIV) positive with that of couples in which neither partner is HIV-positive. Design Retrospective matched case-control study. Setting Fertility center at Tenon Hospital, Paris, France. Patient(s) A total of 179 IVF cycles in couples infected with HIV-1 and 179 IVF cycles in control couples. Intervention(s) Ovarian stimulation, oocytes retrieval, IVF (standard and microinjection), embryo transfer, pregnancy, and live birth follow-up. Main Outcome Measure(s) Live birth rate and IVF outcomes Result(s) The first comparison between HIV and non-HIV couples showed poorer outcomes in the HIV group (higher administered gonadotropin doses and longer stimulation periods, lower cumulative pregnancy and live birth rates, among other things). A subgroup analysis was performed in addition. No differences were found in the “men HIV” group compared with the controls. In contrast, poorer outcomes in the “women HIV” and “women and men HIV” groups were shown in terms of administered doses, duration of stimulation, and number of oocytes retrieved. For the “women HIV” group, lower cumulative clinical pregnancy and live birth rates were found. Conclusion The data suggested that couples with HIV-positive women have poorer medically assisted procreation outcomes than couples with non-HIV-infected women. Therefore, physicians should pay particular attention to couples with HIV-positive women.
Collapse
Affiliation(s)
- Caroline Aimone Vianna
- Biologie de la Reproduction - Centre d'Etude et de Conservation des Oeufs et du Sperme humains, Hôpital Tenon, Paris, France
| | - Charlotte Dupont
- Biologie de la Reproduction - Centre d'Etude et de Conservation des Oeufs et du Sperme humains, Hôpital Tenon, Paris, France
| | - Lise Selleret
- Service de Gynécologie Obstétrique - Médecine de la Reproduction, Hôpital Tenon, Paris, France
| | - Ana Canestri
- Service Maladies Infectieuses et Tropicales, Hôpital Tenon, Paris, France
| | - Rachel Levy
- Biologie de la Reproduction - Centre d'Etude et de Conservation des Oeufs et du Sperme humains, Hôpital Tenon, Paris, France
| | - Rahaf Haj Hamid
- Biologie de la Reproduction - Centre d'Etude et de Conservation des Oeufs et du Sperme humains, Hôpital Tenon, Paris, France
| |
Collapse
|
13
|
Skerritt L, Kaida A, O'Brien N, Burchell AN, Bartlett G, Savoie É, Boucoiran I, Gormley R, Kestler M, Money D, Loutfy M, de Pokomandy A. Patterns of changing pregnancy intentions among women living with HIV in Canada. BMC WOMENS HEALTH 2021; 21:350. [PMID: 34615492 PMCID: PMC8496032 DOI: 10.1186/s12905-021-01492-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/23/2021] [Indexed: 12/01/2022]
Abstract
Background Women with an undetectable viral load can become pregnant and have children with no risk of HIV transmission to their sexual partners and low risk of transmission to their infants. Contemporary pregnancy intentions of women living with HIV in Canada are poorly understood, evidenced by high rates of unintended pregnancy and low uptake of contraceptives. Methods We used longitudinal survey data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) to measure and compare pregnancy intentions (Yes vs No vs Unsure) at baseline, 18-months and 36-months follow-up (from 2013 to 2018) among women living with HIV of reproductive age (16–49 years) and potential. We used Sankey diagrams to depict changes in pregnancy intentions over time and multivariable logistic regression to examine the relationship between pregnancy intention within 2 years and subsequent pregnancy. Results At baseline, 41.9% (119/284) of women intended to become pregnant, 43.3% did not, and 14.8% were unsure. Across 36-months of follow-up, 41.9% (119/284) of women changed their pregnancy intentions, with 25% changing from intending to not intending to become pregnant and 13.1% vice versa. Pregnancy intentions were not strongly associated with subsequent pregnancy between baseline and 18-months (aOR 1.44; 95% CI 0.53, 3.72) or between 18 and 36-months (aOR 2.17; 95% CI 0.92, 5.13). Conclusions Our findings underscore the need for healthcare providers to engage in ongoing discussions with women living with HIV to support their dynamic pregnancy intentions.
Collapse
Affiliation(s)
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Nadia O'Brien
- Centre de Recherche du Centre Hospitalier de l'Université de Montreal (CRCHUM), Montreal, Canada
| | - Ann N Burchell
- Department of Family and Community Medicine, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Gillian Bartlett
- Department of Family and Community Medicine, University of Missouri, Columbia, USA
| | - Édénia Savoie
- Chronic Viral Illness Service, McGill University Health Centre, Glen Site 1001 Decarie Blvd., Rm D02.4110, Montreal, QC, H4A 3J1, Canada
| | - Isabelle Boucoiran
- Women and Children's Infectious Diseases Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada
| | - Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Mary Kestler
- Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, Canada.,Faculty of Medicine, University of British Colombia, Vancouver, Canada
| | - Deborah Money
- Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, Canada.,Faculty of Medicine, University of British Colombia, Vancouver, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, Canada. .,Chronic Viral Illness Service, McGill University Health Centre, Glen Site 1001 Decarie Blvd., Rm D02.4110, Montreal, QC, H4A 3J1, Canada.
| |
Collapse
|
14
|
Shoemaker ES, Volpini K, Smith S, Loutfy M, Kendall C. Equitable Timing of HIV Diagnosis Prior to Pregnancy: A Canadian Perspective. Cureus 2021; 13:e16691. [PMID: 34466322 PMCID: PMC8396133 DOI: 10.7759/cureus.16691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 11/28/2022] Open
Abstract
Initiating antiretrovirals prior to conception leads to a negligible risk of perinatal transmission. This study aimed to determine the timing of HIV diagnosis among pregnant women with HIV in Ontario. A retrospective population-level cohort study using linked health administrative databases was conducted to establish maternal HIV status and timing of HIV diagnosis of all women living with HIV who gave birth in 2006-2018. The majority of the 1012 women living with HIV who gave birth in Ontario were diagnosed prior to pregnancy (87.9%); however, many were not (12.1%). Among those diagnosed during pregnancy, only 23% were diagnosed in the first trimester. While HIV screening tests are being well directed towards young women, several women still enter pregnancy undiagnosed and are not diagnosed early. This calls for a continuous effort to promote universal pre-conception screening and to use HIV point-of-care testing for at-risk pregnant women and those presenting late to prenatal care.
Collapse
Affiliation(s)
- Esther S Shoemaker
- Internal Medicine, C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, CAN.,Internal Medicine, Institute for Clinical Evaluative Sciences (ICES), Toronto, CAN.,Internal Medicine, Ottawa Hospital Research Institute, Ottawa, CAN
| | - Kate Volpini
- Internal Medicine, C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, CAN.,Internal Medicine, University of Ottawa, Ottawa, CAN
| | - Stephanie Smith
- Medicine, C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, CAN
| | - Mona Loutfy
- Infectious Disease, Women's College Research Institute, Women's College Hospital, Toronto, CAN.,Internal Medicine, Institute for Clinical Evaluative Sciences (ICES), Toronto, CAN.,Internal Medicine, University of Toronto, Toronto, CAN
| | - Claire Kendall
- Family Medicine, C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, CAN.,Family Medicine, Institute for Clinical Evaluative Sciences (ICES), Toronto, CAN.,Family Medicine, Ottawa Hospital Research Institute, Ottawa, CAN.,Family Medicine, University of Ottawa, Ottawa, CAN.,Family Medicine, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, CAN
| |
Collapse
|
15
|
Summary of 2021 Clinical Guidelines for the Diagnosis and Treatment of HIV/AIDS in HIV-infected Koreans. Infect Chemother 2021; 53:592-616. [PMID: 34405598 PMCID: PMC8511382 DOI: 10.3947/ic.2021.0305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Indexed: 12/15/2022] Open
Abstract
Since the establishment of the Committee for Clinical Guidelines for the Diagnosis and Treatment of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) by the Korean Society for AIDS in 2010, clinical guidelines have been prepared in 2011, 2013, 2015, and 2018. As new research findings on the epidemiology, diagnosis, and treatment of AIDS have been published in and outside of Korea along with the development and introduction of new antiretroviral medications, a need has arisen to revise the clinical guidelines by analyzing such new data. The clinical guidelines address the initial evaluation of patients diagnosed with HIV/AIDS, follow-up tests, appropriate timing of medication, appropriate antiretroviral medications, treatment strategies for patients who have concurrent infections with hepatitis B or C virus, recommendations for resistance testing, treatment for patients with HIV and tuberculosis coinfections, and treatment in pregnant women. Through these clinical guidelines, the Korean Society for AIDS and the Committee for Clinical Guidelines for the Diagnosis and Treatment of HIV/AIDS contributes to overcoming AIDS by delivering latest data and treatment strategies to healthcare professionals who treat AIDS in the clinic.
Collapse
|
16
|
Brittain K, Teasdale CA, Ngeno B, Odondi J, Ochanda B, Brown K, Langat A, Modi S, Abrams EJ. Improving retention in antenatal and postnatal care: a systematic review of evidence to inform strategies for adolescents and young women living with HIV. J Int AIDS Soc 2021; 24:e25770. [PMID: 34449121 PMCID: PMC8395389 DOI: 10.1002/jia2.25770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/17/2021] [Accepted: 06/01/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Young pregnant and postpartum women living with HIV (WLHIV) are at high risk of poor outcomes in prevention of mother-to-child transmission services. The aim of this systematic review was to collate evidence on strategies to improve retention in antenatal and/or postpartum care in this population. We also conducted a secondary review of strategies to increase attendance at antenatal care (ANC) and/or facility delivery among pregnant adolescents, regardless of HIV status, to identify approaches that could be adapted for adolescents and young WLHIV. METHODS Selected databases were searched on 1 December 2020, for studies published between January 2006 and November 2020, with screening and data abstraction by two independent reviewers. We identified papers that reported age-disaggregated results for adolescents and young WLHIV aged <25 years at the full-text review stage. For the secondary search, we included studies among female adolescents aged 10 to 19 years. RESULTS AND DISCUSSION Of 37 papers examining approaches to increase retention among pregnant and postpartum WLHIV, only two reported age-disaggregated results: one showed that integrated care during the postpartum period increased retention in HIV care among women aged 18 to 24 years; and another showed that a lay counsellor-led combination intervention did not reduce attrition among women aged 16 to 24 years; one further study noted that age did not modify the effectiveness of a combination intervention. Mobile health technologies, enhanced support, active follow-up and tracing and integrated services were commonly examined as standalone interventions or as part of combination approaches, with mixed evidence for each strategy. Of 10 papers identified in the secondary search, adolescent-focused services and continuity of care with the same provider appeared to be effective in improving attendance at ANC and/or facility delivery, while home visits and group ANC had mixed results. CONCLUSIONS This review highlights the lack of evidence regarding effective strategies to improve retention in antenatal and/or postpartum care among adolescents and young WLHIV specifically, as well as a distinct lack of age-disaggregated results in studies examining retention interventions for pregnant WLHIV of all ages. Identifying and prioritizing approaches to improve retention of adolescents and young WLHIV are critical for improving maternal and child health.
Collapse
Affiliation(s)
- Kirsty Brittain
- Division of Epidemiology & BiostatisticsSchool of Public Health & Family MedicineUniversity of Cape TownCape TownSouth Africa
- Centre for Infectious Disease Epidemiology & ResearchSchool of Public Health & Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Chloe A Teasdale
- Mailman School of Public HealthICAP‐Columbia UniversityNew YorkNYUSA
- Department of EpidemiologyMailman School of Public HealthNew YorkNYUSA
- Department of Epidemiology and BiostatisticsCUNY Graduate School of Public Health & Health PolicyNew YorkNYUSA
| | - Bernadette Ngeno
- Division of Global HIV and Tuberculosis (DGHT)US Centers for Disease Control and PreventionAtlantaGAUSA
| | - Judith Odondi
- Mailman School of Public HealthICAP‐Columbia UniversityNew YorkNYUSA
| | - Boniface Ochanda
- Division of Global HIV and Tuberculosis (DGHT)US Centers for Disease Control and PreventionNairobiKenya
| | - Karryn Brown
- Division of Epidemiology & BiostatisticsSchool of Public Health & Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Agnes Langat
- Division of Global HIV and Tuberculosis (DGHT)US Centers for Disease Control and PreventionNairobiKenya
| | - Surbhi Modi
- Division of Global HIV and Tuberculosis (DGHT)US Centers for Disease Control and PreventionAtlantaGAUSA
| | - Elaine J Abrams
- Mailman School of Public HealthICAP‐Columbia UniversityNew YorkNYUSA
- Department of EpidemiologyMailman School of Public HealthNew YorkNYUSA
- Department of PediatricsVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
| |
Collapse
|
17
|
Skerritt L, de Pokomandy A, O'Brien N, Sourial N, Burchell AN, Bartlett G, Schuster T, Rouleau D, Proulx-Boucher K, Pick N, Money D, Gormley R, Carter A, Yudin MH, Loutfy M, Kaida A. Discussing reproductive goals with healthcare providers among women living with HIV in Canada: the role of provider gender and patient comfort. Sex Reprod Health Matters 2021; 29:1932702. [PMID: 34165395 PMCID: PMC8231384 DOI: 10.1080/26410397.2021.1932702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Antiretroviral therapy effectively prevents sexual and vertical transmission of HIV. Yet, some women living with HIV report having unmet needs for reproductive health care. This study measured the prevalence of women discussing reproductive goals with any current healthcare provider and assessed the effect of the current HIV care provider's gender on such discussions and whether comfort was a mediator. We analysed baseline and 18-month survey data from 533 women living with HIV enrolled in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) (2013-2017), a community-based participatory study, restricting the analysis to participants aged 16-45 years. We used causal mediation analysis to estimate direct and indirect effects of the gender of one's HIV care provider on reproductive discussions, incorporating mediating and interaction effects of women having any provider with whom they felt comfortable discussing reproductive goals. Between the baseline and 18-month follow-up surveys, 34.3% (183/533) of women discussed their reproductive goals with a healthcare provider. Having a woman HIV care provider was associated with a 1.18 excess relative risk (ERR) of discussion (95%CI: 0.15, 2.20). The mediating effect of comfort was primarily explained by the fact that those participants with women providers felt more comfortable discussing their reproductive goals compared to participants with men providers, accounting for 66% (95%CI: 32%, 99%) of the total effect. Findings support that HIV provider gender affects women's comfort and whether they discuss reproductive goals, which must be acknowledged and addressed in care delivery.
Collapse
Affiliation(s)
- Lashanda Skerritt
- PhD Candidate, Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Alexandra de Pokomandy
- Associate Professor, Department of Family Medicine, McGill University, Montreal QC, Canada; Clinician-Scientist, Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Nadia O'Brien
- PhD Candidate, Department of Family Medicine, McGill University, Montreal, QC, Canada; Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Nadia Sourial
- Assistant Research Professor, Department of Family and Emergency Medicine, University of Montreal, Montreal, QC, Canada
| | - Ann N Burchell
- Associate Professor, Department of Family and Community Medicine and Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Gillian Bartlett
- Professor, Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Tibor Schuster
- Assistant Professor, Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Danielle Rouleau
- Associate Professor, Department of Microbiology, Infection and Immunology, University of Montreal, Montreal, QC, Canada
| | - Karène Proulx-Boucher
- Research Coordinator, Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Neora Pick
- Medical Director, Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada; Clinical Professor, Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Deborah Money
- Professor, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Clinician-Scientist, Women's Health Research Institute, Vancouver, BC, Canada
| | - Rebecca Gormley
- Research Coordinator, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Allison Carter
- Research Fellow, Faculty of Medicine, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mark H Yudin
- Associate Professor, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | - Mona Loutfy
- Professor, Faculty of Medicine, University of Toronto, Toronto, Canada; Clinician-Scientist, Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Angela Kaida
- Associate Professor and Canada Research Chair in Global Perspectives in HIV and Sexual and Reproductive Health, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada. Correspondence:
| | | |
Collapse
|
18
|
Evaluation of infants with HIV-infected mothers and perinatal transmission in Turkey: A single-center experience. North Clin Istanb 2021; 8:243-248. [PMID: 34222804 PMCID: PMC8240230 DOI: 10.14744/nci.2021.59013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/09/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: The most common route of HIV infection in children is through perinatal transmission. In this study, we aimed to evaluate the characteristics of infants with HIV-infected mothers and perinatal HIV transmission. METHODS: We conducted a retrospective, single-center study of HIV-exposed infants in between December 2017 and October 2019 in a Marmara University Pendik Training and Research Hospital. RESULTS: A total of 18 infants were examined. All babies were born by cesarean section, and none of them were breastfed. Seventeen mothers were diagnosed with HIV before pregnancy. These mothers had received antiretroviral therapy (ART) during pregnancy, and their viral loads before delivery were negative. An antiretroviral prophylaxis with oral zidovudine was started in all infants within their 1st day of birth and continued for at least 6 weeks. All infants were tested for their HIV viral load within the first 48 h of birth, with negative results, and 12 infants were tested for anti-HIV antibodies at the 18th month, again with negative results. In this study, we determined that none of the infants had been infected with HIV. CONCLUSION: Our findings highlight the importance of initiating ART for all HIV-infected pregnant women and the importance of protection modalities during pregnancy, delivery, and the postnatal period for the prevention of perinatal transmission of HIV.
Collapse
|
19
|
Mubiana-Mbewe M, Bosomprah S, Kadota JL, Koyuncu A, Kusanathan T, Mweebo K, Musokotwane K, Mulenga PL, Chi BH, Vinikoor MJ. Effect of Enhanced Adherence Package on Early ART Uptake Among HIV-Positive Pregnant Women in Zambia: An Individual Randomized Controlled Trial. AIDS Behav 2021; 25:992-1000. [PMID: 33033996 PMCID: PMC10580733 DOI: 10.1007/s10461-020-03060-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2020] [Indexed: 10/23/2022]
Abstract
We evaluated the effect of an option B-plus Enhanced Adherence Package (BEAP), on early ART uptake in a randomized controlled trial. HIV-positive, ART naïve pregnant women in Lusaka, Zambia, were randomized to receive BEAP (phone calls/home visits, additional counseling, male partner engagement and missed-visit follow-up) versus standard of care (SOC). The primary outcome was initiating and remaining on ART at 30 days. Analysis was by intention to treat (ITT) using logistic regression. Additional per protocol analysis was done. We enrolled 454 women; 229 randomized to BEAP and 225 to SOC. Within 30 days of eligibility, 445 (98.2%) initiated ART. In ITT analysis, 82.5% BEAP versus 80.4% SOC participants reached primary outcome (crude relative risk [RR] 1.03; 95% confidence interval [CI] 0.91-1.16; Wald test statistic = 0.44; p-value = 0.66). In per protocol analysis, (92 participants (40.2%) excluded), 91.9% BEAP versus 80.4% SOC participants reached primary outcome (crude RR 1.14; 95% CI 1.02-1.29; Wald test statistic = 2.23; p-value = 0.03). Early ART initiation in pregnancy was nearly universal but there was early drop out suggesting need for additional adherence support.This trial was registered at ClinicalTrials.gov (trials number NCT02459678) on May 14, 2015.
Collapse
Affiliation(s)
- Mwangelwa Mubiana-Mbewe
- Centre for Infectious Disease Research in Zambia, Plot 34620 Off Alick Nkhata Road, P.O. Box 34681, Lusaka, Zambia.
| | - Samuel Bosomprah
- Centre for Infectious Disease Research in Zambia, Plot 34620 Off Alick Nkhata Road, P.O. Box 34681, Lusaka, Zambia
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Jillian L Kadota
- Centre for Infectious Disease Research in Zambia, Plot 34620 Off Alick Nkhata Road, P.O. Box 34681, Lusaka, Zambia
- Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, USA
| | - Aybüke Koyuncu
- Centre for Infectious Disease Research in Zambia, Plot 34620 Off Alick Nkhata Road, P.O. Box 34681, Lusaka, Zambia
| | | | - Keith Mweebo
- Prevention, Care and Treatment Branch, U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Kebby Musokotwane
- Prevention, Care and Treatment Branch, U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | | | - Benjamin H Chi
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Michael J Vinikoor
- Centre for Infectious Disease Research in Zambia, Plot 34620 Off Alick Nkhata Road, P.O. Box 34681, Lusaka, Zambia
- Department of Medicine, University of Alabama at Birmingham, Birmingham, USA
| |
Collapse
|
20
|
Management of Viral Complications of Pregnancy: Pharmacotherapy to Reduce Vertical Transmission. Obstet Gynecol Clin North Am 2021; 48:53-74. [PMID: 33573790 DOI: 10.1016/j.ogc.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Viral infections are common complications of pregnancy. Although some infections have maternal sequelae, many viral infections can be perinatally transmitted to cause congenital or chronic infection in fetuses or infants. Treatments of such infections are geared toward reducing maternal symptoms and complications and toward preventing maternal-to-child transmission of viruses. The authors review updates in the treatment of herpes simplex virus, cytomegalovirus, hepatitis B and C viruses, human immunodeficiency virus, and COVID-19 during pregnancy.
Collapse
|
21
|
Blanche S. Mini review: Prevention of mother-child transmission of HIV: 25 years of continuous progress toward the eradication of pediatric AIDS? Virulence 2021; 11:14-22. [PMID: 31885324 PMCID: PMC6961731 DOI: 10.1080/21505594.2019.1697136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Prevention of mother-to-child transmission with antiretrovirals is extraordinarily effective. When medically well followed, a mother living with human immunodeficiency virus can now expect to avoid transmitting the virus to her child. Despite the immense difficulties inherent in the global implementation of this treatment, the virtual disappearance of pediatric AIDS can be considered in the long term.
Collapse
Affiliation(s)
- Stéphane Blanche
- Pediatric Immunology-Hematology Unit, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP) and Faculté de Médecine Paris Descartes, Paris, France
| |
Collapse
|
22
|
Benamor Teixeira MDL, Fuller TL, Fragoso Da Silveira Gouvêa MI, Santos Cruz ML, Ceci L, Pinheiro Lattanzi F, Sidi LC, Mendes-Silva W, Nielsen-Saines K, Joao EC. Efficacy of Three Antiretroviral Regimens Initiated during Pregnancy: Clinical Experience in Rio de Janeiro. Antimicrob Agents Chemother 2020; 64:AAC.01068-20. [PMID: 33020151 PMCID: PMC7674033 DOI: 10.1128/aac.01068-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/24/2020] [Indexed: 11/20/2022] Open
Abstract
Few studies have compared the clinical efficacy and adverse events of combined antiretroviral therapy (cART) regimens in pregnant women seeking obstetrical care. The objective of this study was to compare the efficacy (virus load response), adverse events, and obstetrical and neonatal outcomes of three different regimens of cART in HIV-infected pregnant women initiating treatment in Rio de Janeiro, Brazil. This was a retrospective cohort study of cART-naive pregnant women who initiated either ritonavir-boosted protease inhibitors (atazanavir or lopinavir), efavirenz, or raltegravir plus a backbone regimen. From 2014 to 2018, 390 pregnant women were followed over time. At baseline, the median viral load (VL) for HIV was 4.1 log copies/ml. Among participants who received cART for 2 to 7 weeks, the VL decline was greater for raltegravir (2.24 log copies/ml) than for efavirenz or protease inhibitors (P < 0.001). Virologic suppression was achieved in 87% of women on raltegravir near delivery versus 73% on efavirenz and 70% on protease inhibitors (P = 0.011). Patients on raltegravir achieved virologic suppression faster than those on other regimens (P = 0.019). Overall, the HIV perinatal infection rate was 1.5%. This clinical study compared three potent and well-tolerated cART regimens and demonstrated that a higher proportion of participants on raltegravir achieved an undetectable HIV VL near delivery (P = 0.011) compared to the other arms. These findings suggest that raltegravir-containing regimens are optimal regimens for women with HIV initiating treatment late in pregnancy.
Collapse
Affiliation(s)
- Maria de Lourdes Benamor Teixeira
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Trevon L Fuller
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | - Maria Isabel Fragoso Da Silveira Gouvêa
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Loredana Ceci
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | | | - Leon Claude Sidi
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | - Wallace Mendes-Silva
- Maternity-Fetal Department and Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | - Karin Nielsen-Saines
- Department of Pediatric Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Esau Custodio Joao
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| |
Collapse
|
23
|
Louchet M, Peytavin G, Didelot H, Lê M, Bourgeois-Moine A, Carbillon L, Luton D, Matheron I, Rigonnot L, Mandelbrot L. Frequency of differential placental transfer to twins of maternal antiretroviral medications. Eur J Obstet Gynecol Reprod Biol 2020; 256:405-411. [PMID: 33285497 DOI: 10.1016/j.ejogrb.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/01/2020] [Accepted: 11/05/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Placental passage of drugs in twins is poorly understood, and is unknown regarding antiretrovirals (ARVs). In the event of large differences in the exposure of 2 twins to the same maternal therapy, this could have a clinical impact in terms of prevention of perinatal HIV transmission or adverse effects. OBJECTIVE To describe the frequency of differential transplacental passage of antiretrovirals between twins. STUDY DESIGN The study was performed retrospectively, on data from women included in a multicenter perinatal HIV cohort study. All twin pairs for which the mother received antiretroviral therapy and for which drug concentrations in both of the umbilical cords after cord clamping at delivery were studied. We considered that a difference in concentrations of more than 50 % between twins was a substantial difference (ratios below 0.67 or above 1.50). RESULTS We analyzed 29 twin pairs, 27 dichorionic and 2 monochorionic diamniotic. Cord blood concentrations differed between the 2 twins by more than 50 % for at least one ARV in 9 twin pairs, 8 dichorionic and 1 monochorionic. Discordant concentrations were observed in one or more cases for several nucleoside reverse transcriptase inhibitors (tenofovir, emtricitabine, lamivudine, zidovudine) and protease inhibitors (atazanavir, lopinavir, saquinavir et ritonavir); within individual twin pairs placental transfer was discordant for one or more ARVs, but identical for others. CONCLUSION Concentrations differed in nearly one third of twin pairs. This may be due to interindividual genetic variability of placental transporters between dizygotic twins as well as physiological differences between twins.
Collapse
Affiliation(s)
- Margaux Louchet
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service de Gynécologie-Obstétrique, Colombes, France; Université de Paris, Paris, France; FHU PREMA, Paris, France
| | - Gilles Peytavin
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Service de Pharmacologie-Toxicologie, HUPNVS, Paris, France; Inserm IAME U1137, F-75018, Paris, France
| | - Hélène Didelot
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service de Gynécologie-Obstétrique, Colombes, France; Université de Paris, Paris, France
| | - Minh Lê
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Service de Pharmacologie-Toxicologie, HUPNVS, Paris, France
| | - Agnès Bourgeois-Moine
- FHU PREMA, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Service de Gynécologie-Obstétrique, HUPNVS, Paris, France
| | - Lionel Carbillon
- Assistance Publique-Hôpitaux de Paris, Hôpital Jean Verdier, Service de Gynécologie-Obstétrique, Bondy, France
| | - Dominique Luton
- Université de Paris, Paris, France; FHU PREMA, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Service de Gynécologie-Obstétrique, HUPNVS, Paris, France
| | - Isabelle Matheron
- Centre Hospitalier Intercommunal Villeneuve-St-George, Service de Gynécologie-Obstétrique, Villeneuve St George, France
| | - Luc Rigonnot
- Centre Hospitalier Sud Francilien, Service de Gynécologie-Obstétrique, Corbeil-Essonnes, France
| | - Laurent Mandelbrot
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service de Gynécologie-Obstétrique, Colombes, France; Université de Paris, Paris, France; FHU PREMA, Paris, France; Inserm IAME U1137, F-75018, Paris, France.
| |
Collapse
|
24
|
Raltegravir versus efavirenz in antiretroviral-naive pregnant women living with HIV (NICHD P1081): an open-label, randomised, controlled, phase 4 trial. Lancet HIV 2020; 7:e322-e331. [PMID: 32386720 DOI: 10.1016/s2352-3018(20)30038-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/26/2020] [Accepted: 01/31/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although antiretroviral regimens containing integrase inhibitors rapidly suppress HIV viral load in non-pregnant adults, few published data from randomised controlled trials have compared the safety and efficacy of any integrase inhibitor to efavirenz when initiated during pregnancy. We compared safety and efficacy of antiretroviral therapy with either raltegravir or efavirenz in late pregnancy. METHODS An open-label, randomised controlled trial was done at 19 hospitals and clinics in Argentina, Brazil, South Africa, Tanzania, Thailand, and the USA. Antiretroviral-naive pregnant women (20-<37 weeks gestation) living with HIV were assigned to antiretroviral regimens containing either raltegravir (400 mg twice daily) or efavirenz (600 mg each night) plus lamivudine 150 mg and zidovudine 300 mg twice daily (or approved alternative backbone regimen), using a web-based, permuted-block randomisation stratified by gestational age and backbone regimen. The primary efficacy outcome was plasma HIV viral load below 200 copies per mL at (or near) delivery. The primary efficacy analysis included all women with a viral load measurement at (or near) delivery who had viral load of at least 200 copies per mL before treatment and no genotypic resistance to any study drugs; secondary analyses eliminated these exclusion criteria. The primary safety analyses included all women who received study drug, and their infants. This trial is registered with Clinicaltrials.gov, number NCT01618305. FINDINGS From Sep 5, 2013, to Dec 11, 2018, 408 women were enrolled (206 raltegravir, 202 efavirenz) and 394 delivered on-study (200 raltegravir, 194 efavirenz); 307 were included in the primary efficacy analysis (153 raltegravir, 154 efavirenz). 144 (94%) women in the raltegravir group and 129 (84%) in the efavirenz group met the primary efficacy outcome (absolute difference 10%, 95% CI 3-18; p=0·0015); the difference primarily occurred among women enrolling later in pregnancy (interaction p=0·040). Frequencies of severe or life-threatening adverse events were similar among mothers (30% in each group; 61 raltegravir, 59 efavirenz) and infants (25% in each group; 50 raltegravir, 48 efavirenz), with no treatment-related deaths. INTERPRETATION Our findings support major guidelines. The integrase inhibitor dolutegravir is currently a preferred regimen for the prevention of perinatal HIV transmission with raltegravir recommended as a preferred or alternative integrase inhibitor for pregnant women living with HIV. FUNDING Eunice Kennedy Shriver National Institute of Child Health and Human Development and National Institute of Allergy and Infectious Diseases.
Collapse
|
25
|
Hakim AJ, Callahan T, Benech I, Patel M, Adler M, Modi S, Bateganya M, Parris KA, Bingham T. Addressing Vulnerable Population Needs in the Last Mile to the elimination of mother to child transmission of HIV: (Re)Claiming the HIV Response for Female Sex Workers and Their Children. BMC Public Health 2020; 20:1015. [PMID: 32590975 PMCID: PMC7320569 DOI: 10.1186/s12889-020-09114-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/15/2020] [Indexed: 11/10/2022] Open
Abstract
As countries strive to eliminate mother-to-child transmission of HIV, female sex workers (FSW) and their children still face barriers to accessing these essential services. Data on FSW uptake of HIV and reproductive health services before, during, and after pregnancy reveal inadequate service utilization. Stigma encountered by FSW in healthcare settings may contribute to low uptake of HIV testing, antiretroviral therapy (ART), and other prevention of mother-to-child HIV transmission (PMTCT) services. Coordination between community-based FSW and facility-based PMTCT programs can facilitate successful linkage of pregnant FSW to antenatal services to support PMTCT efforts. We offer a way forward to reach 90-90-90 targets for FSW and their families and eliminate mother-to-child transmission of HIV.
Collapse
Affiliation(s)
- Avi J Hakim
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA.
| | - Tegan Callahan
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Irene Benech
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Monita Patel
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Michelle Adler
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Surbhi Modi
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Moses Bateganya
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Kae Anne Parris
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Trista Bingham
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| |
Collapse
|
26
|
Sandbulte M, Brown M, Wexler C, Maloba M, Gautney B, Goggin K, Muchoki E, Babu S, Maosa N, Finocchario-Kessler S. Maternal viral load monitoring: Coverage and clinical action at 4 Kenyan hospitals. PLoS One 2020; 15:e0232358. [PMID: 32469876 PMCID: PMC7259657 DOI: 10.1371/journal.pone.0232358] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/13/2020] [Indexed: 12/13/2022] Open
Abstract
Background Kenya’s guidelines for prevention of mother-to-child transmission of HIV (PMTCT) recommend routine viral load (VL) monitoring for pregnant and breastfeeding women. Method We assessed PMTCT VL monitoring and clinical action occurring between last menstrual period (LMP) and 6 months postpartum at 4 Kenyan government hospitals. Pregnant women enrolled in the HIV Infant Tracking System from May 2016-March 2018 were included. We computed proportions who received VL testing within recommended timeframes and who received clinical action after unsuppressed VL result. Results Of 424 participants, any VL testing was documented for 305 (72%) women and repeat VL testing was documented for 79 (19%). Only 115 women (27%) received a guideline-adherent baseline VL test and 27 (6%) received a guideline-adherent baseline and repeat VL test sequence. Return of baseline and repeat VL test results to the facility was high (average 96%), but patient notification of VL results was low (36% baseline and 49% repeat). Clinical action for unsuppressed VL results was even lower: 11 of 38 (29%) unsuppressed baseline results and 2 of 14 (14%) unsuppressed repeat results triggered clinical action. Discussion Guideline-adherent VL testing and clinical intervention during PMTCT must be prioritized to improve maternal care and reduce the risk of HIV transmission to infants.
Collapse
Affiliation(s)
- Matthew Sandbulte
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Melinda Brown
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Catherine Wexler
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - May Maloba
- Global Health Innovations, Nairobi, Kenya
| | - Brad Gautney
- Global Health Innovations, Dallas, TX, United States of America
| | - Kathy Goggin
- Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, United States of America.,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, United States of America
| | | | | | | | - Sarah Finocchario-Kessler
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America
| |
Collapse
|
27
|
A Meta-analysis Assessing Diarrhea and Pneumonia in HIV-Exposed Uninfected Compared With HIV-Unexposed Uninfected Infants and Children. J Acquir Immune Defic Syndr 2020; 82:1-8. [PMID: 31408450 DOI: 10.1097/qai.0000000000002097] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Previous studies have demonstrated that HIV-exposed uninfected (HEU) infants and children experience morbidity and mortality at rates exceeding those of their HIV-unexposed uninfected (HUU) counterparts. We sought to summarize the association between HEU vs. HUU infants and children for the outcomes of diarrhea and pneumonia. DESIGN Meta-analysis. METHODS We reviewed studies comparing infants and children in the 2 groups for these infectious disease outcomes, in any setting, from 1993 to 2018 from 6 databases. RESULTS We included 12 studies, and 17,955 subjects total [n = 5074 (28.3%) HEU and n = 12,881 (71.7%) HUU]. Random-effects models showed HEU infants and children had a 20% increase in the relative risk of acute diarrhea and a 30% increase in the relative risk of pneumonia when compared with their HUU counterparts. When stratifying by time since birth, we showed that HEU vs. HUU children had a 50% and 70% increased risk of diarrhea and pneumonia, respectively, in the first 6 months of life. CONCLUSIONS We show an increased risk of diarrhea and pneumonia for HEU vs. HUU infants and children. Although we acknowledge, and commend, the immense public health success of prevention of mother-to-child transmission, we now have an enlarging population of children that seem to be vulnerable to not only death, but increased morbidity. We need to turn our attention to understanding the underlying mechanism and designing effective public health solutions. Further longitudinal research is needed to elucidate possible underlying immunological and/or sociological mechanisms that explain these differences in morbidity.
Collapse
|
28
|
Woldesenbet S, Kufa T, Cheyip M, Ayalew K, Lombard C, Manda S, Nadol P, Barron P, Chirombo B, Igumbor E, Pillay Y, Puren A. Awareness of HIV-positive status and linkage to treatment prior to pregnancy in the "test and treat" era: A national antenatal sentinel survey, 2017, South Africa. PLoS One 2020; 15:e0229874. [PMID: 32168356 PMCID: PMC7069609 DOI: 10.1371/journal.pone.0229874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/15/2020] [Indexed: 02/07/2023] Open
Abstract
Introduction Knowledge of HIV status in South Africa (SA) is reported to be 90% among people living with HIV. National level estimates could mask population-specific levels, which are critical to monitor program coverage and potential impact. Using data from the 2017 national antenatal sentinel survey, we assessed knowledge of HIV-positive status, initiation of antiretroviral therapy (ART), and socio-demographic characteristics associated with knowledge of HIV-positive status prior to the current pregnancy among women attending antenatal care. Methods Between 1 October and 15 November 2017, a nationally representative sample of 32,716 pregnant women were enrolled from 1,595 public health facilities selected from all districts of SA. Data on age, gravidity, knowledge of HIV-positive status and ART initiation prior to pregnancy were extracted from medical records. A blood sample was collected from each woman regardless of prior knowledge of HIV status or ART history, and tested for HIV in the laboratory. All HIV-positive pregnant women enrolled in the survey were eligible for inclusion in the analysis. Multivariable survey logistic regression was used to examine factors associated with knowledge of HIV-positive status prior to the current pregnancy. Results Of 10,065 eligible HIV-positive women, 60.8% (95% confidence interval (CI):59.9%–61.7%) knew their HIV status prior to the current pregnancy, of whom 91.1% (95% CI: 90.4%–91.7%) initiated ART prior to the current pregnancy. Knowledge of HIV-positive status was lower among adolescent girls and young women (15–24 years) (38.9%) and primigravid women (40.5%) compared with older women (35–49 years) (75.5%) and multigravid women (64.7%). In a multivariable analysis, significant effect modification was found between gravidity and age (P value = 0.047). Being in the age group 15–24 years compared to the age group 35–49 years decreased the odds of knowing HIV-positive status by 80% (adjusted odds ratio (AOR): 0.2, 95% CI:0.1–0.4) among primigravid women and by 60%(AOR: 0.4, 95% CI:0.3–0.4) among multigravid women. Conclusion Knowledge of HIV-positive status prior to the current pregnancy fell short of the target of 90% among pregnant women living with HIV. This was especially low among adolescent girls and young women, highlighting the gap in youth friendly reproductive health and HIV testing services.
Collapse
Affiliation(s)
- Selamawit Woldesenbet
- Center for HIV and STI, National Institute for Communicable Diseases, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Tendesayi Kufa
- Center for HIV and STI, National Institute for Communicable Diseases, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Mireille Cheyip
- Strategic Information Unit, Center for Disease Control and Prevention, Pretoria, South Africa
| | - Kassahun Ayalew
- Strategic Information Unit, Center for Disease Control and Prevention, Pretoria, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Samuel Manda
- Biostatistics Unit, South African Medical Research Council, Pretoria, South Africa
| | - Patrick Nadol
- Strategic Information Unit, Center for Disease Control and Prevention, Pretoria, South Africa
| | - Peter Barron
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Brian Chirombo
- HIV and Hepatitis Program, World Health Organization, Pretoria, South Africa
| | - Ehi Igumbor
- Strategic Information Unit, Center for Disease Control and Prevention, Pretoria, South Africa
- School of Public Health, University of the Western Cape, Bellville, Cape Town, South Africa
| | - Yogan Pillay
- HIV & AIDS, TB and Maternal, Child and Women’s Health (MCWH), National Department of Health, Pretoria, South Africa
| | - Adrian Puren
- Center for HIV and STI, National Institute for Communicable Diseases, Johannesburg, South Africa
- Virology Department, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
29
|
Brittain K, Mellins CA, Remien RH, Phillips TK, Zerbe A, Abrams EJ, Myer L. Impact of HIV-Status Disclosure on HIV Viral Load in Pregnant and Postpartum Women on Antiretroviral Therapy. J Acquir Immune Defic Syndr 2020; 81:379-386. [PMID: 30939530 DOI: 10.1097/qai.0000000000002036] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND HIV-status disclosure is widely encouraged by counseling services, in part because it is thought to improve antiretroviral therapy (ART) adherence and thus HIV viral suppression. However, few longitudinal studies have examined the impact of disclosure on HIV viral load (VL) during pregnancy and postpartum. METHODS We explored these associations among 1187 women living with HIV, enrolled between March 2013 and June 2014 in Cape Town, South Africa. RESULTS Among women who tested HIV-positive before pregnancy, we observed no association between disclosure and VL at entry into antenatal care among those already on ART, nor at delivery and 12 months postpartum among those initiating ART. Among women who tested HIV-positive during pregnancy and initiated ART subsequently, disclosure to a male partner was associated with a reduced risk of VL ≥50 copies/mL at delivery (adjusted risk ratio: 0.56; 95% confidence interval: 0.31 to 1.01). After stratification by relationship status, this association was only observed among women who were married and/or cohabiting. In addition, disclosure to ≥1 family/community member was associated with a reduced risk of VL ≥50 copies/mL at 12 months postpartum (adjusted risk ratio: 0.69; 95% confidence interval: 0.48 to 0.97) among newly-diagnosed women. CONCLUSIONS These findings suggest that the impact of disclosure on VL is modified by 3 factors: (1) timing of HIV diagnosis (before vs. during the pregnancy); (2) relationship to the person(s) to whom women disclose; and (3) in the case of disclosure to a male partner, relationship status. Counseling about disclosure may be most effective if tailored to individual women's circumstances.
Collapse
Affiliation(s)
- Kirsty Brittain
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY
| | - Robert H Remien
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY
| | - Tamsin K Phillips
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Allison Zerbe
- Mailman School of Public Health, ICAP at Columbia University, New York, NY
| | - Elaine J Abrams
- Mailman School of Public Health, ICAP at Columbia University, New York, NY.,Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
30
|
Plitt SS, Smith TR, Berry W, Osman M, Senthilselvan A, Charlton CL. Examination of a Canadian provincial prenatal HIV screening program: 2010 to 2014. Canadian Journal of Public Health 2020; 111:555-561. [PMID: 32016920 DOI: 10.17269/s41997-019-00281-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 12/03/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Universal prenatal screening in the Canadian province of Alberta employs an 'opt-out' HIV screening strategy. We examined all women giving birth in the province and determined the frequency and characteristics of women having and not having HIV screening. METHODS All livebirths in Alberta from January 1, 2010 to December 31, 2014 were compiled from the Vital Statistics database and linked to HIV screening data to determine maternal demographic and prenatal care characteristics. Correlates associated with prenatal HIV screening, opting out of HIV screening, and not having any prenatal communicable disease screening were determined by multivariable statistics. RESULTS Of the 256,280 live births, 94.2% had prenatal HIV screening, 1.9% declined prenatal HIV screening, and 3.9% had no record of any prenatal communicable disease testing. Compared with those who had HIV screening, those who opted out of prenatal HIV screening were more likely to be over 40 years of age (adjusted odds ratio (AOR), 2.83 [2.12-3.78]) and less likely to be single (AOR, 0.67 [0.62-0.73]) and First Nations (AOR, 0.67 [0.56-0.82]). Those who received no prenatal communicable disease screening were less likely to be over 40 years of age (AOR, 0.81 [0.69-0.95]) and more likely to be single (AOR, 1.27 [1.21-1.33]) and have received no prenatal care (AOR, 6.78 [6.40-7.19]). Both the HIV decliners and prenatal non-testers were more likely to have used a midwife (AOR, 4.52 [3.83-5.35] and AOR, 2.44 [2.03-2.92], respectively). CONCLUSION Demographic and prenatal care characteristics differ by a pregnant woman's prenatal screening status. Policies to improve HIV screening coverage should take these variations into account.
Collapse
Affiliation(s)
- Sabrina S Plitt
- Public Health Agency of Canada, Ottawa, ON, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Trenton R Smith
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Warren Berry
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | | | - Carmen L Charlton
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada. .,Public Health Laboratory, 2B3.07 WMC, University of Alberta Hospitals, 8440 - 112 Street, Edmonton, Alberta, T6G 2J2, Canada.
| |
Collapse
|
31
|
Floridia M, Dalzero S, Giacomet V, Tamburrini E, Masuelli G, Savasi V, Spinillo A, Tassis B, Franceschetti L, Degli Antoni AM, Sansone M, Guaraldi G, Vimercati A, Meloni A, Ravizza M. Pregnancy and neonatal outcomes in women with HIV-1 exposed to integrase inhibitors, protease inhibitors and non-nucleoside reverse transcriptase inhibitors: an observational study. Infection 2020; 48:249-258. [PMID: 31893354 DOI: 10.1007/s15010-019-01384-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/15/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Recommended regimens for pregnant women with HIV-1 are composed of two nucleoside reverse transcriptase inhibitors (NRTI) plus either a ritonavir-boosted protease inhibitor (PI) or an integrase strand transfer inhibitor (ISTI), with non-nucleoside reverse transcriptase inhibitors (NNRTI) representing an alternative drug class. The study's purpose was to compare these three options in terms of pregnancy outcomes. METHODS Data from a national observational study of pregnant women with HIV-1 were used. The analysis included all pregnancies reported between 2008 and 2018, ending in live births and exposed within 32 weeks of gestation to three-drug regimens composed of a NRTI backbone plus a PI, a NNRTI or a ISTI, without class switching during pregnancy. Clinical and laboratory outcomes were evaluated in univariate and multivariable analyses. RESULTS Overall, 794 exposed pregnancies were analyzed (PI 78.4%, NNRTI 15.4%, ISTI 6.2%). Almost all outcomes had similar rates in the three groups. Women who received PI in pregnancy were less likely to be virologically suppressed at third trimester. PI use was associated with higher bilirubin and triglyceride levels, and ISTI use with a lower rate of low birthweight. The differences in viral suppression at third trimester and in low birthweight were not maintained in multivariable analyses that were adjusted for confounders. DISCUSSION We found no major differences in a wide range of outcomes relevant for pregnant women with HIV. Such results are reassuring, and this information may be helpful in a context of preconception counseling when therapeutic choices for pregnancy are discussed between women and care providers.
Collapse
Affiliation(s)
- Marco Floridia
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
| | - Serena Dalzero
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - Vania Giacomet
- Department of Pediatrics, Luigi Sacco Hospital and University of Milan, Milan, Italy
| | - Enrica Tamburrini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
| | - Giulia Masuelli
- Department of Obstetrics and Neonatology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Valeria Savasi
- Department of Obstetrics and Gynaecology, Luigi Sacco Hospital and University of Milan, Milan, Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynaecology, IRCCS S. Matteo, Pavia, Italy
| | - Beatrice Tassis
- Obstetrics and Gynecology Unit, Fondazione IRCCS Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Laura Franceschetti
- Department of Obstetrics and Gynecology, ASST Spedali Civili, Brescia, Italy
| | - Anna Maria Degli Antoni
- Department of Infectious Diseases and Hepatology, Azienda Ospedaliera di Parma, Parma, Italy
| | - Matilde Sansone
- Department of Neurosciences, Reproductive and Dentistry Science, University Federico II, Naples, Italy
| | - Giovanni Guaraldi
- Department of Medical Specialties, Infectious Diseases Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonella Vimercati
- Department of Biomedical and Human Oncological Science (DIMO), 2nd Unit of Obstetrics and Gynaecology, University of Bari, Bari, Italy
| | - Alessandra Meloni
- Department of Surgical Sciences, Division of Gynaecology and Obstetrics, University of Cagliari, Cagliari, Italy
| | - Marina Ravizza
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | | |
Collapse
|
32
|
Dugdale CM, Phillips TK, Myer L, Hyle EP, Brittain K, Freedberg KA, Cunnama L, Walensky RP, Zerbe A, Weinstein MC, Abrams EJ, Ciaranello AL. Cost-effectiveness of integrating postpartum antiretroviral therapy and infant care into maternal & child health services in South Africa. PLoS One 2019; 14:e0225104. [PMID: 31730630 PMCID: PMC6857940 DOI: 10.1371/journal.pone.0225104] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 10/29/2019] [Indexed: 11/29/2022] Open
Abstract
Background Poor engagement in postpartum maternal HIV care is a challenge worldwide and contributes to adverse maternal outcomes and vertical transmission. Our objective was to project the clinical and economic impact of integrated postpartum maternal antiretroviral therapy (ART) and pediatric care in South Africa. Methods Using the CEPAC computer simulation models, parameterized with data from the Maternal and Child Health–Antiretroviral Therapy (MCH-ART) randomized controlled trial, we evaluated the cost-effectiveness of integrated postpartum care for women initiating ART in pregnancy and their children. We compared two strategies: 1) standard of care (SOC) referral to local clinics after delivery for separate standard ART services for women and pediatric care for infants, and 2) the MCH-ART intervention (MCH-ART) of co-located maternal/pediatric care integrated in Maternal and Child Health (MCH) services throughout breastfeeding. Trial-derived inputs included: 12-month maternal retention in care and virologic suppression (SOC: 49%, MCH-ART: 67%), breastfeeding duration (SOC: 6 months, MCH-ART: 8 months), and postpartum healthcare costs for mother-infant pairs (SOC: $50, MCH-ART: $69). Outcomes included pediatric HIV infections, maternal and infant life expectancy (LE), lifetime HIV-related per-person costs, and incremental cost-effectiveness ratios (ICERs; ICER <US$903/YLS considered “cost-effective”). Results Compared to SOC, MCH-ART increased maternal LE (SOC: 25.26 years, MCH-ART: 26.20 years) and lifetime costs (SOC: $9,912, MCH-ART: $10,207; discounted). Projected pediatric outcomes for all HIV-exposed children were similar between arms, although undiscounted LE for HIV-infected children was shorter in SOC (SOC: 23.13 years, MCH-ART: 23.40 years). Combining discounted maternal and pediatric outcomes, the ICER was $599/YLS. Conclusion Co-located maternal HIV and pediatric care, integrated in MCH services throughout breastfeeding, is a cost-effective strategy to improve maternal and pediatric outcomes and should be implemented in South Africa.
Collapse
Affiliation(s)
- Caitlin M. Dugdale
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- * E-mail:
| | - Tamsin K. Phillips
- Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Emily P. Hyle
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Kirsty Brittain
- Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Kenneth A. Freedberg
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Lucy Cunnama
- Health Economics Unit, School of Public Health & Family Medicine, University of Cape Town, South Africa
| | - Rochelle P. Walensky
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Allison Zerbe
- ICAP at Columbia and the Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Milton C. Weinstein
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Elaine J. Abrams
- ICAP at Columbia and the Mailman School of Public Health, Columbia University, New York, NY, United States of America
- College of Physicians & Surgeons, Columbia University, New York, NY, United States of America
| | - Andrea L. Ciaranello
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | | |
Collapse
|
33
|
Uridine Prevents Negative Effects of OXPHOS Xenobiotics on Dopaminergic Neuronal Differentiation. Cells 2019; 8:cells8111407. [PMID: 31717322 PMCID: PMC6912777 DOI: 10.3390/cells8111407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 12/25/2022] Open
Abstract
Neuronal differentiation appears to be dependent on oxidative phosphorylation capacity. Several drugs inhibit oxidative phosphorylation and might be detrimental for neuronal differentiation. Some pregnant women take these medications during their first weeks of gestation when fetal nervous system is being developed. These treatments might have later negative consequences on the offspring's health. To analyze a potential negative effect of three widely used medications, we studied in vitro dopaminergic neuronal differentiation of cells exposed to pharmacologic concentrations of azidothymidine for acquired immune deficiency syndrome; linezolid for multidrug-resistant tuberculosis; and atovaquone for malaria. We also analyzed the dopaminergic neuronal differentiation in brains of fetuses from pregnant mice exposed to linezolid. The drugs reduced the in vitro oxidative phosphorylation capacity and dopaminergic neuronal differentiation. This differentiation process does not appear to be affected in the prenatally exposed fetus brain. Nevertheless, the global DNA methylation in fetal brain was significantly altered, perhaps linking an early exposure to a negative effect in older life. Uridine was able to prevent the negative effects on in vitro dopaminergic neuronal differentiation and on in vivo global DNA methylation. Uridine could be used as a protective agent against oxidative phosphorylation-inhibiting pharmaceuticals provided during pregnancy when dopaminergic neuronal differentiation is taking place.
Collapse
|
34
|
McFall SM, Maiga M, Glucksberg M, Achenbach CJ, Palamountain KL, Murphy RL. Supporting Diagnosis and Management of HIV/AIDS Patients Through Point-of-Care Technology Development. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2019; 11:9-15. [PMID: 32864521 DOI: 10.1016/j.cobme.2019.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The HIV pandemic disproportionately impacts sub-Saharan Africa where in 2017, 71% of people living with HIV resided, 65% of new infections and 75% of deaths were reported. Prevention, screening and treatment strategies have led to progress in addressing this disease. HIV diagnostics have been crucial for prevention and treatment but more progress is required to reduce HIV infection. The Center for Innovation in Point-of-Care Technologies for HIV/AIDS at Northwestern University (C-THAN) is a vital partner in the National Institute of Biomedical Imaging and Bioengineering Point-of-Care Technologies Research Network. C-THAN's mission is to develop and commercialize a pipeline of point-of-care technologies critical for improved prevention and management of HIV in low- and middle-income countries with specific emphasis on sub-Saharan Africa.
Collapse
Affiliation(s)
- Sally M McFall
- Center for Innovation in Point-of-Care Technologies for HIV/AIDS at Northwestern University, Evanston, IL 60208, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Mamoudou Maiga
- Center for Innovation in Point-of-Care Technologies for HIV/AIDS at Northwestern University, Evanston, IL 60208, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA.,University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - Matthew Glucksberg
- Center for Innovation in Point-of-Care Technologies for HIV/AIDS at Northwestern University, Evanston, IL 60208, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Chad J Achenbach
- Center for Innovation in Point-of-Care Technologies for HIV/AIDS at Northwestern University, Evanston, IL 60208, USA.,Department of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Kara L Palamountain
- Center for Innovation in Point-of-Care Technologies for HIV/AIDS at Northwestern University, Evanston, IL 60208, USA.,Kellogg School of Management, Northwestern University, Evanston, IL 60208, USA
| | - Robert L Murphy
- Center for Innovation in Point-of-Care Technologies for HIV/AIDS at Northwestern University, Evanston, IL 60208, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA.,Department of Medicine, Northwestern University, Chicago, IL 60611, USA
| |
Collapse
|
35
|
Haeri Mazanderani A, Sherman GG. Evolving complexities of infant HIV diagnosis within Prevention of Mother-to-Child Transmission programs. F1000Res 2019; 8. [PMID: 31543952 PMCID: PMC6745762 DOI: 10.12688/f1000research.19637.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2019] [Indexed: 11/20/2022] Open
Abstract
Early diagnosis of HIV infection among infants and children is critical as prompt initiation of antiretroviral therapy prevents morbidity and death. Yet despite advances in the accuracy and availability of infant HIV diagnostic testing, there are increasing challenges with making an early definitive diagnosis. These challenges relate primarily to advances in prevention of mother-to-child transmission (PMTCT) of HIV. Although PMTCT programs have proven to be highly effective in reducing infant HIV infection, infants who are HIV-infected may achieve virological suppression and loss of detectability of HIV nucleic acid prior to diagnosis because of antiretroviral drug exposure. Hence, false-negative and indeterminate HIV polymerase chain reaction (PCR) results can occur, especially among high-risk infants given multi-drug prophylactic regimens. However, the infant HIV diagnostic landscape is also complicated by the inevitable decline in the positive predictive value of early infant diagnosis (EID) assays. As PMTCT programs successfully reduce the mother-to-child transmission rate, the proportion of false-positive EID results will increase. Consequently, false-negative and false-positive HIV PCR results are increasingly likely despite highly accurate diagnostic assays. The problem is compounded by the seemingly intractable prevalence of maternal HIV within some settings, resulting in a considerable absolute burden of HIV-infected infants despite a low mother-to-child transmission rate.
Collapse
Affiliation(s)
- Ahmad Haeri Mazanderani
- Centre for HIV & STIs, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.,Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Gayle G Sherman
- Centre for HIV & STIs, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.,Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
36
|
Pregnancy Loss in Women with HIV is not Associated with HIV Markers: Data from a National Study in Italy, 2001-2018. Mediterr J Hematol Infect Dis 2019; 11:e2019050. [PMID: 31528316 PMCID: PMC6736172 DOI: 10.4084/mjhid.2019.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/08/2019] [Indexed: 11/08/2022] Open
Abstract
Background There is limited information on pregnancy loss in women with HIV, and it is still debated whether HIV-related markers may play a role.Objectives: To explore potential risk factors for pregnancy loss in women with HIV, with particular reference to modifiable risk factors and markers of HIV disease. Methods Multicenter observational study of HIV-positive pregnant women. The main outcome measure was pregnancy loss, including both miscarriage (<22 weeks) and stillbirth (≥22 weeks). Possible associations of pregnancy loss were evaluated in univariate and multivariate analyses. Results Among 2696 eligible pregnancies reported between 2001 and 2018, 226 (8.4%) ended in pregnancy loss (miscarriage 198, 7.3%; stillbirth 28, 1.0%). In multivariate analyses, only older age (adjusted odds ratio [AOR] per additional year of age: 1.079, 95% confidence interval [CI] 1.046-1.113), HIV diagnosis before pregnancy (AOR: 2.533, 95%CI 1.407-4.561) and history of pregnancy loss (AOR: 1.625, 95%CI 1.178-2.243) were significantly associated with pregnancy loss. No significant association with pregnancy loss was found for parity, coinfections, sexually transmitted diseases, hypertension, smoking, alcohol and substance use, CD4 cell count, HIV-RNA viral load, and CDC HIV stage. Conclusions Older women and those with a previous history of pregnancy loss should be considered at higher risk of pregnancy loss. The severity of HIV disease and potentially modifiable risk factors did not increase the risk of pregnancy loss.
Collapse
|
37
|
Mandelbrot L, Ceccaldi PF, Duro D, Lê M, Pencolé L, Peytavin G. Placental transfer and tissue accumulation of dolutegravir in the ex vivo human cotyledon perfusion model. PLoS One 2019; 14:e0220323. [PMID: 31408460 PMCID: PMC6692001 DOI: 10.1371/journal.pone.0220323] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 07/12/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To determine the transplacental pharmacokinetics of the HIV integrase inhibitor dolutegravir. STUDY DESIGN Maternal-to-fetal transfer across the term human placenta was investigated with the ex-vivo dually perfused cotyledon model, in 5 closed-circuit, recirculating experiments. Dolutegravir was added to a maternal perfusate containing antipyrine, a marker to validate the cotyledon's viability, and 2 g/liter of human albumin. RESULTS After 3h of recirculating perfusion, the mean (± SD) DTG concentrations in the maternal and in the fetal compartments were respectively 2450 ± 286 ng/mL and 715 ± 369 ng/mL, with a fetal-to-maternal ratio of 34% ± 18% and a clearance index (in comparison with antipyrine transfer) of 79% ± 23%. The mean cotyledon accumulation index was 153% ± 25%. CONCLUSION Fetal transplacental exposure to dolutegravir was considerable as well as accumulation in placental tissue. Whether this may lead to risks for the exposed fetus requires more investigation.
Collapse
Affiliation(s)
- Laurent Mandelbrot
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service de Gynécologie-Obstétrique, Hôpitaux Universitaires Paris-Nord Val de Seine, Colombes, France.,Université Paris-Diderot, Université Sorbonne Paris-Cité, Paris, France.,Département Hospitalier Universitaire Risques et Grossesse, Paris, France.,IAME, UMR 1137, INSERM, Paris, France
| | - Pierre-François Ceccaldi
- Université Paris-Diderot, Université Sorbonne Paris-Cité, Paris, France.,Département Hospitalier Universitaire Risques et Grossesse, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Service de Gynécologie-Obstétrique, Hôpitaux Universitaires Paris-Nord Val de Seine, Clichy, France
| | - Dominique Duro
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service de Gynécologie-Obstétrique, Hôpitaux Universitaires Paris-Nord Val de Seine, Colombes, France.,Agence Nationale de Recherches sur le Sida et Hépatites Virales (Inserm-ANRS), Paris, France
| | - Minh Lê
- IAME, UMR 1137, INSERM, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Pharmaco-Toxicology Department, Hôpitaux Universitaires Paris-Nord Val de Seine, Paris, France
| | - Lucile Pencolé
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service de Gynécologie-Obstétrique, Hôpitaux Universitaires Paris-Nord Val de Seine, Colombes, France.,Université Paris-Diderot, Université Sorbonne Paris-Cité, Paris, France.,IAME, UMR 1137, INSERM, Paris, France
| | - Gilles Peytavin
- IAME, UMR 1137, INSERM, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Pharmaco-Toxicology Department, Hôpitaux Universitaires Paris-Nord Val de Seine, Paris, France
| |
Collapse
|
38
|
Mazanderani AH, Murray TY, Sherman GG, Snyman T, George J, Avenant T, Goga AE, Pepper MS, du Plessis N. Non-nucleoside reverse transcriptase inhibitor levels among HIV-exposed uninfected infants at the time of HIV PCR testing - findings from a tertiary healthcare facility in Pretoria, South Africa. J Int AIDS Soc 2019; 22:e25284. [PMID: 31215757 PMCID: PMC6582367 DOI: 10.1002/jia2.25284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 03/29/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION To date, very little programmatic data has been published regarding serial antiretroviral (ARV) levels in infants exposed to maternal treatment and/or infant prophylaxis during the first months of life. Such data provide the opportunity to describe the proportion of infants exposed to virologically suppressive levels of ARVs and to gauge adherence to the prevention of mother-to-child transmission of HIV (PMTCT) programme. METHODS From August 2014 to January 2016, HIV-exposed infants born at Kalafong Provincial Tertiary Hospital in Pretoria, South Africa were enrolled as part of an observational cohort study. Plasma samples from HIV-exposed uninfected infants were obtained at birth, 6-weeks, 10-weeks and 14-weeks of age and quantitative efavirenz (EFV) and nevirapine (NVP) drug level testing performed using liquid chromatography-mass spectrometry, irrespective of maternal ARV regimen. Descriptive analysis of EFV and NVP levels in relation to self-reported maternal and infant ARV exposure was performed. EFV levels >500 ng/mL and NVP levels >100 ng/mL were reported based on studies suggesting that trough levels above these thresholds are associated with virological suppression and PMTCT respectively. RESULTS Among 66 infants exposed to maternal EFVin utero, 29 (44%) had virologically suppressive plasma EFV levels at birth, with a median level of 1665 ng/mL (IQR: 1094 to 3673). Among infants who were exclusively breastfed at 6-, 10- and 14 weeks, 13/48 (27%), 5/25 (25%) and 0/21 (0%) had virologically suppressive EFV levels. Among 64 infants whose mothers reported administering daily infant NVP at time of their 6-week HIV PCR test, only 45 (70%) had NVP levels above the minimum prophylactic trough level. CONCLUSIONS During the first 10-weeks after delivery, a quarter of breastfed infants born to women on an EFV-containing treatment regimen maintained virologically suppressive EFV plasma levels. This finding highlights the importance of both careful monitoring of ARV side effects and repeat HIV PCR after the first few months of life among HIV-exposed uninfected infants. As 30% of infants had inadequate NVP plasma levels at 6-weeks of age, adherence counselling to caregivers regarding infant prophylaxis needs to be enhanced to further reduce mother-to-child transmission of HIV.
Collapse
Affiliation(s)
- Ahmad Haeri Mazanderani
- Centre for HIV & STIsNational Institute for Communicable DiseasesNational Health Laboratory ServiceJohannesburgSouth Africa
- Department of Medical VirologyFaculty of Health SciencesUniversity of PretoriaPretoriaSouth Africa
| | - Tanya Y Murray
- Centre for HIV & STIsNational Institute for Communicable DiseasesNational Health Laboratory ServiceJohannesburgSouth Africa
- Paediatric HIV DiagnosticsWits Health ConsortiumJohannesburgSouth Africa
| | - Gayle G Sherman
- Centre for HIV & STIsNational Institute for Communicable DiseasesNational Health Laboratory ServiceJohannesburgSouth Africa
- Paediatric HIV DiagnosticsWits Health ConsortiumJohannesburgSouth Africa
- Department of Paediatrics & Child HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Tracy Snyman
- Department of Chemical PathologyNational Health Laboratory Service and University of WitwatersrandJohannesburgSouth Africa
| | - Jaya George
- Department of Chemical PathologyNational Health Laboratory Service and University of WitwatersrandJohannesburgSouth Africa
| | - Theunis Avenant
- Paediatric Infectious Diseases DivisionDepartment of PaediatricsKalafong Provincial Tertiary HospitalPretoriaSouth Africa
- Department of Paediatrics and Child HealthFaculty of Health SciencesUniversity of PretoriaPretoriaSouth Africa
| | - Ameena E Goga
- Department of Paediatrics and Child HealthFaculty of Health SciencesUniversity of PretoriaPretoriaSouth Africa
- Health Systems Research UnitSouth African Medical Research CouncilCape TownSouth Africa
| | - Michael S Pepper
- Institute for Cellular and Molecular MedicineDepartment of ImmunologySAMRC Extramural Unit for Stem Cell Research and TherapyFaculty of Health SciencesUniversity of PretoriaPretoriaSouth Africa
| | - Nicolette du Plessis
- Paediatric Infectious Diseases DivisionDepartment of PaediatricsKalafong Provincial Tertiary HospitalPretoriaSouth Africa
- Department of Paediatrics and Child HealthFaculty of Health SciencesUniversity of PretoriaPretoriaSouth Africa
| |
Collapse
|
39
|
Twahirwa Rwema JO, Baral S, Ketende S, Phaswana-Mafuya N, Lambert A, Kose Z, Mcingana M, Rao A, Hausler H, Schwartz S. Evaluating the vertical HIV transmission risks among South African female sex workers; have we forgotten PMTCT in their HIV programming? BMC Public Health 2019; 19:605. [PMID: 31138154 PMCID: PMC6538543 DOI: 10.1186/s12889-019-6811-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Female sex workers (FSW) have a greater HIV burden compared to other reproductive-aged women and experience high incidence of pregnancies. However, there are limited data on mother-to-child transmission of HIV in the context of sex work. This study assessed the uptake of prevention of mother-to-child transmission (PMTCT) services to understand the vertical HIV transmission risks among FSW in South Africa. Methods FSW ≥18 years were recruited into a cross-sectional study using respondent-driven sampling (RDS) between October 2014–April 2015 in Port Elizabeth, South Africa. An interviewer-administered questionnaire captured information on demographics, reproductive health histories, and HIV care, including engagement in PMTCT care and ART. HIV and pregnancy testing were biologically assessed. This analysis characterizes FSW engagement in HIV prevention and treatment cascades of the four prongs of PMTCT. Results Overall, 410 FSW were enrolled. The RDS-weighted HIV prevalence was 61.5% (95% bootstrapped confidence interval 54.1–68.0). A comprehensive assessment of the four PMTCT prongs showed gaps in cascades for each of the prongs. In Prongs 1 and 2, gaps of 42% in consistent condom use with clients among HIV-negative FSW and 43% in long-term high efficacy contraceptive method use among HIV-positive FSW were observed. The analyses for prongs three and four pertained to 192 women with children < 5 years; 101/192 knew their HIV diagnosis prior to the study, of whom 85% (86/101) had their children tested for HIV after birth, but only 36% (31/86) of those who breastfed retested their children post-breastfeeding. A substantial proportion (35%, 42/120) of all HIV-positive women with children < 5 years of age were HIV-negative at their last delivery and seroconverted after delivery. Less than half (45%) of mothers with children < 5 years (45/101) were on ART and 12% (12/101) reported at least one child under five living with HIV. Conclusion These findings show significant gaps in engagement in the PMTCT cascades for FSW, evidenced by sub-optimal uptake of HIV prevention and treatment in the peri/post-natal periods and insufficient prevention of unintended pregnancies among FSW living with HIV. These gaps result in elevated risks for vertical transmission among FSW and the need for PMTCT services within FSW programs. Electronic supplementary material The online version of this article (10.1186/s12889-019-6811-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jean Olivier Twahirwa Rwema
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.
| | - Stefan Baral
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Sosthenes Ketende
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Nancy Phaswana-Mafuya
- The Human Sciences Research Council, Port Elizabeth, South Africa.,Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | | | - Zamakayise Kose
- The Human Sciences Research Council, Port Elizabeth, South Africa
| | - Mfezi Mcingana
- The TB/HIV Care Association, Port Elizabeth, South Africa
| | - Amrita Rao
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Harry Hausler
- The TB/HIV Care Association, Cape Town, South Africa
| | - Sheree Schwartz
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
| |
Collapse
|
40
|
Srivastava M, Sullivan D, Phelps BR, Modi S, Broyles LN. Boosting ART uptake and retention among HIV-infected pregnant and breastfeeding women and their infants: the promise of innovative service delivery models. J Int AIDS Soc 2019; 21. [PMID: 29356376 PMCID: PMC5810330 DOI: 10.1002/jia2.25053] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 12/21/2017] [Indexed: 11/15/2022] Open
Abstract
Introduction With the rapid scale‐up of antiretroviral treatment (ART) in the “Treat All” era, there has been increasing emphasis on using differentiated models of HIV service delivery. The gaps within the clinical cascade for mothers and their infants suggest that current service delivery models are not meeting families' needs and prompt re‐consideration of how services are provided. This article will explore considerations for differentiated care and encourage the ongoing increase of ART coverage through innovative strategies while also addressing the unique needs of mothers and infants. Discussion Service delivery models should recognize that the timing of the mother's HIV diagnosis is a critical aspect of determining eligibility. Women newly diagnosed with HIV require a more intensive approach so that adequate counselling and monitoring of ART initiation and response can be provided. Women already on ART with evidence of virologic failure are also at high risk of transmitting HIV to their infants and require close follow‐up. However, women stable on ART with a suppressed viral load before conception have a very low likelihood of HIV transmission and thus are strong candidates for multi‐month ART dispensing, community‐based distribution of ART, adherence clubs, community adherence support groups and longer intervals between clinical visits. A number of other factors should be considered when defining eligibility of mothers and infants for differentiated care, including location of services, viral load monitoring and duration on ART. To provide differentiated care that is client‐centred and driven while encompassing a family‐based approach, it will be critical to engage mothers, families and communities in models that will optimize client satisfaction, retention in care and quality of services. Conclusions Differentiated care for mothers and infants represents an opportunity to provide client‐centred care that reduces the burden on clients and health systems while improving the quality and uptake of services for families. However, with decreasing funding, stable HIV incidence, and aspirations for sustainability, it is critical to consider efficient, customized and cost‐effective models of care for these populations as we aspire to eliminate mother‐to‐child transmission of HIV.
Collapse
Affiliation(s)
- Meena Srivastava
- Pediatric Maternal Clinical Branch, Office of HIV/AIDS, U.S. Agency for International Development, Arlington, VA, USA
| | - David Sullivan
- Pediatric Maternal Clinical Branch, Office of HIV/AIDS, U.S. Agency for International Development, Arlington, VA, USA
| | - B Ryan Phelps
- Pediatric Maternal Clinical Branch, Office of HIV/AIDS, U.S. Agency for International Development, Arlington, VA, USA
| | - Surbhi Modi
- Maternal and Child Health Branch, Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Laura N Broyles
- Maternal and Child Health Branch, Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
41
|
Dugdale CM, Ciaranello AL, Bekker LG, Stern ME, Myer L, Wood R, Sax PE, Abrams EJ, Freedberg KA, Walensky RP. Risks and Benefits of Dolutegravir- and Efavirenz-Based Strategies for South African Women With HIV of Child-Bearing Potential: A Modeling Study. Ann Intern Med 2019; 170:614-625. [PMID: 30934067 PMCID: PMC6736740 DOI: 10.7326/m18-3358] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Dolutegravir is superior to efavirenz for HIV antiretroviral therapy (ART) but may be associated with an increased risk for neural tube defects (NTDs) in newborns if used by women at conception. Objective To project clinical outcomes of ART policies for women of child-bearing potential in South Africa. Design Model of 3 strategies: efavirenz for all women of child-bearing potential (EFV), dolutegravir for all women of child-bearing potential (DTG), or World Health Organization (WHO)-recommended efavirenz without contraception or dolutegravir with contraception (WHO approach). Data Sources Published data on NTD risks (efavirenz, 0.05%; dolutegravir, 0.67% [Tsepamo study]), 48-week ART efficacy with initiation (efavirenz, 60% to 91%; dolutegravir, 96%), and age-stratified fertility rates (2 to 139 per 1000 women). Target Population 3.1 million South African women with HIV (aged 15 to 49 years) starting or continuing first-line ART, and their children. Time Horizon 5 years. Perspective Societal. Intervention EFV, DTG, and WHO approach. Outcome Measures Deaths among women and children, sexual and pediatric HIV transmissions, and NTDs. Results of Base-Case Analysis Compared with EFV, DTG averted 13 700 women's deaths (0.44% decrease) and 57 700 sexual HIV transmissions, but increased total pediatric deaths by 4400 because of more NTDs. The WHO approach offered some benefits compared with EFV, averting 4900 women's deaths and 20 500 sexual transmissions while adding 300 pediatric deaths. Overall, combined deaths among women and children were lowest with DTG (358 000 deaths) compared with the WHO approach (362 800 deaths) or EFV (367 300 deaths). Results of Sensitivity Analysis Women's deaths averted with DTG exceeded pediatric deaths added with EFV unless dolutegravir-associated NTD risk was 1.5% or greater. Limitation Uncertainty in NTD risks and dolutegravir efficacy in resource-limited settings, each examined in sensitivity analyses. Conclusion Although NTD risks may be higher with dolutegravir than efavirenz, dolutegravir will lead to many fewer deaths among women, as well as fewer overall HIV transmissions. These results argue against a uniform policy of avoiding dolutegravir in women of child-bearing potential. Primary Funding Source National Institutes of Health, National Institute of Allergy and Infectious Diseases and Eunice Kennedy Shriver National Institute of Child Health and Human Development; Massachusetts General Hospital; and Harvard University Center for AIDS Research.
Collapse
Affiliation(s)
- Caitlin M Dugdale
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (C.M.D., A.L.C., K.A.F.)
| | - Andrea L Ciaranello
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (C.M.D., A.L.C., K.A.F.)
| | | | | | - Landon Myer
- University of Cape Town, Cape Town, South Africa (L.B., L.M., R.W.)
| | - Robin Wood
- University of Cape Town, Cape Town, South Africa (L.B., L.M., R.W.)
| | - Paul E Sax
- Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts (P.E.S.)
| | | | - Kenneth A Freedberg
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (C.M.D., A.L.C., K.A.F.)
| | - Rochelle P Walensky
- Massachusetts General Hospital, Harvard Medical School, and Brigham and Women's Hospital, Boston, Massachusetts (R.P.W.)
| |
Collapse
|
42
|
Predictors of Perinatal HIV Transmission Among Women Without Prior Antiretroviral Therapy in a Resource-Limited Setting: The Breastfeeding, Antiretrovirals and Nutrition Study. Pediatr Infect Dis J 2019; 38:508-512. [PMID: 30985546 PMCID: PMC6481191 DOI: 10.1097/inf.0000000000002220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To investigate potential risk factors for perinatal (intrauterine and intrapartum) mother-to-child transmission (MTCT) of HIV in women unexposed to antiretroviral therapy (ART) during pregnancy. METHODS We compared factors according to perinatal MTCT outcome among 2275 ART-naive (until the onset of labor) HIV-infected women in the Breastfeeding, Antiretrovirals and Nutrition study (2004-2010) in Lilongwe, Malawi. Factors included HIV viral load during pregnancy, food security, demographic characteristics, hematologic and blood chemistry measures, medical history and physical factors. Associations with perinatal MTCT and interactions with maternal viral load were assessed using simple and multivariable logistic regression. RESULTS There were 119 (115 intrauterine and 4 intrapartum) cases of perinatal MTCT, only one to a mother with <1000 HIV copies/mL. Maternal viral loads >10,000 copies/mL were common (63.1%). Lower maternal viral load (<1000 copies/mL and 1000.1-10,000 copies/mL) was associated with reduced odds of perinatal MTCT [adjusted odds ratio (aOR), 0.1; 95% confidence interval (CI): 0.01-0.4 and aOR, 0.2; 95% CI: 0.1-0.4, respectively), compared with maternal viral load >10,000 copies/mL. Low CD4+ T cell count (≤350 cells/μL) was only associated with perinatal MTCT in unadjusted models. Food shortage (aOR, 1.8; 95% CI: 1.2-2.6), sexually transmitted infection (STI) (past year; aOR, 1.9; 95% CI: 1.0-3.7), histories of herpes zoster (aOR, 3.0; 95% CI: 1.6-5.6) and tuberculosis (aOR, 2.5; 95% CI: 1.1-5.7) were associated with increased odds of perinatal MTCT. CONCLUSIONS These findings confirm that lowering maternal HIV viral load is most important in preventing perinatal MTCT and support efforts to address food shortage, STI and tuberculosis prevention, while informing programs to improve ART coverage in pregnancy.
Collapse
|
43
|
Gantner P, Sylla B, Morand-Joubert L, Frange P, Lacombe K, Khuong MA, Duvivier C, Launay O, Karmochkine M, Arvieux C, Ménard A, Piroth L, Canestri A, Trias D, Peytavin G, Landman R, Ghosn J. "Real life" use of raltegravir during pregnancy in France: The Coferal-IMEA048 cohort study. PLoS One 2019; 14:e0216010. [PMID: 31017957 PMCID: PMC6481866 DOI: 10.1371/journal.pone.0216010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/11/2019] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Limited "real life" data on raltegravir (RAL) use during pregnancy are available. Thus, we aimed at describing effectiveness and safety of RAL-based combined antiretroviral therapy (cART) in this setting. METHODS HIV-1-infected women receiving RAL during pregnancy between 2008 and 2014 in ten French centers were retrospectively analysed for: (1) proportion of women receiving RAL anytime during pregnancy who achieved a plasma HIV-RNA (pVL) < 50 copies/mL at delivery, and (2) description of demographics, immuno-virological parameters and safety in women and new-borns. RESULTS We included 94 women (median age, 33 years) of which 85% originated from Sub-Saharan Africa and 16% did not have regular health insurance coverage. Sixteen women were cART-naïve (median HIV diagnosis at 30 weeks of gestation), whereas 78 were already on cART before pregnancy (40% with pVL < 50 copies/mL). RAL was initiated before pregnancy (n = 33), during the second trimester (n = 11) and the third trimester of pregnancy (n = 50). No RAL discontinuations due to adverse events were observed. Overall, at the time of delivery, pVL was < 50 copies/mL in 70% and < 400 copies/mL in 84% of women. Specifically, pVL at delivery was < 50 copies/mL in 82%, 55% and 56% of cases when RAL was started before pregnancy, during the second or third trimester of pregnancy, respectively. Median term was 38 weeks of gestation, no defect was reported and all new-borns were HIV non-infected at Month 6. CONCLUSIONS RAL appears safe and effective in this "real-life" study. No defect and no HIV transmission was reported in new-borns.
Collapse
Affiliation(s)
- Pierre Gantner
- Hôpitaux Universitaires de Strasbourg, Laboratoire de Virologie, Strasbourg, France
| | - Babacar Sylla
- IMEA, CHU Bichat Claude Bernard, Paris, France Paris, France
| | - Laurence Morand-Joubert
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Laboratoire de Virologie, Hôpital Saint-Antoine, Paris, France
| | - Pierre Frange
- APHP, Hopital Necker Enfants malades, Laboratoire de Microbiologie clinique, Paris, France
- EHU 7328, Institut Imagine, Université Paris Descartes, Paris, France
| | - Karine Lacombe
- Inserm UMR-S1136, IPLESP, AP-HP, Hôpital Saint Antoine, Department of Infectious Diseases, Paris, France
| | - Marie-Aude Khuong
- Hôpital Delafontaine, Department of Infectious Diseases, Saint Denis, France
| | - Claudine Duvivier
- APHP, Hopital Necker Enfants Malades, Department of Infectious Diseases, Centre d’Infectiologie Necker – Pasteur, IHU Imagine, Paris, France
| | - Odile Launay
- Université Paris Descartes, APHP, CIC Cochin Pasteur, Paris, France
| | - Marina Karmochkine
- APHP, Hopital Européen Georges Pompidou, Department of Clinical Immunology, Paris, France
| | | | - Amélie Ménard
- Institut hospitalo-universitaire (IHU) Méditerranée infection, Marseille, France
| | - Lionel Piroth
- Département d’Infectiologie, CHU Dijon, Dijon, France
| | - Ana Canestri
- APHP, Hôpital Tenon, Maladies Infectieuses, Paris, France
| | | | - Gilles Peytavin
- APHP, Hopital Bichat Claude Bernard, Department of Pharmacology-Toxicology, Paris, France
- INSERM IAME UMR-S 1137, Université Paris Diderot, Paris, France
| | - Roland Landman
- IMEA, CHU Bichat Claude Bernard, Paris, France Paris, France
- INSERM IAME UMR-S 1137, Université Paris Diderot, Paris, France
- APHP, Hopital Bichat Claude Bernard, Department of Infectious Diseases, Paris, France
| | - Jade Ghosn
- INSERM IAME UMR-S 1137, Université Paris Diderot, Paris, France
- APHP, Hopital Bichat Claude Bernard, Department of Infectious Diseases, Paris, France
| | | |
Collapse
|
44
|
Ntlantsana V, Hift RJ, Mphatswe WP. HIV viraemia during pregnancy in women receiving preconception antiretroviral therapy in KwaDukuza, KwaZulu-Natal. South Afr J HIV Med 2019; 20:847. [PMID: 31061722 PMCID: PMC6494933 DOI: 10.4102/sajhivmed.v20i1.847] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 02/05/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Preconception antiretroviral therapy (PCART) followed by sustained viral suppression is effective in preventing mother-to-child transmission of HIV. The rates of persistent and transient viraemia in such patients have not been prospectively assessed in South Africa. OBJECTIVES We determined the prevalence of transient and persistent viraemia in HIV-positive women entering antenatal care on PCART and studied variables associated with viraemia. METHODS We performed a prospective cross-sectional observational study of HIV-positive pregnant women presenting to a primary healthcare facility in KwaZulu-Natal. All had received at least 6 months of first-line PCART. Viral load (VL) was measured, patients were interviewed, adherence estimated using a visual analogue scale and adherence counselling provided. Viral load was repeated after 4 weeks where baseline VL exceeded 50 copies/mL. RESULTS We enrolled 82 participants. Of them, 59 (72%) pregnancies were unplanned. Fifteen participants (18.3%) were viraemic at presentation with VL > 50 copies/mL. Of these, seven (8.5%) had viral suppression (VL < 50 copies/mL), and eight remained viraemic at the second visit. Adherence correlated significantly with viraemia at baseline. Level of knowledge correlated with adherence but not with lack of viral suppression at baseline. Socio-economic indicators did not correlate with viraemia. No instances of vertical transmission were observed at birth. CONCLUSIONS Approximately 20% of women receiving PCART may demonstrate viraemia. Half of these may be transient. Poor adherence is associated with viraemia, and efforts to encourage and monitor adherence are essential. The rate of unplanned pregnancies is high, and antiretroviral therapy programmes should focus on family planning needs of women in the reproductive age group to prevent viral non-suppression prior to pregnancy. KEYWORDS Preconception Antiretroviral Therapy; HIV; Viraemia; Antenatal Care; Adherence.
Collapse
Affiliation(s)
- Vuyokazi Ntlantsana
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Richard J. Hift
- School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Wendy P. Mphatswe
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
45
|
Chen JS, Pence BW, Rahangdale L, Patterson KB, Farel CE, Durr AL, Antono AC, Zakharova O, Eron JJ, Napravnik S. Postpartum HIV care continuum outcomes in the southeastern USA. AIDS 2019; 33:637-644. [PMID: 30531320 PMCID: PMC6503530 DOI: 10.1097/qad.0000000000002094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate postpartum HIV care outcomes. DESIGN A prospective clinical cohort of women with HIV and a live birth at the University of North Carolina, 1996-2014. METHODS We estimated two stages of the HIV care continuum in the first 24 months postpartum: care retention (at least two visits per year, ≥90 days apart) and viral suppression (HIV RNA < 400 copies/ml). Multivariable models were fit using logistic regression. RESULTS Among 1416 women, 141 experienced a live birth at a median age of 28 years, with 74% virally suppressed at delivery. Among all women, 48% were retained in care and 25% maintained viral suppression for the first 24 months postpartum. Among women with available HIV RNA measures, 42% were suppressed at 24 months. HIV care retention estimates were stable across calendar years, but viral suppression rates at 24 months postpartum, among women with available HIV RNA measures, increased from 33 to 67% from 1996-2001 to 2009-2014 (P = 0.04). Being at least 30 years old was positively, and receiving less than 12 weeks of antenatal antiretroviral therapy was negatively, associated with HIV care retention at 24 months postpartum [adjusted odds ratio (AOR): 2.41, 95% confidence interval (95% CI): 1.09-5.29 and AOR: 0.27, 95% CI: 0.08-0.86]. Older maternal age and viral suppression at delivery were both positively associated with virologic suppression at 24 months postpartum (AOR: 2.52, CI: 1.02-6.22, and AOR: 6.42 CI: 1.29-31.97, respectively). CONCLUSION HIV care continuum outcomes decrease substantially postpartum, with younger women and those with less antenatal HIV care less likely to successfully remain engaged in HIV care following childbirth.
Collapse
Affiliation(s)
| | | | | | - Kristine B Patterson
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Claire E Farel
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Amy L Durr
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Amanda C Antono
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Oksana Zakharova
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joseph J Eron
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sonia Napravnik
- Department of Epidemiology
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
46
|
Carlsson-Lalloo E, Berg M, Mellgren Å, Rusner M. Sexuality and childbearing as it is experienced by women living with HIV in Sweden: a lifeworld phenomenological study. Int J Qual Stud Health Well-being 2018; 13:1487760. [PMID: 29972346 PMCID: PMC6032009 DOI: 10.1080/17482631.2018.1487760] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2018] [Indexed: 11/10/2022] Open
Abstract
The effectiveness of antiretroviral treatment has reduced sexual HIV transmission and mother-to-child-transmission. To optimally support women living with HIV, health care providers need deepened knowledge about HIV, sexuality and childbearing. The aim of this study was to describe the phenomenon sexuality and childbearing as experienced by women living with HIV in Sweden. Data were collected by phenomenon-oriented interviews with 18 HIV-positive women. A reflective lifeworld analysis based on phenomenological philosophy was conducted, describing the meaning structure of the phenomenon. The essence of the phenomenon is that perceptions about HIV and its contagiousness profoundly influence sexual habits and considerations in relation to pregnancy and childbearing. These perceptions are formed in combination with knowledge and interpretations about HIV by the women themselves and by their environments. The essence is further described by its constituents: Risk of transmission imposes demands on responsibility; The contagiousness of HIV limits sexuality and childbearing; Knowledge about HIV transmission provides confident choices and decisions; and To re-create sexuality and childbearing. Although HIV has a low risk of transmission if being well treated, our study shows that HIV-positive women feel more or less contagious, which influences sexuality and decision-making in relation to become pregnant and give birth.
Collapse
Affiliation(s)
- Ewa Carlsson-Lalloo
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Clinic of Infectious Diseases, Södra Älvsborg Hospital, Borås, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Åsa Mellgren
- Clinic of Infectious Diseases, Södra Älvsborg Hospital, Borås, Sweden
| | - Marie Rusner
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Research, Södra Älvsborg Hospital, Borås, Sweden
| |
Collapse
|
47
|
Davies NECG, Ashford G, Bekker LG, Chandiwana N, Cooper D, Dyer SJ, Jankelowitz L, Mhlongo O, Mnyani CN, Mulaudzi MB, Moorhouse M, Myer L, Patel M, Pleaner M, Ramos T, Rees H, Schwartz S, Smit J, van Zyl DS. Guidelines to support HIV-affected individuals and couples to achieve pregnancy safely: Update 2018. South Afr J HIV Med 2018; 19:915. [PMID: 30473876 PMCID: PMC6244351 DOI: 10.4102/sajhivmed.v19i1.915] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 09/20/2018] [Indexed: 11/23/2022] Open
Affiliation(s)
- Natasha E C G Davies
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | | | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Nomathemba Chandiwana
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Diane Cooper
- School of Public Health, University of Western Cape, South Africa
| | - Silker J Dyer
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa
| | | | - Otty Mhlongo
- KwaZulu-Natal Department of Health, South Africa
| | - Coceka N Mnyani
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of the Witwatersrand, South Africa
| | | | - Michelle Moorhouse
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Malika Patel
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Melanie Pleaner
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Tatiana Ramos
- Southern African HIV Clinicians' Society, South Africa
| | - Helen Rees
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Sheree Schwartz
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, South Africa.,Department of Epidemiology, Johns Hopkins School of Public Health, United States
| | - Jenni Smit
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of the Witwatersrand, South Africa
| | | |
Collapse
|
48
|
Brittain K, Remien RH, Mellins CA, Phillips TK, Zerbe A, Abrams EJ, Myer L. Determinants of suboptimal adherence and elevated HIV viral load in pregnant women already on antiretroviral therapy when entering antenatal care in Cape Town, South Africa. AIDS Care 2018; 30:1517-1523. [PMID: 30047287 DOI: 10.1080/09540121.2018.1503637] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Across sub-Saharan Africa, prevention of mother-to-child transmission services are encountering increasing numbers of women already established on antiretroviral therapy (ART) when entering antenatal care. However, there are few data examining ART adherence and HIV viral load in this group. We used multivariable logistic regression models to examine self-reported suboptimal adherence (defined as missed ART doses on ≥2 days during the preceding 30 days), elevated viral load (≥1000 copies/mL), and factors associated with each among women entering antenatal care on ART. Participants were recruited from one primary care clinic in Gugulethu, Cape Town, as part of a larger study of HIV-positive pregnant and postpartum women. Among 482 pregnant women established on ART and enrolled between May 2013 and June 2014 (median age: 31 years; median duration of ART use: 3 years), 15% reported suboptimal adherence and 12% had elevated viral load. After adjustment for age, suboptimal adherence was significantly more common among women who were not married/cohabiting and women who reported a higher level of concern about taking ART; a higher level of adherence self-efficacy was associated with a reduced odds of suboptimal adherence. In a multivariable model, elevated viral load was significantly associated with previous discontinuation of ART, a higher level of concern about taking ART, and report of an unintended pregnancy. Suboptimal adherence and elevated viral load are common among women entering antenatal care already on ART. Our findings highlight specific beliefs and concerns about ART use during pregnancy that should be addressed in counselling messaging, and suggest that family planning should be more effectively integrated into HIV care. Including adherence and viral load monitoring as part of pregnancy planning for women on ART may be important to achieve safer conception and promote healthy pregnancies.
Collapse
Affiliation(s)
- Kirsty Brittain
- a Division of Epidemiology & Biostatistics , School of Public Health & Family Medicine, University of Cape Town , Cape Town , South Africa.,b Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town , Cape Town , South Africa
| | - Robert H Remien
- c HIV Center for Clinical and Behavioral Studies , New York State Psychiatric Institute, Columbia University , New York , NY , USA
| | - Claude A Mellins
- c HIV Center for Clinical and Behavioral Studies , New York State Psychiatric Institute, Columbia University , New York , NY , USA
| | - Tamsin K Phillips
- a Division of Epidemiology & Biostatistics , School of Public Health & Family Medicine, University of Cape Town , Cape Town , South Africa.,b Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town , Cape Town , South Africa
| | - Allison Zerbe
- d ICAP , Columbia University, Mailman School of Public Health , New York , NY , USA
| | - Elaine J Abrams
- d ICAP , Columbia University, Mailman School of Public Health , New York , NY , USA.,e College of Physicians & Surgeons , Columbia University , New York , NY , USA
| | - Landon Myer
- a Division of Epidemiology & Biostatistics , School of Public Health & Family Medicine, University of Cape Town , Cape Town , South Africa.,b Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town , Cape Town , South Africa
| |
Collapse
|
49
|
Simone J, Hoyt MJ, Storm DS, Finocchario-Kessler S. Models of HIV Preconception Care and Key Elements Influencing These Services: Findings from Healthcare Providers in Seven US Cities. AIDS Patient Care STDS 2018; 32:272-281. [PMID: 29870269 PMCID: PMC6034389 DOI: 10.1089/apc.2017.0299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Preconception care can improve maternal and infant outcomes by identifying and modifying health risks before pregnancy and reducing unplanned pregnancies. However, information about how preconception care is provided to persons living with HIV (PLWH) is lacking. This study uses qualitative interviews with HIV care providers to describe current models of preconception care and explore factors influencing services. Single, anonymous, telephone interviews were conducted with 92 purposively selected HIV healthcare providers in Atlanta, Baltimore, Houston, Kansas City, Newark, Philadelphia, and San Francisco in 2013-2014. Content analysis and a grounded theory approach were used to analyze data. Participants included 57% physicians with a median of 10 [interquartile range (IQR) = 5-17] years HIV care experience; the mean proportion of female patients was 45%. Participants described Individual Provider (48.9%), Team-based (43.2%), and Referral-only (7.6%) models of preconception care, with 63% incorporating referrals outside their clinics. Thematic analysis identified five key elements influencing the provision of preconception care within and across models: consistency of delivery, knowledge and attitudes, clinic characteristics, coordination of care, and referral accessibility. Described models of preconception care reflect the complexity of our healthcare system. Qualitative analysis offers insights about how HIV clinicians provide preconception care and how key elements influence services. However, additional research about the models and outcomes of preconception care services are needed. To improve preconception care for PLWH, research and quality improvement initiatives must utilize available strengths and tackle existing barriers, identified by our study and others, to define and implement effective models of preconception care services.
Collapse
Affiliation(s)
- Joanne Simone
- François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Mary Jo Hoyt
- François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Deborah S. Storm
- François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey
| | | |
Collapse
|
50
|
Yee LM, McGregor DV, Sutton SH, Garcia PM, Miller ES. Association between maternal HIV disclosure and risk factors for perinatal transmission. J Perinatol 2018; 38:639-644. [PMID: 29434253 PMCID: PMC6030432 DOI: 10.1038/s41372-018-0066-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/02/2018] [Accepted: 01/18/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine whether maternal disclosure of HIV serostatus is associated with uptake of perinatal HIV transmission prevention interventions. STUDY DESIGN Retrospective cohort study of women living with HIV enrolled in a perinatal HIV clinic. Women who disclosed their HIV serostatus to sexual partner(s) prior to delivery were compared to non-disclosers. Multivariable logistic regression was performed. RESULTS Of 209 women, 71.3% (N = 149) disclosed. Non-disclosers were more likely to attend <10 prenatal visits, demonstrated worse antiretroviral therapy adherence, required more time to achieve virologic suppression, and were less likely to have an undetectable viral load. On multivariable analyses, disclosure status did not remain associated with these factors. However, compared to non-disclosers, disclosers had lower odds of preterm delivery (OR: 0.43, 95% CI: 0.19-0.94) and greater odds of postpartum visit attendance (aOR: 5.10, 95% CI: 1.65-15.72). CONCLUSIONS Non-disclosure of HIV status to sexual partner(s) during pregnancy may be a risk factor for preterm birth and poorer postpartum visit attendance.
Collapse
Affiliation(s)
- Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Donna V McGregor
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine
| | - Sarah H Sutton
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine
| | - Patricia M Garcia
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine
| | - Emily S Miller
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine
| |
Collapse
|