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Pasquale DK, Niehaus ED, Beyrer C. The Gaps That Remain: A Commentary on the 2024 JPHMP Article "Late Identification of Perinatal Transmission of HIV in an Infant at High-Risk". JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:619-621. [PMID: 39041755 DOI: 10.1097/phh.0000000000002005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Affiliation(s)
- Dana K Pasquale
- Department of Population Health Sciences (Dr Pasquale); Department of Medicine, Duke University School of Medicine (Dr Niehaus); Duke Global Health Institute, Duke University (Dr Beyrer); and Department of Medicine, Duke University School of Medicine, Durham, North Carolina (Dr Beyrer)
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Lampe MA, Nesheim SR, Mendoza MCB, Borkowf CB, Henderson AC, Ewing AC, Kourtis AP. Prevented perinatal HIV infections in the era of antiretroviral prophylaxis and treatment, United States, 1994-2020. Int J Gynaecol Obstet 2024; 166:126-134. [PMID: 38415793 DOI: 10.1002/ijgo.15438] [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: 07/20/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE The primary aim of this serial cross-sectional analysis is to estimate the total number of prevented perinatal HIV transmissions from the time of the initial recommendation for perinatal zidovudine (ZDV) prophylaxis in 1994 through 2020 in the US. METHODS The estimated number of prevented transmissions was calculated as annual differences between expected and observed numbers of perinatal HIV transmissions. Annual expected number of transmissions was estimated by multiplying the annual number of births to women with HIV by 0.2255 (22.55%), i.e., the transmission rate of the control group in the ACTG Protocol 076 trial. We used published point estimates or, if only ranges were given, the midpoints of those ranges as the best estimates of the annual numbers of births to women with HIV and infants with perinatal HIV. When data were not available, we linearly interpolated or extrapolated the available data to obtain estimated numbers for each year. RESULTS Between 1978 and 2020, the approximate number of live births to women with HIV was 191 267 (95% confidence interval [CI] 190 392-192 110) and for infants with diagnosed perinatal HIV, it was 21 379 (95% CI 21 088-21 695). Since 1994, the annual number of infants born with HIV decreased from 1263 (95% CI 1194-1333) to 33 in 2019 (95% CI 22-45) and 36 in 2020 (95% CI 25-48), corresponding to a 97% reduction. Cumulatively, an estimated total of 22 732 (95% CI 21 340-24 462) perinatal HIV infections were prevented from 1994 through to 2020. CONCLUSION The elimination of perinatal HIV transmission-accompanied by the cumulative number of prevented cases exceeding that of perinatal HIV infections-is a major public health achievement in the US.
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Affiliation(s)
- Margaret A Lampe
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Steven R Nesheim
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maria C B Mendoza
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Craig B Borkowf
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alexis C Henderson
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- DLH Corporation, Atlanta, Georgia, USA
| | - Alexander C Ewing
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Athena P Kourtis
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Al Yazidi LS, Britton PN, Gilroy N, Lai T, Kesson A. Post-Natal Anti-Retroviral Prophylaxis for Neonates Born to Mothers Living with Resistant HIV Infection. Sultan Qaboos Univ Med J 2023; 23:405-410. [PMID: 37655070 PMCID: PMC10467559 DOI: 10.18295/squmj.5.2022.039] [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: 01/31/2022] [Revised: 04/24/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
Mother-to-child transmission accounts for the majority of new HIV infections among children worldwide. Post-natal prophylaxis, in addition to other preventive measures, have been very successful in reducing transmission to babies born to mothers living with HIV infection to <2%. Single-drug prophylaxis with zidovudine is the mainstay regimen for infants in low-risk transmission settings. The optimal regimen for newborns of women with anti-retroviral (ARV)-resistant HIV is unknown. We report a baby born to a young mother living with highly resistant perinatally-acquired HIV at a tertiary care centre in Sydney, Australia, in 2018. Furthermore, the challenges with giving postnatal ARV prophylaxis to her baby, in light of the lack of dosing and safety data for many antiretroviral agents for neonates, is discussed. The baby received a combination of lamivudine and raltegravir for a total of six weeks and he was not breast-fed. He had negative HIV proviral DNA polymerase chain reaction at six weeks and three months and a negative HIV serology at 18 months of age.
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Affiliation(s)
- Laila S. Al Yazidi
- Infectious Diseases and Microbiology, The Children’s Hospital at Westmead, Sydney, Australia
- Department of Child Health, College of Medicine, Sultan Qaboos University, Muscat, Oman
| | - Philip N. Britton
- Infectious Diseases and Microbiology, The Children’s Hospital at Westmead, Sydney, Australia
- Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia
| | - Nicole Gilroy
- Centre for Infectious Diseases and Microbiology, Westmead Hospital NSW, Sydney, Australia
| | - Tony Lai
- Infectious Diseases and Microbiology, The Children’s Hospital at Westmead, Sydney, Australia
| | - Alison Kesson
- Infectious Diseases and Microbiology, The Children’s Hospital at Westmead, Sydney, Australia
- Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia
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Lin D, Zhang C, Shi H. Adverse Impact of Intimate Partner Violence Against HIV-Positive Women During Pregnancy and Post-Partum: Results From a Meta-Analysis of Observational Studies. TRAUMA, VIOLENCE & ABUSE 2023; 24:1624-1639. [PMID: 35258353 DOI: 10.1177/15248380211073845] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Objectives: Intimate partner violence (IPV) against pregnant or human immunodeficiency virus (HIV)-positive women have been previously studied. However, data on the impact of IPV on HIV-positive pregnant women have not been systematically synthesized. We performed a meta-analysis to explore this issue and provide evidence regarding IPV prevention and HIV infection control. Method: The PubMed, Web of Science, Cochrane Library, and Embase databases were systematically searched. Studies that quantitatively assessed the association between IPV and its adverse impact on HIV-positive women during pregnancy and post-partum were eligible for inclusion. Pooled odds ratios (ORs) were calculated. Findings: Eight studies were identified to meet our eligibility criteria. The adverse impacts of IPV against HIV-positive pregnant women mainly included nonadherence to maternal antiretroviral treatment during pregnancy, nondisclosure of HIV-positive status to male partners, nonadherence to infant antiretroviral prophylaxis, and antenatal depression. IPV caused a 180% and 145% increase in the odds of antenatal depression and nonadherence to infant antiretroviral prophylaxis, respectively, among HIV-positive women, compared to the odds of their IPV-free counterparts [OR = 2.80, 95% confidence interval (CI): 1.66-4.74; OR = 2.45, 95% CI: 1.40-4.27]. Conclusion: Limited evidence has suggested that IPV against HIV-positive pregnant women caused maternal depression during pregnancy and led to the possible failure of HIV prophylaxis adherence in infants. Interventions to address IPV may ultimately reduce the risk of depression-related adverse birth outcomes and vertical transmission in infants exposed to maternal HIV. Prevention and control against IPV should be developed for HIV-positive pregnant women.
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Affiliation(s)
- Dan Lin
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
| | - Chunyang Zhang
- Fujian Centre for Disease Control and Prevention, Fuzhou, China
| | - Huijing Shi
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
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5
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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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6
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Abstract
Maternal pathogens can be transmitted to the fetus resulting in congenital infection with sequelae ranging from asymptomatic infection to severe debilitating disease and still birth. The TORCH pneumonic (toxoplasmosis, rubella, cytomegalovirus, and herpes simplex virus) is used widely, but it provides a limited description of the expanding list of pathogens associated with congenital infection. This article focuses on the evaluation and management of infants with common congenital infections such as cytomegalovirus, and infections that warrant early diagnosis and treatment to prevent serious complications, such as toxoplasmosis, human immunodeficiency virus, and syphilis. Zika virus and Chagas disease remain uncommon.
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Affiliation(s)
- Amaran Moodley
- Department of Pediatrics, Rady Childrens Hospital & University of California San Diego, 3020 Children's Way, MC 5041, San Diego, CA 92123, USA
| | - Kurlen S E Payton
- David Geffen School of Medicine at University of California Los Angeles, Division of Neonatology, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, NT Suite 4221, Los Angeles, CA 90048, USA.
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7
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Lin SH, Wang Y, Hartley SW, Karyadi DM, Lee OW, Zhu B, Zhou W, Brown DW, Beilstein-Wedel E, Hazra R, Kacanek D, Chadwick EG, Marsit CJ, Poirier MC, Brummel SS, Chanock SJ, Engels EA, Machiela MJ. In-utero exposure to zidovudine-containing antiretroviral therapy and clonal hematopoiesis in HIV-exposed uninfected newborns. AIDS 2021; 35:1525-1535. [PMID: 33756513 PMCID: PMC8286286 DOI: 10.1097/qad.0000000000002894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Zidovudine (ZDV) has been extensively used in pregnant women to prevent vertical transmission of HIV but few studies have evaluated potential mutagenic effects of ZDV during fetal development. DESIGN Our study investigated clonal hematopoiesis in HIV-exposed uninfected (HEU) newborns, 94 of whom were ZDV-exposed and 91 antiretroviral therapy (ART)-unexposed and matched for potential confounding factors. METHODS Utilizing high depth sequencing and genotyping arrays, we comprehensively examined blood samples collected during the first week after birth for potential clonal hematopoiesis associated with fetal ZDV exposure, including clonal single nucleotide variants (SNVs), small insertions and deletions (indels), and large structural copy number or copy neutral alterations. RESULTS We observed no statistically significant difference in the number of SNVs and indels per person in ZDV-exposed children (adjusted ratio [95% confidence interval, CI] for expected number of mutations = 0.79 [0.50--1.22], P = 0.3), and no difference in the number of large structural alterations. Mutations in common clonal hematopoiesis driver genes were not found in the study population. Mutational signature analyses on SNVs detected no novel signatures unique to the ZDV-exposed children and the mutational profiles were similar between the two groups. CONCLUSION Our results suggest that clonal hematopoiesis at levels detectable in our study is not strongly influenced by in-utero ZDV exposure; however, additional follow-up studies are needed to further evaluate the safety and potential long-term impacts of in-utero ZDV exposure in HEU children as well as better investigate genomic aberrations occurring late in pregnancy.
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Affiliation(s)
- Shu-Hong Lin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville
| | - Youjin Wang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville
| | - Stephen W Hartley
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville
| | - Danielle M Karyadi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville
| | - Olivia W Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville
| | - Bin Zhu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville
| | - Weiyin Zhou
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Derek W Brown
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville
| | - Erin Beilstein-Wedel
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Rohan Hazra
- Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Deborah Kacanek
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ellen G Chadwick
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Carmen J Marsit
- Departments of Environmental Health and Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Miriam C Poirier
- Carcinogen-DNA Interactions Section, Laboratory of Cancer Biology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sean S Brummel
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville
| | - Mitchell J Machiela
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville
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Larki M, Bahri N, Moghri J, Latifnejad Roudsari R. Living with Discordance: A Qualitative Description of the Challenges Faced by HIV Negative Married Women. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2020; 8:103-115. [PMID: 32309452 PMCID: PMC7153425 DOI: 10.30476/ijcbnm.2020.82845.1093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Serodiscordant couples are faced with many social, sexual and relationship challenges in all aspects of their lives.
The sources of conflicts could be disease acquisition, transfer of HIV to the uninfected partner, and fertility decisions.
The current qualitative study was designed to explore the challenges faced by HIV negative women in serodiscordant relationships. Methods: This qualitative description was conducted in Mashhad, Northeast of Iran, between October 2018 and June 2019. 15 HIV-negative
women who were living with their HIV-positive husbands were selected through purposive sampling method. The data were collected
using semi-structured interviews. Data were analyzed using conventional content analysis adopted by Graneheim and Lundman.
MAXQDA version 12, was used for data organization. Components of rigor including credibility, dependability, confirmability and transferability were considered. Results: The main overarching theme which emerged from the qualitative study was “threats to family life”, consisting of five categories
along with their subcategories. These categories included stigmatic reactions followed by disclosure of the status, social misconceptions
and limitation of information sources, psychological disruptions, hard decision making for fertility, and role conflict in the family. Conclusion: This study provides an insight into different aspects of challenges faced by Iranian women in HIV-serodiscordant relationships. Also,
our study supports the view of other investigators who believe that there is an urgent need for provision of counseling and empowerment interventions for HIV- serodiscordant couples.
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Affiliation(s)
- Mona Larki
- Student Research Committee, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Narjes Bahri
- Department of Midwifery, School of Medicine, Social Development & Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Javad Moghri
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Robab Latifnejad Roudsari
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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Owens DK, Davidson KW, Krist AH, Barry MJ, Cabana M, Caughey AB, Curry SJ, Doubeni CA, Epling JW, Kubik M, Landefeld CS, Mangione CM, Pbert L, Silverstein M, Simon MA, Tseng CW, Wong JB. Screening for HIV Infection: US Preventive Services Task Force Recommendation Statement. JAMA 2019; 321:2326-2336. [PMID: 31184701 DOI: 10.1001/jama.2019.6587] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Approximately 1.1 million persons in the United States are currently living with HIV, and more than 700 000 persons have died of AIDS since the first cases were reported in 1981. There were approximately 38 300 new diagnoses of HIV infection in 2017. The estimated prevalence of HIV infection among persons 13 years and older in the United States is 0.4%, and data from the Centers for Disease Control and Prevention show a significant increase in HIV diagnoses starting at age 15 years. An estimated 8700 women living with HIV give birth each year in the United States. HIV can be transmitted from mother to child during pregnancy, labor, delivery, and breastfeeding. The incidence of perinatal HIV infection in the United States peaked in 1992 and has declined significantly following the implementation of routine prenatal HIV screening and the use of effective therapies and precautions to prevent mother-to-child transmission. OBJECTIVE To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on screening for HIV infection in adolescents, adults, and pregnant women. EVIDENCE REVIEW The USPSTF reviewed the evidence on the benefits and harms of screening for HIV infection in nonpregnant adolescents and adults, the yield of screening for HIV infection at different intervals, the effects of initiating antiretroviral therapy (ART) at a higher vs lower CD4 cell count, and the longer-term harms associated with currently recommended ART regimens. The USPSTF also reviewed the evidence on the benefits (specifically, reduced risk of mother-to-child transmission of HIV infection) and harms of screening for HIV infection in pregnant persons, the yield of repeat screening for HIV at different intervals during pregnancy, the effectiveness of currently recommended ART regimens for reducing mother-to-child transmission of HIV infection, and the harms of ART during pregnancy to the mother and infant. FINDINGS The USPSTF found convincing evidence that currently recommended HIV tests are highly accurate in diagnosing HIV infection. The USPSTF found convincing evidence that identification and early treatment of HIV infection is of substantial benefit in reducing the risk of AIDS-related events or death. The USPSTF found convincing evidence that the use of ART is of substantial benefit in decreasing the risk of HIV transmission to uninfected sex partners. The USPSTF also found convincing evidence that identification and treatment of pregnant women living with HIV infection is of substantial benefit in reducing the rate of mother-to-child transmission. The USPSTF found adequate evidence that ART is associated with some harms, including neuropsychiatric, renal, and hepatic harms, and an increased risk of preterm birth in pregnant women. The USPSTF concludes with high certainty that the net benefit of screening for HIV infection in adolescents, adults, and pregnant women is substantial. CONCLUSIONS AND RECOMMENDATION The USPSTF recommends screening for HIV infection in adolescents and adults aged 15 to 65 years. Younger adolescents and older adults who are at increased risk of infection should also be screened. (A recommendation) The USPSTF recommends screening for HIV infection in all pregnant persons, including those who present in labor or at delivery whose HIV status is unknown. (A recommendation).
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Affiliation(s)
| | - Douglas K Owens
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Stanford University, Stanford, California
| | - Karina W Davidson
- Feinstein Institute for Medical Research at Northwell Health, Manhasset, New York
| | - Alex H Krist
- Fairfax Family Practice Residency, Fairfax, Virginia
- Virginia Commonwealth University, Richmond
| | | | | | | | | | | | | | | | | | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
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10
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Abstract
The number of infants born with HIV in the United States has decreased for years, approaching the Centers for Disease Control and Prevention's incidence goal for eliminating perinatal HIV transmission. We reviewed recent literature on perinatal HIV transmission in the United States. Among perinatally HIV-exposed infants (whose mothers have HIV, without regard to infants' HIV diagnosis), prenatal and natal antiretroviral use has increased, maternal HIV infection is more frequently diagnosed before pregnancy and breast-feeding is uncommon. In contrast, mothers of infants with HIV are tested at a lower rate for HIV, receive prenatal care less often, receive antiretrovirals (prenatal and natal) less often and breastfeed more often. The incidence of perinatal HIV remains 5 times as high among black than white infants. The annual number of births to women with HIV was estimated last for 2006 (8700) but has likely decreased. The numbers of women of childbearing age living with HIV and HIV diagnoses have decreased. The estimated time from HIV infection to diagnosis remains long among women and men who acquired HIV heterosexually. It is important to review the epidemiology and to continue monitoring outcomes and other health indicators for reproductive age adults living with HIV and their infants.
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11
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Tran NK, Welles SL. Four Decades of Epidemiologic Science on HIV Infection and Disease, and Its Impact on Public Health Practice and Policy for Sexual and Gender Minority Persons. Dela J Public Health 2019; 5:64-71. [PMID: 34467031 PMCID: PMC8396754 DOI: 10.32481/djph.2019.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Even at the cusp of the second decade of the new millennia, HIV continues to be a significant public health challenge for sexual and gender minorities (SGM). Men who have sex with men and transgender women, in particular, continue to report higher rates of HIV incidence compared to their heterosexual counterparts, while facing significant barriers to comprehensive sexual healthcare. In Delaware, HIV infection impacts a substantial number of individuals with approximately 14.5 incident cases per 100,000. This ranks Delaware as the 14th highest for HIV incidence among U.S. states. However, the largest healthcare provider in Delaware, Christiana Care Health System, has created many health initiatives to support the health needs of SGM and those living with HIV. The current sustained rate of HIV infection indicates the need for enhanced epidemiologic work to identify HIV cases in subgroups of diverse sexuality and gender identity, collaboration within and across research institution and community organizations, as well as engagement in creative solutions that target the multiple levels of factors contributing to HIV incidence. In addition, it is imperative that local agencies and health organizations continue to support these communities of SGM individuals during the current sociopolitical climate of the national U.S. government.
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Affiliation(s)
- Nguyen K Tran
- Department of Epidemiology & Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA
| | - Seth L Welles
- Department of Epidemiology & Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA
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12
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HIV Status and Other Risk Factors for Prevalent and Incident Sexually Transmitted Infection during Pregnancy (2000-2014). Infect Dis Obstet Gynecol 2019; 2019:6584101. [PMID: 31057323 PMCID: PMC6463595 DOI: 10.1155/2019/6584101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/28/2019] [Accepted: 03/14/2019] [Indexed: 02/07/2023] Open
Abstract
Background Sexually transmitted infections (STIs) are associated with adverse birth outcomes. Current prenatal STI screening guidelines define "risk" without explicit consideration of HIV status. Our objective was to test the hypothesis that HIV status is associated with bacterial STI in pregnant women. Methods We designed a retrospective cohort study to identify pregnant women with HIV who delivered at our facility during 2000-2014. HIV+ women were compared to HIV- women with matching by year of delivery. Logistic regression was used to model adjusted odds of prevalent and incident STI. Prevalent STI was defined as chlamydia (CT), gonorrhea (GC), syphilis, or trichomoniasis detected on an initial prenatal screening test and incident STI as a newly positive result following a negative prenatal test. Results The cohort included 432 women, 210 HIV+ and 222 HIV-. Most pregnant women were screened for STI (92% of HIV+ women and 74% of HIV- women). STI rates were high and particularly elevated in HIV+ women: 29% vs 18% (p=0.02), for prevalent STI and 11% vs 2% (p<0.001) for incident STI. Risk factors for prevalent STI were as follows: HIV status (aOR 3.0, CI: 1.4-6.4), Black race (aOR 2.7, 95% CI: 1.1-6.6), and more recent delivery (2007-2014 compared to 2000-2006) (aOR 2.3, CI: 1.1-4.7). HIV status was an independent risk factor for incident STI (aOR 7.2, CI: 2.1-25.0). Conclusion Pregnant women who delivered in our center had high STI rates. Since HIV infection was independently associated with prevalent and incident STI, prenatal screening guidelines may need to incorporate HIV status as a high-risk group for repeat testing.
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García-Otero L, López M, Guitart-Mampel M, Morén C, Goncé A, Esteve C, Salazar L, Gómez O, Martínez JM, Torres B, César S, Garrabou G, Crispi F, Gratacós E. Cardiac and mitochondrial function in HIV-uninfected fetuses exposed to antiretroviral treatment. PLoS One 2019; 14:e0213279. [PMID: 30830946 PMCID: PMC6398922 DOI: 10.1371/journal.pone.0213279] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 02/18/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Mitochondrial toxicity related to maternal combined antiretroviral treatment (cART) may have an impact on the heart of HIV-exposed uninfected (HEU) fetuses. Our objective was to evaluate fetal cardiovascular and mitochondrial biomarkers in HIV pregnancies. METHODS Prospective cohort including 47 HIV-infected and 47 non HIV-infected pregnancies. Fetal echocardiography was performed at 26-32 weeks of pregnancy. Umbilical cord blood and placental tissue were collected to study mitochondrial DNA content (mtDNA) (ratio 12SrRNA/RNAseP) and mitochondrial function (cytochrome c oxidase, COX, enzymatic activity) normalized by mitochondrial content (citrate synthase, CS). RESULTS HEU fetuses showed hypertrophic hearts (left myocardial wall thickness: HIV mean 3.21 mm (SD 0.81) vs. non-HIV 2.72 (0.42), p = 0.012), with signs of systolic and diastolic dysfunction (isovolumic relaxation time: HIV 52.2 ms (8.85) vs. non-HIV 42.5 ms (7.30); p<0.001). Cord blood mitochondrial content was significantly increased in HIV-exposed fetuses (CS activity: HIV 82.9 nmol/min.mg of protein (SD 40.5) vs. non-HIV 56.7 nmol/min.mg of protein (28.4); p = 0.007), with no differences in mtDNA content and COX activity. Both myocardial and mitochondrial mass parameters were significantly associated with zidovudine exposure. CONCLUSIONS HEU fetuses showed signs of increased myocardial and mitochondrial mass associated with maternal zidovudine treatment, suggesting a fetal adaptive response to cART toxicity.
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Affiliation(s)
- Laura García-Otero
- Fetal i+D Fetal Medicine Research Center, BCNatal—Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Marta López
- Fetal i+D Fetal Medicine Research Center, BCNatal—Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Mariona Guitart-Mampel
- Muscle Research and Mitochondrial Function Laboratory, Cellex IDIBAPS, Faculty of Medicine and Health Sciences-University of Barcelona, Internal Medicine Service-Hospital Clínic of Barcelona (Barcelona, Spain) and CIBER-ER
| | - Constanza Morén
- Muscle Research and Mitochondrial Function Laboratory, Cellex IDIBAPS, Faculty of Medicine and Health Sciences-University of Barcelona, Internal Medicine Service-Hospital Clínic of Barcelona (Barcelona, Spain) and CIBER-ER
| | - Anna Goncé
- Fetal i+D Fetal Medicine Research Center, BCNatal—Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Carol Esteve
- Fetal i+D Fetal Medicine Research Center, BCNatal—Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Laura Salazar
- Fetal i+D Fetal Medicine Research Center, BCNatal—Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Olga Gómez
- Fetal i+D Fetal Medicine Research Center, BCNatal—Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Josep María Martínez
- Fetal i+D Fetal Medicine Research Center, BCNatal—Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Berta Torres
- Infectious Diseases Department, Hospital Clínic, Fundació Clínic per a la Recerca Biomèdica (FCRB), Barcelona, Spain
| | - Sergi César
- Department of Pediatric Cardiology, Hospital Sant Joan de Déu Barcelona, University of Barcelona, Barcelona, Spain
| | - Glòria Garrabou
- Muscle Research and Mitochondrial Function Laboratory, Cellex IDIBAPS, Faculty of Medicine and Health Sciences-University of Barcelona, Internal Medicine Service-Hospital Clínic of Barcelona (Barcelona, Spain) and CIBER-ER
| | - Fàtima Crispi
- Fetal i+D Fetal Medicine Research Center, BCNatal—Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Eduard Gratacós
- Fetal i+D Fetal Medicine Research Center, BCNatal—Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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14
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Gnanashanmugam D, Rakhmanina N, Crawford KW, Nesheim S, Ruel T, Birkhead GS, Chakraborty R, Lawrence R, Jean-Philippe P, Jayashankar L, Hoover A, Statton A, DʼSouza P, Fitzgibbon J, Hazra R, Warren B, Smith S, Abrams EJ. Eliminating perinatal HIV in the United States: mission possible? AIDS 2019; 33:377-385. [PMID: 30475262 PMCID: PMC6355361 DOI: 10.1097/qad.0000000000002080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: In 2015, only 53 infants born in the United States acquired HIV - the lowest recorded number of perinatal HIV infections. Recognizing this significant achievement, we must acknowledge that the United States has not yet reached the goal of eliminating perinatal HIV transmission. This analysis describes different approaches to perinatal HIV preventive services among five states and the District of Columbia as case studies. Continuous focus on improving identification, surveillance and prevention of HIV infection in pregnant women and their infants is necessary to reach the goal of eliminating perinatal HIV transmission in the United States.
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Affiliation(s)
- Devasena Gnanashanmugam
- Division of AIDS, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | - Natella Rakhmanina
- Children's National Medical Center, Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia
| | - Keith W Crawford
- Division of AIDS, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | - Steven Nesheim
- Centers for Disease Control and Prevention (Division of HIV/AIDS Prevention), Atlanta, Georgia
| | - Theodore Ruel
- University of California- San Francisco, San Francisco, California
| | | | | | | | - Patrick Jean-Philippe
- Division of AIDS, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | - Lakshmi Jayashankar
- Columbus Technologies Inc., Contractor to National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | - Ashley Hoover
- Louisiana State Department of Health, Baton Rouge, Louisiana
| | - Anne Statton
- Pediatric AIDS Chicago Prevention Initiative, Chicago, Illinois
| | - Patricia DʼSouza
- Division of AIDS, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | - Joseph Fitzgibbon
- Division of AIDS, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | - Rohan Hazra
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | | | - Somer Smith
- Emory University School of Medicine, Atlanta, Georgia
- Theratechnologies, Inc., Montreal, Quebec, Canada
| | - Elaine J Abrams
- ICAP at Columbia University, Mailman School of Public Health and Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, USA
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15
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Oliver C, Rebeiro PF, Hopkins MJ, Byram B, Carpenter L, Clouse K, Castilho JL, Rogers W, Turner M, Bebawy SS, Pettit AC. Substance Use, Demographic and Socioeconomic Factors Are Independently Associated With Postpartum HIV Care Engagement in the Southern United States, 1999-2016. Open Forum Infect Dis 2019; 6:ofz023. [PMID: 30793010 PMCID: PMC6372056 DOI: 10.1093/ofid/ofz023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 01/14/2019] [Indexed: 11/21/2022] Open
Abstract
Background Retention in care (RIC) and viral suppression (VS) are associated with reduced HIV transmission and mortality. Studies addressing postpartum engagement in HIV care have been limited by small sample size, short follow-up, and a lack of data from the Southeast United States. Methods HIV-positive adult women with ≥1 prenatal visit at the Vanderbilt Obstetrics Comprehensive Care Clinic from 1999 to 2015 were included. Poor RIC was defined as not having ≥2 encounters per year, ≥90 days apart; poor VS was a viral load >200 copies/mL. Modified Poisson regression was used to estimate adjusted relative risks (aRRs) of poor postpartum RIC and VS. Results Among 248 women over 2070 person-years of follow-up, 37.6% person-years had poor RIC and 50.4% lacked VS. Prenatal substance use was independently associated with poor RIC (aRR, 1.40; 95% confidence interval [CI], 1.08–1.80) and poor VS (aRR, 1.20; 95% CI, 1.04–1.38), and lack of VS at enrollment was associated with poor RIC (aRR, 1.64; 95% CI, 1.15–2.35) and poor VS (aRR, 1.59; 95% CI, 1.30–1.94). Hispanic women were less likely and women with lower educational attainment were more likely to have poor RIC. Women >30 years of age and married women were less likely to have poor VS. Conclusions In this population of women in prenatal care at an HIV primary medical home in Tennessee, women with prenatal substance use and a lack of VS at enrollment into prenatal care were at greater risk of poor RIC and lack of VS postpartum. Interventions aimed at improving postpartum engagement in HIV care among these high-risk groups are needed.
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Affiliation(s)
- Cassandra Oliver
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Peter F Rebeiro
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee.,Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mary J Hopkins
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Beverly Byram
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lavenia Carpenter
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kate Clouse
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jessica L Castilho
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Megan Turner
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sally S Bebawy
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - April C Pettit
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee.,Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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16
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Siegel K, Meunier É, Tocco JU, Lekas HM. Reproductive Desires and Considerations of HIV-Positive Men in Heterosexual Relationships in New York City. AIDS Behav 2018; 22:1736-1749. [PMID: 28726042 PMCID: PMC5786488 DOI: 10.1007/s10461-017-1864-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The reproductive desires of HIV-positive men have been investigated far less than those of HIV-positive women, especially in the US. This qualitative study of a sample of 94 HIV-positive men in New York City who were in a relationship with a woman of reproductive age examined their reasons for wanting a child as well as the conditions under which they would feel ready to attempt conception. Participants felt a child would make them feel normal, give meaning to their lives, or make others in their life happy. Although they reported HIV-related concerns (i.e., horizontal or vertical transmission, reinfection, or shortened life expectancy), participants mostly discussed factors unrelated to HIV (e.g., finances, housing, incarceration, substance abuse, or relationships) as deterrents to acting on their desire to having a child. When providing information on safer conception, healthcare providers should be aware of the broad desires and factors informing HIV-positive men's reproductive goals.
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Affiliation(s)
- Karolynn Siegel
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Medical Center, 722 West 168th Street, 9th Fl., New York, NY, 10032, USA.
| | - Étienne Meunier
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Medical Center, 722 West 168th Street, 9th Fl., New York, NY, 10032, USA
| | - Jack Ume Tocco
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Helen-Maria Lekas
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Medical Center, 722 West 168th Street, 9th Fl., New York, NY, 10032, USA
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
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17
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Siegel K, Meunier É, Lekas HM. The experience and management of HIV stigma among HIV-negative adults in heterosexual serodiscordant relationships in New York City. AIDS Care 2018; 30:871-878. [PMID: 29458264 DOI: 10.1080/09540121.2018.1441971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Despite treatment advances that have improved the health and life expectancy of HIV-positive people and contribute to the prevention of HIV transmission, HIV stigma is still frequently experienced by HIV-infected individuals and those close to them. This study investigated the types of HIV-related stigma experienced by HIV-negative adults in serodiscordant heterosexual relationships when their partner's HIV-positive status was revealed to family and friends and their strategies to manage such stigma. In-depth interviews were conducted in New York City with 56 men and 44 women who were HIV negative and had been in a relationship for at least six months with an HIV-positive partner of the opposite sex. Those who had disclosed the HIV status of their partner to family or friends experienced four main types of stigmatizing behaviours: distancing (avoidance of the participant or his/her partner for fear of infection), depreciation of the partner (being told their partner is not worthy of them), violation of privacy (people spreading the information that the partner is HIV positive), or accusations (being told that it was wrong to be in a relationship with HIV-positive people or to try to conceive with them). Participants described four main ways of managing actual or anticipated stigma: secrecy (not disclosing the HIV status of their partner to anyone), avoidance (breaking ties with people who held stigmatizing views), seeking support from their partner or the HIV-positive community (e.g., HIV-related organizations or their partner's family or friends), or education (informing family or friends about HIV treatment and prevention). Findings show that HIV-related "courtesy" stigma is frequently experienced by HIV-negative people in serodiscordant relationships but often can be managed. Offering support to individuals in serodiscordant relationships can improve the quality of life of HIV-positive people and their HIV-negative partners and potentially reduce HIV stigma.
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Affiliation(s)
- Karolynn Siegel
- a Department of Sociomedical Sciences , Columbia University Mailman School of Public Health , New York , NY , USA
| | - Étienne Meunier
- a Department of Sociomedical Sciences , Columbia University Mailman School of Public Health , New York , NY , USA
| | - Helen-Maria Lekas
- a Department of Sociomedical Sciences , Columbia University Mailman School of Public Health , New York , NY , USA.,b Nathan Kline Institute for Psychiatric Research , Orangeburg , NY , USA
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18
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Takah NF, Atem JA, Aminde LN, Malisheni M, Murewenhema G. Male partner involvement in increasing the uptake of infant antiretroviral prophylaxis/treatment in sub Saharan Africa: A systematic review and meta-analysis. BMC Public Health 2018; 18:249. [PMID: 29439695 PMCID: PMC5812221 DOI: 10.1186/s12889-018-5171-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 02/09/2018] [Indexed: 11/23/2022] Open
Abstract
Background Infant antiretroviral prophylaxis plays an important role towards ensuring the reduction of HIV transmission from mother to child in the postpartum period. However in sub Saharan Africa (SSA), the low level of involvement of male partners may hinder the uptake of such services by HIV positive mothers. We conducted a systematic review and meta-analysis to determine the impact of male partner involvement approaches on the uptake of infant antiretroviral prophylaxis in SSA. Methods In this systematic review and meta-analysis, Ovid Medline, Embase, PsycINFO, Cochrane library, ClinicalTrials.gov, Web of Science and Current Controlled Trials were searched from 1st December 2015 up until 30th March 2016. Only studies carried out in SSA that reported an approach used in involving male partners and the impact on the uptake of infant antiretroviral prophylaxis irrespective of the Language and date of publication were included. Odds ratios were extracted or calculated from studies and combined in a meta-analysis using the statistical package Stata version 11.0. Forest plots were generated using the random effect model. Results From an initial 2316 non-duplicate articles, 09 articles were included in the systematic review and meta-analysis. The pooled unadjusted odds ratio was 2.09(95% CI: 1.31 to 3.36) while the unadjusted odds ratios for enhanced psychosocial interventions (02 studies pooled), complex community interventions (02 studies pooled), verbal encouragement (02 studies pooled) and invitation letters(03 pooled studies) were 3.48(95% CI: 1.42 to 8.53), 1.85(95%CI: 0.85 to 4.03), 2.37(95%CI: 1.22 to 4.61) and 1.81(95%CI: 0.64 to 5.14) respectively. I squared was 89.5%, p < 0.001 and the heterogeneity was not explained by any of the variables in meta-regression. Conclusion There was stronger evidence for enhanced psychosocial intervention and verbal encouragement in increasing the uptake of infant prophylaxis. The high heterogeneity suggests more studies are needed to draw a definite inference from the meta-analysis. More studies with larger sample sizes that are conducted using similar methods are needed in the future. Trial registration Prospero registration number: 42016032673.
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Affiliation(s)
- Noah F Takah
- Department of Maternal and Child Health, Limbe Regional Hospital, Ministry of Public Health, Limbe Health District, Limbe, South West Region, Cameroon. .,Department of Clinical Research, London School of Hygiene and Tropical Medicine, Harare, UK.
| | - Jeannine A Atem
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Leopold N Aminde
- Faculty of Health Sciences, University of Buea, Buea, Cameroon.,School of Public Health, University of Queensland, Brisbane, Australia
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19
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Acheampong AK, Naab F, Kwashie A. The Voices That Influence HIV-Positive Mothers' Breastfeeding Practices in an Urban, Ghanaian Society. J Hum Lact 2018; 34:176-183. [PMID: 29268662 DOI: 10.1177/0890334417740345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The World Health Organization recommends that HIV-positive mothers should breastfeed for at least 1 year. There are people in the lives of these mothers who influence their decisions. Research aim: The aim was to explore the role of social persuasion in the decision-making processes of HIV-positive breastfeeding mothers. METHODS A qualitative, exploratory research design was employed ( N = 13). Participants were recruited from a public hospital in the Greater Accra Region of Ghana. One-on-one interviews were recorded and transcribed verbatim, and the contents of the transcripts were analyzed for emerging themes. RESULTS The perspectives of spouses, health workers, counselors, and siblings about breastfeeding affect the breastfeeding practices of mothers living with HIV in Ghana. Most of the women had negative experiences with their midwives. Because of complex social and cultural influences, the opinions of spouses, health professionals, siblings, and members of the communities in which breastfeeding mothers with HIV live influence breastfeeding practices. CONCLUSION This study described HIV-positive, breastfeeding mothers' perceptions of the role played by spouses, health professionals, siblings, and the community in breastfeeding decisions and practices. Influential people in the lives of breastfeeding mothers with HIV should be involved during interventions by HIV counselors to promote breastfeeding practices.
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Affiliation(s)
| | - Florence Naab
- 2 Department of Maternal and Child Health, School of Nursing, College of Health Sciences, University of Ghana, Legon, Greater Accra, Ghana
| | - Adzo Kwashie
- 3 Department of Education and Administration, School of Nursing, College of Health Sciences, University of Ghana, Legon, Greater Accra, Ghana
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20
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Williams PL, Huo Y, Rutstein R, Hazra R, Rough K, Van Dyke RB, Chadwick EG, for the Pediatric HIV/AIDS Cohort S. Trends in Neonatal Prophylaxis and Predictors of Combination Antiretroviral Prophylaxis in US Infants from 1990 to 2015. AIDS Patient Care STDS 2018; 32:48-57. [PMID: 30346801 DOI: 10.1089/apc.2017.0295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Postnatal antiretroviral (ARV) prophylaxis for infants born to women with HIV is a critical component of perinatal HIV transmission prevention. However, variability in prophylaxis regimens remains and consistency with guidelines has not been evaluated in the United States. We evaluated trends over time in prophylaxis regimens among 6386 HIV-exposed uninfected (HEU) infants using pooled data spanning two decades from three US-based cohorts: the Women and Infants Transmission Study (WITS, 1990-2007), Pediatric AIDS Clinical Trials Group (PACTG) 219C (1993-2007), and the PHACS Surveillance Monitoring of ART Toxicities (SMARTT) study (2007-2015). We also identified maternal and infant risk factors for use of combination prophylaxis regimens (≥2 ARVs) and examined consistency with US perinatal guidelines. We found that receipt of combination prophylaxis between 1996 and 2015 ranged from 2% to 15%, with a consistent median duration of 6 weeks. Infants whose mothers had lower CD4 T-cell counts, higher viral load (VL), no antepartum ARVs, age <20 years at delivery, and Cesarean delivery had significantly higher rates of combination prophylaxis, while infants born 2006-2010 (vs. 2011-2015), who were Hispanic or with lower maternal education levels, had significantly lower rates. Predictors for combination prophylaxis varied over time, with the strongest associations of maternal VL in later birth cohorts. While use of combination prophylaxis increased over time, only 50% of high-risk infants received such regimens in 2011-2015. In conclusion, HEU infants at higher risk of HIV acquisition are more likely to receive combination neonatal prophylaxis, consistent with US guidelines. However, substantial variability remains, and infants at higher risk often fail to receive combination prophylaxis.
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Affiliation(s)
- Paige L. Williams
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Yanling Huo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Richard Rutstein
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rohan Hazra
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Kathryn Rough
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Russell B. Van Dyke
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana
| | - Ellen G. Chadwick
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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21
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Nesheim SR, Wiener J, Fitz Harris LF, Lampe MA, Weidle PJ. Brief Report: Estimated Incidence of Perinatally Acquired HIV Infection in the United States, 1978-2013. J Acquir Immune Defic Syndr 2017; 76:461-464. [PMID: 28991886 PMCID: PMC6267853 DOI: 10.1097/qai.0000000000001552] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND An incidence of perinatally acquired HIV infection less than 1:100,000 live births is one of the Centers for Disease Control and Prevention (CDC) goals of the United States. Such an estimate has only been possible in recent years because regular nationwide data were lacking. METHOD Using previously published CDC estimates of the number of infants born with HIV infection in the United States (interpolating for years for which there was no published estimate), and census data on the annual number of live-born infants, estimated incidence was calculated for 1978-2013. Exact 95% confidence intervals (CIs) were calculated using the Poisson distribution. RESULTS Estimated incidence of perinatally acquired HIV infection peaked at 43.1 (95% CI: 41.1 to 45.1) in 1992 and declined rapidly after the use of zidovudine prophylaxis was recommended in 1994. In 2013, estimated incidence of perinatally acquired HIV infection in the United States was 1.8 (95% CI: 1.4 to 2.2), a 96% decline since the peak. CONCLUSION Estimated incidence of perinatally acquired HIV infection in the United States in 2013 was 1.8/100,000 live births.
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Affiliation(s)
- Steven R. Nesheim
- Centers for Disease Control and Prevention/National Center for HIV, Viral Hepatitis, Sexually Transmitted Diseases and Tuberculosis Prevention/Division of HIV/AIDS Prevention/Epidemiology Branch
| | - Jeffrey Wiener
- Centers for Disease Control and Prevention/National Center for HIV, Viral Hepatitis, Sexually Transmitted Diseases and Tuberculosis Prevention/Division of HIV/AIDS Prevention, Quantitative, Statistical and Data Management Branch
| | - Lauren F. Fitz Harris
- Centers for Disease Control and Prevention/National Center for HIV, Viral Hepatitis, Sexually Transmitted Diseases and Tuberculosis Prevention/Division of HIV/AIDS Prevention/Epidemiology Branch
- Centers for Disease Control and Prevention/National Center for HIV, Viral Hepatitis, Sexually Transmitted Diseases and Tuberculosis Prevention/Division of HIV/AIDS Prevention/Epidemiology Branch, ICF International
| | - Margaret A. Lampe
- Centers for Disease Control and Prevention/National Center for HIV, Viral Hepatitis, Sexually Transmitted Diseases and Tuberculosis Prevention/Division of HIV/AIDS Prevention/Epidemiology Branch
| | - Paul J. Weidle
- Centers for Disease Control and Prevention/National Center for HIV, Viral Hepatitis, Sexually Transmitted Diseases and Tuberculosis Prevention/Division of HIV/AIDS Prevention/Epidemiology Branch
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22
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The Effect of HIV-Centered Obstetric Care on Perinatal Outcomes Among a Cohort of Women Living With HIV. J Acquir Immune Defic Syndr 2017; 75:431-438. [PMID: 28452911 DOI: 10.1097/qai.0000000000001432] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Elimination of perinatal transmission is possible but limited by missed care opportunities. Our objective was to investigate the effects of HIV-centered obstetric care (HCC) on missed care opportunities and perinatal HIV transmission in 2 obstetric cohorts at our institution from 2000 to 2014. METHODS This was a retrospective cohort study of HIV-exposed mother-infant pairs delivering from 2000 to 2014, analyzed according to SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence) guidelines. Before 2009, women received care in high-risk obstetric care (HRC); subsequently, an HCC service was established. Women who received HRC vs HCC obstetric care were compared to determine differences in maternal and neonatal outcomes. Continuous variables were compared with Student t test and Wilcoxon rank sum tests. Categorical variables were compared using χ test and Fisher exact test. Logistic regression analyses were performed to determine factors associated with outcomes of interest. RESULTS Over 14 years, 161 women delivered 217 HIV-exposed infants; 78 (36%) women received HCC. Two perinatal HIV transmissions (1.5%) occurred in HRC group compared with none in the HCC group (P = 0.3). Women in HCC were more likely to have HIV RNA viral load <1000 copies per milliliter at delivery (12% vs 26%, P = 0.02), have a contraception plan before delivery (93% vs 60%, P < 0.001), return for postpartum evaluation (80% vs 63%, P = 0.01), and have undetectable HIV viral load postpartum (50 copies per milliliter vs 2067, P < 0.0001). CONCLUSIONS HCC can potentially reduce the risk of perinatal HIV transmission by improving maternal virologic control during pregnancy and postpartum and increasing postpartum contraceptive use.
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