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Modjadji P, Mokgalaboni K, Nonterah EA, Lebelo SL, Mchiza ZJR, Madiba S, Kengne AP. A Systematic Review on Cardiometabolic Risks and Perinatal Outcomes among Pregnant Women Living with HIV in the Era of Antiretroviral Therapy. Viruses 2023; 15:1441. [PMID: 37515129 PMCID: PMC10385451 DOI: 10.3390/v15071441] [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: 05/17/2023] [Revised: 06/23/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
Antiretroviral therapy (ART) regimens have been shown to cause metabolic changes in people living with HIV (PLWH), predisposing them to cardiometabolic disease (CVMD). However, such evidence is less established in pregnant women living with HIV (pWLWH) on ART. Pregnancy-induced cardiometabolic risks (CMR) can predispose to unfavourable pregnancy outcomes and further persist in the postpartum period, resolve, and recur in subsequent pregnancies, or emerge as newly diagnosed chronic diseases of ageing. Therefore, this systematic review aimed at synthesizing evidence on CMR and perinatal outcomes among pWLWH in the era of ART. We considered prospective and retrospective cohorts, case-control, cross-sectional, and interventional studies published in English. Specific keywords were used to conduct a thorough literature search on PubMed-Medline and Scopus following the Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. Two investigators independently screened the search outputs and reviewed full texts of potentially eligible articles. Data extraction was conducted by one investigator and verified by the second investigator. Thirty-one relevant studies conducted on 20,904 pWLWH on ART across Africa, Asia, Europe, and America were included. Studies demonstrate inconclusive findings, especially on perinatal outcomes, but significant risks of gestational hypertension and dyslipidemia were reported in pWLWH on ART compared to the control group. Therefore, future studies should focus more on these perinatal outcomes, and their impact on postpartum maternal health and growth trajectories of uninfected infants born from pWLWH who are either on ART or ART-naïve in comparison to infants born of HIV-negative mothers over the life course, especially in HIV-burdened African countries.
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Affiliation(s)
- Perpetua Modjadji
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa
| | - Kabelo Mokgalaboni
- Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Florida Campus, Johannesburg 1709, South Africa
| | - Engelbert A Nonterah
- Navrongo Health Research Centre, Ghana Health Service, Navrongo P.O. Box 114, Ghana
| | - Sogolo Lucky Lebelo
- Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Florida Campus, Johannesburg 1709, South Africa
| | - Zandile June-Rose Mchiza
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa
| | - Sphiwe Madiba
- Faculty of Health Sciences, University of Limpopo, Polokwane 0700, South Africa
| | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa
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Portwood C, Sexton H, Kumarendran M, Brandon Z, Kirtley S, Hemelaar J. Adverse perinatal outcomes associated with antiretroviral therapy in women living with HIV: A systematic review and meta-analysis. Front Med (Lausanne) 2023; 9:924593. [PMID: 36816720 PMCID: PMC9935588 DOI: 10.3389/fmed.2022.924593] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 12/20/2022] [Indexed: 02/05/2023] Open
Abstract
Background Maternal HIV infection is associated with an increased risk of adverse perinatal outcomes. The World Health Organization (WHO) recommends immediate initiation of lifelong antiretroviral therapy (ART) for all people living with HIV, including pregnant women living with HIV (WLHIV). We aimed to assess the risk of adverse perinatal outcomes in WLHIV receiving ART compared to ART-naïve WLHIV and HIV-negative women. Materials and methods We conducted a systematic literature review by searching PubMed, CINAHL, Global Health, and EMBASE for studies published between Jan 1, 1980, and April 20, 2020. Two investigators independently selected relevant studies and extracted data from studies reporting on the association of pregnant WLHIV receiving ART with adverse perinatal outcomes. Perinatal outcomes examined were preterm birth (PTB), very PTB, spontaneous PTB (sPTB), low birth weight (LBW), very LBW (VLBW), term LBW, preterm LBW, small for gestational age (SGA), very SGA (VSGA), stillbirth, and neonatal death. Random-effects meta-analyses examined the risk of adverse perinatal outcomes in WLHIV receiving ART compared to ART-naïve WLHIV and HIV-negative women. Subgroup and sensitivity analyses were performed based on country income status and study quality, and adjustment for confounding factors assessed. Results Of 94,594 studies identified, 73 cohort studies, including 424,277 pregnant women, met the inclusion criteria. We found that WLHIV receiving ART are associated with a significantly decreased risk of PTB (relative risk 0.79, 95% CI 0.67-0.93), sPTB (0.46, 0.32-0.66), LBW (0.86, 0.79-0.93), and VLBW (0.62, 0.39-0.97) compared to ART-naïve WLHIV. However, WLHIV receiving ART are associated with a significantly increased risk of PTB (1.42, 1.28-1.57), sPTB (2.20, 1.32-3.67), LBW (1.58, 1.36-1.84), term LBW (1.88, 1.23-2.85), SGA (1.69, 1.32-2.17), and VSGA (1.22, 1.10-1.34) compared to HIV-negative women. Conclusion ART reduces the risk of adverse perinatal outcomes in pregnant WLHIV, but the risk remains higher than in HIV-negative women. Our findings support the WHO recommendation of immediate initiation of lifelong ART for all people living with HIV, including pregnant WLHIV. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42021248987.
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Affiliation(s)
- Clara Portwood
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Harriet Sexton
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Mary Kumarendran
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Zoe Brandon
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Shona Kirtley
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Joris Hemelaar
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom,*Correspondence: Joris Hemelaar,
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Worku WZ, Azale T, Ayele TA, Mekonnen DK. Effects of HIV Infection on Pregnancy Outcomes Among Women Attending Antenatal Care in Referral Hospitals of the Amhara Regional State, Ethiopia: A Prospective Cohort Study. Int J Womens Health 2022; 14:1405-1423. [PMID: 36176965 PMCID: PMC9514786 DOI: 10.2147/ijwh.s382685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) has remained to be a significant public health problem worldwide mainly affecting women. Despite a 2 to 3 times higher risk of adverse pregnancy outcomes, around 2 million HIV positive women give birth each year globally. However, there is a dearth of evidences in Ethiopia about the effect of maternal HIV infection on pregnancy outcomes where adverse birth outcomes are still a significant health problem. This study is, therefore, aimed to examine the effect of HIV on the risk of adverse pregnancy outcomes in Amhara Regional State, Ethiopia. Methods A prospective cohort study was conducted among 704 pregnant women (352 women with HIV and 352 women without HIV infection). Systematic random sampling technique was employed to select the study participants. Data on socio-demographic, obstetric, clinical, as well as behavioral and psychosocial characteristics were collected using a validated tool. Data on the outcome variables were also collected following delivery. Modified Poisson regression was employed to estimate the relative risk (RR) of HIV on low birth weight (LBW), preterm birth, and still birth at 95% confidence level. Attributable fraction (AF) was used to report the impact of HIV infection on pregnancy outcomes. Results Of the total 704 pregnant women enrolled for the study, 96.3% (678) completed the study. The mean age of the study participants was 30.8 (SD ± 5.4) for HIV positive and 27 (SD ± 5.4) for HIV negative women. The cumulative incidence of low birth weight, preterm birth, and stillbirth were 21.4%, 9.4%, and 4.1%, respectively. The incidence of LBW was 24.7% among HIV positive and 17.8% among HIV negative women. The incidence of preterm birth was 10.7% among HIV positive and 7.9% among HIV negative women. And the incidence of stillbirth was 3.7% and 4.6% among HIV positive and those HIV negative women. New-borns from women with HIV infection had a higher risk of low birth weight and preterm birth than those HIV negative women (Adjusted Relative Risk (ARR) = 1.47; 95% CI: 1.06–2.03) and (ARR = 1.74; 95% CI: 1.08–2.79), respectively. The attributable risk of HIV on low birth weight was 32% (Attributable Fraction (AF) = 32%, 95% CI: 23–46%), and 43% (AF = 43%, 95% CI: 23–46%) for preterm birth. Conclusion Maternal HIV infection increased the risk of low birth weight and preterm birth. This implies due attention is required while providing maternal health services primarily antenatal care and delivery services. These services should be aimed at reducing adverse pregnancy outcomes with more attention given to women with HIV infection. Moreover, reinforcement of HIV prevention intervention strategies should be considered at all levels.
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Affiliation(s)
- Workie Zemene Worku
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Telake Azale
- Department of Health Education and Behavioural Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dawit Kassahun Mekonnen
- Department of Gynaecology and Obstetrics, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Jones AJ, Eke UA, Eke AC. Prediction and prevention of preterm birth in pregnant women living with HIV on antiretroviral therapy. Expert Rev Anti Infect Ther 2022; 20:837-848. [PMID: 35196941 PMCID: PMC9133156 DOI: 10.1080/14787210.2022.2046463] [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: 10/10/2021] [Accepted: 02/22/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The rate of spontaneous preterm-birth among pregnant women living with HIV on antiretroviral therapy (ART) is 3- to 4-fold higher when compared to HIV-negative women. The pathophysiology of preterm-birth related to HIV or ART remains unknown, especially as women living with HIV are often excluded from preterm birth studies. AREAS COVERED This review discusses the currently available evidence on the prediction and prevention of preterm-birth in pregnant women living with HIV. A review of the literature was conducted of primary articles between 2005 and 2021 measuring the association or lack thereof between combination ART and preterm birth, as well as of other predisposing factors to preterm birth in women living with HIV, including cervical length, vaginal microbiome, and cervico-vaginal biomarkers. EXPERT OPINION Further research into the effect of ART exposure on preterm-birth risk is critical, and development of preterm-birth predictive tools in this population should be a priority. Vaginal progesterone supplementation deserves further investigation as a therapeutic option to prevent recurrent preterm birth in pregnant women living with HIV. The ProSPAR study, a multicenter randomized controlled trial studying progesterone supplementation in pregnant women on protease inhibitor-based regimens, has been designed but is not yet recruiting patients.
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Affiliation(s)
| | - Uzoamaka A Eke
- Division of Infectious Diseases and Institute of Human Virology, Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, United States of America
| | - Ahizechukwu C Eke
- Division of Maternal Fetal Medicine, Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore
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Adverse perinatal outcomes associated with HAART and monotherapy: systematic review and meta-analysis. AIDS 2022; 36:1409-1427. [PMID: 35608111 DOI: 10.1097/qad.0000000000003248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Assess adverse perinatal outcomes in women living with HIV (WLHIV) receiving HAART or zidovudine (ZDV) monotherapy, compared with antiretroviral therapy (ART)-naive WLHIV and HIV-negative women. DESIGN Systematic review and meta-analysis. METHODS We conducted a systematic literature review by searching PubMed, CINAHL, Global Health, and EMBASE for studies published during 1 January 1980 to 20 April 2020. We included studies reporting on the association of pregnant WLHIV receiving HAART or ZDV monotherapy with 11 perinatal outcomes: preterm birth (PTB), very PTB, spontaneous PTB (sPTB), low birth weight (LBW), very LBW, term LBW, preterm LBW, small for gestational age (SGA), very SGA (VSGA), stillbirth, and neonatal death. Random-effects meta-analyses were conducted. RESULTS Sixty-one cohort studies assessing 409 781 women were included. WLHIV receiving ZDV monotherapy were associated with a decreased risk of PTB [relative risk 0.70, 95% confidence interval (CI) 0.62-0.79] and LBW (0.77, 0.67-0.88), and comparable risk of SGA, compared with ART-naive WLHIV. WLHIV receiving ZDV monotherapy had a comparable risk of PTB and LBW, and an increased risk of SGA (1.16, 1.04-1.30) compared with HIV-negative women. In contrast, WLHIV receiving HAART were associated with a comparable risk of PTB and LBW, and increased risk of SGA (1.38, 1.09-1.75), compared with ART-naive WLHIV. WLHIV receiving HAART were associated with an increased risk of PTB (1.55, 1.38-1.74), sPTB (2.09, 1.48-2.96), LBW (1.79, 1.51-2.13), term LBW (1.88, 1.23-2.85), SGA (1.80,1.34-2.40), and VSGA (1.22, 1.10-1.34) compared with HIV-negative women. CONCLUSION Pregnant WLHIV receiving HAART have an increased risk of a wide range of perinatal outcomes compared with HIV-negative women.
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Cowdell I, Beck K, Portwood C, Sexton H, Kumarendran M, Brandon Z, Kirtley S, Hemelaar J. Adverse perinatal outcomes associated with protease inhibitor-based antiretroviral therapy in pregnant women living with HIV: A systematic review and meta-analysis. EClinicalMedicine 2022; 46:101368. [PMID: 35521067 PMCID: PMC9061981 DOI: 10.1016/j.eclinm.2022.101368] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The World Health Organization recommends protease inhibitor (PI)-based antiretroviral therapy (ART) as second-line and third-line regimens in pregnant women living with HIV (WLHIV). US, European, and UK guidelines include PI-based ART as first-line regimens, but advise against the use of lopinavir/ritonavir (LPV/r)-based ART, citing an increased risk of preterm birth (PTB). We aimed to assess the risk of adverse perinatal outcomes in WLHIV receiving PI-ART and the comparative risks associated with different PI-ART regimens. METHODS We conducted a systematic literature review by searching PubMed, CINAHL, Global Health, and EMBASE for studies published between Jan 1, 1980, and April 20, 2020. Two investigators independently selected studies and extracted data from studies reporting on the association of pregnant WLHIV receiving PI-ART with 11 perinatal outcomes: PTB, very PTB (VPTB), spontaneous PTB (sPTB), low birth weight (LBW), very LBW (VLBW), term LBW, preterm LBW, small for gestational age (SGA), very SGA (VSGA), stillbirth, and neonatal death. Pairwise random-effects meta-analyses examined the risk of each adverse perinatal outcome in WLHIV receiving PI-ART compared to non-PI-based ART (non-PI-ART), and comparisons of different PI-ART regimens. Quality assessments of studies were performed, subgroup and sensitivity analyses were conducted based on country income status and study quality, heterogeneity assessed, and the effect of adjustment for confounding factors assessed. The protocol is registered with PROSPERO, CRD42021248987. FINDINGS Of 94,594 studies identified, 34 cohort studies including 57,546 women met the inclusion criteria. Random-effects meta-analyses showed that PI-ART was associated with a significantly increased risk of SGA (Relative Risk [RR] 1.24, 95% CI 1.08-1.43; I2 =66.7%) and VSGA (RR 1.40, 1.09-1.81; I2 =0.0%), but not PTB (RR 1.09, 0.95-1.24; I2 =68.3%), VPTB (RR 1.30, 0.78-2.18; I2 =43.0%), sPTB (RR 1.91, 0.61-5.99; I2 =95.7%), LBW (RR 1.04, 0.85-1.27; I2 =63.9%), VLBW (RR 0.72, 0.37-1.43; I2 =37.9%), term LBW (RR 0.94, 0.30-3.02; I2 =0.0%), stillbirth (RR 1.04, 0.60-1.79; I2 =0.0%), and neonatal death (RR 1.82, 0.97-3.40; I2 =0.0%), compared to non-PI-ART. We found no significant differences in perinatal outcomes between ART regimens containing LPV/r, atazanavir/ritonavir (ATV/r), and darunavir/ritonavir (DRV/r), which are the most commonly used PIs. INTERPRETATION PI-ART is associated with an increased risk of SGA and VSGA, but not PTB or other perinatal outcomes. No significant differences in perinatal outcomes were found between LPV/r, ATV/r, and DRV/r. These findings should inform clinical guidelines, and further efforts should be made to improve perinatal outcomes among pregnant WLHIV. FUNDING None.
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Affiliation(s)
- Imogen Cowdell
- National Perinatal Epidemiology Unit, Oxford Population Health, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Katharina Beck
- National Perinatal Epidemiology Unit, Oxford Population Health, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Clara Portwood
- National Perinatal Epidemiology Unit, Oxford Population Health, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Harriet Sexton
- National Perinatal Epidemiology Unit, Oxford Population Health, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Mary Kumarendran
- National Perinatal Epidemiology Unit, Oxford Population Health, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Zoe Brandon
- National Perinatal Epidemiology Unit, Oxford Population Health, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Shona Kirtley
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Joris Hemelaar
- National Perinatal Epidemiology Unit, Oxford Population Health, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
- Corresponding author at: National Perinatal Epidemiology Unit, Oxford Population Health, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
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Shinar S, Agrawal S, Ryu M, Walmsley S, Serghides L, Yudin MH, Murphy KE. Perinatal outcomes in women living with HIV-1 and receiving antiretroviral therapy-a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2021; 101:168-182. [PMID: 34704251 DOI: 10.1111/aogs.14282] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 08/24/2021] [Accepted: 10/04/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Antiretroviral therapy-naïve pregnant women living with HIV are at an increased risk for adverse pregnancy outcomes. It remains controversial whether this risk persists with antiretroviral therapy. We conducted a systematic review and meta-analysis to evaluate whether pregnant women living with HIV and receiving antiretroviral therapy antenatally, are at an increased risk of adverse outcomes compared with HIV-negative controls. MATERIAL AND METHODS We searched MEDLINE, Embase, International Pharmaceutical Abstracts, EBM Reviews, PubMed (non-MEDLINE records), EBSCO CINAHL Complete, Clarivate Web of Science, African Index Medicus, LILACS and Google Scholar for all observational studies comparing pregnant women living with HIV on antiretroviral therapy with HIV-negative controls from 1 January 1994 to 10 August 2021 with no language or geographic restrictions. Perinatal outcomes included preterm birth (PTB), low birthweight, small-for-gestational age and preeclampsia. Using a random-effects model we pooled raw data to generate odds ratio (OR) with 95% confidence intervals (CI) for each outcome. Sub-analyses for high and low resource countries and time of antiretroviral therapy initiation were performed. This systematic review and meta-analysis is registered with PROSPERO, number CRD42020182722. RESULTS Of the 7900 citations identified, 27 were eligible for analysis (12 636 pregnant women living with HIV on antiretroviral therapy and 7 812 115 HIV-negative controls). ORs (95% CI) of PTB (1.88 [1.63-2.17]), small-for-gestational age (1.60 [1.18-2.17]) and low birthweight (2.15 [1.58-2.92]) were significantly higher in pregnant women living with HIV than in HIV-negative women, while the risk of preeclampsia (0.86 [0.57-1.30]) was comparable. The risk of PTB and low birthweight was higher in both high resource and low resource countries, while the risk of small-for-gestational age was higher only in the former. Preconceptional antiretroviral therapy was associated with a higher risk of PTB compared with antenatal initiation. CONCLUSIONS Pregnant women living with HIV on antiretroviral therapy have an increased risk of PTB, low birthweight and small-for-gestational age in high resource countries, as well as PTB and low birthweight in low income countries compared with HIV-negative controls.
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Affiliation(s)
- Shiri Shinar
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Swati Agrawal
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Ryu
- Sidney Liswood Health Sciences Library, Sinai Health System, Toronto, Ontario, Canada.,MacDonald/Brayley Health Sciences Library, Trillium Health Partners, Toronto, Ontario, Canada
| | - Sharon Walmsley
- Immunodeficiency Clinic, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, University Health Network, Ontario, Canada
| | - Lena Serghides
- Toronto General Hospital Research Institute, University Health Network, Ontario, Canada.,Department of Immunology and Institute of Medical Sciences, University of Toronto, Ontario, Canada
| | - Mark H Yudin
- Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kellie E Murphy
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Mishra RK, Chakravarty R, Siddique N, Pandey KR. Pregnancy outcomes following exposure to efavirenz based antiretroviral therapy in indian women. Indian J Pharmacol 2021; 52:467-471. [PMID: 33666186 PMCID: PMC8092176 DOI: 10.4103/ijp.ijp_263_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES: Mother-to-child transmission of HIV has witnessed a significant reduction due to effective antiretroviral therapy (ART). Efavirenz has been introduced as a part of ART since last few years in the national Prevention of Parent to Child Transmission (PPTCT) program for pregnant women living with HIV. However, data related to adverse pregnancy outcomes associated with efavirenz-based ART are limited in the Indian scenario. The present study evaluated pregnancy outcomes in HIV-infected pregnant women who were given efavirenz-based ART during pregnancy. MATERIALS AND METHODS: It is a retrospective, observational, analytic study carried out at a referral hospital in Western India. Collection of data was done for a period of 5 years, and various adverse outcomes were studied which included preterm delivery, low birth weight (LBW), stillbirths, congenital anomaly, and neonatal death. RESULTS: This study showed a preterm birth rate of 19% and LBW in 36% of cases. There was no significant association with congenital anomaly, stillbirth, or neonatal death. CONCLUSION: There was an association of exposure to efavirenz with an increased incidence of adverse pregnancy outcomes, especially LBW infants. This study emphasizes the requirement of large prospective studies to investigate fetomaternal outcomes in pregnant women exposed to efavirenz.
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Affiliation(s)
- Rajesh Kumar Mishra
- Department of Obstetrics and Gynaecology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Rony Chakravarty
- Department of Obstetrics and Gynaecology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Nilopher Siddique
- Department of Obstetrics and Gynaecology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Kirit Rajendra Pandey
- Department of Obstetrics and Gynaecology, Armed Forces Medical College, Pune, Maharashtra, India
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Piske M, Qiu AQ, Maan EJ, Sauvé LJ, Forbes JC, Alimenti A, Janssen PA, Money DM, Côté HCF. Preterm Birth and Antiretroviral Exposure in Infants HIV-exposed Uninfected. Pediatr Infect Dis J 2021; 40:245-250. [PMID: 33480662 DOI: 10.1097/inf.0000000000002984] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Infants HIV-exposed and uninfected (IHEU) who are born to women living with HIV are at an increased risk of preterm birth (PTB). Antenatal exposure to certain maternal antiretroviral therapy (ART) regimens has been associated with PTB, although existing studies in this domain are limited and report discordant findings. We determined odds of PTB among IHEU by antenatal ART regimens and timing of exposure, adjusting for maternal risk factors. METHODS We retrospectively studied IHEU born in British Columbia (BC), Canada between 1990 and 2012 utilizing provincial health administrative databases. We included data from a control group of infants HIV-unexposed and uninfected (IHUU) matched ~3:1 for each IHEU on age, sex and geocode. RESULTS A total of 411 IHEU and 1224 IHUU were included in univariable analysis. PTB was more frequent among IHEU (20%) compared with IHUU (7%). IHEU were more often antenatally exposed to alcohol, tobacco, as well as prescription, nonprescription, and illicit drugs (IHEU: 36%, 8% and 35%; vs. IHUU: 3%, 1% and 9%, respectively). After adjusting for maternal substance use and smoking exposure, IHEU remained at increased odds of PTB [adjusted odds ratio (aOR) (95% CI): 2.66; (1.73, 4.08)] compared with matched IHUU controls. ART-exposed IHEU (excluding those with NRTIs only ART) had lower adjusted odds of PTB compared with IHEU with no maternal ART exposure, regardless of regimen [aOR range: 0.16-0.29 (0.02-0.95)]. Odds of PTB between IHEU exposed to ART from conception compared with IHEU exposed to ART postconception did not differ [aOR: 0.91 (0.47, 1.76)]; however, both groups experienced lower odds of PTB compared with IHEU with no maternal ART [preconception: aOR: 0.28 (0.08, 0.89); postconception: aOR 0.30 (0.11, 0.83)]. CONCLUSIONS BC IHEU were over twice as likely to be born preterm compared with demographically matched controls. Maternal substance use in pregnancy modulated this risk; however, we found no adverse associations of PTB with exposure to antenatal ART.
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Affiliation(s)
- Micah Piske
- From the Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Annie Q Qiu
- BC Women's Hospital, Vancouver, British Columbia
| | - Evelyn J Maan
- BC Women's Hospital, Vancouver, British Columbia
- Women's Health Research Institute, Vancouver, British Columbia
| | - Laura J Sauvé
- BC Women's Hospital, Vancouver, British Columbia
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - John C Forbes
- BC Women's Hospital, Vancouver, British Columbia
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Ariane Alimenti
- BC Women's Hospital, Vancouver, British Columbia
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Patricia A Janssen
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia
- Women's Health Research Institute, Vancouver, British Columbia
| | - Deborah M Money
- BC Women's Hospital, Vancouver, British Columbia
- Women's Health Research Institute, Vancouver, British Columbia
- Department of Obstetrics, University of British Columbia, Vancouver, British Columbia
| | - Hélène C F Côté
- From the Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Women's Health Research Institute, Vancouver, British Columbia
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10
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Shallie PD, Naicker T. Differential upregulations of SMAC and LAMIN B levels in the buffy coat of HIV associated preeclamptic women. J Matern Fetal Neonatal Med 2021; 35:5080-5086. [PMID: 33478301 DOI: 10.1080/14767058.2021.1875210] [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: 10/22/2022]
Abstract
OBJECTIVE To assess HIV positivity as an apoptotic confounding variable in pregnancies complicated by preeclampsia. METHODS AND MATERIALS Using a Bio-plex Multiplex Immunoassay, Smac and Lamin B concentrations (ng/ml) were analyzed in a buffy coat collected from 128 pregnant women attending a large regional hospital in Durban, South Africa. Study groups consisted of Normotensive and Preeclamptic pregnant women stratified according to their HIV status. All HIV positive groups received highly active antiretroviral therapy (HAART). RESULTS Our findings showed significant (p < .05) upregulation in the levels of both SMAC and LAMIN B in the HIV positive patients and a concomitant downregulation of the same apoptotic makers were observed in preeclampsia regardless of HIV status. CONCLUSIONS These results could be associated with the fact that apoptosis promotes deregulation of mitochondrial dynamics, contributing to the associated severe obstetric events observed in pregnancies among HIV-infected women on HAART.
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Affiliation(s)
- Philemon D Shallie
- Optics and Imaging Centre, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.,Anatomy, College of Medicine, Olabisi Onabanjo University, Sagamu, Nigeria
| | - Thajasvarie Naicker
- Optics and Imaging Centre, College of Health Sciences, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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11
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Ajaykumar A, Zhu M, Kakkar F, Brophy J, Bitnun A, Alimenti A, Soudeyns H, Saberi S, Albert AYK, Money DM, Côté HCF. Elevated Blood Mitochondrial DNA in Early Life Among Uninfected Children Exposed to Human Immunodeficiency Virus and Combination Antiretroviral Therapy in utero. J Infect Dis 2020; 223:621-631. [PMID: 32638023 DOI: 10.1093/infdis/jiaa410] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/03/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Combination antiretroviral therapy (cART) during pregnancy prevents vertical transmission, but many antiretrovirals cross the placenta and several can affect mitochondria. Exposure to maternal human immunodeficiency virus (HIV) and/or cART could have long-term effects on children who are HIV exposed and uninfected (CHEU). Our objective was to compare blood mitochondrial DNA (mtDNA) content in CHEU and children who are HIV unexposed and uninfected (CHUU), at birth and in early life. METHODS Whole-blood mtDNA content at birth and in early life (age 0-3 years) was compared cross-sectionally between CHEU and CHUU. Longitudinal changes in mtDNA content among CHEU was also evaluated. RESULTS At birth, CHEU status and younger gestational age were associated with higher mtDNA content. These remained independently associated with mtDNA content in multivariable analyses, whether considering all infants, or only those born at term. Longitudinally, CHEU mtDNA levels remained unchanged during the first 6 months of life, and gradually declined thereafter. A separate age- and sex-matched cross-sectional analysis (in 214 CHEU and 214 CHUU) illustrates that the difference in mtDNA between the groups remains detectable throughout the first 3 years of life. CONCLUSION The persistently elevated blood mtDNA content observed among CHEU represents a long-term effect, possibly resulting from in utero stresses related to maternal HIV and/or cART. The clinical impact of altered mtDNA levels is unclear.
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Affiliation(s)
- Abhinav Ajaykumar
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mayanne Zhu
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fatima Kakkar
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Jason Brophy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Ari Bitnun
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ariane Alimenti
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Hugo Soudeyns
- Unité d'Immunopathologie Virale, Centre de Recherche du CHU Sainte-Justine, Montreal, Quebec, Canada.,Department of Microbiology, Infectiology & Immunology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Sara Saberi
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Deborah M Money
- BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada.,Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hélène C F Côté
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada
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12
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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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13
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dos Reis HLB, Boldrini NAT, Rangel AFR, Barros VF, Merçon de Vargas PR, Miranda AE. Placental growth disorders and perinatal adverse outcomes in Brazilian HIV-infected pregnant women. PLoS One 2020; 15:e0231938. [PMID: 32352999 PMCID: PMC7192492 DOI: 10.1371/journal.pone.0231938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 04/03/2020] [Indexed: 12/18/2022] Open
Abstract
Fetal and placental growth disorders are common in maternal human immunodeficiency virus (HIV) infection and can be attributed to both the infection and comorbidities not associated with HIV. We describe placental growth disorders and adverse reproductive outcomes in HIV-infected pregnant women whose delivery occurred between 2001-2014 in Vitoria, Brazil. Cases with gestational age (GA) ≥ than 22 weeks validated by ultrasonography, with placental and fetal weight dimensions at birth, were studied. Outcomes were summarized as proportions of small (SGA), appropriate (AGA), and large (LGA) for GA when the z-score values were below -1.28, between -1.28 and +1.28, or above +1.28, respectively. Of 187 fetal attachment requisitions, 122(65.2%) women and their newborns participated in the study. The median maternal age was 28 years and 81(66.4%) underwent ≥ 6 prenatal visits. A total of 81(66.4%) were diagnosed before current pregnancy; 68(55.7%) exhibited criteria for acquired immunodeficiency syndrome (AIDS); 64(52.4%) had detectable viral load; 25(20.5%) cases presented SGA placental weight and 6(4.9%) SGA placental thickness. SGA placental area was observed in 41(33.6%) cases, and among the SGA placental weight cases 12(48%) were also SGA fetal weight. Preterm birth (PTB) occurred in 15.6%(19/122) of cases; perinatal death in 4.1%(5/122) and HIV vertical transmission in 6 of 122 (4.9%). Women, ≥36 years old, were 5.7 times more likely to have PTB than those under 36. Also, patients with AIDS-defining criteria were 3.7 times more likely to have PTB. Prenatal care was inversely associated with PTB. Statistically significant associations were observed between AGA placental area and Protease Inhibitor usage and between SGA placental weight and SGA area. We found a prevalence of placental growth disorders in HIV-infected pregnant women and values higher than international reference values. The restriction of placental growth was a common disorder, possibly attributed to virus effects or a combination of antiretroviral regimens.
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Affiliation(s)
- Helena Lucia Barroso dos Reis
- Post-Graduate Program of Infectious Diseases, Federal University of Espírito Santo, Vitória, Espírito Santo State, Brazil
- * E-mail:
| | | | - Ana Fernanda Ribeiro Rangel
- Department of Pathology, Pathology Laboratory of Cassiano Antonio Moraes University Hospital, Federal University of Espírito Santo, Vitória, Espírito Santo State, Brazil
| | - Vinicius Felipe Barros
- Department of Pathology, Pathology Laboratory of Cassiano Antonio Moraes University Hospital, Federal University of Espírito Santo, Vitória, Espírito Santo State, Brazil
| | - Paulo Roberto Merçon de Vargas
- Department of Pathology, Pathology Laboratory of Cassiano Antonio Moraes University Hospital, Federal University of Espírito Santo, Vitória, Espírito Santo State, Brazil
| | - Angélica Espinosa Miranda
- Post-Graduate Program of Infectious Diseases, Federal University of Espírito Santo, Vitória, Espírito Santo State, Brazil
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14
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Ørbaek M, Thorsteinsson K, Moseholm Larsen E, Katzenstein TL, Storgaard M, Johansen IS, Pedersen G, Bach D, Helleberg M, Weis N, Lebech AM. Risk factors during pregnancy and birth-related complications in HIV-positive versus HIV-negative women in Denmark, 2002-2014. HIV Med 2019; 21:84-95. [PMID: 31603598 DOI: 10.1111/hiv.12798] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES We aimed to compare risk factors for adverse pregnancy outcomes in women living with HIV (WLWH) with those in women of the general population (WGP) in Denmark. Further, we estimated risk of pregnancy- or birth-related complications. METHODS A retrospective cohort study including all WLWH who delivered a live-born child from 2002 to 2014 and WGP, matched by origin, age, year and parity, was carried out. We compared risk factors during pregnancy and estimated risk of pregnancy- and birth-related complications using multivariate logistic regression. RESULTS A total of 2334 pregnancies in 304 WLWH and 1945 WGP were included in the study. WLWH had more risk factors present than WGP during pregnancy: previous caesarean section (CS) (24.7% versus 16.3%, respectively; P = 0.0001), smoking (14.2% versus 7.5%, respectively; P = 0.0001) and previous perinatal/neonatal death (2.3% versus 0.9%, respectively; P = 0.03). We found no difference between groups regarding gestational diabetes, hypertensive disorders, low birth weights or premature delivery. More children of WLWH had intrauterine growth retardation (IUGR) [adjusted odds ratio (aOR) 1.9; 95% confidence interval (CI) 1.1-3.2; P = 0.02]. Median gestational age and birth weight were lower in children born to WLWH. WLWH had a higher risk of emergency CS (EmCS) (aOR 1.6; 95% CI 1.2-2.1; P = 0.0005) and postpartum haemorrhage (aOR 1.4; 95% CI 1.0-1.9; P = 0.02) but not infection, amniotomy, failure to progress, low activity-pulse-grimace-appearance-respiration (APGAR) score or signs of asphyxia. CONCLUSIONS WLWH had more risk factors present during pregnancy, similar risks of most pregnancy- and birth-related complications but a higher risk of postpartum haemorrhage and EmCS compared with WGP. Children born to WLWH had lower median birth weights and gestational ages and were at higher risk of IUGR.
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Affiliation(s)
- M Ørbaek
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - K Thorsteinsson
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - E Moseholm Larsen
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - T L Katzenstein
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark
| | - I S Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - G Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - D Bach
- Department of Gynecology and Obstetrics, Copenhagen University Hospital, Hvidovre, Denmark
| | - M Helleberg
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - N Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - A-M Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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15
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Nourollahpour Shiadeh M, Riahi SM, Khani S, Alizadeh S, Hosseinzadeh R, Hasanpour AH, Shahbazi M, Ebrahimpour S, Javanian M, Fakhri Y, Vasigala V, Rostami A. Human Immunodeficiency Virus and risk of pre-eclampsia and eclampsia in pregnant women: A meta-analysis on cohort studies. Pregnancy Hypertens 2019; 17:269-275. [PMID: 31487651 DOI: 10.1016/j.preghy.2019.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/22/2019] [Accepted: 07/30/2019] [Indexed: 12/13/2022]
Abstract
Maternal HIV infection is related to several perinatal adverse outcomes. This study is aimed at establishing whether maternal HIV infection is associated with the development of pre-eclampsia (PE) and eclampsia. We comprehensively searched MEDLINE/PubMed, Web of Science, SCOPUS and Embase databases for relevant studies published up to 20 November 2018, without time and language restrictions. We have limited our literature searches to observational studies in humans. We applied a random-effects model to calculate the relative risks (RR) and 95% confidence intervals (CI) for the meta-analyses. We also systematically reviewed eligible studies to determine the effects of HIV infection on imbalance of angiogenic and anti-angiogenic factors, which are effective in increased risk of PE or eclampsia. We identified a total of 11,186 publications, out of which 22 eligible studies (11 prospective and 11 retrospective cohort studies) comprising 90,514 HIV-positive and 66,085,278 HIV-negative pregnant women were included in meta-analysis. Results of the meta-analyses suggested that maternal HIV infection is not significantly associated with the development of PE (RR, 1.04; 95%CI, 0.89-1.21) and eclampsia (RR, 1.05; 95%CI, 0.63-1.75). Six studies were included to understand the effects of HIV infection on imbalance of angiogenic and anti-angiogenic factors. All six studies demonstrated that HIV infection had no significant effect on expression levels of these factors in pre-eclamptic and normotensive pregnant women. Our study showed that maternal HIV infection was not significantly associated with increased or reduced risks of pre-eclampsia and eclampsia. More well-designed studies with large sample size and well defined outcomes are recommended to confirm or refute the present findings.
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Affiliation(s)
| | - Seyed Mohammad Riahi
- Cardiovascular Diseases Research Center, Department of Epidemiology and Biostatistics, Faculty of Health, Birjand University of Medical Sciences, Birjand, Iran.
| | - Soghra Khani
- Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Solmaz Alizadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Rezvan Hosseinzadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Amir Hossein Hasanpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mehdi Shahbazi
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran; Immunoregulation Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mostafa Javanian
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Yadollah Fakhri
- Department of Environmental Health Engineering, Student Research Committee, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran; Immunoregulation Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
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16
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Premkumar A, Dude AM, Haddad LB, Yee LM. Combined antiretroviral therapy for HIV and the risk of hypertensive disorders of pregnancy: A systematic review. Pregnancy Hypertens 2019; 17:178-190. [PMID: 31487638 PMCID: PMC6733581 DOI: 10.1016/j.preghy.2019.05.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/18/2019] [Accepted: 05/17/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess if there is a relationship between use of combined antiretroviral therapy among pregnant women living with HIV and hypertensive disorders of pregnancy (HDP). DESIGN Due to the heterogeneity of study designs in the literature and the utilization of different outcome measures in regards to assessing the presence of HDP, a systematic review was performed. METHODS ClinicalTrials.gov and MEDLINE, via PubMed, EMBASE, Scopus, CINAHL, ProQuest Dissertations & Theses Global, EBSCOHost, DARE, and the Cochrane Library, were queried from January 1997 to October 2017. Studies were included if they reported HDP and focused on pregnant women living with HIV who used combined antiretroviral therapy. The Cochrane Collaboration's tool for assessment of risk of bias and the U.S. Preventive Services Task Force grading scale were used to assess the studies. RESULTS Of 1055 abstracts, 28 articles met inclusion criteria. The data are marked by multiple biases and poor study design. All studies demonstrate an increased risk of HDP among pregnant women living with HIV who used combined antiretroviral therapy when compared to seropositive pregnant women not using antiretroviral therapy. Three studies suggest protease inhibitors may be associated with a higher risk of HDP. CONCLUSION Despite all studies indicating a higher frequency of HDP among pregnant women living with HIV using combined antiretroviral therapy when compared with seropositive pregnant women not using antiretroviral therapy, the quality of the studies is mixed, necessitating further research.
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Affiliation(s)
- Ashish Premkumar
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, 250 E. Superior Street, Chicago, IL 60611, USA.
| | - Annie M Dude
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, 250 E. Superior Street, Chicago, IL 60611, USA
| | - Lisa B Haddad
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 49 Jesse Hill Jr Dr SE, Atlanta, GA 30303, USA
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, 250 E. Superior Street, Chicago, IL 60611, USA
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17
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Msukwa MT, Keiser O, Jahn A, Van Oosterhout JJ, Edmonds A, Phiri N, Manjomo R, Davies MA, Estill J. Timing of combination antiretroviral therapy (cART) initiation is not associated with stillbirth among HIV-infected pregnant women in Malawi. Trop Med Int Health 2019; 24:727-735. [PMID: 30891866 PMCID: PMC7137352 DOI: 10.1111/tmi.13233] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To assess the association between timing of maternal combination ART (cART) initiation and stillbirth among HIV-infected pregnant women in Malawi's Option B+ programme. METHODS Cohort study of HIV-infected pregnant women delivering singleton live or stillborn babies at ≥28 weeks of gestation using routine data from maternity registers between 1 January 2012 and 30 June 2015. We defined stillbirth as death of a foetus at ≥28 weeks of gestation. We report proportions of stillbirth according to timing of maternal cART initiation (before pregnancy, 1st or 2nd trimester, or 3rd trimester or labour). We used logistic regression, with robust standard errors to account for clustering of women within health facilities, to investigate the association between timing of cART initiation and stillbirth. RESULTS Of 10 558 mother-infant pairs abstracted from registers, 8380 (79.4%) met inclusion criteria. The overall rate of stillbirth was 25 per 1000 deliveries (95% confidence interval 22-29). We found no significant association between timing of maternal cART initiation and stillbirth. In multivariable models, older maternal age, male sex of the infant, breech vaginal delivery, delivery at < 34 weeks of gestation and experience of any maternal obstetric complication were associated with higher odds of stillbirth. Deliveries managed by a mission hospital or health centre were associated with lower odds of stillbirth. CONCLUSION Pregnant women's exposure to cART, regardless of time of its initiation, was not associated with increased odds of stillbirth.
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Affiliation(s)
- Malango T. Msukwa
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- Baobab Health Trust, Lilongwe, Malawi
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Andreas Jahn
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi
| | - Joep J. Van Oosterhout
- Dignitas International, Zomba, Malawi
- Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Andrew Edmonds
- The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Nozgechi Phiri
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- Baobab Health Trust, Lilongwe, Malawi
| | | | - Mary-Ann Davies
- Centre of Infectious Disease Epidemiology and Research, University of Cape Town, South Africa
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- Institute of Mathematical Statistics and Actuarial Science, University of Bern, Switzerland
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18
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Abdi F, Alimoradi Z, Alidost F. Pregnancy outcomes and effects of antiretroviral drugs in HIV-positive pregnant women: a systematic review. Future Virol 2019. [DOI: 10.2217/fvl-2018-0213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: Despite the clear morbidity, mortality and vertical transmission rates in women infected with HIV, there is still controversy surrounding the relationship between maternal infection and adverse neonatal outcomes. Antiretroviral therapy during pregnancy is considered the main and most effective method for reducing the vertical transmission of infection. However, there is no consensus over potential associations between antiretroviral therapy and adverse pregnancy outcomes. This systematic review focuses on the effects of antiretroviral drugs on pregnancy outcomes in HIV-positive women. Methods: After searching MEDLINE, the Cochrane Database of Systematic Reviews, the ISI Web of Sciences and EMBASE, 570 potentially eligible papers were identified. Only 32 papers were selected based on the inclusion criteria. Results: The most prevalent adverse pregnancy outcomes were low birth weight, preterm birth and stillbirth. Conclusion: Considering the higher prevalence of adverse pregnancy outcomes in HIV-infected women, HIV screening methods should be administered in all pregnant women. Appropriate treatment modalities should also be selected to minimize adverse pregnancy outcomes.
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Affiliation(s)
- Fatemeh Abdi
- Student Research Committee, Nursing & Midwifery Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zainab Alimoradi
- Department of Midwifery, Nursing & Midwifery Faculty, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Farzane Alidost
- Department of Reproductive Health, Nursing & Midwifery Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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19
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Timing of Initiation of Antiretroviral Therapy and Risk of Preterm Birth in Studies of HIV-infected Pregnant Women: The Role of Selection Bias. Epidemiology 2019; 29:224-229. [PMID: 29045283 DOI: 10.1097/ede.0000000000000772] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Women who initiate antiretroviral therapy (ART) during pregnancy are reported to have lower risk of preterm birth compared with those who enter pregnancy care already receiving ART. We hypothesize this association can be largely attributed to selection bias. METHODS We simulated a cohort of 1000 preconceptional, HIV-infected women, where half were randomly allocated to receive immediate ART and half to delay ART until their presentation for pregnancy care. Gestational age at delivery was drawn from population data unrelated to randomization group (i.e., the true effect of delayed ART was null). Outcomes of interest were preterm birth (<37 weeks), very preterm birth (<32 weeks), and extreme preterm birth (<28 weeks). We analyzed outcomes in 2 ways: (1) a prospectively enrolled clinical trial, where all women were considered (the intent-to-treat (ITT) analysis); and (2) an observational study, where women who deliver before initiating ART were excluded (the naïve analysis). We explored the impact of later ART initiation and gestational age measurement error on our findings. RESULTS Preconception ART initiation was not associated with preterm birth in ITT analyses. Risk ratios (RRs) for the effect of preconception ART initiation were RR = 1.10 (preterm), RR = 1.41 (very preterm), and RR = 5.01 (extreme preterm) in naïve analyses. Selection bias increased in the naïve analysis with advancing gestational age at ART initiation and with introduction of gestational age measurement error. CONCLUSIONS Analyses of preterm birth that compare a preconception exposure to one that occurs in pregnancy are at risk of selection bias. See video abstract at, http://links.lww.com/EDE/B313.
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Pregnancy outcomes in young mothers with perinatally and behaviorally acquired HIV infections in Rio de Janeiro. Braz J Infect Dis 2018; 22:412-417. [PMID: 30339778 PMCID: PMC9427968 DOI: 10.1016/j.bjid.2018.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/09/2018] [Accepted: 08/13/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Perinatally HIV-infected children are surviving into adulthood, and getting pregnant. There is a scarcity of information on health and pregnancy outcomes in these women. AIM To evaluate characteristics related to HIV disease and pregnancy outcomes in perinatally infected women, and to compare these women with a group of youth with behaviorally acquired HIV-infection, at a reference hospital in Rio de Janeiro, Brazil. METHODS A cohort study. Epidemiological, clinical, and laboratory data were compared between perinatally (PHIV) and behaviorally HIV-infected (BHIV) pregnant youth with the primary aim to study pregnancy outcomes in the PHIV group and compare with outcomes to BHIV group. RESULTS Thirty-two pregnancies occurred in PHIV group, and 595 in BHIV group. A total of seven (22%) PHIV women and 64 (11%) BHIV women had a premature delivery (p=0.04), however, when adjusting for younger age at pregnancy, and antiretroviral therapy initiation in 1st trimester of pregnancy (OR=18.66, 95%CI=5.52-63.14), the difference was no longer significant. No cases of mother-to-child HIV transmission (MTCT) were observed in the PHIV group while there was a 2% MTCT rate in BHIV group. CONCLUSION Pregnancy among PHIV was as safe as among BHIV. The differences between those groups were probably related to treatment and prolonged care in the first group.
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Phoswa WN, Naicker T, Ramsuran V, Moodley J. Pre-eclampsia: the role of highly active antiretroviral therapy and immune markers. Inflamm Res 2018; 68:47-57. [PMID: 30276649 DOI: 10.1007/s00011-018-1190-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/26/2018] [Accepted: 09/27/2018] [Indexed: 02/06/2023] Open
Abstract
PURPOSE OF THE REVIEW This review highlights the role immune cells and markers such as natural killer (NK) cells, cytokines and human leukocyte antigen (HLA-G) play in predisposing HIV-infected women who are on HAART to develop PE, thus contributing to a better understanding and early diagnosis of PE with a subsequent reduction in maternal foetal and neonatal deaths. RECENT FINDINGS Pregnant women infected with the Human Immunodeficiency Virus (HIV) have a 25% risk of mother to child transmission. This risk, however, decreases to 2% if the women is on treatment. Highly active antiretroviral therapy (HAART) is the recommended treatment for both pregnant and non-pregnant women infected with HIV. Treatment with HAART is reported to potentiate predisposition to the development of hypertensive disorders of pregnancy such as pre-eclampsia (PE). Pre-eclampsia accounts for 7-10% of abnormal pregnancies worldwide. Studies demonstrate that pregnant women with HIV have PE at lower frequencies than uninfected women, however, the converse is observed upon HAART initiation. HIV-infected women on HAART exhibit a greater tendency to develop PE, emanating from immune reconstitution induced by HAART. There is paucity of information as to the pathogenesis of PE upon HAART initiation and there are, therefore, controversial data as to whether HAART predisposes women to a lower, equal or higher risk of PE development compared to the general population, further investigations on the impact of HIV infection and HAART on the immune response and rate of PE development in HIV infected pregnant women are urgently needed.
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Affiliation(s)
- Wendy N Phoswa
- Discipline of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - Thajasvarie Naicker
- Optics and Imaging Centre, University of KwaZulu-Natal, Durban, South Africa
| | - Veron Ramsuran
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.,Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Jagidesa Moodley
- Women's Health and HIV Research Group, University of KwaZulu-Natal, Durban, South Africa
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Malaba TR, Newell ML, Madlala H, Perez A, Gray C, Myer L. Methods of gestational age assessment influence the observed association between antiretroviral therapy exposure, preterm delivery, and small-for-gestational age infants: a prospective study in Cape Town, South Africa. Ann Epidemiol 2018; 28:893-900. [PMID: 30293920 DOI: 10.1016/j.annepidem.2018.08.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/21/2018] [Accepted: 08/23/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Heterogeneous findings exist on antiretroviral therapy (ART) use in pregnancy and preterm delivery (PTD) or infants born small-for-gestational age (SGA). Whether reported differences may be explained by methods used to ascertain gestational age (GA) has not been explored. METHODS We enrolled consecutive pregnant women attending a large primary care antenatal clinic in South Africa. Public-sector midwives assessed GA by last menstrual period (LMP) and symphysis-fundal height (SFH). Separately, if clinical GA was less than 24 weeks, ultrasound (US) was performed by a research sonographer blinded to midwife assessments. In analysis, the impact of measurement error on the association between HIV/ART status and birth outcome by GA method was assessed, and factors associated with clinical GA underestimation or overestimation identified. RESULTS In 1787 women included overall, estimated PTD incidence was 36% by LMP, 17% by SFH, and 11% by US. PTD risk was higher for HIV-infected than HIV-uninfected women using US-GA (adjusted odds ratio [aOR] 1.95; 95% CI 1.10-3.46); for LMP/SFH-GA, the associations were smaller and not significant. These findings persisted after adjustment for age, parity, height, and previous PTD. PTD risk did not vary by timing of ART initiation (before or during pregnancy) for any method. Elevated BMI and older age were associated with decreased risk of underestimation by both LMP and SFH; HIV status and obesity were associated with increased risk of overestimation by SFH. There were no differences in SGA incidence across GA methods. CONCLUSIONS Findings for an association between HIV/ART and birth outcomes are substantially influenced by GA assessment method. With growing public health interest in this association, future research efforts should seek to standardize optimal measures of gestation.
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Affiliation(s)
- Thokozile Rosemary Malaba
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa; Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Marie-Louise Newell
- Institute for Developmental Science, Faculty of Medicine, University of Southampton, Southampton, UK; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Hlengiwe Madlala
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa; Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Alexander Perez
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa; Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Clive Gray
- Division of Immunology, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa; Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
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Veroniki AA, Antony J, Straus SE, Ashoor HM, Finkelstein Y, Khan PA, Ghassemi M, Blondal E, Ivory JD, Hutton B, Gough K, Hemmelgarn BR, Lillie E, Vafaei A, Tricco AC. Comparative safety and effectiveness of perinatal antiretroviral therapies for HIV-infected women and their children: Systematic review and network meta-analysis including different study designs. PLoS One 2018; 13:e0198447. [PMID: 29912896 PMCID: PMC6005568 DOI: 10.1371/journal.pone.0198447] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 05/20/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Nearly all newly infected children acquire Human Immunodeficiency virus (HIV) via mother-to-child transmission (MTCT) during pregnancy, labour or breastfeeding from untreated HIV-positive mothers. Antiretroviral therapy (ART) is the standard care for pregnant women with HIV. However, evidence of ART effectiveness and harms in infants and children of HIV-positive pregnant women exposed to ART has been largely inconclusive. The aim of our systematic review and network meta-analysis (NMA) was to evaluate the comparative safety and effectiveness of ART drugs in children exposed to maternal HIV and ART (or no ART/placebo) across different study designs. METHODS We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (inception until December 7, 2015). Primary outcomes were any congenital malformations (CMs; safety), including overall major and minor CMs, and mother-to-child transmission (MTCT; effectiveness). Random-effects Bayesian pairwise meta-analyses and NMAs were conducted. After screening 6,468 citations and 1,373 full-text articles, 90 studies of various study designs and 90,563 patients were included. RESULTS The NMA on CMs (20 studies, 7,503 children, 16 drugs) found that none of the ART drugs examined here were associated with a significant increase in CMs. However, zidovudine administered with lamivudine and indinavir was associated with increased risk of preterm births, zidovudine administered with nevirapine was associated with increased risk of stillbirths, and lamivudine administered with stavudine and efavirenz was associated with increased risk of low birth weight. A NMA on MTCT (11 studies, 10,786 patients, 6 drugs) found that zidovudine administered once (odds ratio [OR] = 0.39, 95% credible interval [CrI]: 0.19-0.83) or twice (OR = 0.43, 95% CrI: 0.21-0.68) was associated with significantly reduced risk of MTCT. CONCLUSIONS Our findings suggest that ART drugs are not associated with an increased risk of CMs, yet some may increase adverse birth events. Some ART drugs (e.g., zidovudine) effectively reduce MTCT.
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Affiliation(s)
| | - Jesmin Antony
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Sharon E. Straus
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Huda M. Ashoor
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Yaron Finkelstein
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Paul A. Khan
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Marco Ghassemi
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Erik Blondal
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - John D. Ivory
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Brian Hutton
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Center for Practice Changing Research, The Ottawa Hospital–General Campus, Ottawa, Ontario, Canada
| | - Kevin Gough
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brenda R. Hemmelgarn
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Erin Lillie
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Afshin Vafaei
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Andrea C. Tricco
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Snijdewind IJM, Smit C, Godfried MH, Bakker R, Nellen JFJB, Jaddoe VWV, van Leeuwen E, Reiss P, Steegers EAP, van der Ende ME. Preconception use of cART by HIV-positive pregnant women increases the risk of infants being born small for gestational age. PLoS One 2018; 13:e0191389. [PMID: 29351561 PMCID: PMC5774764 DOI: 10.1371/journal.pone.0191389] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 01/04/2018] [Indexed: 11/18/2022] Open
Abstract
Background The benefits of combination anti-retroviral therapy (cART) in HIV-positive pregnant women (improved maternal health and prevention of mother to child transmission [pMTCT]) currently outweigh the adverse effects due to cART. As the variety of cART increases, however, the question arises as to which type of cART is safest for pregnant women and women of childbearing age. We studied the effect of timing and exposure to different classes of cART on adverse birth outcomes in a large HIV cohort in the Netherlands. Materials and methods We included singleton HEU infants registered in the ATHENA cohort from 1997 to 2015. Multivariate logistic regression analysis for single and multiple pregnancies was used to evaluate predictors of small for gestational age (SGA, birth weight <10th percentile for gestational age), low birth weight and preterm delivery. Results A total of 1392 children born to 1022 mothers were included. Of these, 331 (23.8%) children were SGA. Women starting cART before conception had an increased risk of having a SGA infant compared to women starting cART after conception (OR 1.35, 95% CI 1.03−1.77, p = 0.03). The risk for SGA was highest in women who started a protease inhibitor-(PI) based regimen prior to pregnancy, compared with women who initiated PI-based cART during pregnancy. While the association of preterm delivery and preconception cART was significant in univariate analysis, on multivariate analysis only a non-significant trend was observed (OR 1.39, 95% CI 0.94−1.92, p = 0.06) in women who had started cART before compared to after conception. In multivariate analysis, the risk of low birth weight (OR 1.34, 95% CI 0.94−1.92, p = 0.11) was not significantly increased in women who had started cART prior to conception compared to after conception. Conclusion In our cohort of pregnant HIV-positive women, the use of cART prior to conception, most notably a PI-based regimen, was associated with intrauterine growth restriction resulting in SGA. Data showed a non-significant trend in the risk of PTD associated with preconception use of cART compared to its use after conception. More studies are needed with regard to the mechanisms taking place in the placenta during fetal growth in pregnant HIV-positive women using cART. It will only be with this knowledge that we can begin to understand the potential impact of HIV and cART on the fetus, in order to be able to determine the optimal individualised drug regimen for HIV-infected women of childbearing age.
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Affiliation(s)
- Ingrid J. M. Snijdewind
- Department of Internal Medicine, Section Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Colette Smit
- Stichting HIV Monitoring (SHM), Amsterdam, The Netherlands
| | - Mieke H. Godfried
- Department of Internal Medicine and Infectious Disease, Academic Medical Center, Amsterdam, The Netherlands
| | - Rachel Bakker
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jeannine F. J. B. Nellen
- Department of Internal Medicine and Infectious Disease, Academic Medical Center, Amsterdam, The Netherlands
| | - Vincent W. V. Jaddoe
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Paediatrics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Elisabeth van Leeuwen
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands
| | - Peter Reiss
- Stichting HIV Monitoring (SHM), Amsterdam, The Netherlands
- Department of Internal Medicine and Infectious Disease, Academic Medical Center, Amsterdam, The Netherlands
- Department of Global Health, Academic Medical Center and Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Eric A. P. Steegers
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marchina E. van der Ende
- Department of Internal Medicine, Section Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
- * E-mail:
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Antiretroviral combination use during pregnancy and the risk of major congenital malformations. AIDS 2017; 31:2267-2277. [PMID: 28806195 DOI: 10.1097/qad.0000000000001610] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To quantify the risk of major congenital malformations (MCMs) associated with gestational combination antiretroviral use. DESIGN Population-based prospective cohort study. METHODS Using the Quebec Pregnancy Cohort from 1998 to 2015, we included women who were covered by the Quebec Drug Plan and had a singleton livebirth. All antiretroviral use alone or in combination were considered. MCMs overall and organ-specific malformations in the first year of life were identified. RESULTS In total, 214 240 pregnancies met inclusion criteria; 0.09% (n = 198) occurred while on antiretroviral combinations during the first trimester; 169 HIV-positive women without antiretroviral treatment were included. Compared with the general population in this cohort, the prevalence of MCMs was significantly higher in unexposed HIV-positive women (14.8 vs. 8.6%, P = 0.004) but not in antiretroviral-exposed HIV-positive women (10.3%, P = 0.41). Adjusting for potential confounders, including maternal HIV status, antiretroviral use during the first trimester was not associated with the risk of MCMs (adjusted odds ratio 0.59, 95% confidence interval 0.33-1.06). However, antiretroviral combination use during the first trimester was associated with an increased risk of defects of the small intestine (adjusted odds ratio 10.32, 95% confidence interval 2.85-37.38, P = 0.0004). CONCLUSION Antiretroviral therapy during the first trimester was not associated with the risk of overall MCMs but may be associated with an increased risk of defects of the small intestine. However, HIV-positive pregnant women who are not treated with antiretrovirals during pregnancy seem to have a higher risk of malformations; this is not seen among those who are treated, which could indicate that the underlying condition puts women at risk and not the treatment.
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Radhika AG, Chawla S, Bhaskaran S. Prevention of Parent to Child Transmission of HIV: Single Centre Experience of 14 years at Tertiary Care Hospital in Delhi, India. J Clin Diagn Res 2017; 11:QC04-QC07. [PMID: 28969210 DOI: 10.7860/jcdr/2017/26432.10423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 06/20/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Prevention of Parent To Child Transmission (PPTCT) of HIV/AIDS is an integral component of AIDS control programme. PPTCT is an ongoing programme since last 15 years. AIM The aim of the study was to evaluate the reduction in the burden of disease in newborn and infants by prevention of parents to child transmission of HIV/AIDS. MATERIALS AND METHODS This retrospective study was conducted at Department of Obstetrics and Gynecology in a tertiary care hospital of Delhi from May 2002 to May 2015. The data was collected from records of maternal details registered at PPTCT clinic as well as list of infants undergoing Early Infant Diagnosis (EID) recorded in the standard format as per instructions from National AIDS Control Organization (NACO) of India. The Programme performance was assessed against performance indicators stated by NACO, India. RESULTS Evaluation was done by dividing study period into two halves of seven years each. Out of 2,52,447 new antenatal case registration, overall, 43% received pretest of which, 91% were tested. Antenatal seropositivity rate varied from 0.1%-0.25%. Of 243 seropositive antenatal women 187 partners tested positive. While 25 women opted for MTP, 15 had still births. There were 17 neonatal deaths at 3-12 months attributable to respiratory infections and diarrheal diseases. Operative delivery rates declined from 50% to 31% over the years. Most women opted for breast feeding. The lost to follow up rate of newborns was quite high with details of only 43.5% being available at 18 months of infant's age. A total of three infants tested HIV positive at 18 months of age. CONCLUSION The study highlights the practical aspects of policy implementation and operational issues involved in low resource country.
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Affiliation(s)
- A G Radhika
- Senior Specialist, Department of Obstetrics and Gynaecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Sonia Chawla
- Senior Resident, Department of Obstetrics and Gynaecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Sruthi Bhaskaran
- Assistant Professor, Department of Obstetrics and Gynaecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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Malaba TR, Phillips T, Le Roux S, Brittain K, Zerbe A, Petro G, Ronan A, McIntyre JA, Abrams EJ, Myer L. Antiretroviral therapy use during pregnancy and adverse birth outcomes in South African women. Int J Epidemiol 2017; 46:1678-1689. [PMID: 29040569 PMCID: PMC5837407 DOI: 10.1093/ije/dyx136] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/22/2017] [Accepted: 06/27/2017] [Indexed: 11/12/2022] Open
Abstract
Background Studies of antiretroviral therapy (ART) use during pregnancy in HIV-infected women have suggested that ART exposure may be associated with adverse birth outcomes. However, there are few data from sub-Saharan Africa where HIV is most common, and few studies involving the World Health Organization's (WHO's) recommended first-line regimens. Methods We enrolled consecutive HIV-infected pregnant women and a comparator cohort of uninfected women at a primary-level antenatal care facility in Cape Town, South Africa. Gestational assessment combined clinical history, examination and ultrasonography; outcomes included preterm (PTD), low birthweight (LBW) and small for gestational age (SGA) deliveries. In analysis we compared birth outcomes between HIV-infected and -uninfected women, and HIV-infected women who initiated ART before vs during pregnancy. Results In 1554 women (mean age 29 years) with live singleton births at time of analysis, 82% were HIV-infected, 92% of whom received a first-line regimen of tenofovir, emtricitabine and efavirenz. Overall, higher levels of PTD [22% vs 13%; odds ratio (OR) 1.94, 95% confidence interval (CI): 1.34, 2.82] and LBW (14% vs 9%; OR 1.62, 95% CI: 1.05, 2.29) were observed in HIV-infected vs uninfected women, although SGA deliveries were similar (9% vs 11%; OR 1.06, 95% CI: 0.71, 1.61). Adjusting for demographic characteristics and HIV disease measures, HIV-infected (vs HIV-uninfected) women had persistently increased odds of PTD [adjusted odds ratio (AOR) 2.03; CI 1.33, 3.10]; associations with LBW were attenuated (AOR 1.47; CI 0.90, 2.40). Among all HIV-infected women, there appeared to be no association between the timing of ART initiation (before or during pregnancy) and adverse birth outcomes. Conclusions These findings suggest that current WHO-recommended ART regimens appear relatively safe in pregnancy, although more data are required to understand the aetiology of preterm delivery in HIV-infected women using ART.
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Affiliation(s)
- Thokozile R Malaba
- Division of Epidemiology and Biostatistics
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Tamsin Phillips
- Division of Epidemiology and Biostatistics
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Stanzi Le Roux
- Division of Epidemiology and Biostatistics
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Kirsty Brittain
- Division of Epidemiology and Biostatistics
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Allison Zerbe
- ICAP, Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Greg Petro
- Department of Obstetrics and Gynaecology, New Somerset Hospital, University of Cape Town, Cape Town, South Africa
| | - Agnes Ronan
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - James A McIntyre
- Division of Epidemiology and Biostatistics
- ANOVA Health Institute, Johannesburg, South Africa
| | - Elaine J Abrams
- ICAP, Columbia University, Mailman School of Public Health, New York, NY, USA
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Landon Myer
- Division of Epidemiology and Biostatistics
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Human infectious diseases and risk of preeclampsia: an updated review of the literature. Infection 2017; 45:589-600. [PMID: 28577241 DOI: 10.1007/s15010-017-1031-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/25/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Preeclampsia (PE) is one of the major causes of maternal and perinatal morbidity and mortality, especially in low- and middle-income countries. In recent years, a growing body of literatures suggests that infections by bacteria, viruses, and parasites and their related inflammations play an important role in the pathogenesis of PE. METHODS We searched PubMed, Google scholar, and Cochrane databases using the following search words: "infection and preeclampsia," "bacterial infection and preeclampsia," "viral infection and preeclampsia" and "parasitic infection and preeclampsia." RESULTS The literature review revealed that many bacteria including Helicobacter pylori, Chlamydia pneumonia, and those are involved in periodontal disease or urinary tract infections (UTIs) and some viral agents such as Cytomegalovirus, herpes simplex virus type-2, human immunodeficiency virus, and some parasites especially Plasmodium spp. and Toxoplasma gondii can be effective in development of PE. Inflammation responses against infections has major role in the inducement of PE. The shift of immunological cytokine profile of Th2 toward Th1 and high levels of pro-inflammatory cytokines (TNF-ɑ, IL-12, IFN-γ, etc.), increase of oxidative stress, increase of anti-angiogenic proteins, increase of vascular endothelial growth factor receptor 1 (sVEGFR1), and complement C5a are the main potential mechanisms related to infections and enhanced development of PE. CONCLUSION Thus, early diagnosis and treatment of bacterial, viral, and parasitic infections could be an effective strategy to reduce the incidence of PE.
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Ørbaek M, Thorsteinsson K, Helleberg M, Moseholm E, Katzenstein TL, Storgaard M, Johansen IS, Pedersen G, Weis N, Lebech AM. Assessment of mode of delivery and predictors of emergency caesarean section among women living with HIV in a matched-pair setting with women from the general population in Denmark, 2002-2014. HIV Med 2017; 18:736-747. [PMID: 28544321 DOI: 10.1111/hiv.12519] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We aimed to assess mode of delivery and predictors of emergency caesarean section (EmCS) in women living with HIV (WLWH) in a matched-pair setting with women from the general population (WGP) in Denmark. Further, we analysed birth plan in WLWH. METHODS All WLWH giving birth to live-born children from 2002 to 2014 were included in the study. Data were retrieved from medical records and national registries. WLWH were matched 1:5 by age, birth year, parity and ethnicity to WGP. Multivariate logistic regression was used to estimate predictors. RESULTS We included 389 WLWH and 1945 WGP in the study. At delivery, all WLWH were on antiretroviral therapy and 85.6% had HIV RNA <40 HIV-1 RNA copies/mL. Mean age was 32.7 years [95% confidence interval (CI) 32.1-33.2 years]. Mode of delivery differed significantly between WLWH and WGP [vaginal delivery, 33.4% versus 73.3%, respectively; elective caesarean section (ECS), 40.6% versus 9.7%, respectively; EmCS, 26% versus 17%, respectively; P < 0.0001]. Age > 40 years [adjusted odds ratio (aOR) 2.3; 95% CI 1.5-3.5], asphyxia (aOR 3.2; 95% CI 2.4-4.1), delivery during the evening and at night [aOR 2.3 (95% CI 1.7-3.0) and aOR 2.0 (95% CI 1.5-2.7), respectively], preterm delivery (aOR 3.8; 95% CI 2.6-5.6) and premature rupture of membranes (aOR 3.0; 95% CI 2.1-4.4) predicted EmCS. WLWH had a higher risk of EmCS compared with WGP [2002-2006, aOR 2.0 (95% CI 1.2-3.3); 2007-2008, aOR 2.9 (95% CI 1.4-5.9); 2009-2014, aOR 2.6 (95% CI 1.7-3.9)]. After 2007, more than half of WLWH planned to deliver vaginally. Prior caesarean section was associated with ECS (aOR 11.0; 95% CI 4.5-26.8). No mother-to-child transmission occurred. CONCLUSIONS Increasing numbers of WLWH deliver vaginally. Despite virological suppression, more WLWH plan and deliver by ECS than WGP. WLWH had a twofold higher risk of EmCS compared with WGP.
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Affiliation(s)
- M Ørbaek
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - K Thorsteinsson
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - M Helleberg
- Department of Infectious Diseases, The National University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - E Moseholm
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - T L Katzenstein
- Department of Infectious Diseases, The National University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - M Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark
| | - I S Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - G Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - N Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - A-M Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Rempis EM, Schnack A, Decker S, Braun V, Rubaihayo J, Tumwesigye NM, Busingye P, Harms G, Theuring S. Option B+ for prevention of vertical HIV transmission has no influence on adverse birth outcomes in a cross-sectional cohort in Western Uganda. BMC Pregnancy Childbirth 2017; 17:82. [PMID: 28270119 PMCID: PMC5341453 DOI: 10.1186/s12884-017-1263-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 02/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While most Sub-Saharan African countries are now implementing the WHO-recommended Option B+ protocol for prevention of vertical HIV transmission, there is a lack of knowledge regarding the influence of Option B+ exposure on adverse birth outcomes (ABOs). Against this background, we assessed ABOs among delivering women in Western Uganda. METHODS A cross-sectional, observational study was performed within a cohort of 412 mother-newborn-pairs in Virika Hospital, Fort Portal in 2013. The occurrence of stillbirth, pre-term delivery, and small size for gestational age (SGA) was analysed, looking for influencing factors related to HIV-status, antiretroviral drug exposure and duration, and other sociodemographic and clinical parameters. RESULTS Among 302 HIV-negative and 110 HIV-positive women, ABOs occurred in 40.5%, with stillbirth in 6.3%, pre-term delivery in 28.6%, and SGA in 12.2% of deliveries. For Option B+ intake (n = 59), no significant association was found with stillbirth (OR 0.48, p = 0.55), pre-term delivery (OR 0.97, p = 0.92) and SGA (OR 1.5, p = 0.3) compared to seronegative women. Women enrolled on antiretroviral therapy (ART) before conception (n = 38) had no different risk for ABOs than women on Option B+ or HIV-negative women. Identified risk factors for stillbirth included lack of formal education, poor socio-economic status, long travel distance, hypertension and anaemia. Pre-term delivery risk was increased with poor socio-economic status, primiparity, Malaria and anaemia. The occurrence of SGA was influenced by older age and Malaria. CONCLUSION In our study, women on Option B+ showed no difference in ABOs compared to HIV-negative women and to women on ART. We identified several non-HIV/ART-related influencing factors, suggesting an urgent need for improving early risk assessment mechanisms in antenatal care through better screening and triage systems. Our results are encouraging with regard to continued universal scale-up of Option B+ and ART programmes.
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Affiliation(s)
- Eva M. Rempis
- Institute of Tropical Medicine and International Health, Charité- University Medicine, Augustenburger Platz 1, Berlin, 13353 Germany
| | - Alexandra Schnack
- Institute of Tropical Medicine and International Health, Charité- University Medicine, Augustenburger Platz 1, Berlin, 13353 Germany
| | - Sarah Decker
- Institute of Tropical Medicine and International Health, Charité- University Medicine, Augustenburger Platz 1, Berlin, 13353 Germany
| | - Vera Braun
- Institute of Tropical Medicine and International Health, Charité- University Medicine, Augustenburger Platz 1, Berlin, 13353 Germany
| | - John Rubaihayo
- Department of Public Health, Mountains of the Moon University, Fort Portal, Kabarole Uganda
| | | | | | - Gundel Harms
- Institute of Tropical Medicine and International Health, Charité- University Medicine, Augustenburger Platz 1, Berlin, 13353 Germany
| | - Stefanie Theuring
- Institute of Tropical Medicine and International Health, Charité- University Medicine, Augustenburger Platz 1, Berlin, 13353 Germany
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Raffe S, Curtis H, Tookey P, Peters H, Freedman A, Gilleece Y. UK national clinical audit: management of pregnancies in women with HIV. BMC Infect Dis 2017; 17:158. [PMID: 28219333 PMCID: PMC5319092 DOI: 10.1186/s12879-017-2255-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/08/2017] [Indexed: 11/23/2022] Open
Abstract
Background The potential for HIV transmission between a pregnant woman and her unborn child was first recognized in 1982. Since then a complex package of measures to reduce risk has been developed. This project aims to review UK management of HIV in pregnancy as part of the British HIV Association (BHIVA) audit programme. Methods The National Study of HIV in Pregnancy and Childhood (NSHPC), a population-based surveillance study, provided data for pregnancies with an expected delivery date from 1/1/13 - 30/6/14. Services also completed a survey on local management policies. Data were audited against the 2012 BHIVA pregnancy guidelines. Results During the audit period 1483 pregnancies were reported and 112 services completed the survey. Use of dedicated multidisciplinary teams was reported by 99% although 26% included neither a specialist midwife nor nurse. 17% of services reported delays >1 week for HIV specialist review of women diagnosed antenatally. Problematic urgent HIV testing had been experienced by 9% of services although in a further 49% the need for urgent testing had not arisen. Delays of >2 h in obtaining urgent results were common. Antiretroviral therapy (ART) was started during pregnancy in 37% women with >94% regimens in accordance with guidelines. Late ART initiation was common, particularly in those with a low CD4 count or high viral load. Eleven percent of services reported local policy contrary to guidelines regarding delivery mode for women with a VL <50 copies/mL at ≥36 weeks. According to NSHPC reports 27% of women virologically eligible for vaginal delivery planned to deliver by CS. Conclusions Pregnant women in the UK are managed largely in accordance with BHIVA guidelines. Improvements are needed to ensure timely referral and ART initiation to ensure the best possible outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2255-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Raffe
- British HIV Association, London, UK.
| | - H Curtis
- British HIV Association, London, UK
| | - P Tookey
- National Study of HIV in Pregnancy and Childhood, University College London, London, UK
| | - H Peters
- National Study of HIV in Pregnancy and Childhood, University College London, London, UK
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Hernandez S, Moren C, Catalán‐García M, Lopez M, Guitart‐Mampel M, Coll O, Garcia L, Milisenda J, Justamante A, Gatell JM, Cardellach F, Gratacos E, Miro Ò, Garrabou G. Mitochondrial toxicity and caspase activation in HIV pregnant women. J Cell Mol Med 2017; 21:26-34. [PMID: 27577111 PMCID: PMC5192803 DOI: 10.1111/jcmm.12935] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 06/12/2016] [Indexed: 12/19/2022] Open
Abstract
To assess the impact of HIV-infection and highly active anti-retroviral treatment in mitochondria and apoptotic activation of caspases during pregnancy and their association with adverse perinatal outcome. Changes of mitochondrial parameters and apoptotic caspase activation in maternal peripheral blood mononuclear cells were compared at first trimester of pregnancy and delivery in 27 HIV-infected and -treated pregnant women versus 24 uninfected pregnant controls. We correlated immunovirological, therapeutic and perinatal outcome with experimental findings: mitochondrial DNA (mtDNA) content, mitochondrial protein synthesis, mitochondrial function and apoptotic caspase activation. The HIV pregnancies showed increased adverse perinatal outcome (OR: 4.81 [1.14-20.16]; P < 0.05) and decreased mtDNA content (42.66 ± 5.94%, P < 0.01) compared to controls, even higher in naïve participants. This depletion caused a correlated decrease in mitochondrial protein synthesis (12.82 ± 5.73%, P < 0.01) and function (20.50 ± 10.14%, P < 0.001), not observed in controls. Along pregnancy, apoptotic caspase-3 activation increased 63.64 ± 45.45% in controls (P < 0.001) and 100.00 ± 47.37% in HIV-pregnancies (P < 0.001), in correlation with longer exposure to nucleoside analogues. HIV-infected women showed increased obstetric problems and declined genetic and functional mitochondrial parameters during pregnancy, especially those firstly exposed to anti-retrovirals. The apoptotic activation of caspases along pregnancy is emphasized in HIV pregnancies promoted by nucleoside analogues. However, we could not demonstrate direct mitochondrial or apoptotic implication in adverse obstetric outcome probably because of the reduced sample size.
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Affiliation(s)
- Sandra Hernandez
- Maternal‐Fetal Medicine DepartmentClinical Institute of Gynecology, Obstetrics and NeonatologyHospital Clinic of BarcelonaBarcelonaSpain
- Muscle Research and Mitochondrial Function LaboratoryCellex‐IDIBAPSFaculty of Medicine‐University of BarcelonaHospital Clinic of BarcelonaBarcelonaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER)MadridSpain
| | - Constanza Moren
- Muscle Research and Mitochondrial Function LaboratoryCellex‐IDIBAPSFaculty of Medicine‐University of BarcelonaHospital Clinic of BarcelonaBarcelonaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER)MadridSpain
| | - Marc Catalán‐García
- Muscle Research and Mitochondrial Function LaboratoryCellex‐IDIBAPSFaculty of Medicine‐University of BarcelonaHospital Clinic of BarcelonaBarcelonaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER)MadridSpain
| | - Marta Lopez
- Maternal‐Fetal Medicine DepartmentClinical Institute of Gynecology, Obstetrics and NeonatologyHospital Clinic of BarcelonaBarcelonaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER)MadridSpain
| | - Mariona Guitart‐Mampel
- Muscle Research and Mitochondrial Function LaboratoryCellex‐IDIBAPSFaculty of Medicine‐University of BarcelonaHospital Clinic of BarcelonaBarcelonaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER)MadridSpain
| | | | - Laura Garcia
- Maternal‐Fetal Medicine DepartmentClinical Institute of Gynecology, Obstetrics and NeonatologyHospital Clinic of BarcelonaBarcelonaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER)MadridSpain
| | - Jose Milisenda
- Muscle Research and Mitochondrial Function LaboratoryCellex‐IDIBAPSFaculty of Medicine‐University of BarcelonaHospital Clinic of BarcelonaBarcelonaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER)MadridSpain
| | - Angela Justamante
- Muscle Research and Mitochondrial Function LaboratoryCellex‐IDIBAPSFaculty of Medicine‐University of BarcelonaHospital Clinic of BarcelonaBarcelonaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER)MadridSpain
| | | | - Francesc Cardellach
- Muscle Research and Mitochondrial Function LaboratoryCellex‐IDIBAPSFaculty of Medicine‐University of BarcelonaHospital Clinic of BarcelonaBarcelonaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER)MadridSpain
| | - Eduard Gratacos
- Maternal‐Fetal Medicine DepartmentClinical Institute of Gynecology, Obstetrics and NeonatologyHospital Clinic of BarcelonaBarcelonaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER)MadridSpain
| | - Òscar Miro
- Muscle Research and Mitochondrial Function LaboratoryCellex‐IDIBAPSFaculty of Medicine‐University of BarcelonaHospital Clinic of BarcelonaBarcelonaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER)MadridSpain
| | - Gloria Garrabou
- Muscle Research and Mitochondrial Function LaboratoryCellex‐IDIBAPSFaculty of Medicine‐University of BarcelonaHospital Clinic of BarcelonaBarcelonaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER)MadridSpain
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The impact of highly active antiretroviral therapy on obstetric conditions: A review. Eur J Obstet Gynecol Reprod Biol 2016; 210:126-131. [PMID: 28013100 DOI: 10.1016/j.ejogrb.2016.12.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/01/2016] [Accepted: 12/08/2016] [Indexed: 01/05/2023]
Abstract
HIV is the leading cause of maternal and neonatal morbidity and mortality in resource constrained countries. Highly active antiretroviral treatment (HAART) initiated in pregnancy has now almost eliminated mother to child transmission of the virus, and is beginning to show the desired effect of reducing HIV related maternal mortality. By modulating host immunological responses HAART has the potential to alter infections during pregnancy, in addition to modifying clinical conditions such as preeclampsia. There is increasing evidence of the benefits of HAART given to pregnant women, however there is paucity of data that distinguishes HIV or HAART as the cause or exacerbation of pre-existing medical conditions or conditions specific to pregnancy. Anaemia is the commonest haematological disorder seen in HIV infected women and is more pronounced during pregnancy. The use of HAART has the potential to reduce the incidence and severity of the disease. Tuberculosis (TB) is the commonest chest infection amongst HIV infected people, being more common amongst pregnant than non-pregnant women. It is the leading cause of death from infectious diseases amongst women of reproductive age, and accounts for at least a quarter of all cases of maternal deaths associated with non-pregnancy related infections (NPRI). TB can manifest at any stage of the HIV infection, including during treatment with HAART. The latter (ie TB manifestation during HAART treatment) is thought to be the commonest manifestation of what is now known as immune reconstitution inflammatory syndrome (IRIS). In a South African report on maternal deaths, 55% of women who died of TB were on HAART, and a further 35% of women in the NPRI category died from other pneumoniae, notably pneumocystis jorevicci, which is also related to HIV infection. With regards to puerperal sepsis, studies are yet to show the impact of HAART independent of antibiotics in reducing infectious morbidity in HIV infected women. Preeclampsia has been associated with HIV infection, where most studies point towards a reduced risk in HIV infected women. There is increasing evidence that this reduced risk is reversed in the presence of HAART, with women accessing HAART having almost the same risk as HIV uninfected women. HIV or its treatment may be associated with increased risk of obstetric haemorrhage, and an increasing trend of obstetric haemorrhage as a cause of maternal deaths has been recently reported, proportionally in line with the introduction and increasing availability of HAART for pregnant women The mechanism by which this may occur remains elusive since pregnancy is a pro-thrombotic state, however, HIV-related thrombocytopenia or vasculitis could account for the association, if found. HAART would then be expected to reverse this. HAART especially protease inhibitor containing combinations, have been associated with preterm deliveries and low birth weight, particularly when initiated prior to the index pregnancy. With these overall findings of the effect of HAART on obstetric conditions, this review is intended to encourage heightened surveillance of adverse events associated with HAART use in pregnant women.
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Soriano-Arandes A, Noguera-Julian A, López-Lacort M, Soler-Palacín P, Mur A, Méndez M, Mayol L, Vallmanya T, Almeda J, Carnicer-Pont D, Casabona J, Fortuny C. Pregnancy as an opportunity to diagnose human-immunodeficiency virus immigrant women in Catalonia. Enferm Infecc Microbiol Clin 2016; 36:9-15. [PMID: 27609632 DOI: 10.1016/j.eimc.2016.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 07/13/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Mother-to-child transmission (MTCT) is relevant in the global epidemiology of human-immunodeficiency virus (HIV), as it represents the main route of infection in children. The study objectives were to determine the rate of HIV-MTCT and its epidemiological trend between the Spanish-born and immigrant population in Catalonia in the period 2000-2014. METHODS A prospective observational study of mother-child pairs exposed to HIV, treated in 12 hospitals in Catalonia in the period 2000-2014. HIV-MTCT rate was estimated using a Bayesian logistic regression model. R and WinBUGS statistical software were used. RESULTS The analysis included 909 pregnant women, 1,009 pregnancies, and 1,032 children. Data on maternal origin was obtained in 79.4% of women, of whom 32.7% were immigrants, with 53.0% of these from sub-Saharan Africa. The overall HIV-MTCT rate was 1.4% (14/1,023; 95% CI; 0.8-2.3). The risk of MTCT-HIV was 10-fold lower in women with good virological control (P=.01), which was achieved by two-thirds of them. The proportion of immigrants was significantly higher in the period 2008-2014 (P<.0001), for the HIV-diagnosis (P<.0001), and antiretroviral administration (P=.02) during pregnancy, and for undetectable viral load next to delivery (P<.001). There were no differences in the rate of MTCT-HIV among Spanish-born and immigrant women (P=.6). CONCLUSIONS There is a gradual increase in HIV pregnant immigrants in Catalonia. Although most immigrant women were diagnosed during pregnancy, the rate of MTCT-HIV was no different from the Spanish-born women.
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Affiliation(s)
- Antoni Soriano-Arandes
- Unidad de Enfermedades Infecciosas e Inmunodeficiencias Pediátricas, Servicio de Pediatría, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Antoni Noguera-Julian
- Unidad de Infectologia, Servei de Pediatria, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España
| | - Mónica López-Lacort
- FISABIO, Centro de Salud Pública de la Generalitat de Valencia, Valencia, España
| | - Pere Soler-Palacín
- Unidad de Enfermedades Infecciosas e Inmunodeficiencias Pediátricas, Servicio de Pediatría, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Antonio Mur
- Hospital Universitari del Mar, Universidad Autónoma de Barcelona, Barcelona, España
| | - María Méndez
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - Lluís Mayol
- Hospital Universitari Josep Trueta, Girona, España
| | | | - Jesús Almeda
- Centre d'Estudis Epidemiològics sobre les ITS i SIDA de Catalunya (CEEISCAT), Catalunya, España
| | - Dolors Carnicer-Pont
- Centre d'Estudis Epidemiològics sobre les ITS i SIDA de Catalunya (CEEISCAT), Catalunya, España
| | - Jordi Casabona
- Centre d'Estudis Epidemiològics sobre les ITS i SIDA de Catalunya (CEEISCAT), Catalunya, España
| | - Claudia Fortuny
- Unidad de Infectologia, Servei de Pediatria, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España
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Siou K, Walmsley SL, Murphy KE, Raboud J, Loutfy M, Yudin MH, Silverman M, Ladhani NN, Serghides L. Progesterone supplementation for HIV-positive pregnant women on protease inhibitor-based antiretroviral regimens (the ProSPAR study): a study protocol for a pilot randomized controlled trial. Pilot Feasibility Stud 2016; 2:49. [PMID: 27965866 PMCID: PMC5153916 DOI: 10.1186/s40814-016-0087-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/26/2016] [Indexed: 12/04/2022] Open
Abstract
Background In Canada, the majority of HIV-positive pregnant women receive combination antiretroviral therapy that includes a ritonavir-boosted protease inhibitor to prevent mother-to-child HIV transmission. However, protease inhibitor-based combination antiretroviral therapy has been associated with increased rates of preterm, low birth weight, and small for gestational age births. Our previous experimental findings demonstrate that protease inhibitor use during pregnancy is associated with decreased progesterone levels that correlate with fetal growth, and that progesterone supplementation can improve protease inhibitor-induced fetal growth restriction. We hypothesize that HIV-positive pregnant women who receive protease inhibitor-based combination therapy may also benefit from progesterone supplementation during pregnancy. Methods/design In order to test this hypothesis, we have designed an open-label, multi-centre, randomized controlled (parallel group) pilot trial. The initial goal of this trial is to test feasibility and acceptability of our intervention. Forty HIV-positive pregnant women who are either on, or intending to start or switch to a boosted protease inhibitor-based combination antiretroviral regimen will be enrolled from six sites across Ontario, Canada. Twenty-five women will be randomized to self-administer natural progesterone (Prometrium, 200 mg) vaginally every night starting between gestational week 16 and 24 until week 36, and 15 women will be randomized to no intervention. While the participants and treating physicians will not be blinded, the laboratory personnel performing the biochemical and morphological evaluations will be blinded to ensure unbiased evaluation. The primary outcome of the pilot study is the feasibility of enrolment as measured by the recruitment rate and patient-reported reasons to decline participation. Secondary outcomes in participants include safety, acceptability, and adherence to progesterone supplementation. Discussion Given the safety of intravaginal progesterone and its current use in the general obstetrical population to prevent recurrent preterm delivery, this pilot study will provide data to determine the feasibility of a larger randomized controlled trial to assess the impact of this intervention on improving neonatal health in the context of HIV-positive pregnancies. Trial registration ClinicalTrials.gov, NCT02400021
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Affiliation(s)
- Kaitlin Siou
- Toronto General Research Institute, Toronto, Canada
| | - Sharon L Walmsley
- Toronto General Hospital, Toronto, Canada ; University of Toronto, Toronto, Canada
| | - Kellie E Murphy
- Mount Sinai Hospital, Toronto, Canada ; University of Toronto, Toronto, Canada
| | - Janet Raboud
- Toronto General Research Institute, Toronto, Canada
| | - Mona Loutfy
- Maple Leaf Medical Clinic, Toronto, Canada ; Women's College Research Institute, Toronto, Canada ; University of Toronto, Toronto, Canada
| | - Mark H Yudin
- St. Michael's Hospital, Toronto, Canada ; University of Toronto, Toronto, Canada
| | - Michael Silverman
- St. Joseph's Health Care London, London, Canada ; University of Western Ontario, London, Canada
| | - Noor N Ladhani
- Sunnybrook Health Sciences Centre, Toronto, Canada ; University of Toronto, Toronto, Canada
| | - Lena Serghides
- Toronto General Research Institute, Toronto, Canada ; University of Toronto, Toronto, Canada ; Women's College Research Institute, Toronto, Canada
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Buxmann H, Reitter A, Bapistella S, Stürmer M, Königs C, Ackermann H, Louwen F, Bader P, Schlößer RL, Willasch AM. Maternal CD4+ microchimerism in HIV-exposed newborns after spontaneous vaginal delivery or caesarean section. Early Hum Dev 2016; 98:49-55. [PMID: 27351353 DOI: 10.1016/j.earlhumdev.2016.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 05/24/2016] [Accepted: 06/14/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Maternal CD4+ cell microchimerism may be greater after caesarean section compared to spontaneous vaginal delivery and could cause mother-to-child transmission (MTCT) in HIV-exposed newborns. AIMS To evaluate maternal CD4+ cell microchimerism in HIV-exposed newborns after spontaneous vaginal delivery or caesarean section. STUDY DESIGN AND SUBJECTS In this prospective single-centre study, neonates whose mothers were infected with HIV and had normal MTCT risk according to the German Austrian Guidelines were considered for study enrolment. Maternal CD4+ cell microchimerism in the newborns' umbilical cord blood was measured and compared by mode of delivery. RESULTS Thirty-seven HIV-infected mothers and their 39 newborns were included in the study. None of the 17 (0.0%) newborns delivered vaginally had quantifiable maternal CD4+ cells (95% confidence interval (CI): 0.00-0.00) in their circulation at birth compared with four of 16 (25.0%) newborns delivered via planned caesarean section, who showed 0.01-0.66% maternal cells (95% CI: -0.06-0.16; P=0.02) in their circulation. The intention to treat analysis, which included six additional newborns delivered by unplanned caesarean section, showed quantifiable maternal CD4+ cells in one (0.05%; 95% CI: -0.02-0.04) of 23 (4.3%) newborn at birth compared to four of 16 (25.0%) born via planned caesarean section (95% CI: -0.06-0.16; P=0.04). There was no MTCT in any of the newborns. CONCLUSION In this small cohort, spontaneous vaginal delivery in HIV-infected women with normal MTCT risk was associated with lower maternal CD4+ cell transfer to newborns compared to planned caesarean section.
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Affiliation(s)
- H Buxmann
- Goethe University, Department for Children and Adolescents, Division for Neonatology, University Hospital Frankfurt/Main, Germany.
| | - A Reitter
- Department of Gynecology and Obstetrics, Division of Obstetrics and Prenatal Medicine, University Hospital Frankfurt/Main, Germany
| | - S Bapistella
- Goethe University, Department for Children and Adolescents, Division for Neonatology, University Hospital Frankfurt/Main, Germany
| | - M Stürmer
- Institute for Medical Virology, University Hospital Frankfurt/Main, Germany
| | - C Königs
- Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt/Main, Germany
| | - H Ackermann
- Institute of Biostatistics and Mathematical Modeling, University Hospital Frankfurt/Main, Germany
| | - F Louwen
- Department of Gynecology and Obstetrics, Division of Obstetrics and Prenatal Medicine, University Hospital Frankfurt/Main, Germany
| | - P Bader
- Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt/Main, Germany
| | - R L Schlößer
- Goethe University, Department for Children and Adolescents, Division for Neonatology, University Hospital Frankfurt/Main, Germany
| | - A M Willasch
- Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt/Main, Germany
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Stoner MCD, Vwalika B, Smid MC, George S, Chi BH, Stringer EM, Stringer JSA. A retrospective study of HIV, antiretroviral therapy, and pregnancy-associated hypertension among women in Lusaka, Zambia. Int J Gynaecol Obstet 2016; 134:299-303. [PMID: 27365290 DOI: 10.1016/j.ijgo.2016.03.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 02/21/2016] [Accepted: 05/19/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the association between HIV, antiretroviral therapy (ART), and pregnancy-associated hypertension (PAH) in an HIV-endemic setting. METHODS A retrospective cohort study was undertaken of pregnant women for whom information was recorded between February 2006 and December 2012 in the Zambia Electronic Perinatal Record System, which captures data from 25 facilities in Lusaka, Zambia. PAH was defined as eclampsia, pre-eclampsia, hypertension, or elevated blood pressure (>140/80mm Hg) during delivery admission. Logistic regression estimated the odds of PAH among women by HIV serostatus, and by most recent CD4 T lymphocyte count and ART status among women with HIV infection. RESULTS Among 249 771 women included in the analysis, 5354 (2.1%) had PAH. Compared with women without HIV infection, women with HIV infection not receiving ART had lower odds of PAH (adjusted odds ratio [AOR] 0.86, 95% confidence interval 0.78-0.95), whereas those with HIV infection who had initiated ART had higher odds of PAH (AOR 1.15, 95% CI 1.01-1.32). No association was found between PAH and timing of ART initiation or CD4 lymphocyte count. CONCLUSION In a large African urban cohort, women with untreated HIV infection had the lowest odds of PAH. Treatment with ART could increase PAH risk beyond that of women without HIV infection and those with untreated infection.
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Affiliation(s)
- Marie C D Stoner
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Bellington Vwalika
- Department of Obstetrics and Gynecology, University of Zambia School of Medicine, Lusaka, Zambia
| | - Marcela C Smid
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shalin George
- Department of Obstetrics and Gynecology, University of Zambia School of Medicine, Lusaka, Zambia
| | - Benjamin H Chi
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth M Stringer
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jeffrey S A Stringer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Tooke L, Riemer L, Matjila M, Harrison M. Antiretrovirals causing severe pre-eclampsia. Pregnancy Hypertens 2016; 6:266-268. [PMID: 27939465 DOI: 10.1016/j.preghy.2016.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 04/18/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Extremely low birth weight infants (ELBW) (⩽1000g) at our tertiary hospital have a much higher HIV exposure rate than bigger babies and are mainly delivered due to complications of pre-eclampsia. Studies investigating the effect of HIV or antiretroviral therapy on pre-eclampsia, a partially immune-mediated disease have produced contradictory results. OBJECTIVE To determine if there was an association between pre-eclampsia and HIV and/or antiretrovirals in the mothers of ELBW infants. STUDY DESIGN A prospective database was maintained for all ELBW infants born from August 2011 till January 2013. Data included maternal information such as HIV status, antiretroviral medication (duration and type) and mode and indication for delivery. RESULTS Of the 195 mothers who delivered ELBW infants, 46 (24%) were HIV positive. This is significantly different to the 17% HIV prevalence in mothers with bigger children (p=0.02). The main indication (59%) for delivery of the infant was hypertension related with the majority of these (94%) being classified as pre-eclampsia. Although HIV on its own showed no association (p=0.13), mothers who received greater than 4weeks of antiretrovirals were more likely to develop severe pre-eclampsia (p=0.007). CONCLUSION The debate about ARVs and PET is not yet over. We postulate that in a small group of susceptible women, ARVs may trigger early severe PET. It is unclear from our study if this would be due on a toxic or immune basis.
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Affiliation(s)
- Lloyd Tooke
- Department of Neonatology, Groote Schuur Hospital, University of Cape Town, South Africa.
| | - Linda Riemer
- Department of Neonatology, Groote Schuur Hospital, University of Cape Town, South Africa.
| | - Mushi Matjila
- Department of Obstetrics, Groote Schuur Hospital, University of Cape Town, South Africa.
| | - Michael Harrison
- Department of Neonatology, Groote Schuur Hospital, University of Cape Town, South Africa.
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Dos Reis HLB, Araujo KDS, Ribeiro LP, Da Rocha DR, Rosato DP, Passos MRL, Merçon De Vargas PR. Preterm birth and fetal growth restriction in HIV-infected Brazilian pregnant women. Rev Inst Med Trop Sao Paulo 2016; 57:111-20. [PMID: 25923889 PMCID: PMC4435008 DOI: 10.1590/s0036-46652015000200003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 07/24/2014] [Indexed: 01/06/2023] Open
Abstract
Introduction: Maternal HIV infection and related co-morbidities may have two outstanding
consequences to fetal health: mother-to-child transmission (MTCT) and adverse
perinatal outcomes. After Brazilian success in reducing MTCT, the attention must
now be diverted to the potentially increased risk for preterm birth (PTB) and
intrauterine fetal growth restriction (IUGR). Objective: To determine the prevalence of PTB and IUGR in low income, antiretroviral users,
publicly assisted, HIV-infected women and to verify its relation to the HIV
infection stage. Patients and Methods: Out of 250 deliveries from HIV-infected mothers that delivered at a tertiary
public university hospital in the city of Vitória, state of Espírito Santo,
Southeastern Brazil, from November 2001 to May 2012, 74 single pregnancies were
selected for study, with ultrasound validated gestational age (GA) and data on
birth dimensions: fetal weight (FW), birth length (BL), head and abdominal
circumferences (HC, AC). The data were extracted from clinical and pathological
records, and the outcomes summarized as proportions of preterm birth (PTB, < 37
weeks), low birth weight (LBW, < 2500g) and small (SGA), adequate (AGA) and
large (LGA) for GA, defined as having a value below, between or beyond the ±1.28
z/GA score, the usual clinical cut-off to demarcate the 10th and 90th
percentiles. Results: PTB was observed in 17.5%, LBW in 20.2% and SGA FW, BL, HC and AC in 16.2%, 19.1%,
13.8%, and 17.4% respectively. The proportions in HIV-only and AIDS cases were:
PTB: 5.9 versus 27.5%, LBW: 14.7% versus 25.0%, SGA BW: 17.6% versus 15.0%, BL:
6.0% versus 30.0%, HC: 9.0% versus 17.9%, and AC: 13.3% versus 21.2%; only SGA BL
attained a significant difference. Out of 15 cases of LBW, eight (53.3%) were
preterm only, four (26.7%) were SGA only, and three (20.0%) were both PTB and SGA
cases. A concomitant presence of, at least, two SGA dimensions in the same fetus
was frequent. Conclusions: The proportions of preterm birth and low birth weight were higher than the local
and Brazilian prevalence and a trend was observed for higher proportions of SGA
fetal dimensions than the expected population distribution in this small casuistry
of newborn from the HIV-infected, low income, antiretroviral users, and publicly
assisted pregnant women. A trend for higher prevalence of PTB, LBW and SGA fetal
dimensions was also observed in infants born to mothers with AIDS compared to
HIV-infected mothers without AIDS.
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Affiliation(s)
| | | | | | | | | | - Mauro Romero Leal Passos
- Materno-fetal Health Postgraduate Course, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil
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Adams JW, Watts DH, Phelps BR. A systematic review of the effect of HIV infection and antiretroviral therapy on the risk of pre-eclampsia. Int J Gynaecol Obstet 2015; 133:17-21. [PMID: 26797203 DOI: 10.1016/j.ijgo.2015.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 07/24/2015] [Accepted: 11/27/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND The associations between HIV infection, antiretroviral therapy (ART), and pre-eclampsia are unclear. OBJECTIVES To summarize research and clarify the implications of HIV and ART on pre-eclampsia risk. SEARCH STRATEGY MedLine, PubMed, Web of Science, and the Cochrane Library were searched for studies published between 2003 and July 2014, using relevant keywords. SELECTION CRITERIA Full-text review was dependent on the inclusion of pre-eclampsia as an outcome and original data. DATA COLLECTION AND ANALYSIS Data for population, confounders, limitations, and measures of association were qualitatively assessed. MAIN RESULTS Among 550 records identified, 70 were screened, and 13 were included. Five of the nine studies comparing pre-eclampsia risk between women with and without HIV infection found no significant difference; only one found that women living with HIV were more likely to experience pre-eclampsia. Two studies found that women living with HIV who were receiving ART at conception were more likely to experience pre-eclampsia than were those not receiving ART at conception. Two studies reported that pre-eclampsia rates did not differ by ART regimen. CONCLUSIONS There is insufficient evidence to conclude that women living with HIV and receiving ART have a higher risk of pre-eclampsia than do women without HIV infection; further research is needed to assess the association between ART and pre-eclampsia.
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Affiliation(s)
- Joëlla W Adams
- United States Agency for International Development, Washington, DC, USA.
| | - D Heather Watts
- Pediatric, Adolescent, and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute for Child Health and Human Development, Bethesda, MD, USA
| | - B Ryan Phelps
- United States Agency for International Development, Washington, DC, USA
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HIV, Antiretroviral Therapy, and Hypertensive Disorders in Pregnancy: A Systematic Review and Meta-analysis. J Acquir Immune Defic Syndr 2015; 70:91-8. [PMID: 26322669 DOI: 10.1097/qai.0000000000000686] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There are data to suggest that infection with HIV or use of highly active antiretroviral therapy increases the risk of hypertensive disorders in pregnancy. This systematic review and meta-analysis aims to provide an overview of the research hitherto. METHODS A systematic review of EMBASE, PubMed, and The Cochrane Library databases was conducted to obtain articles about the association between HIV in pregnancy and/or HIV therapy and the risk of developing pregnancy-induced hypertension (PIH), pre-eclampsia, eclampsia, or Hemolysis Elevated Liver enzymes Low Platelet count syndrome. Quality of articles was evaluated with an adapted Cochrane Collaboration bias assessment tool. Relative risks (RRs) were pooled with a random-effects meta-analysis weighted by the inverse of their variance. RESULTS Of the 2136 articles screened, 28 studies were eligible for inclusion; 15 studies reported on the association with PIH, 16 on pre-eclampsia, 5 on eclampsia, and 3 articles on HIV therapy regimens. All articles had a high risk of bias, and between-study heterogeneity was considerable. Based on the meta-analysis, there does not seem to be an association between HIV and PIH [RR 1.26, 95% confidence interval (CI): 0.87 to 1.83, I = 78.6%], pre-eclampsia (RR 1.01, 95% CI: 0.87 to 1.18, I = 63.9%), or eclampsia (RR 1.61, 95% CI: 0.14 to 18.68, I = 97.0%). A meta-analysis of the association with HIV therapy and risk of hypertensive disorders in pregnancy could not be performed. CONCLUSIONS This meta-analysis shows no significant association between HIV positivity and PIH, pre-eclampsia, or eclampsia. However, the high risk of bias within most studies limits the strength of conclusions and well-designed studies are necessary to confirm or refute these findings.
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Xiao PL, Zhou YB, Chen Y, Yang MX, Song XX, Shi Y, Jiang QW. Association between maternal HIV infection and low birth weight and prematurity: a meta-analysis of cohort studies. BMC Pregnancy Childbirth 2015; 15:246. [PMID: 26450602 PMCID: PMC4599647 DOI: 10.1186/s12884-015-0684-z] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 10/04/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To assess the association between maternal human immunodeficiency virus (HIV) infection and low birth weight (LBW)/prematurity (PTD), we conducted a meta-analysis of cohort studies of HIV infected and uninfected women. METHODS Several English and Chinese databases were searched (updated to May 2015) to find the studies reporting infant outcomes associated with exposure to maternal HIV infection during pregnancy. Relevant articles were manually selected based on several inclusion and exclusion criteria. RESULTS Fifty-two cohort studies including 15,538 (for LBW) and 200,896 (for PTD) HIV infected women met the inclusion criteria. There was significant heterogeneity among studies for maternal HIV infection associated with LBW/PTD (I(2) = 71.7%, P < 0.05, and I(2) = 51.8%, P < 0.05 for LBW and PTD, respectively). The meta-analysis demonstrated that the maternal HIV infection was significantly associated with both LBW (pooled odds ratio (OR): 1.73, 95% confidence interval (CI): 1.64, 1.82, P < 0.001) and PTD (pooled OR: 1.56, 95% CI: 1.49, 1.63, P < 0.001). No significant difference in the relationship between maternal HIV infection and adverse pregnancy outcomes was detected among the groups of different study periods. HIV infected women were at slightly higher risk of LBW in developing countries compared with women in developed countries (OR: 2.12 (95% CI: 1.81, 2.48) vs. 1.75 (95% CI: 1.44, 2.12)). Antiretroviral drugs usage did not significantly change the associations of maternal HIV exposure with LBW and PTD. CONCLUSIONS HIV infected women were at higher risk of having a low birth weight infant or a preterm delivery infant compared with uninfected women. Such associations did not change significantly over time or were not significantly affected by the usage of antiretroviral drugs.
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Affiliation(s)
- Peng-Lei Xiao
- Fudan University School of Public Health, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
| | - Yi-Biao Zhou
- Fudan University School of Public Health, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
| | - Yue Chen
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8 M5, Canada.
| | - Mei-Xia Yang
- Xuhui Center for Disease Prevention and Control, 50 Yongchuan Road, Xuhui District, Shanghai, 200032, China.
| | - Xiu-Xia Song
- Fudan University School of Public Health, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
| | - Yan Shi
- Fudan University School of Public Health, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
| | - Qing-Wu Jiang
- Fudan University School of Public Health, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
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Ng R, Macdonald EM, Yudin MH, Bayoumi AM, Loutfy MR, Raboud J, Masinde KI, Tharao WE, Brophy J, Glazier RH, Antoniou T. Maternal placental syndromes among women living with HIV in Ontario: a population-based study. CMAJ Open 2015; 3:E360-5. [PMID: 26770960 PMCID: PMC4701653 DOI: 10.9778/cmajo.20140112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Maternal placental syndromes are associated with adverse fetal outcomes and maternal cardiovascular disease. However, whether HIV infection increases the risk of maternal placental syndromes is unknown. Our objective was to compare the risk of maternal placental syndromes between women living with and without HIV infection in Ontario. METHODS We conducted a population-based study using health administrative data from Ontario. We identified all pregnancies resulting in a live birth between Apr. 1, 2002, and Mar. 31, 2011; we identified women living with HIV using a validated case-finding algorithm. Our primary composite outcome was maternal placental syndromes, defined as a diagnosis of preeclampsia, eclampsia, placental abruption or placental infarction. We used generalized estimating equations with a logit link function to derive adjusted odds ratios (AORs) and 95% confidence intervals (CI) for the association between HIV infection and maternal placental syndromes. RESULTS Data from 1 132 871 pregnancies were available for analysis; 634 (0.06%) of the pregnancies were in women living with HIV. After multivariable adjustment, we found no difference in the risk of maternal placental syndromes between women living with HIV and those without HIV infection (5.8% v. 5.6%; AOR 0.85 [95% CI 0.59-1.21]). An increased risk of maternal placental syndromes was associated with pre-existing diabetes (AOR 1.47 [95% CI 1.39-1.54]), pre-existing hypertension (AOR 4.28 [95% CI 4.15-4.42]) and chronic kidney disease (AOR 1.83 [95% CI 1.61-2.08]). INTERPRETATION Women with HIV are not at increased risk of maternal placental syndromes. Our results underscore the importance of optimizing the management of comorbid illness associated with maternal placental syndromes during the prenatal period for all women, irrespective of HIV status.
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Affiliation(s)
- Ryan Ng
- Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont
| | - Erin M Macdonald
- Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont
| | - Mark H Yudin
- Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont
| | - Ahmed M Bayoumi
- Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont
| | - Mona R Loutfy
- Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont
| | - Janet Raboud
- Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont
| | - Khatundi-Irene Masinde
- Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont
| | - Wangari E Tharao
- Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont
| | - Jason Brophy
- Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont
| | - Richard H Glazier
- Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont
| | - Tony Antoniou
- Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont
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44
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Ikpim EM, Edet UA, Bassey AU, Asuquo OA, Inyang EE. HIV infection in pregnancy: maternal and perinatal outcomes in a tertiary care hospital in Calabar, Nigeria. Trop Doct 2015; 46:78-86. [PMID: 26351304 DOI: 10.1177/0049475515605003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection is likely to have untoward effects on pregnancy and its outcome. This study assessed the impact of maternal HIV infection on pregnancy outcomes in a tertiary centre in Calabar, Nigeria. METHODS This retrospective study analysed delivery records of 258 HIV-positive and 257 HIV-negative women for pregnancy and delivery complications. Maternal and fetal outcomes of HIV-positive pregnancies were compared with those of HIV-negative controls. RESULTS Adverse pregnancy outcomes significantly associated with HIV status were: anaemia: 33 (8.1%) vs. 8 (3.1%) in controls; puerperal sepsis: 18 (7%) vs. 2 (0.8%); and low birth weight: 56 (21.7%) vs. 37 (14.4%). Caesarean delivery was higher among HIV-positive women than controls: 96 (37.2%) vs. 58 (22.6%). Preterm births were higher in those HIV cohorts who did not receive antiretroviral therapy (ART): 13 (16.9%) vs. 7 (3.9%). CONCLUSION HIV-positive status increased adverse birth outcome of pregnancy. ART appeared to reduce the risk of preterm births in HIV-positive cohorts.
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Affiliation(s)
- Ekott Mabel Ikpim
- Reader, Department of Obstetrics & Gynaecology, University of Calabar, Calabar, Nigeria
| | - Udo Atim Edet
- Reader, Department of Obstetrics & Gynaecology, University of Calabar, Calabar, Nigeria
| | - Akpan Ubong Bassey
- Lecturer , Department of Obstetrics & Gynaecology, University of Calabar, Calabar, Nigeria
| | - Otu Akaninyene Asuquo
- Lecturer, Department of Internal Medicine, University of Calabar, Calabar, Cross River State, Nigeria
| | - Ekanem Etim Inyang
- Lecturer, Department of Internal Medicine, University of Calabar, Calabar, Cross River State, Nigeria
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45
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Macdonald EM, Ng R, Bayoumi AM, Raboud J, Brophy J, Masinde KI, Tharao WE, Yudin MH, Loutfy MR, Glazier RH, Antoniou T. Adverse Neonatal Outcomes Among Women Living With HIV: A Population-Based Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:302-309. [PMID: 26001682 DOI: 10.1016/s1701-2163(15)30279-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND There have been few population-based studies describing the risk of adverse neonatal outcomes among women living with HIV in Canada. Accordingly, we compared the risk of preterm birth (PTB), low birth weight (LBW) and small for gestational age births among Ontario women aged 18 to 49 years living with and without HIV infection. METHODS We conducted a population-based study using Ontario health administrative data. Generalized estimating equations with a logit link function were used to derive adjusted odds ratios (aORs) and 95% confidence intervals for the association of HIV infection with adverse neonatal outcomes. RESULTS Between 2002-2003 and 2010-2011, a total of 1 113 874 singleton live births were available for analysis, of which 615 (0.06%) were to women living with HIV. The proportion of singleton births that were SGA (14.6% vs. 10.3%; P < 0.001), PTB (14.6% vs. 6.3%; P < 0.001), and LBW (12.5% vs. 4.6%; P < 0.001) were higher among women living with HIV than among women without HIV. Following multivariable adjustment, the risks of PTB (aOR 1.76; 95% CI 1.38 to 2.24), SGA (aOR 1.43; 95% CI 1.12 to 1.81), and LBW (aOR 1.90; 95% CI 1.47 to 2.45) were higher for women living with HIV than for women without HIV. CONCLUSION Women with HIV are at higher risk of adverse neonatal outcomes than HIV-negative women. Further research is required to develop preconception and prenatal interventions that could reduce the excess burden of poor pregnancy outcomes among women living with HIV.
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Affiliation(s)
| | - Ryan Ng
- Institute for Clinical Evaluative Sciences, Toronto ON
| | - Ahmed M Bayoumi
- Institute for Clinical Evaluative Sciences, Toronto ON; Li Ka Shing Knowledge institute, Toronto ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto ON; Department of Medicine, University of Toronto, Toronto ON; Centre for Research on inner City Health, St. Michael's Hospital, Toronto ON
| | - Janet Raboud
- Institute for Clinical Evaluative Sciences, Toronto ON; Toronto General Research institute, University Health Network, Toronto ON; Dalla Lana School of Public Health, University of Toronto, Toronto ON
| | - Jason Brophy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa ON
| | | | - Wangari E Tharao
- Women's Health in Women's Hands Community Health Centre, Toronto ON
| | - Mark H Yudin
- Li Ka Shing Knowledge institute, Toronto ON; Centre for Research on inner City Health, St. Michael's Hospital, Toronto ON; Department of Obstetrics and Gynecology, St. Michael's Hospital and University of Toronto, Toronto ON
| | - Mona R Loutfy
- Institute for Clinical Evaluative Sciences, Toronto ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto ON; Department of Medicine, University of Toronto, Toronto ON; Women's College Research institute, Women's College Hospital, Toronto ON
| | - Richard H Glazier
- Institute for Clinical Evaluative Sciences, Toronto ON; Li Ka Shing Knowledge institute, Toronto ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto ON; Centre for Research on inner City Health, St. Michael's Hospital, Toronto ON; Dalla Lana School of Public Health, University of Toronto, Toronto ON; Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto ON
| | - Tony Antoniou
- Institute for Clinical Evaluative Sciences, Toronto ON; Li Ka Shing Knowledge institute, Toronto ON; Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto ON; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto ON
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46
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López M, Figueras F, Coll O, Goncé A, Hernández S, Loncá M, Vila J, Gratacós E, Palacio M. Inflammatory Markers Related to Microbial Translocation Among HIV-Infected Pregnant Women: A Risk Factor of Preterm Delivery. J Infect Dis 2015; 213:343-50. [PMID: 26265778 DOI: 10.1093/infdis/jiv416] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/03/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND This study was performed to assess the role of lipopolysaccharide modulators as a marker of microbial translocation among human immunodeficiency virus (HIV)-infected women during pregnancy and to evaluate their association with preterm delivery. METHODS The study had a prospective cohort design and was performed at the Hospital Clínic in Barcelona, Spain. Thirty-six pregnant women with and 36 without HIV infection, matched on the basis of age and parity, were included. Maternal blood samples were obtained during the first trimester, during the third trimester, and at delivery. Levels of soluble CD14 (sCD14), human lipopolysaccharide-binding protein (LBP), immunoglobulin M endotoxin core antibodies to lipopolysaccharide (EndoCAb), and interleukin 6 (IL-6) were determined. Fetal cord blood levels of sCD14, LBP, and IL-6 were determined. Results were compared between groups. RESULTS First trimester sCD14 and LBP levels and third trimester sCD14 levels were significantly higher in the HIV-infected group. HIV-infected women with preterm births and spontaneous preterm births had significantly increased levels of sCD14 throughout pregnancy and significantly increased levels of LBP during the first trimester, compared with HIV-infected women with delivery at term or with HIV-negative women. On multivariate analysis, an independent association was observed between first trimester sCD14 levels and preterm delivery among HIV-infected women. CONCLUSIONS This is the first study to assess inflammatory markers related to microbial translocation during pregnancy among HIV-infected women. Higher levels of sCD14 and LBP were observed in HIV-infected pregnant women and were associated with preterm delivery.
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Affiliation(s)
- Marta López
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, Centre for Biomedical Research on Rare Diseases (CIBER-ER)
| | - Francesc Figueras
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, Centre for Biomedical Research on Rare Diseases (CIBER-ER)
| | - Oriol Coll
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, Centre for Biomedical Research on Rare Diseases (CIBER-ER)
| | - Anna Goncé
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, Centre for Biomedical Research on Rare Diseases (CIBER-ER)
| | - Sandra Hernández
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, Centre for Biomedical Research on Rare Diseases (CIBER-ER)
| | - Montse Loncá
- Infectious Diseases Department, Hospital Clinic, IDIBAPS
| | - Jordi Vila
- Department of Microbiology, Hospital Clinic, CRESIB, University of Barcelona, Spain
| | - Eduard Gratacós
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, Centre for Biomedical Research on Rare Diseases (CIBER-ER)
| | - Montse Palacio
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, Centre for Biomedical Research on Rare Diseases (CIBER-ER)
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Li N, Sando MM, Spiegelman D, Hertzmark E, Liu E, Sando D, Machumi L, Chalamilla G, Fawzi W. Antiretroviral Therapy in Relation to Birth Outcomes among HIV-infected Women: A Cohort Study. J Infect Dis 2015; 213:1057-64. [PMID: 26265780 DOI: 10.1093/infdis/jiv389] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 06/15/2015] [Indexed: 11/14/2022] Open
Abstract
Although the beneficial effects of antiretroviral (ARV) therapy for preventing mother-to-child transmission are indisputable, studies in developed and developing countries have reported conflicting findings on the association between ARV exposure and adverse birth outcomes. We conducted a prospective observational study at 10 human immunodeficiency virus (HIV) care and treatment centers in Dar es Salaam, Tanzania. Multivariate log-binomial regression was used to investigate the associations between ARV use and adverse birth outcomes among HIV-negative HIV-exposed infants. Our findings demonstrate an increased risk of adverse birth outcomes associated with the use of highly active antiretroviral therapy during pregnancy. Further studies are needed to investigate the underlying mechanisms and identify the safest ARV regimens for use during pregnancy.
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Affiliation(s)
- Nan Li
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health (HSPH), Boston, Massachusetts
| | | | - Donna Spiegelman
- Departments of Epidemiology, HSPH, Boston, Massachusetts Biostatistics, HSPH, Boston, Massachusetts
| | | | - Enju Liu
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health (HSPH), Boston, Massachusetts
| | - David Sando
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Lameck Machumi
- Management and Development for Health, Dar es Salaam, Tanzania
| | | | - Wafaie Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health (HSPH), Boston, Massachusetts Departments of Epidemiology, HSPH, Boston, Massachusetts Nutrition, HSPH, Boston, Massachusetts
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48
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Money DM, Wagner EC, Maan EJ, Chaworth-Musters T, Gadawski I, van Schalkwyk JE, Forbes JC, Burdge DR, Albert AYK, Lohn Z, Côté HCF. Evidence of Subclinical mtDNA Alterations in HIV-Infected Pregnant Women Receiving Combination Antiretroviral Therapy Compared to HIV-Negative Pregnant Women. PLoS One 2015; 10:e0135041. [PMID: 26247211 PMCID: PMC4527775 DOI: 10.1371/journal.pone.0135041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/16/2015] [Indexed: 01/16/2023] Open
Abstract
Introduction Combination antiretroviral therapy (cART) can effectively prevent vertical transmission of HIV but there is potential risk of adverse maternal, foetal or infant effects. Specifically, the effect of cART use during pregnancy on mitochondrial DNA (mtDNA) content in HIV-positive (HIV+) women is unclear. We sought to characterize subclinical alterations in peripheral blood mtDNA levels in cART-treated HIV+ women during pregnancy and the postpartum period. Methods This prospective longitudinal observational cohort study enrolled both HIV+ and HIV-negative (HIV-) pregnant women. Clinical data and blood samples were collected at three time points in pregnancy (13-<23 weeks, 23-<30 weeks, 30–40 weeks), and at delivery and six weeks post-partum in HIV+ women. Peripheral blood mtDNA to nuclear DNA (nDNA) ratio was measured by qPCR. Results Over a four year period, 63 HIV+ and 42 HIV- women were enrolled. HIV+ women showed significantly lower mtDNA/nDNA ratios compared to HIV- women during pregnancy (p = 0.003), after controlling for platelet count and repeated measurements using a multivariable mixed-effects model. Ethnicity, gestational age (GA) and substance use were also significantly associated with mtDNA/nDNA ratio (p≤0.02). Among HIV+ women, higher CD4 nadir was associated with higher mtDNA/nDNA ratios (p<0.0001), and these ratio were significantly lower during pregnancy compared to the postpartum period (p<0.0001). Conclusions In the context of this study, it was not possible to distinguish between mtDNA effects related to HIV infection versus cART therapy. Nevertheless, while mtDNA levels were relatively stable over time in both groups during pregnancy, they were significantly lower in HIV+ women compared to HIV- women. Although no immediate clinical impact was observed on maternal or infant health, lower maternal mtDNA levels may exert long-term effects on women and children and remain a concern. Improved knowledge of such subclinical alterations is another step toward optimizing the safety and efficacy of cART regimens during pregnancy.
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Affiliation(s)
- Deborah M. Money
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Women’s Health Research Institute, BC Women’s Hospital and Health Centre, Vancouver, BC, Canada
- Oak Tree Clinic, BC Women’s Hospital and Health Centre, Vancouver, BC, Canada
- * E-mail:
| | - Emily C. Wagner
- Women’s Health Research Institute, BC Women’s Hospital and Health Centre, Vancouver, BC, Canada
| | - Evelyn J. Maan
- Women’s Health Research Institute, BC Women’s Hospital and Health Centre, Vancouver, BC, Canada
- Oak Tree Clinic, BC Women’s Hospital and Health Centre, Vancouver, BC, Canada
| | - Tessa Chaworth-Musters
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Izabelle Gadawski
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julie E. van Schalkwyk
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Women’s Health Research Institute, BC Women’s Hospital and Health Centre, Vancouver, BC, Canada
| | - John C. Forbes
- Department of Paediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - David R. Burdge
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Women’s Health Research Institute, BC Women’s Hospital and Health Centre, Vancouver, BC, Canada
| | - Arianne Y. K. Albert
- Women’s Health Research Institute, BC Women’s Hospital and Health Centre, Vancouver, BC, Canada
| | - Zoe Lohn
- Women’s Health Research Institute, BC Women’s Hospital and Health Centre, Vancouver, BC, Canada
| | - Hélène C. F. Côté
- Women’s Health Research Institute, BC Women’s Hospital and Health Centre, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Canlorbe G, Matheron S, Mandelbrot L, Oudet B, Luton D, Azria E. Vasculoplacental complications in pregnant women with HIV infection: a case-control study. Am J Obstet Gynecol 2015; 213:241.e1-9. [PMID: 25797234 DOI: 10.1016/j.ajog.2015.03.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 01/21/2015] [Accepted: 03/16/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Data from the international literature suggest that there may be an association between maternal human immunodeficiency virus (HIV) infection and vasculoplacental complications during pregnancy. Studies on this subject have reached discordant conclusions. The aim of this study was to assess the incidence of vasculoplacental complications during pregnancy in women with and without HIV infection. STUDY DESIGN This single-center case-control study compared the incidence of pregnancy-related hypertension, preeclampsia, eclampsia, and vascular intrauterine growth restriction in 280 women with HIV and 560 women not infected with HIV, matched for age, parity, and geographic origin. RESULTS The incidence rates of pregnancy-related hypertension, preeclampsia, eclampsia, and vascular growth restriction did not differ between the women with and without HIV infection. The overall incidence of vasculoplacental complications did not differ between the 2 groups (7.5% vs 9.8%, respectively; P = .27). The risk of these was not associated with exposure to antiretroviral treatments, viral load, or CD4 T-cell counts at the beginning of pregnancy. CONCLUSION This study shows no difference in the incidence of vasculoplacental complications between women with and without HIV infection.
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Affiliation(s)
- Geoffroy Canlorbe
- Department of Gynecology and Obstetrics, Hôpital Bichat-Claude Bernard, Université Paris Diderot, Paris, France; Hospital and University Departments of Risk in Pregnancy, Paris, France
| | - Sophie Matheron
- Department of Infectious and Tropical Infections, Hôpital Bichat-Claude Bernard, Université Paris Diderot, Paris, France; Infection, Antimicrobials, Modeling, and Evolution Unité Mixte de Recherche 1137, French Institute of Health and Medical Research, Paris, France
| | - Laurent Mandelbrot
- Hospital and University Departments of Risk in Pregnancy, Paris, France; Department of Gynecology and Obstetrics, Assistance Publique-Hôpitaux de Paris Hôpital Louis Mourier, Colombes, France
| | - Barbara Oudet
- Department of Gynecology and Obstetrics, Hôpital Bichat-Claude Bernard, Université Paris Diderot, Paris, France; Hospital and University Departments of Risk in Pregnancy, Paris, France
| | - Dominique Luton
- Department of Gynecology and Obstetrics, Hôpital Bichat-Claude Bernard, Université Paris Diderot, Paris, France; Hospital and University Departments of Risk in Pregnancy, Paris, France
| | - Elie Azria
- Department of Gynecology and Obstetrics, Hôpital Bichat-Claude Bernard, Université Paris Diderot, Paris, France; Hospital and University Departments of Risk in Pregnancy, Paris, France; Obstetric, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Center, Institute of Health and Medical Research Unité 1153, Sorbonne Paris Cité Center, Paris, France.
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50
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de Ruiter A, Taylor GP, Clayden P, Dhar J, Gandhi K, Gilleece Y, Harding K, Hay P, Kennedy J, Low-Beer N, Lyall H, Palfreeman A, O'Shea S, Tookey P, Tosswill J, Welch S, Wilkins E. British HIV Association guidelines for the management of HIV infection in pregnant women 2012 (2014 interim review). HIV Med 2015; 15 Suppl 4:1-77. [PMID: 25604045 DOI: 10.1111/hiv.12185] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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