Breastfeeding in HIV-positive women: What can be recommended?

Mother-to-Child Transmission of Arboviruses during Breastfeeding: From Epidemiology to Cellular Mechanisms

Most viruses use several entry sites and modes of transmission to infect their host (parenteral, sexual, respiratory, oro-fecal, transplacental, transcutaneous, etc.). Some of them are known to be essentially transmitted via arthropod bites (mosquitoes, ticks, phlebotomes, sandflies, etc.), and are thus named arthropod-borne viruses, or arboviruses. During the last decades, several arboviruses have emerged or re-emerged in different countries in the form of notable outbreaks, resulting in a growing interest from scientific and medical communities as well as an increase in epidemiological studies. These studies have highlighted the existence of other modes of transmission. Among them, mother-to-child transmission (MTCT) during breastfeeding was highlighted for the vaccine strain of yellow fever virus (YFV) and Zika virus (ZIKV), and suggested for other arboviruses such as Chikungunya virus (CHIKV), dengue virus (DENV), and West Nile virus (WNV). In this review, we summarize all epidemiological and clinical clues that suggest the existence of breastfeeding as a neglected route for MTCT of arboviruses and we decipher some of the mechanisms that chronologically occur during MTCT via breastfeeding by focusing on ZIKV transmission process.

Simultaneous quantification of four antiretroviral drugs in breast milk samples from HIV-positive women by an ultra-high performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) method

The primary strategy to avoid mother-to-child transmission of human immunodeficiency virus (HIV) through breastfeeding is administration of highly active antiretroviral therapy (HAART) to HIV-positive pregnant women. Because significant changes in the pharmacokinetics of antiretroviral (ARV) drugs occur during pregnancy, quantifying HAART and the viral load in breast milk in this population is essential. Here, we developed an analytical assay for the simultaneous quantification of four ARV drugs in breast milk using ultra-performance liquid chromatography coupled to tandem mass spectrometry. We validated this method following Mexican and international guidelines. ARV drugs. We extracted the ARV drugs from 200 μL samples of breast milk and detected these drugs in a triple quadrupole mass spectrometer with positive electrospray ionization. The validated concentration ranges (ng/mL) for zidovudine, lamivudine, lopinavir, and ritonavir were 12.5–750, 50–2500, 100–5000 and 5 to 250, respectively. Additionally, the absolute recovery percentages (and matrix effects) were 91.4 (8.39), 88.78 (28.75), 91.38 (11.77) and 89.78 (12.37), respectively. We determined that ARV drugs are stable for 24 h at 8°C and 24°C for 15 days at –80°C. This methodology had the capacity for simultaneous detection; separation; and accurate, precise quantification of ARV drugs in human breast milk samples according to Mexican standard laws and United States Food and Drug Administration guidelines.

Role of HIV exposure and infection in relation to neonatal GBS disease and rectovaginal GBS carriage: a systematic review and meta-analysis

Streptococcus agalactiae (GBS) is the leading cause worldwide of neonatal sepsis. We sought to assess to which extent HIV exposure of neonates is associated with GBS neonatal disease. Furthermore, we assessed to which extent HIV infection in women is associated with maternal rectovaginal GBS carriage, the single most important risk factor for GBS neonatal disease. We searched Pubmed, Embase, and Web of Science for studies assessing the association between neonatal GBS disease and HIV-status of the mother and studies that assessed the association between rectovaginal GBS colonization and HIV status in women. HIV-exposed uninfected neonates were more than twice as likely to have neonatal GBS disease compared to unexposed neonates. HIV-exposed neonates were not at increased risk for early-onset neonatal disease, but were 4.43 times more likely to have late-onset neonatal GBS disease. There was no significant association between HIV infection status and rectovaginal GBS carriage. Public health interventions preventing neonatal GBS disease are urgently needed for the increasing group of HIV-exposed neonates. A framework integrating and explaining our findings highlights opportunities for the clinical practice and global health policy to prevent disease. Well-designed studies should clarify the relation between HIV-status and GBS carriage.

Short-term effectiveness of a community health worker intervention for HIV-infected pregnant women in Tanzania to improve treatment adherence and retention in care: A cluster-randomized trial

INTRODUCTION

Community health workers (CHWs) are lay workers who have the potential to enhance services to prevent mother-to-child HIV transmission (PMTCT) and improve the health of women living with HIV infection. We conducted a cluster-randomized trial of an intervention to integrate CHWs with 'Option B+' PMTCT services in Shinyanga Region, Tanzania.

METHODS

The intervention was implemented for 11 months and included four integrated components: 1) formal linkage of CHWs to health facilities; 2) CHW-led antiretroviral therapy (ART) adherence counseling; 3) loss to follow-up tracing by CHWs; and 4) distribution of Action Birth Cards (ABCs), a birth planning tool. We cluster-randomized 32 facilities offering PMTCT services, within strata of size, to the intervention (n = 15) or comparison (standard of care, n = 17) groups. Intervention effectiveness was determined with a difference-in-differences strategy based on clinical and pharmacy data from HIV-infected postpartum women at baseline (births in 2014) and endline (births April-Oct 2015). The primary outcome was retention in care between 60 and 120 days postpartum. Secondary outcomes included ART initiation, timing of ART initiation (as measured by week of gestation), and ART adherence 90 days postpartum, measured using the medication possession ratio (MPR≥95%).

RESULTS

Intervention and comparison facilities were similar at baseline. Data were collected from 1,152 and 678 mother-infant pairs at baseline and endline, respectively. There were no significant differences in retention in care, ART initiation, or timing of ART initiation between the intervention and control groups. Adherence (MPR≥95%) at 90 days postpartum was 11.3 percentage points higher in the intervention group in ITT analyses (95% CI: -0.7, 23.3, p = 0.06), though this effect was attenuated after adjusting for baseline imbalance (9.5 percentage points, 95% CI: -2.9, 22.0, p = 0.13). Among only sites that had the greatest fidelity to the intervention, however, we found a stronger effect on adherence (13.6 percentage points, 95% CI: 2.5, 24.6).

CONCLUSIONS

Despite being feasible and acceptable, the CHW-based intervention did not have strong effects on most PMTCT indicators. CHW involvement in PMTCT programs may improve ART adherence among HIV-infected postpartum women, however, and success appears heavily dependent on program implementation.

TRIAL REGISTRATION

Registry for International Development Impact Evaluations (RIDIE, ID 552553838b402) and ClinicalTrials.gov (NCT03058484).

Refugees’ perceptions regarding HIV and AIDS in Ba-Phalaborwa Municipality in Limpopo Province

Background: Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV and AIDS) remain a serious threat to population health and economic well-being of individuals in conflict societies. Sub-Saharan Africa (SSA) is overwhelmingly affected by HIV and is the region with the highest number of armed conflicts worldwide.Aim: The research aimed at exploring and describing the perceptions of the refugees at Humulani Village in Ba-Phalaborwa municipality, Limpopo province, about HIV and AIDS.Objectives: The objectives included determining the gender perceptions about HIV and AIDS and also providing recommendations for ways to increase the refugees understanding of this disease.Methods: The approach used for the research was quantitative. The target population of the study was all the refugees at Humulani Village. The sample comprised both men (n = 78) and women (n = 122) who participated by completing questionnaires. The sample of the refugees consisted of different ethnic groups from Mozambique, Nigeria, Ghana and Zimbabwe. The questionnaire consisted of two sections, section A contained the biographic data and section B interrogated the refugees’ knowledge of HIV.Results: The findings of the study revealed that the participants had low levels of knowledge regarding HIV which could be attributed to their believing the myths about HIV and AIDS.Conclusion: The HIV-infected refugee population in Limpopo may continue to grow unless the unique needs of the refugees, such as strengthening the reproductive health services, maternal and child care and family planning, improving the educational and socio-economic status, are not addressed.Agtergrond: Menslike immuniteitsgebrekvirus (MIV) en verworwe immuniteitsgebrek-sindroom (vigs) bly ’n ernstige bedreiging vir die gesondheid van die bevolking, asook die ekonomiese welstand van individue in konflik-samelewings. Sub-Sahara Afrika (SSA) word oorweldigend deur MIV geraak en is die streek met die hoogste aantal gewapende konflikte wêreldwyd.Doelwitte: Die navorsing het ten doel gehad om vlugtelinge te Humulani dorpie in Ba-Phalaborwa munisipaliteit, Limpopo provinsie, se persepsies oor MIV en vigs te ondersoek en beskryf. Die doelwitte het die bepaling van geslagspersepsies oor MIV en vigs ingesluit, asook om aanbevelings te bied vir maniere om die vlugtelinge ’n beter begrip van MIV en vigs te gee.Metode: ’n Kwantitatiewe benadering tot hierdie navorsing is gevolg. Die teikenpopulasie van die studie was al die vlugtelinge te Humulani dorpie. Die steekproef het uit beide manlike (n = 78) en vroulike (n = 122) deelnemers bestaan wat vraelyste voltooi het. Die steekproef vlugtelinge was van verskillende etniese groepe afkomstig: Mosambiek, Nigerië, Ghana en Zimbabwe. Die vraelys het twee afdelings gehad: Afdeling A het die biografiese data bevat en Afdeling B het die vlugtelinge se kennis van MIV ondersoek.Resultate: Die bevindinge van die studie het onthul dat die deelnemers oor lae kennisvlakke rakende MIV beskik – dit kan toegeskryf word aan hul geloof in die mites aangaande MIV en vigs.Gevolgtrekking: Die populasie van MIV-besmette vlugtelinge in Limpopo mag steeds groei indien daar nie aandag geskenk word aan die unieke behoeftes van die vlugtelinge nie, soos die versterking van voortplantingsgesondheidsdienste, gesinsbeplanning, en moeder- en kindersorg, asook die verbetering van hul opvoedkundige en sosio-ekonomiese welstand.