1
|
Kacanek D, Yee LM, Yao TJ, Lee J, Chadwick EG, Williams PL, Barr EA, Berman CA, Davtyan M, DiPerna A, Flores A, Green J, Haddad LB, Hyzy L, Jacobson DL, James-Todd T, Jao J, Khadraoui A, Malee KM, Moscicki AB, Patel K, Robinson LG, Salomon L, Sanders K, Siminski S, Smith RA, Wolbach T, Powis KM. Health Outcomes around Pregnancy and Exposure to HIV/Antiretrovirals (HOPE) study protocol: a prospective observational cohort study of reproductive-aged women living with HIV. BMJ Open 2024; 14:e084835. [PMID: 38969382 PMCID: PMC11228391 DOI: 10.1136/bmjopen-2024-084835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 06/04/2024] [Indexed: 07/07/2024] Open
Abstract
INTRODUCTION Over 265 000 women are living with HIV in the USA, but limited research has investigated the physical, mental and behavioural health outcomes among women living with HIV of reproductive age. Health status during the reproductive years before, during and after pregnancy affects pregnancy outcomes and long-term health. Understanding health outcomes among women living with HIV of reproductive age is of substantial public health importance, regardless of whether they experience pregnancy. The Health Outcomes around Pregnancy and Exposure to HIV/Antiretrovirals (HOPE) study is a prospective observational cohort study designed to investigate physical and mental health outcomes of young women living with HIV as they age, including HIV disease course, engagement in care, reproductive health and choices and cardiometabolic health. We describe the HOPE study design, and characteristics of the first 437 participants enrolled as of 1 January 2024. METHODS AND ANALYSIS The HOPE study seeks to enrol and follow 1630 women living with HIV of reproductive age, including those with perinatally-acquired HIV, at 12 clinical sites across 9 US states and Puerto Rico. HOPE studies multilevel dynamic determinants influencing physical, mental and social well-being and behaviours of women living with HIV across the reproductive life course (preconception, pregnancy, post partum, not or never-pregnant), informed by the socioecological model. Key research areas include the clinical course of HIV, relationship of HIV and antiretroviral medications to reproductive health, pregnancy outcomes and comorbidities and the influence of racism and social determinants of health. HOPE began enrolling in April 2022. ETHICS AND DISSEMINATION The HOPE study received approval from the Harvard Longwood Campus Institutional Review Board, the single institutional review board of record for all HOPE sites. Results will be disseminated through conference presentations, peer-reviewed journals and lay summaries.
Collapse
Affiliation(s)
- Deborah Kacanek
- Center for Biostatistics in AIDS Research, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tzy-Jyun Yao
- Center for Biostatistics in AIDS Research, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Jessica Lee
- Center for Biostatistics in AIDS Research, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Ellen G Chadwick
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Paige L Williams
- Departments of Epidemiology and Biostatistics, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Emily A Barr
- The University of Texas Health Science Center at Houston Cizik School of Nursing, Houston, Texas, USA
| | - Claire A Berman
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Mariam Davtyan
- Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Alex DiPerna
- Frontier Science Foundation, Amherst, New York, USA
| | - Amanda Flores
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Lisa B Haddad
- Population Council Center for Biomedical Research, New York City, New York, USA
| | - Laurie Hyzy
- Frontier Science Foundation, Amherst, New York, USA
| | - Denise L Jacobson
- Center for Biostatistics in AIDS Research, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Tamarra James-Todd
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Jennifer Jao
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anisa Khadraoui
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Kathleen M Malee
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Kunjal Patel
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Lisa-Gaye Robinson
- Broward Health, Children's Diagnostic and Treatment Center, Fort Lauderdale, Florida, USA
| | - Liz Salomon
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | | | | | - Renee A Smith
- Department of Pediatrics, University of Illinois Chicago, Chicago, Illinois, USA
| | | | - Kathleen M Powis
- Departments of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Immunology and Infectious Disease, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Smith C, Fought AJ, Sung JF, McKinney JR, Metz TD, Fetters KB, Lazarus S, Capraro S, Barr E, Glenny C, Buehler J, Weinberg A. Congenital malformations and preeclampsia associated with integrase inhibitor use in pregnancy: A single-center analysis. PLoS One 2023; 18:e0276473. [PMID: 37307279 PMCID: PMC10259792 DOI: 10.1371/journal.pone.0276473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 05/30/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) decreases perinatal HIV transmission, but concerns exist regarding maternal and infant safety. We compared the incidence of congenital malformations and other adverse outcomes in pregnancies exposed to integrase inhibitor (INSTI) versus non-INSTI ART. SETTING Single-site review of all pregnancies among women living with HIV between 2008 and 2018. METHODS We used binomial family generalized estimating equations to model the relationship of congenital anomalies and pregnancy outcomes with exposure to INSTI or dolutegravir (DTG) versus non-INSTI ART. RESULTS Among 257 pregnancies, 77 women received ≥1 INSTI (54 DTG, 14 elvitegravir, 15 raltegravir), 167 received non-INSTI, and 3 had missing data. Fifty congenital anomalies were identified in 36 infants. Infants with first-trimester DTG or any first-trimester INSTI exposure had higher odds of congenital anomalies than infants with first-trimester non-INSTI exposure (OR = 2.55; 95%CI = 1.07-6.10; OR = 2.61; 95%CI = 1.15-5.94, respectively). Infants with INSTI exposure after the second trimester had no increased odds of anomalies. Women with INSTI exposure had higher odds of preeclampsia (OR = 4.73; 95%CI = 1.70-13.19). Among women who received INSTI, grade ≥3 laboratory abnormalities were noted in 2.6% while receiving the INSTI and 3.9% while not receiving the INSTI, versus 16.2% in women who received non-INSTI. There was no association between INSTI exposure and other pregnancy outcomes. CONCLUSION In our cohort, first-trimester INSTI exposure was associated with increased rates of congenital anomalies and use of INSTI during pregnancy was associated with preeclampsia. These findings underscore the need for continued monitoring of the safety of INSTI in pregnancy.
Collapse
Affiliation(s)
- Christiana Smith
- Department of Pediatrics, University of Colorado, Aurora, CO, United States of America
| | | | - Joyce F. Sung
- University of Colorado, Aurora, CO, United States of America
| | | | - Torri D. Metz
- University of Utah Health, Salt Lake City, UT, United States of America
| | - Kirk B. Fetters
- Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, United States of America
| | - Sarah Lazarus
- University of Wisconsin, Madison, WI, United States of America
| | - Shannon Capraro
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO, United States of America
| | - Emily Barr
- UT Health Houston, Cizik School of Nursing, Houston, TX, United States of America
| | - Carrie Glenny
- Children’s Hospital Colorado, Aurora, CO, United States of America
| | - Jenna Buehler
- University of Colorado, Aurora, CO, United States of America
| | - Adriana Weinberg
- Department of Pediatrics, University of Colorado, Aurora, CO, United States of America
- Departments of Medicine and Pathology, University of Colorado, Aurora, CO, United States of America
| | | |
Collapse
|
3
|
Poliektov NE, Badell ML. Antiretroviral Options and Treatment Decisions During Pregnancy. Paediatr Drugs 2023; 25:267-282. [PMID: 36729360 DOI: 10.1007/s40272-023-00559-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 02/03/2023]
Abstract
The majority of pediatric human immunodeficiency virus (HIV) infections are the result of vertical transmissions that occur during pregnancy, childbirth, and breastfeeding. The treatment of all pregnant persons living with HIV remains a global health initiative. Early and consistent use of antiretroviral therapy throughout pregnancy and childbirth drastically reduces the risk of perinatal transmission of HIV, resulting in fewer children living with the disease worldwide. Given that the maternal HIV viral load is the strongest predictor of perinatal transmission, suppressive antiretroviral treatment during pregnancy is the principal means to eliminate transmission of HIV from mother to child. With the use of combined antiretroviral therapy, typically with dual-nucleoside reverse transcriptase inhibitors plus an integrase strand transfer inhibitor or a ritonavir-boosted protease inhibitor, HIV-infected mothers can now achieve virologic suppression to undetectable levels and yield a perinatal transmission rate of less than 2%. Important considerations of HIV treatment in pregnancy include the safety and efficacy of antiretroviral drugs, altered pregnancy-related pharmacokinetics, potential for birth defects or adverse neonatal outcomes, and individualized delivery planning based on maternal viral load. This practical review article summarizes the options, considerations, and recommendations for antiretroviral treatment in pregnancy to reduce perinatal HIV transmission and optimize health outcomes for mothers and infants worldwide.
Collapse
Affiliation(s)
- Natalie E Poliektov
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Martina L Badell
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA.
| |
Collapse
|
4
|
Wu M, Yan Y, Zou S, Wu S, Feng L, Liu Y, Guo W, Tang W, Liang K. Adverse pregnancy outcomes among pregnant women living with HIV in Hubei province, China: prevalence and risk factors. AIDS Care 2022; 35:351-358. [PMID: 35187997 DOI: 10.1080/09540121.2022.2039358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Mother-to-child transmission of Human Immunodeficiency Virus (HIV) has been greatly reduced with the advance of intervention technology. However, adverse pregnancy outcomes (APOs) are still common, and little is known about the driving forces of APOs among pregnant women living with HIV in China. Between January 2004 and December 2020, a total of 638 pregnancies among pregnant women living with HIV were enrolled in this study, 84 (13.2%) pregnancies with 87 APOs were reported. Preterm birth (3.8%), ectopic pregnancy (3.4%), spontaneous abortion (2.0%), and embryo arrest (1.7%) were the most common APOs in pregnant women living with HIV. Exposure to antiretroviral drugs (ARVs) during the first trimester (RR = 4.077, 95% CI: 0.521, 1.484, P<0.001) and the first CD4+ T lymphocyte count (CD4 count)≤ 350/μl (RR = 2.227, 95% CI: 0.063, 0.991, P = 0.026) were risk factors of APOs. The age≤ 30 years (RR = -2.513, 95% CI: -1.067, -0.132, P = 0.012) was associated with the decreasing of APOs. Encouraging people to initiate combination antiretroviral therapy and reach a high CD4 count level before pregnancy would be helpful to prevent APOs. Pregnant women exposed to ARVs in the first trimester needed more attention for APOs.
Collapse
Affiliation(s)
- Mengmeng Wu
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Yajun Yan
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Shi Zou
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Songjie Wu
- Department of Nosocomial Infection Management, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Ling Feng
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Yanbin Liu
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Wei Guo
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China.,Department of Pathology, School of Basic Medical Sciences, Wuhan University, Wuhan, People's Republic of China
| | - Weiming Tang
- Guangdong Second Provincial General Hospital, Guangzhou, People's Republic of China.,University of North Carolina Project-China, Guangzhou, People's Republic of China
| | - Ke Liang
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China.,Department of Nosocomial Infection Management, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China.,Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, People's Republic of China.,Hubei Engineering Center for Infectious Disease Prevention, Control and Treatment, Wuhan, People's Republic of China
| |
Collapse
|