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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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Nott VR, Hazell GA, Ayres S, Kirkhope N, Fidler S, Foster C. Sexual and reproductive health needs of young women living with perinatally acquired HIV. Int J STD AIDS 2023; 34:791-794. [PMID: 37279784 PMCID: PMC10561520 DOI: 10.1177/09564624231179768] [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: 03/02/2023] [Accepted: 05/17/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Increasingly, young women living with perinatally acquired HIV (YWLPaHIV) have transitioned from paediatric to adult services. There remains a paucity of data on the sexual and reproductive health (SRH) needs of YWLPaHIV and their access to youth-friendly care. Amidst healthcare changes due to COVID-19 pandemic restrictions, we explored SRH needs of a cohort of YWLPaHIV. METHODS Evaluation of SRH needs of YWLPaHIV attending a UK NHS-youth HIV service with data collected from patient records and self-reported questionnaires amongst women attending between July and November 2020 following easing of the first lockdown and reintroduction of in-person appointments. RESULTS 71 of 112 YWLPaHIV registered at the clinic completed questionnaires during the study period and were included in the analysis. Median age was 23 y (IQR 21-27, range 18-36). 51/71(72%) reported coitarche, average age 17.6 y (IQR 16-18, range 14-24). 24 women reported 47 pregnancies resulting in 16 (34%) HIV-negative live-births, 19 (40%) terminations, 9(19%) miscarriages, with 3 pregnancies ongoing. 31/48(65%) sexually active women reported current contraception: 10 (32%) condoms, 19 (62%) long-acting, and 3(10%) oral contraceptive pill. 18/51(35%) reported a previous sexually transmitted infection; human papillomavirus (HPV) (11), Chlamydia trachomatis (9) and herpes simplex (2). 27/71(38%) women had undergone cervical cytology including 20/28(71%) women aged ≥25 y with abnormalities documented in 29%. HPV vaccination was reported in 83%, with protective hepatitis B titres in 71%. CONCLUSION High rates of unplanned pregnancy, STIs and cervical abnormalities highlight the continuing SRH needs of YWLPaHIV and requirement for open access to integrated HIV/SRH services despite pandemic restrictions.
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Affiliation(s)
| | | | - Sara Ayres
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Sarah Fidler
- Department of Medicine, Imperial College, London, UK
- Imperial College Healthcare NHS Trust, London, UK
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Lumbiganon P, Kariminia A, Anugulruengkitt S, Ounchanum P, Denjanta S, Puthanakit T, Kosalaraksa P, Sudjaritruk T, Detsakunathiwatchara C, Do VC, Vu AT, Van Nguyen L, Thuy GTT, Suwanlerk T, Sohn AH. Pregnancy and birth outcomes among young women living with perinatally acquired HIV in Thailand and Vietnam. AIDS Care 2023; 35:818-823. [PMID: 36223538 PMCID: PMC10090220 DOI: 10.1080/09540121.2022.2132371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/28/2022] [Indexed: 10/17/2022]
Abstract
We conducted a retrospective cohort study of pregnancy and infant outcomes in 670 adolescents and young adult women with perinatally acquired HIV (AYAPHIV), aged 15-24 years, in Thailand and Vietnam. Between January 2013 and December 2018, there were 52 pregnancies, for an incidence of 2.49 (95% CI 1.90-3.27) per 100 person-years. The median age at pregnancy was 17.7 years (IQR 16.8-18.9). Pregnant AYAPHIV had been on cART for a lifetime median of 9.8 years (IQR 7.3-12.4). At the time of conception, the median CD4 was 521 cells/mm3 (IQR 213-760), and 76% had HIV RNA ≤400 copies/ml. Of the 51 pregnancies with available outcomes, 90% resulted in live singleton births at a median gestational age of 38 weeks (IQR 37-39); 77% of mothers (n = 27/35) had HIV RNA ≤400 copies/ml at delivery. Among infants with available data, 50% (n = 21/42) were male and 29% (n = 12/42) were reported to be low birthweight (<2,500gm); none (n = 0/41) were breastfed. One infant was diagnosed with HIV. Our findings emphasize that efforts to strengthen reproductive health education, including contraception, pregnancy-related psychosocial support services, and prevention of vertical HIV transmission interventions, in our region are needed for adolescents with perinatally acquired HIV as they transition to young adults.
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Affiliation(s)
- Pagakrong Lumbiganon
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Suvaporn Anugulruengkitt
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | - Thanyawee Puthanakit
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pope Kosalaraksa
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Tavitiya Sudjaritruk
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Clinical and Molecular Epidemiology of Emerging and Re-emerging Infectious Diseases Research Cluster, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Viet Chau Do
- Children’s Hospital 2, Ho Chi Minh City, Vietnam
| | - An Thien Vu
- Children’s Hospital 2, Ho Chi Minh City, Vietnam
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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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Wariyo A, Oljira L, Golicha W, Dirirsa G. Effect of predictors on incidence rate of pregnancy among reproductive age women on antiretroviral therapy at public hospitals of Jigjiga and Harar Towns, Eastern Ethiopia: a retrospective cohort study. BMC Womens Health 2022; 22:548. [PMID: 36572915 PMCID: PMC9793559 DOI: 10.1186/s12905-022-02135-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/16/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Globally, Human Immunodeficiency Virus (HIV) is the leading cause of death in women of reproductive age and accountable for a quarter of deaths during pregnancy in sub-Saharan Africa including Ethiopia. Introduction of antiretroviral therapy to women living with HIV highly improves lifestyle and the desire to have children. A comprehensive understanding of baseline predictors of pregnancy among women receiving ART essential to reduces unintended pregnancies, appropriate care, and preventing transmission from mother to child. OBJECTIVE To determine the effect of baseline predictors on incidence rate of pregnancy among reproductive age women on antiretroviral therapy at public hospitals of Jigjiga and Harar town, Eastern Ethiopia from February 15 to march 15, 2020. METHODS Retrospective cohort study was conducted on randomly selected 420 HIV-infected women using data recorded from September 11, 2014, to September 10, 2019 in Jigjiga and Harar town in Eastern Ethiopia. Simple random sampling was used to select study subjects from each hospital. Data were entered to Epi data version 3.2 and exported to Stata version 14.2 for analysis. Kaplan-Meier failure, and Cox proportional hazards model were used to estimate the incidence, and to identify predictors of pregnancy respectively. Variables which were significant (P value < 0.05) in the multivariate analysis were considered independent predictors of pregnancy. RESULTS The overall incidence rate of pregnancy was 9.1 per 100 person-years (95% CI 7.19, 11.76). Being unadvanced HIV disease stage (AHR: 2.50; 95% CI 1.46, 4.19), having less than two children (AHR: 2.93; 95% CI 1.59, 5.40), and disclosed HIV status (AHR: 2.25; 95% CI 1.34, 3.79) were independent predictors of pregnancy. CONCLUSION The incidence rate of pregnancy among reproductive age women on ART was found to be considerable. Being unadvanced HIV disease stage, having less than two children, and disclosed HIV status were independent predictors of pregnancy. Thus, tailoring counseling have to be designed to enhance better pregnancy planning and consecutive health outcomes.
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Affiliation(s)
- Abdi Wariyo
- grid.449426.90000 0004 1783 7069School of Public Health, College of Health and Medical Sciences, Jigjiga University, Jigjiga, Ethiopia
| | - Lemessa Oljira
- grid.192267.90000 0001 0108 7468School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Wako Golicha
- grid.472427.00000 0004 4901 9087School of Public Health, Bule Hora University, Bule Hora, Ethiopia
| | - Gebisa Dirirsa
- grid.192267.90000 0001 0108 7468Department of Environmental Health, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
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Rasi V, Peters H, Sconza R, Francis K, Bukasa L, Thorne C, Cortina‐Borja M. Trends in antiretroviral use in pregnancy in the UK and Ireland, 2008-2018. HIV Med 2022; 23:397-405. [PMID: 35178841 PMCID: PMC9306524 DOI: 10.1111/hiv.13243] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/11/2022] [Indexed: 12/21/2022]
Abstract
INTRODUCTION HIV treatment recommendations have evolved over time, reflecting both growing availability of new antiretrovirals and accumulating evidence on their safe and effective use. We analysed patterns of antiretroviral use among diagnosed pregnant women living with HIV delivering in the UK and Ireland between 2008 and 2018 using national surveillance data. METHODS All singleton pregnancies with known outcomes and known timing of antiretroviral initiation reported to the National Surveillance of HIV in Pregnancy and Childhood were included. Every individual instance of specific antiretroviral use was the unit of analysis in generating a snapshot of antiretroviral use overall and over calendar time. The final analysis was restricted to the 14 most frequently prescribed antiretrovirals. RESULTS There were 12 099 singleton pregnancies reported during 2008-2018 and a total of 38 214 individual uses of the 14 most commonly prescribed antiretrovirals, the majority of which were started before conception (70.9%). In 2008, 37.7% (482/1279) of pregnancies were conceived under treatment, reaching 80.9% (509/629) by 2018. Patterns of antiretroviral use have changed over time, particularly for third agents. Between 2008 and 2018 the most frequently used protease inhibitor shifted from lopinavir to darunavir, whereas use of integrase inhibitors increased steadily over time. CONCLUSIONS These national surveillance data enable investigation of the 'real-world' use of antiretrovirals in pregnancy on a population level. Findings demonstrate mixed responsiveness of antiretroviral prescription to changes in pregnancy guideline recommendations and may also reflect changes in commissioning and in the characteristics of pregnant women living with HIV.
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Affiliation(s)
- Virginia Rasi
- Population, Policy and Practice Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Helen Peters
- Population, Policy and Practice Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Rebecca Sconza
- Population, Policy and Practice Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Kate Francis
- Population, Policy and Practice Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Laurette Bukasa
- Population, Policy and Practice Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Claire Thorne
- Population, Policy and Practice Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Mario Cortina‐Borja
- Population, Policy and Practice Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
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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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MILLAR JR, FATTI I, MCHUNU N, BENGU N, GRAYSON NE, ADLAND E, BONSALL D, ARCHARY M, MATTHEWS PC, NDUNG’U T, GOULDER P. Second-generation mother-to-child HIV transmission in South Africa is characterized by poor outcomes. AIDS 2021; 35:1597-1604. [PMID: 34270488 PMCID: PMC8288499 DOI: 10.1097/qad.0000000000002915] [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: 11/25/2022]
Abstract
OBJECTIVE The worldwide incidence of pregnancy for women living with perinatal HIV infection is increasing. Subsequently, there is growing risk of second-generation mother-to-child HIV transmission. The infant clinical outcomes for such a phenomenon have yet to be described. DESIGN As part of a wider observational study in KwaZulu-Natal, South Africa, six infants with in-utero HIV infection were identified as being born to mothers with perinatal HIV infection. METHODS Blood results and clinical data were collected in the first 3 years of life. In two cases, sample availability allowed confirmation by phylogenetic analysis of grandmother-to-mother-to-child HIV transmission. RESULTS Outcomes were poor in all six cases. All six mothers had difficulty administering twice daily combination antiretroviral therapy to their infants due to difficulties with acceptance, disclosure, poor health and being themselves long-term nonprogressors. Nonnucleoside reverse transcriptase inhibitor-resistant virus was detected in all mothers tested. None of the infants maintained suppression of viraemia on combination antiretroviral therapy. One infant died, and another was lost to follow-up. CONCLUSION As the numbers of second-generation mother-to-child transmissions increase, it is important to highlight that this mother-infant dyad represents an extremely vulnerable group. In order for them to survive and thrive, these infants' mothers require their specific needs to be addressed and given intensive support.
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Affiliation(s)
- Jane R. MILLAR
- HIV Pathogenesis Programme, The Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Isabella FATTI
- Umkhuseli Innovation and Research Management, Pietermaritzburg, South Africa
| | - Noxolo MCHUNU
- Umkhuseli Innovation and Research Management, Pietermaritzburg, South Africa
| | - Nomonde BENGU
- Umkhuseli Innovation and Research Management, Pietermaritzburg, South Africa
| | - Nicholas E. GRAYSON
- Department of Paediatrics, University of Oxford, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Emily ADLAND
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - David BONSALL
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Moherndran ARCHARY
- Department of Paediatrics, King Edward VIII Hospital/University of KwaZulu-Natal, Durban, South Africa
| | - Philippa C. MATTHEWS
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford BRC, John Radcliffe Hospital, Oxford, UK
| | - Thumbi NDUNG’U
- HIV Pathogenesis Programme, The Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
- Africa Health Research Institute (AHRI), Durban, South Africa
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
- Max Planck Institute for Infection Biology, Berlin, Germany
- Division of Infection and Immunity, University College London, London, UK
| | - Philip GOULDER
- HIV Pathogenesis Programme, The Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
- Department of Paediatrics, University of Oxford, Oxford, UK
- Africa Health Research Institute (AHRI), Durban, South Africa
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, 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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11
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Pasvol TJ, Teh J, Balfoussia D, Hall R, Petersen C, Khan M, Ayres S, Jayasena CN, Foster C, Fidler S. Outcomes of fertility investigations in a cohort of adults with perinatally acquired HIV-1 infection: a UK cross-sectional observational study. AIDS 2021; 35:343-345. [PMID: 33165031 PMCID: PMC7810410 DOI: 10.1097/qad.0000000000002745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/31/2020] [Accepted: 10/24/2020] [Indexed: 11/29/2022]
Abstract
There are no published studies of fertility measurements in people living with perinatally acquired HIV (PaHIV). We performed fertility investigations in 25 adults with PaHIV. Seven (78%) men had sperm morphology normal forms (%) below the fifth centile for the general population with four (44%) having no normal forms. Mean (SD) serum anti-Müllerian hormone level was 19.4 (9.5) pmol/l; lower than expected for this age group. A larger study is needed to verify our findings.
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Affiliation(s)
- Thomas J. Pasvol
- Clinical Trials Centre, Winston Churchill Wing, St Mary's Hospital, Imperial College London
- Imperial College Healthcare NHS Trust, London
- Research Department of Primary Care and Population Health, University College London
| | - Jhia Teh
- Clinical Trials Centre, Winston Churchill Wing, St Mary's Hospital, Imperial College London
| | - Danai Balfoussia
- Imperial College Healthcare NHS Trust, London
- Department of Andrology, Hammersmith Hospital & Section of Investigative Medicine, Imperial College London, UK
| | - Rebecca Hall
- Clinical Trials Centre, Winston Churchill Wing, St Mary's Hospital, Imperial College London
- Imperial College Healthcare NHS Trust, London
| | - Claire Petersen
- Clinical Trials Centre, Winston Churchill Wing, St Mary's Hospital, Imperial College London
- Imperial College Healthcare NHS Trust, London
| | - Maryam Khan
- Clinical Trials Centre, Winston Churchill Wing, St Mary's Hospital, Imperial College London
| | - Sara Ayres
- Imperial College Healthcare NHS Trust, London
| | - Channa N. Jayasena
- Imperial College Healthcare NHS Trust, London
- Department of Andrology, Hammersmith Hospital & Section of Investigative Medicine, Imperial College London, UK
| | | | - Sarah Fidler
- Clinical Trials Centre, Winston Churchill Wing, St Mary's Hospital, Imperial College London
- Imperial College Healthcare NHS Trust, London
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12
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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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13
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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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Gilleece DY, Tariq DS, Bamford DA, Bhagani DS, Byrne DL, Clarke DE, Clayden MP, Lyall DH, Metcalfe DR, Palfreeman DA, Rubinstein DL, Sonecha MS, Thorley DL, Tookey DP, Tosswill MJ, Utting MD, Welch DS, Wright MA. British HIV Association guidelines for the management of HIV in pregnancy and postpartum 2018. HIV Med 2020; 20 Suppl 3:s2-s85. [PMID: 30869192 DOI: 10.1111/hiv.12720] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Dr Yvonne Gilleece
- Honorary Clinical Senior Lecturer and Consultant Physician in HIV and Genitourinary Medicine, Brighton and Sussex University Hospitals NHS Trust
| | - Dr Shema Tariq
- Postdoctoral Clinical Research Fellow, University College London, and Honorary Consultant Physician in HIV, Central and North West London NHS Foundation Trust
| | - Dr Alasdair Bamford
- Consultant in Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London
| | - Dr Sanjay Bhagani
- Consultant Physician in Infectious Diseases, Royal Free Hospital NHS Trust, London
| | - Dr Laura Byrne
- Locum Consultant in HIV Medicine, St George's University Hospitals NHS Foundation Trust, London
| | - Dr Emily Clarke
- Consultant in Genitourinary Medicine, Royal Liverpool and Broadgreen University Hospitals NHS Trust
| | - Ms Polly Clayden
- UK Community Advisory Board representative/HIV treatment advocates network
| | - Dr Hermione Lyall
- Clinical Director for Children's Services and Consultant Paediatrician in Infectious Diseases, Imperial College Healthcare NHS Trust, London
| | | | - Dr Adrian Palfreeman
- Consultant in Genitourinary Medicine, University Hospitals of Leicester NHS Trust
| | - Dr Luciana Rubinstein
- Consultant in Genitourinary Medicine, London North West Healthcare University NHS Trust, London
| | - Ms Sonali Sonecha
- Lead Directorate Pharmacist HIV/GUM, Chelsea and Westminster Healthcare NHS Foundation Trust, London
| | | | - Dr Pat Tookey
- Honorary Senior Lecturer and Co-Investigator National Study of HIV in Pregnancy and Childhood, UCL Great Ormond Street Institute of Child Health, London
| | | | - Mr David Utting
- Consultant Obstetrician and Gynaecologist, Brighton and Sussex University Hospitals NHS Trust
| | - Dr Steven Welch
- Consultant in Paediatric Infectious Diseases, Heart of England NHS Foundation Trust, Birmingham
| | - Ms Alison Wright
- Consultant Obstetrician and Gynaecologist, Royal Free Hospitals NHS Foundation Trust, London
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15
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Li C, Yang Y, Wang Y, Dong S, Yang Y, Shi Y, Li L, Jiang F, Chen Y, Jiang Q, Zhou Y. Impact of maternal HIV-HBV coinfection on pregnancy outcomes in an underdeveloped rural area of southwest China. Sex Transm Infect 2020; 96:509-515. [PMID: 31911426 DOI: 10.1136/sextrans-2019-054295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 12/07/2019] [Accepted: 12/12/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Our objective was to determine the impact of maternal HIV-hepatitis B virus (HBV) coinfection on pregnancy outcomes. METHODS The current study was conducted in a county of Yi Autonomous Prefecture in southwest China. Data were abstracted from hospitalisation records, including maternal and infant information. The seroprevalences of HIV and HBV infections and HIV-HBV coinfection were determined and the impact of maternal HIV-HBV coinfection on adverse pregnancy outcomes was assessed using logistic regression analysis. A treatment effects linear regression model was also applied to examine the effect of HBV, HIV or coinfection to quantify the absolute difference in birth weight from a reference of HBV-HIV negative participants. RESULTS A total of 13 198 pregnant women were included in our study, and among them, 99.1% were Yi people and 90.8% lived in rural area. The seroprevalences of HIV and HBV infections and HIV-HBV coinfection were 3.6% (95% CI: 3.2% to 3.9%), 3.2% (95% CI: 2.9% to 3.5%) and 0.2% (95% CI: 0.1% to 0.2%) among the pregnant women, respectively. Maternal HIV-HBV coinfection was a risk factor for low birth weight (adjusted OR (aOR)=5.52, 95% CI: 1.97 to 15.40). Compared with the HIV mono-infection group, the risk of low birth weight was significantly higher in the HIV-HBV coinfection group (aOR=3.62, 95% CI: 1.24 to 10.56). Maternal HIV infection was associated with an increased risk of low birth weight (aOR=1.90, 95% CI: 1.38 to 2.60) and preterm delivery (aOR=2.84, 95% CI: 1.81 to 4.47). Perinatal death was more common when mothers were infected with HBV (aOR=2.85, 95% CI: 1.54 to 5.26). CONCLUSIONS The prevalence of HIV infection was high among pregnant women of the Yi region. Both HIV and HBV infections might have adverse effects on pregnancy outcomes. Maternal HIV-HBV coinfection might be a risk factor for low birth weight in the Yi region, which needs to be confirmed.
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Affiliation(s)
- Chunlin Li
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China.,Centre for Tropical Disease Research, Fudan University, Shanghai, China
| | - Yu Yang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China.,Centre for Tropical Disease Research, Fudan University, Shanghai, China
| | - Yingjian Wang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China.,Centre for Tropical Disease Research, Fudan University, Shanghai, China
| | - Shurong Dong
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China.,Centre for Tropical Disease Research, Fudan University, Shanghai, China
| | - Ya Yang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China.,Centre for Tropical Disease Research, Fudan University, Shanghai, China
| | - Ying Shi
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China.,Centre for Tropical Disease Research, Fudan University, Shanghai, China
| | - Linhan Li
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China.,Centre for Tropical Disease Research, Fudan University, Shanghai, China
| | - Feng Jiang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China.,Centre for Tropical Disease Research, Fudan University, Shanghai, China
| | - Yue Chen
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Qingwu Jiang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China.,Centre for Tropical Disease Research, Fudan University, Shanghai, China
| | - Yibiao Zhou
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China .,Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China.,Centre for Tropical Disease Research, Fudan University, Shanghai, China
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16
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Trahan MJ, Boucher M, Renaud C, Karatzios C, Metras ME, Valois S, Ransy DG, Lamarre V, Kakkar F. Pregnancies Among the First Generation of Survivors of Perinatal HIV Infection. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 42:446-452. [PMID: 31882286 DOI: 10.1016/j.jogc.2019.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Little is known about pregnancy outcomes among women who have acquired human immunodeficiency virus (HIV) through perinatal infection and survived into adulthood. The objectives of this study were to describe pregnancy outcomes among women with perinatal HIV infection (PHIV) in Canada and to identify potential challenges in the prevention of perinatal HIV transmission in this population. METHODS A retrospective review of all pregnancies among women with PHIV who were previously followed as children at two tertiary care centres in Montréal, Québec, was conducted. Data were extracted from pediatric and obstetrical records. RESULTS There were 21 pregnancies among 11 women, and 18 of these pregnancies were unintentional. Mean age at first pregnancy was 19.5 years (range 15-29 years). At the first prenatal visit, 79% had a detectable viral load, 36% were immunosuppressed (CD4 T cell count <200 mm3), and only 36% were receiving antiretroviral therapy (ART). At the time of delivery, although all were prescribed ART, 50% of these women still had a detectable viral load, and 36% remained immunosuppressed. All of the women harboured mutations conferring drug resistance to zidovudine and lamivudine, and the majority (73%) were also resistant to nevirapine. None of the infants were HIV infected, although all received prophylaxis with agents to which their mother's virus was resistant. CONCLUSION Unplanned pregnancies, difficulties with adherence to ART, and drug resistance were identified challenges in the management of pregnancies among women with PHIV. This study highlights a gap in the reproductive counselling of adolescents with PHIV and the need for close follow-up and adherence support during pregnancy in this population.
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Affiliation(s)
- Marie-Julie Trahan
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montréal, QC
| | - Marc Boucher
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC; Centre Maternel et Infantile sur le SIDA, Montréal, QC
| | - Christian Renaud
- Centre Maternel et Infantile sur le SIDA, Montréal, QC; Department of Microbiology and Immunology, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC; Division of Pediatric Infectious Diseases, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC
| | - Christos Karatzios
- Centre Maternel et Infantile sur le SIDA, Montréal, QC; Division of Pediatrics Infectious Diseases, McGill University Health Centre, Montréal, QC
| | - Marie-Elaine Metras
- Department of Pharmacy, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC
| | - Silvie Valois
- Centre Maternel et Infantile sur le SIDA, Montréal, QC
| | - Doris G Ransy
- Centre Maternel et Infantile sur le SIDA, Montréal, QC
| | - Valérie Lamarre
- Centre Maternel et Infantile sur le SIDA, Montréal, QC; Division of Pediatric Infectious Diseases, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC
| | - Fatima Kakkar
- Centre Maternel et Infantile sur le SIDA, Montréal, QC; Division of Pediatric Infectious Diseases, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC.
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17
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Simulation Modeling and Metamodeling to Inform National and International HIV Policies for Children and Adolescents. J Acquir Immune Defic Syndr 2019; 78 Suppl 1:S49-S57. [PMID: 29994920 PMCID: PMC6042862 DOI: 10.1097/qai.0000000000001749] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objective and Approach: Computer-based simulation models serve an important purpose in informing HIV care for children and adolescents. We review current model-based approaches to informing pediatric and adolescent HIV estimates and guidelines. Findings: Clinical disease simulation models and epidemiologic models are used to inform global and regional estimates of numbers of children and adolescents living with HIV and in need of antiretroviral therapy, to develop normative guidelines addressing strategies for diagnosis and treatment of HIV in children, and to forecast future need for pediatric and adolescent antiretroviral therapy formulations and commodities. To improve current model-generated estimates and policy recommendations, better country-level and regional-level data are needed about children living with HIV, as are improved data about survival and treatment outcomes for children with perinatal HIV infection as they age into adolescence and adulthood. In addition, novel metamodeling and value of information methods are being developed to improve the transparency of model methods and results, as well as to allow users to more easily tailor model-based analyses to their own settings. Conclusions: Substantial progress has been made in using models to estimate the size of the pediatric and adolescent HIV epidemic, to inform the development of guidelines for children and adolescents affected by HIV, and to support targeted implementation of policy recommendations to maximize impact. Ongoing work will address key limitations and further improve these model-based projections.
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18
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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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19
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Abrams EJ, Mellins CA, Bucek A, Dolezal C, Raymond J, Wiznia A, Jurgrau A, Bamji M, Leu CS, Ng YKW. Behavioral Health and Adult Milestones in Young Adults With Perinatal HIV Infection or Exposure. Pediatrics 2018; 142:e20180938. [PMID: 30097528 PMCID: PMC6317560 DOI: 10.1542/peds.2018-0938] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Young adults living with perinatally acquired HIV infection (PHIVYAs) are at risk for poor biomedical and behavioral health outcomes. Few studies offer a comprehensive overview of the functioning of this population in young adulthood and the role of HIV. METHODS Data come from the Child and Adolescent Self-Awareness and Health Study, a longitudinal behavioral health cohort study of PHIVYAs and perinatally HIV-exposed but uninfected young adults (PHEUYAs) who are compared on psychiatric and neurocognitive functioning, sexual and substance use behaviors, health and reproductive outcomes, and young adult milestones. RESULTS Overall, 27% of participants met criteria for a psychiatric disorder, including mood (11%), anxiety (22%), and substance use (28%), with no HIV status differences. PHIVYAs performed worse on 2 neurocognitive tests. There were no HIV status differences in condomless sex (41%) or pregnancies (41% women; 38% men). Both groups exhibited similar adult milestones: 67% graduated high school or an equivalent, 19% were in college, and 42% were employed. However, 38% were neither in school or working, 12% reported incarceration, and 16% were ever homeless. Among PHIVYAs, 36% were viremic (>200 copies per mL), and 15% were severely immunocompromised (CD4+ cell count <100 cells per mm3). CONCLUSIONS Many PHIVYAs achieve adult milestones related to school, employment, sexual relationships, and starting families. However, they and PHEUYAs have high rates of psychiatric and substance use disorders and behavioral risks, which can jeopardize long-term health and adult functioning, particularly in the context of HIV. These findings underscore an urgent need to escalate interventions.
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Affiliation(s)
- Elaine J Abrams
- ICAP at Columbia University, Mailman School of Public Health,
- Vagelos College of Physicians and Surgeons, and
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York
| | - Amelia Bucek
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York
| | - Jeannette Raymond
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York
| | - Andrew Wiznia
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Andrea Jurgrau
- New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York; and
| | | | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York
| | - Yiu Kee Warren Ng
- New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York; and
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Cecchini D, Martinez M, Brusati FV, Rodriguez C. Pregnancies in perinatally HIV-infected women: antiretroviral treatment strategies, obstetric and virologic outcomes. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2018; 31:291-292. [PMID: 29791125 PMCID: PMC6166250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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