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Berhie S, Kacanek D, Lee J, Jao J, Powis K, Salomon L, Siddiqui D, Yee LM. Routine Vaccination During Pregnancy Among People Living With HIV in the United States. JAMA Netw Open 2024; 7:e249531. [PMID: 38696165 PMCID: PMC11066702 DOI: 10.1001/jamanetworkopen.2024.9531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/28/2024] [Indexed: 05/05/2024] Open
Abstract
Importance Pregnancy represents a window of opportunity for vaccination due to established maternal and fetal benefits of vaccination. Little is known about receipt of routinely recommended vaccines in pregnancy, specifically tetanus, diphtheria, plus acellular pertussis (Tdap) and influenza, among pregnant people living with HIV (PLHIV). Objective To estimate prevalence of vaccination receipt among pregnant people with HIV (PLHIV) and identify demographic and clinical characteristics associated with vaccination. Design, Setting, and Participants This multicenter cohort study included women participating in Women's Health Study (WHS) of the Surveillance Monitoring for ART Toxicities (SMARTT) Study of the Pediatric HIV/AIDS Cohort Study. The network has been enrolling pregnant PLHIV at 22 US sites since 2007. Participants for this study enrolled between December 2017 and July 2019. Data analysis was conducted from October 2021 to March 2022. Exposure Data on vaccination in pregnancy were collected through medical record abstraction. Main Outcomes and Measures Vaccination receipt was defined as Tdap vaccination received at less than 36 weeks' gestation and influenza vaccination at any gestational age, based on current guidelines. Log-binomial and modified Poisson regression models with generalized estimating equations were fit to identify factors associated with successful receipt of (1) Tdap, (2) influenza, and (3) both vaccinations. Results A total of 310 pregnancies among 278 people participating in the WHS were included (mean [SD] age, 29.5 [6.1] years; 220 [71%] Black, 77 [25%] Hispanic, and 77 [25%] race and ethnicity other than Black; 64 [21%] with perinatally acquired HIV). Less than one-third of pregnancies were vaccinated as recommended (Tdap, 32.6% [95% CI, 27.4%-38.1%]; influenza, 31.6% [95% CI, 26.5%-37.1%]; both, 22.6% [95% CI, 18.0%-27.6%]). People living with perinatally acquired HIV, those who did not identify as Black, or those who were multiparous had adjusted risk ratios (aRRs) less than 1, while older PLHIV had aRRs greater than 1, but these differences did not reach statistical significance (perinatally acquired HIV: adjusted risk ratio [aRR], 0.46; 95% CI, 0.21-1.02; race other than Black: aRR, 0.53; 95% CI, 0.26-1.08; multiparous: aRR, 0.59; 95% CI, 0.35-1.00; age 24-29 years: aRR, 2.03; 95% CI, 0.92-4.48). Conclusions and Relevance In this diverse, multicenter cohort of pregnant PLHIV, receipt of recommended vaccinations was low. Identifying and addressing barriers to vaccination receipt is urgently needed for pregnant people with HIV.
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Affiliation(s)
- Saba Berhie
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Deborah Kacanek
- Center for Biostatistics in AIDS Research, Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jessica Lee
- Center for Biostatistics in AIDS Research, Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jennifer Jao
- Division of Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kathleen Powis
- Departments of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Liz Salomon
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Danish Siddiqui
- American University of Integrative Sciences, St Michael, Barbados
| | - Lynn M. Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Henderson M, Fidler S, Foster C. Adults with Perinatally Acquired HIV; Emerging Clinical Outcomes and Data Gaps. Trop Med Infect Dis 2024; 9:74. [PMID: 38668535 PMCID: PMC11053933 DOI: 10.3390/tropicalmed9040074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/29/2024] [Accepted: 03/30/2024] [Indexed: 04/29/2024] Open
Abstract
In resourced settings, adults living with perinatally acquired HIV are approaching the 5th decade of life. Their clinical and psychological outcomes highlight potential future issues for the much larger number of adolescents growing up with HIV in sub-Saharan Africa, and will inform the development of appropriate healthcare services. Lifelong exposure to HIV, and increasingly to antiretroviral therapy throughout growth and development, contrasts with adults acquiring HIV in later life. This review describes the clinical outcomes for adults living with perinatally acquired HIV including post transition mortality, morbidity and retention in care. Rates of viral suppression, drug resistance and immunological function are explored. Co-morbidities focus on metabolic, cardiovascular, respiratory and bone health with quality-of-life data including neurocognitive functioning and mental health. Sexual and reproductive health including vaccine-preventable disease and the prevention of onward transmission to partners and infants are considered. The data gaps and future research questions to optimise outcomes for this emerging adult cohort are highlighted.
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Affiliation(s)
- Merle Henderson
- 900 Clinic, Imperial College Healthcare NHS Trust, London W2 1NY, UK; (M.H.); (S.F.)
- Department of Infectious Diseases, Imperial College London, Imperial College NIHR BRC, London W2 1NY, UK
| | - Sarah Fidler
- 900 Clinic, Imperial College Healthcare NHS Trust, London W2 1NY, UK; (M.H.); (S.F.)
- Department of Infectious Diseases, Imperial College London, Imperial College NIHR BRC, London W2 1NY, UK
| | - Caroline Foster
- 900 Clinic, Imperial College Healthcare NHS Trust, London W2 1NY, UK; (M.H.); (S.F.)
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London W2 1NY, UK
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Sibiude J, Le Chenadec J, Mandelbrot L, Hoctin A, Dollfus C, Faye A, Bui E, Pannier E, Ghosn J, Garrait V, Avettand-Fenoel V, Frange P, Warszawski J, Tubiana R. Update of Perinatal Human Immunodeficiency Virus Type 1 Transmission in France: Zero Transmission for 5482 Mothers on Continuous Antiretroviral Therapy From Conception and With Undetectable Viral Load at Delivery. Clin Infect Dis 2023; 76:e590-e598. [PMID: 36037040 DOI: 10.1093/cid/ciac703] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 08/04/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) is remarkably effective in preventing perinatal transmission (PT) of HIV-1. We evaluated the PT rate in a population of women with widespread access to ART before conception. METHODS The analysis included 14 630 women with HIV-1 who delivered from 2000 to 2017 at centers participating in the nationwide prospective multicenter French Perinatal Cohort (ANRS-EPF). PT was analyzed according to time period, timing of ART initiation, maternal plasma viral load (pVL), and gestational age at birth. No infants were breastfed, and all received neonatal prophylaxis. RESULTS PT decreased between 3 periods, from 1.1% in 2000-2005 (58/5123) to 0.7% in 2006-2010 (30/4600) and to 0.2% in 2011-2017 (10/4907; P < .001). Restriction of the analysis to the 6316/14 630 (43%) women on ART at conception, PT decreased from 0.42% (6/1434) in 2000-2005 to 0.03% (1/3117) in 2011-2017 (P = .007). Among women treated at conception, if maternal pVL was undetectable near delivery, no PT was observed regardless of the ART combination [95%CI 0-0.07] (0/5482). Among women who started ART during pregnancy and with undetectable pVL near delivery, PT was 0.57% [95%CI 0.37-0.83] (26/4596). Among women treated at conception but with a detectable pVL near delivery, PT was 1.08% [95%CI 0.49-2.04] (9/834). We also qualitatively described 10 cases of transmission that occurred during the 2011-2017 period. CONCLUSIONS In a setting with free access to ART, monthly pVL assessment, infant ART prophylaxis, and in the absence of breastfeeding, suppressive ART initiated before pregnancy and continued throughout pregnancy can reduce PT of HIV to almost zero.
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Affiliation(s)
- Jeanne Sibiude
- Department of Gynecology-Obstetrics, Assistance Publique des Hôpitaux de Paris Hôpital Louis Mourier, Colombes, France.,Université de Paris, Infection, Antimicrobials, Modelling, Evolution UMR 1137, Institut national de la santé et de la recherche médicale, Paris, France
| | - Jérôme Le Chenadec
- Institut national de la santé et de la recherche médicale Centre d'Epidémiologie et de Santé des Populations U1018, Le Kremlin-Bicêtre, France
| | - Laurent Mandelbrot
- Université de Paris, Infection, Antimicrobials, Modelling, Evolution UMR 1137, Institut national de la santé et de la recherche médicale, Paris, France
| | - Alexandre Hoctin
- Institut national de la santé et de la recherche médicale Centre d'Epidémiologie et de Santé des Populations U1018, Le Kremlin-Bicêtre, France
| | - Catherine Dollfus
- Department of Pediatric Hematology-oncology, Assistance Publique des Hôpitaux de Paris Hôpital Trousseau, Paris, France
| | - Albert Faye
- Department of Pediatrics and Infectious Diseases, Assistance Publique des Hôpitaux de Paris Hôpital Robert Debré, Paris, France.,Université de Paris, Institut national de la santé et de la recherche médicale, U1123, Paris, France
| | - Eida Bui
- Department of Gynécology-Obstetrics, Assistance Publique des Hôpitaux de Paris Hôpital Trousseau, Paris, France
| | - Emmanuelle Pannier
- Department of Gynecology and Obstetrics, Assistance Publique des Hôpitaux de Paris, Maternité Port Royal, Paris, France
| | - Jade Ghosn
- Department of Infectious and Tropical Diseases, Assistance Publique des Hôpitaux de Paris, Nord, Hôpital Bichat - Claude Bernard, Paris, France
| | - Valerie Garrait
- Department of infectious diseases, Centre Hospitalier inter-communal de Créteil, Créteil, France
| | - Véronique Avettand-Fenoel
- Department of Clinical Microbiology, Assistance Publique des Hôpitaux de Paris Hôpital Necker-Enfants Malades, Université de Paris, Paris, France.,Institut national de la santé et de la recherche médicale U1016, Centre national de la recherche scientifique UMR8104, Institut Cochin, Paris, France
| | - Pierre Frange
- EHU 7328 PACT, Institut Imagine, Université de Paris, Paris, France
| | - Josiane Warszawski
- Department of Epidemiology and Public Health, Assistance Publique des Hôpitaux de Paris Hôpital Bicêtre, Le Kremlin-Bicêtre, France.,Université Paris-Saclay, Institut national de la santé et de la recherche médicale Centre d'Epidémiologie et de Santé des Populations U1018, Le Kremlin-Bicêtre, France
| | - Roland Tubiana
- Department of Infectious and Tropical Diseases, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France.,Institut national de la santé et de la recherche médicale, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
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Osmundo GDS, da Costa RA, Ruocco RMA, Francisco RPV. Pregnancy in women living with perinatally acquired HIV: Perinatal outcomes and drug resistance profile. Clinics (Sao Paulo) 2023; 78:100174. [PMID: 36870111 PMCID: PMC9995930 DOI: 10.1016/j.clinsp.2023.100174] [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] [Received: 11/08/2022] [Revised: 01/27/2023] [Accepted: 02/10/2023] [Indexed: 03/06/2023] Open
Abstract
OBJECTIVES To analyze the perinatal outcomes of Perinatally acquired HIV Infection (PHIV) in pregnant women. METHOD This retrospective cohort study included singleton pregnancies in Women Living with HIV (WLH) between 2006 and 2019. Patient charts were revised, and maternal characteristics, type of HIV infection (perinatal vs. behavioral), Antiretroviral Therapy (ART) exposure, and obstetric and neonatal outcomes were assessed. The HIV-related aspects considered were: Viral Load (VL), CD4+ cell count, opportunistic infections, and genotype testing. Laboratory analyses were performed at baseline (first appointment) and 34 weeks of gestation. RESULTS There were 186 WLH pregnancies, and 54 (29%) patients had PHIV. Patients with PHIV were younger (p < 0.001), had less frequently stable partnerships (p < 0.001), had more commonly serodiscordant partners (p < 0.001), had a longer time on ART (p < 0.001), and had lower rates of undetectable VL at baseline (p = 0.046) and at 34 weeks of gestation (p < 0.001). No association was observed between PHIV and adverse perinatal outcomes. Among patients with PHIV, third trimester anemia was associated with preterm birth (p = 0.039). Genotype testing was available only for 11 patients with PHIV, who presented multiple mutations related to ART resistance. CONCLUSIONS PHIV did not seem to increase the risk of adverse perinatal outcomes. However, PHIV pregnancies have a higher risk of viral suppression failure and exposure to complex ARTs.
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Affiliation(s)
- Gilmar de Souza Osmundo
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
| | - Rafaela Alkmin da Costa
- Divisão de Clínica Obstétrica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Rosa Maria Aveiro Ruocco
- Divisão de Clínica Obstétrica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Rossana Pulcineli Vieira Francisco
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
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Impact of HAART Therapy and HIV Infection over Fetal Growth-An Anthropometric Point of View. Microorganisms 2022; 10:microorganisms10061123. [PMID: 35744641 PMCID: PMC9229979 DOI: 10.3390/microorganisms10061123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 02/04/2023] Open
Abstract
Human immunodeficiency virus (HIV) infection cannot be completely eliminated from the body because the virus integrates its genetic code into that of the host cell. The prevalence of pregnancy in women with HIV infection has increased due to the efficacy of antiretroviral therapy (ART). Placental insufficiency is associated with a reduction in blood flow and circulatory redistribution, resulting in fetal hypoxia and nutrient deprivation as a consequence of an altered placental function, and it can result in a lower birthweight. The aim of the study was to determine the combined effect of HIV infection and ART on the anthropometric parameters of infants born to HIV-positive pregnant women under ART compared to the values of these parameters in a control group of infants born to healthy mothers. There are no significant differences between the two groups in terms of gestational age at birth. We found a statistically significant lower birth weight in infants born from HIV-positive mothers under ART, with 3041 g in the control group compared to 2758 g in the group of HIV positive pregnant women (p < 0.01). There were statistically significant differences in all anthropometric parameters, these showing higher values in the control group (seronegative pregnant women).
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Yu W, Jacobson DL, Williams PL, Patel K, Geffner ME, Van Dyke RB, Kacanek D, DiMeglio LA, Jao J. Growth patterns of uninfected children born to women living with perinatally versus nonperinatally acquired HIV. AIDS 2022; 36:593-603. [PMID: 34860195 PMCID: PMC8881380 DOI: 10.1097/qad.0000000000003136] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to compare long-term growth between HIV-exposed uninfected children (CHEU) born to women with perinatally acquired HIV (CHEU-PHIV) and CHEU born to women with nonperinatally acquired HIV (CHEU-NPHIV). DESIGN A longitudinal analysis of anthropometric measurements from a U.S.-based multisite prospective cohort study enrolling CHEU and their mothers since April 2007. METHODS CHEU were evaluated for growth annually from birth through age 5 and again at age 7 years. Z-scores were calculated using U.S. growth references for weight (WTZ), height (HTZ), and weight-for-length or BMI-for-age (WLZ/BMIZ). Mid-upper arm circumference (MUACZ) and triceps skinfold thickness (TSFZ) Z-scores were obtained from ages 1 and 2, respectively, through age 7 years. Piecewise mixed-effects models, overall and stratified by race and sex, were fit to assess differential growth patterns across age by maternal PHIV status. RESULTS One thousand four hundred fifty-four singleton infants (286 CHEU-PHIV and 1168 CHEU-NPHIV) were included. CHEU-PHIV had slower growth rates than CHEU-NPHIV for WTZ and WLZ/BMIZ at earlier ages and continued to have lower mean WTZ [-0.27, 95% confidence interval (95% CI): -0.50, -0.04] and WLZ/BMIZ (-0.39, 95% CI: -0.67, -0.11) through age 7. Among non-Black boys, CHEU-PHIV had slightly lower WTZ and WLZ/BMIZ at birth than CHEU-NPHIV and these growth deficits persisted through age 7 years. CONCLUSION Compared with CHEU-NPHIV, CHEU-PHIV had diminished growth in early childhood with differences most pronounced among non-Black male children. Further longitudinal follow-up of CHEU-PHIV into young adulthood is needed to understand whether these early effects of maternal PHIV status on growth persist and have other health consequences.
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Affiliation(s)
- Wendy Yu
- Center for Biostatistics in AIDS Research
| | | | - Paige L Williams
- Center for Biostatistics in AIDS Research, Departments of Biostatistics and Epidemiology
| | - Kunjal Patel
- Center for Biostatistics in AIDS Research, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Mitchell E Geffner
- The Saban Research Institute of Children's Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, California
| | - Russell B Van Dyke
- Tulane University School of Medicine, Department of Pediatrics, New Orleans, Los Angeles
| | | | - Linda A DiMeglio
- Indiana University School of Medicine, Department of Pediatrics, Indianapolis, Indiana
| | - Jennifer Jao
- Northwestern University Feinberg School of Medicine, Department of Pediatrics, Department of Medicine, Chicago, Illinois, USA
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Anderson K, Mutemaringa T, Technau KG, Johnson LF, Braithwaite K, Mokotoane E, Boulle A, Davies On Behalf Of IeDEA-Sa Pediatrics MA. The next generation: Pregnancy in adolescents and women living with perinatally acquired HIV in South Africa. S Afr Med J 2021; 111:260-264. [PMID: 33944749 PMCID: PMC8847806 DOI: 10.7196/samj.2021.v111i3.14987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND An increasing number of girls living with perinatally acquired HIV (PHIV) are reaching adolescence and adulthood and becoming pregnant. Youth living with PHIV (YLPHIV) may have HIV-associated infections/complications, long-term exposure to antiretroviral treatment (ART), drug resistance and increased psychosocial challenges, which may adversely affect pregnancy outcomes. There is a lack of published studies on pregnancy in YLPHIV in sub-Saharan Africa. Objectives. To describe characteristics of pregnant South African (SA) YLPHIV and their pregnancy outcomes. METHODS We retrospectively identified pregnancies in YLPHIV, who were diagnosed with HIV when they were <12 years old and before their first pregnancy (as a proxy for perinatal route of infection), from routinely collected data in Western Cape Province, SA (2007 - 2018). We combined these with pregnancies from a Johannesburg cohort of YLPHIV. Results. We identified 258 pregnancies among 232 females living with likely PHIV; 38.8% of pregnancies occurred in YLPHIV ≤16 years old, 39.1% at age 17 - 19 years and 22.1% at age ≥20 years. In recent years, a steady increase in the number of pregnancies in YLPHIV was noted; more than two-thirds occurred during 2016 - 2018. ART was commenced prior to pregnancy in 84.9% of YLPHIV, during pregnancy in 6.6% and was not commenced by pregnancy end date in 8.5%. Of the pregnancies in young women with documented outcomes (88.8%; n=229), 80.3% were live births, 14.4% terminations, 3.1% miscarriages and 2.2% stillbirths. Mother-to-child transmission of HIV occurred in 2.2% of infants, 75.3% were uninfected when last tested and 22.6% had unknown HIV status. Among YLPHIV with CD4 counts available within 12 months of pregnancy end date (n=202), 20.3% had a CD4 count <200 cells/μL, 43.1% CD4 count 200 - 499 cells/μL and 36.6% CD4 count ≥500 cells/μL. Among those with a viral load (VL) available within 12 months of pregnancy end date (n=219), 66.7% had a VL <400 copies/mL, 5.0% VL 400 - 999 copies/mL and 28.3% VL ≥1 000 copies/mL. Of 186 neonates, 20.4% were preterm deliveries (<37 weeks' gestation). Among neonates with known birthweight (n=176), the mean birthweight was 2 900 g (95% confidence interval (CI) 2 747 - 2 935 g) and 20.5% had a low birthweight (<2 500 g). One congenital malformation (musculoskeletal) and 2 neonatal deaths were recorded. CONCLUSIONS In recent years, the number of pregnancies in YLPHIV has increased. A considerable proportion of pregnancies occurred in YLPHIV ≤16 years old. A high proportion of pregnancies was electively terminated. The prevalence of elevated VL and poor immunological status among pregnant YLPHIV is concerning.
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Affiliation(s)
- K Anderson
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
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Neurodevelopment of HIV-Exposed Uninfected Infants Born to Women With Perinatally Acquired HIV in the United States. J Acquir Immune Defic Syndr 2021; 84:213-219. [PMID: 32032301 DOI: 10.1097/qai.0000000000002318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Lifelong HIV and antiretroviral therapy may confer neurodevelopmental risk on the children of women with perinatally acquired HIV infection (PHIV). SETTING We analyzed data from HIV-exposed uninfected (HEU) infants born to women with PHIV vs. non-perinatally acquired HIV (NPHIV) enrolled in the Surveillance Monitoring for Antiretroviral Therapy Toxicities (SMARTT) study. METHODS Using the Bayley Scales of Infant and Toddler Development, third Ed. (Bayley-III), we compared neurodevelopmental outcomes at the age of 1 year in HEU infants born to women with PHIV vs. NPHIV. Those with valid Bayley-III data at the age of 1 year and a mother born after 1982 were included. Cognitive, language, and motor domains were assessed as continuous composite scores. Linear mixed effects models were fit to estimate the mean difference in Bayley-III scores between groups, adjusting for confounders. RESULTS Five hundred fifty women with HIV gave birth to 678 HEU children (125 and 553 born to women with PHIV and NPHIV, respectively). Mean scores for each of the Bayley-III domains were not significantly different between infants born to women with PHIV vs. NPHIV in unadjusted models. After adjustment, infants of women with PHIV had lower language (91.9 vs. 94.8, P = 0.05) and motor (93.7 vs. 96.8, P = 0.03) composite scores, but no differences in cognitive composite scores. CONCLUSIONS Cognitive domain outcomes of infants born to women with PHIV vs. NPHIV are reassuring. Differences in early language and motor functioning, while of modest clinical significance, highlight the importance of long-term monitoring of neurodevelopment in children of women with PHIV.
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O’Brien BE, Williams PL, Huo Y, Kacanek D, Chadwick EG, Powis KM, Correia K, Haddad LB, Yee LM, Chakhtoura N, Dola C, Van Dyke RB. Repeat Pregnancies Among US Women Living With HIV in the SMARTT Study: Temporal Changes in HIV Disease Status and Predictors of Preterm Birth. J Acquir Immune Defic Syndr 2020; 85:346-354. [PMID: 32701825 PMCID: PMC8086749 DOI: 10.1097/qai.0000000000002445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Birth rates among women living with HIV (WLHIV) have increased recently, with many experiencing multiple pregnancies. Yet, viral suppression is often not sustained between pregnancies. In addition, protease inhibitors (PIs) have been associated with preterm birth, but associations between integrase strand transfer inhibitors (INSTIs) and preterm birth are less well characterized. METHODS We studied WLHIV with ≥2 live-born infants enrolled into the Pediatric HIV/AIDS Cohort Study Surveillance Monitoring for Antiretroviral Treatment Toxicities (SMARTT) study between 2007 and 2018, comparing CD4 counts and viral loads (VLs) between 2 consecutive SMARTT pregnancies. We evaluated associations of covariates with CD4 and viral suppression and the association of PI/INSTI use during pregnancy with odds of preterm birth. RESULTS There were 736 women who had ≥2 live-born children enrolled in SMARTT (1695 pregnancies). Median CD4 counts remained stable over repeat pregnancies. Although >80% of women achieved VL suppression during pregnancy, more than half had a detectable VL early in their subsequent pregnancy. In adjusted models including all singleton pregnancies, an increased odds of preterm birth was observed for women with first trimester PI initiation (adjusted odds ratio: 1.97; 95% confidence interval: 1.27 to 3.07) compared with those not receiving PIs during pregnancy and for first trimester INSTI initiation (adjusted odds ratio: 2.39; 95% confidence interval: 1.04 to 5.46) compared with those never using INSTIs during pregnancy. CONCLUSIONS Most WLHIV achieved VL suppression by late pregnancy but many were viremic early in subsequent pregnancies. First trimester initiation of PIs or INSTIs was associated with a higher risk of preterm birth.
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Affiliation(s)
- Brigid E. O’Brien
- Department of Pediatrics, Section of Infectious Diseases, Tulane University School of Medicine, New Orleans, LA
| | - Paige L. Williams
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Yanling Huo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Deborah Kacanek
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Ellen G. Chadwick
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kathleen M. Powis
- Departments of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, MA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Katharine Correia
- Department of Mathematics & Statistics, Amherst College, Amherst, MA
| | - Lisa B. Haddad
- Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia
| | - Lynn M. Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nahida Chakhtoura
- Eunice Kennedy Shriver, National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Chi Dola
- Department of Obstetrics and Gynecology. Tulane University School of Medicine, New Orleans, LA
| | - Russell B. Van Dyke
- Department of Pediatrics, Section of Infectious Diseases, Tulane University School of Medicine, New Orleans, LA
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Fennell C, Seage GR, Zash R, Phiri K, Diseko M, Mayondi G, Lockman S, Sekoto T, Mmalane M, Makhema J, Shapiro R. Adverse Birth Outcomes in Botswana Among Women With Vertically or Horizontally Acquired Human Immunodeficiency Virus. J Pediatric Infect Dis Soc 2020; 10:252-258. [PMID: 32539088 PMCID: PMC8023308 DOI: 10.1093/jpids/piaa051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/27/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Women with vertically acquired HIV (VHIV) may have a greater risk of adverse birth outcomes than women with horizontally acquired HIV (HHIV). METHODS The Tsepamo study performed birth outcomes surveillance at 8 government delivery sites in Botswana from July 2014 through March 2019. Pregnant women diagnosed with HIV before their 11th birthday received VHIV status, and other women had HHIV. Small for gestational age (SGA), preterm delivery (PTD), stillbirth, and neonatal death were compared using χ2 and Fisher's exact tests. Log-binomial regression models determined risk ratios (RRs). RESULTS VHIV women (n = 402) aged 15-27 years were identified over 4 years of surveillance and compared with HHIV women (n = 8465) of the same age. VHIV women were more likely to use nevirapine (NVP)-based antiretroviral treatment (ART) in pregnancy and to have SGA and very SGA infants, but less likely to have very PTD infants. In unadjusted analyses, VHIV women had a higher risk of any adverse birth outcome combined (RR = 1.21, 95% confidence interval [CI], 1.08-1.36). After adjusting for potential confounders, particularly use of NVP-based regimens, the risk of adverse birth outcomes among VHIV and HHIV women was similar. CONCLUSIONS NVP-based ART is a primary and modifiable risk factor for adverse birth outcomes. Updating ART regimens could improve birth outcomes for women with HIV.
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Affiliation(s)
- Christina Fennell
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA,Correspondence: Christina Fennell, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02215 ()
| | - George R Seage
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rebecca Zash
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA,Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana
| | - Kelesitse Phiri
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana
| | - Modiegi Diseko
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana
| | - Gloria Mayondi
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana
| | - Shahin Lockman
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA,Division of Infectious Disease, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Tumalano Sekoto
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana
| | - Mompati Mmalane
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana
| | - Joseph Makhema
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana
| | - Roger Shapiro
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Cohn E, Korte JE, Lazenby GB. Timing is everything: assessing the impact of maternal HIV infection diagnosis timing on infant outcomes in a ten-year retrospective cohort study in South Carolina. AIDS Care 2019; 33:299-305. [PMID: 31870184 DOI: 10.1080/09540121.2019.1707470] [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: 10/25/2022]
Abstract
The aims were to evaluate the impact of maternal HIV infection diagnosis timing on infant outcomes. The outcomes of interest included preterm delivery (PTD) and confirmed infant HIV infection. Data for all HIV-exposed infants from 2004-14 were obtained. Maternal HIV infection diagnosis timing was categorized as: perinatal (PHIV), adult infection before conception, and after conception. Infant outcomes were compared according to timing of maternal HIV diagnosis. Bivariate outcomes were compared using χ 2 tests. Continuous variables were compared using Kruskal-Wallis tests. Logistic regression was used to determine predictors of PTD and infant HIV infection. Most women were diagnosed with HIV before conception: PHIV (21, 3%), before conception (431, 69%), and post-conception (176, 28%). Women diagnosed with HIV as an adult before conception were more likely to deliver preterm (P = 0.007). Prenatal care was associated with lower risk of PTD (aOR 0.1, 95% CI 0.04-0.5). Six infants contracted HIV. Infant HIV infection was more likely in women who did not take antiretroviral therapy (aOR 13.5, 95% CI 2.5-72.1) or delivered preterm (aOR 5.3, 95% 1.1-25.1). Women with PHIV were more likely to deliver at term, and there were no HIV infections among PHIV-exposed infants. These findings are reassuring to PHIV women who desire pregnancy.
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Affiliation(s)
- Ellery Cohn
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Jeffrey E Korte
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Gweneth B Lazenby
- Departments of Obstetrics and Gynecology and Medicine, Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC, USA
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12
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Trends in post-partum viral load among women living with perinatal HIV infection in the USA: a prospective cohort study. Lancet HIV 2019; 7:e184-e192. [PMID: 31870676 DOI: 10.1016/s2352-3018(19)30339-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/12/2019] [Accepted: 09/19/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Small studies reported poor post-partum outcomes among young women living with perinatal HIV infection who are now ageing into adulthood and becoming pregnant. For targeted clinical intervention, we sought to identify women in this population at risk of poor post-partum virological control. METHODS We abstracted data on pregnancy history for women living with perinatal HIV infection in the Pediatric HIV/AIDS Cohort Study-AMP Up protocol, a prospective study of young adults living with perinatal HIV from 14 sites in the USA. Linear models with generalised estimating equations described trends in HIV viral load through 1 year post-pregnancy by pregnancy outcome. We used group-based trajectory modelling to identify viral load trajectory groups in the first post-partum year after livebirths. We then compared sociodemographic and clinical factors across identified groups. We defined viraemia as 400 copies per mL or more. FINDINGS Between April 15, 2014, and Oct 1, 2017, we enrolled 323 women, of whom 234 had perinatal HIV infection, and reported age at sexual debut and history of heterosexual vaginal intercourse. Of the 172 pregnancies recorded in these women, 147 (85%, 104 livebirths and 43 spontaneous or elective abortions) were eligible for post-pregnancy viral load trajectory analyses (ie, had at least two viral loads in the year after end of pregnancy). Viral load increased by 0·7 log10 copies per mL (95% CI 0·5 to 1·0) in the first 12 weeks post partum after 104 livebirths, and subsequently stabilised from 13 weeks to 1 year post partum (slope -0·01 log10 copies per mL, 95% CI -0·3 to 0·3). By comparison, the average viral load trajectory after 43 spontaneous or elective abortions remained at less than 400 copies per mL. We identified three distinct groups of viral load trajectories after 104 livebirths, classified as reflecting sustained suppression (31 [30%]), rebound viraemia (55 [53%]), and persistent viraemia (18 [17%]). Women with sustained post-partum suppression were older at conception (22·9 years, IQR 19·4-25·9) than those with rebound viraemia (20·4 years, 18·8-22·2), or persistent post-partum viraemia (19·0 years, 17·7-20·5). Pre-conception viraemia and immune suppression were also strong risk factors for post-partum viraemia. INTERPRETATION Despite success achieving viral load suppression during pregnancy, women living with perinatal HIV infection have a high risk of post-partum viraemia. Younger age at conception, pre-conception viraemia, and pre-conception immune suppression could identify women in this population most likely to benefit from post-partum adherence interventions. FUNDING National Institutes of Health.
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Berhie S, Yee L, Jao J. The Reproductive Years of Women with Perinatally Acquired HIV: From Gynecologic Care to Obstetric Outcomes. Infect Dis Clin North Am 2019; 33:817-833. [PMID: 31248702 DOI: 10.1016/j.idc.2019.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Women with PHIV have distinct medical and social concerns in the context of lifelong immunosuppression, complex HIV care, and stigma because of with HIV from an early age. This article reviews the gynecologic and obstetric concerns experienced by women with PHIV. Cervical cancer screening is suboptimal, and data suggest higher rates of unintended pregnancy. Pregnant women with PHIV are younger and exposed to more antiretroviral therapy regimens compared with women with NPHIV. Although obstetric outcomes are similar between women with PHIV and NPHIV, there are concerns that infant morbidity may be increased in infants of women with PHIV.
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Affiliation(s)
- Saba Berhie
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Northwestern University Feinberg School of Medicine, 250 E Superior Street, Suite 5-2149, Chicago, IL 60611, USA.
| | - Lynn Yee
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Northwestern University Feinberg School of Medicine, 250 E Superior Street, Suite 5-2149, Chicago, IL 60611, USA
| | - Jennifer Jao
- Ann & Robert H. Lurie Children's Hospital of Chicago, Box 20, 225 E Chicago Avenue, Chicago, IL 60611, USA
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Maternal Perinatal HIV Infection Is Associated With Increased Infectious Morbidity in HIV-exposed Uninfected Infants. Pediatr Infect Dis J 2019; 38:500-502. [PMID: 30461574 PMCID: PMC6465126 DOI: 10.1097/inf.0000000000002253] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The aging population of females with perinatally-acquired HIV (PHIV) are having their own children. HIV-exposed uninfected infants (HEU-N) born to women living with non-perinatally-acquired HIV (NPHIV) experience higher infectious morbidity compared with HIV-unexposed infants (HUU). Little is known about the infectious morbidity risk of HIV-exposed uninfected infants (HEU-P) born to PHIV women. METHODS We evaluated prevalence of infectious cause hospitalizations (ICH) during the first year of life among HEU-P, HEU-N and HUU infants in a United States (U.S) tertiary care center. Maternal HIV status was categorized as PHIV vs. NPHIV vs. HIV-uninfected. Generalized Estimating Equation models were fit to evaluate the association between maternal HIV status and infant ICH. RESULTS ICH was evaluated among 205 infants, 28 HEU-P infants, 112 HEU-N infants, and 65 HUU infants. PHIV women were younger compared with NPHIV and HIV-uninfected women (median age 22 years vs. 29 and 23 respectively, p<0.01). Overall, 21% of HEU-P, 4% of HEU-N and 12% of HUU infants experienced at least one ICH event (p<0.01) in the first year of life. After adjusting for confounders, HEU-P infants were at increased ICH risk compared with HEU-N infants [adjusted odds ratio (aOR)=7.45, 95% Confidence Interval (CI):1.58-35.04]. In sub-group analysis of HEU infants, excluding HUU infants, this relationship persisted after adjustment for maternal CD4 and HIV RNA level (aOR=10.24, 95% CI:1.66-63.31) CONCLUSIONS:: In a small U.S. cohort, HEU-P infants experienced increased ICH risk. Differences in intrauterine environments, social factors, or access to care may be important factors to assess in future larger studies.
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Abstract
: The World Health Organization estimates that over four million children have been infected with HIV, most via perinatal transmission. The availability of safe and effective antiretroviral therapy (ART) has radically reduced mortality in this population and most that have access to ART are now thriving. However, long-term effects of HIV infection and its therapy have significant impact on aging adolescents and young adults with perinatal HIV infection. Many of the complications of long-term HIV infection seen in adults are also present, although the main impact of long-standing HIV infection and its treatment in children has been on growth and development, including neurodevelopment. A better understanding of the complexities of growing up with perinatal HIV will help prepare low and middle-income countries of the world where ART is now available to successfully manage their aging up populations of adolescents and young adults with perinatal HIV infection.
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Lazenby GB, Powell AM, Sullivan SA, Soper DE. The Impact of Delivery in a Rural County on a Cohort of Women Living with HIV Infection and Their Infants. J Rural Health 2018; 35:319-329. [PMID: 30010217 DOI: 10.1111/jrh.12312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE We sought to determine if infants born in rural counties had an increased risk of contracting HIV. METHODS Data were obtained from the South Carolina Department of Health and Environmental Control for all women living with HIV delivering from 2004 to 2014. In this retrospective cohort study, maternal and neonatal outcomes from urban and rural counties were compared. Binomial statistical analyses were conducted using Wilcoxon Rank Sum Tests, χ2 or Fisher's exact tests. Logistic regression analyses were performed to evaluate factors associated with perinatal HIV infection. FINDINGS Six hundred and sixty-six women living with HIV had 868 pregnancies and delivered 885 infants; 17% (148) were born in rural counties. Eleven infants (1.2%) were diagnosed with perinatal HIV infection. The proportion of women taking antenatal antiretroviral therapy (ART) was similar between rural and urban counties (84% vs 87%; P = .3), but women in urban counties were more likely to have an HIV RNA viral load <40 copies/mL before delivery (32% vs 42%; P = .05). Factors associated with perinatal HIV infection were intra- and postpartum maternal HIV diagnosis (aOR 61.4 [95% CI: 6.7-562.5]; P < .001), parenteral drug use (aOR 7.5 [1.6-34.7]; P = .01), and preterm birth (<37 weeks gestation) (aOR 4.6 [1.2-17.8]; P = .3). CONCLUSIONS Delivery in a rural county was not associated with an increased risk of perinatal HIV transmission. Women delivering in rural counties taking ART were less likely to have HIV viral suppression, which is a risk factor for perinatal HIV infection.
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Affiliation(s)
- Gweneth B Lazenby
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
| | - Anna M Powell
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
| | - Scott A Sullivan
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
| | - David E Soper
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
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