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Atkinson A, Tulloch K, Boucoiran I, Money D. Guideline No. 450: Care of Pregnant Women Living with HIV and Interventions to Reduce Perinatal Transmission. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102551. [PMID: 38734074 DOI: 10.1016/j.jogc.2024.102551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
OBJECTIVE This guideline provides an update on the care of pregnant women living with HIV and the prevention of perinatal HIV transmission. This guideline is a revision of the previous guideline, No. 310 Guidelines for the Care of Pregnant Women Living With HIV and Interventions to Reduce Perinatal Transmission, and includes an updated review of the literature with contemporary recommendations. TARGET POPULATION Pregnant women newly diagnosed with HIV during antenatal screening and women living with HIV who become pregnant. This guideline does not include specific guidance for girls/women of reproductive age living with HIV who are not pregnant. OUTCOMES Prevention of perinatal HIV transmission is a key indicator of the success of a health care system and requires multidisciplinary care of pregnant women living with HIV. Intended outcomes include guidance on best practice in perinatal management for Canadian health care providers for pregnant women living with HIV; reduction of perinatal transmission of HIV toward a target of eradication of perinatal transmission; provision of optimal antenatal care for pregnant women to ensure the best maternal health outcomes and HIV suppression; and evidence-based support and recommendations for pregnant women living with HIV, maintaining awareness and consideration of the complex psychosocial impacts of living with HIV. BENEFITS, HARMS, AND COSTS The perinatal transmission of HIV has significant morbidity and mortality implications for the child, with associated lifelong health care costs. Pregnancy presents an emotionally and physically vulnerable time for pregnant women as well as an opportunity to engage them in health promotion. This guidance does not include recommendations with additional costs to health care facilities compared with the previous guideline. Application of the recommendations is aimed at health benefits to both mother and child by optimizing maternal health and preventing perinatal HIV transmission. EVIDENCE Published and unpublished literature was reviewed with a focus on publications post-2013. OVID-Medline, Embase, PubMed and the Cochrane Library databases were searched for relevant publications available in English or French for each section of this guideline. Results included systematic reviews, randomized controlled trials, and observational studies published from 2012 to 2022. Searches were updated on a regular basis and incorporated in the guideline until May 2023. Unpublished literature, protocols, and international guidelines were identified by accessing the websites of health-related agencies, clinical practice guideline collections, and national and international medical specialty societies. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional recommendations). INTENDED AUDIENCE The intended users of this guideline include obstetric care providers and infectious disease clinicians who provide care for pregnant women living with HIV. SOCIAL MEDIA SUMMARY Updated Canadian HIV in pregnancy guideline informed by global research and tailored to Canadian healthcare needs and goals for pregnant women living with HIV and their families. SUMMARY STATEMENTS RECOMMENDATIONS.
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Atkinson A, Tulloch K, Boucoiran I, Money D. Directive clinique n o 450 : Prise en charge des femmes enceintes vivant avec le VIH et interventions pour réduire le risque de transmission périnatale. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102552. [PMID: 38729607 DOI: 10.1016/j.jogc.2024.102552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
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Fu W, McClymont E, Av-Gay G, Dorling M, Atkinson A, Azampanah A, Elwood C, Sauvé L, van Schalkwyk J, Sotindjo T, Money D. Retrospective Cohort Study on the Impact of the COVID-19 Pandemic on Pregnancy Outcomes for Women Living With HIV in British Columbia. J Acquir Immune Defic Syndr 2024; 95:411-416. [PMID: 38489490 DOI: 10.1097/qai.0000000000003384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/18/2023] [Indexed: 03/17/2024]
Abstract
BACKGROUND For pregnant women living with HIV (WLWH), engagement in care is crucial to maternal health and reducing the risk of perinatal transmission. To date, there have been no studies in Canada examining the impact of the COVID-19 pandemic on pregnant WLWH. METHODS This was a retrospective cohort study assessing the impact of the pandemic on perinatal outcomes for pregnant WLWH using data from the Perinatal HIV Surveillance Program in British Columbia, Canada. We compared maternal characteristics, pregnancy outcomes, and clinical indicators related to engagement with care between a prepandemic (January 2017-March 2020) and pandemic cohort (March 2020-December 2022). We investigated preterm birth rates with explanatory variables using logistic regression analysis. RESULTS The prepandemic cohort (n = 87) had a significantly (P < 0.05) lower gestational age at the first antenatal encounter (9.0 vs 11.8) and lower rates of preterm births compared with the pandemic cohort (n = 56; 15% vs 37%). Adjusted odds of preterm birth increased with the presence of substance use in pregnancy (aOR = 10.45, 95% confidence interval: 2.19 to 49.94) in WLWH. There were 2 cases of perinatal transmission of HIV in the pandemic cohort, whereas the prepandemic cohort had none. CONCLUSIONS The pandemic had pronounced effects on pregnant WLWH and their infants in British Columbia including higher rates of preterm birth and higher gestational age at the first antenatal encounter. The nonstatistically significant increase in perinatal transmission rates is of high clinical importance.
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Affiliation(s)
- Winnie Fu
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada; and
| | - Elisabeth McClymont
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada; and
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Gal Av-Gay
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada; and
| | - Marisa Dorling
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada; and
| | - Andrea Atkinson
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
| | | | - Chelsea Elwood
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada; and
| | - Laura Sauvé
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Julie van Schalkwyk
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada; and
| | - Tatiana Sotindjo
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Deborah Money
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada; and
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Gacic N, Tulloch K, Money D, Tkachuk S. Daily ritonavir-boosted darunavir for viral suppression in pregnancy (DRV-P). HIV Med 2024; 25:129-134. [PMID: 37816686 DOI: 10.1111/hiv.13546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/06/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Ritonavir-boosted darunavir (DRV/r) is a preferred protease inhibitor in pregnant women living with HIV. Current practice at British Columbia's referral centre (the Oak Tree Clinic) is to dose DRV/r as 800/100 mg daily throughout pregnancy, although some guidelines recommend DRV/r 600/100 mg twice daily due to altered pharmacokinetics with once-daily dosing. OBJECTIVES We describe the effect of once-daily DRV/r on viral suppression, vertical transmission, adverse drug effects and adherence in pregnant women living with HIV. METHODS This was a retrospective analysis of pregnant women living with HIV in British Columbia. Eligible women gave birth between January 2015 and August 2021, and took DRV/r 800/100 mg daily at any time during pregnancy. RESULTS Thirty-four women were included in this study. The mean (SD) age was 33 (5) years. Thirty (88%) women were diagnosed with HIV prior to pregnancy, with 22 (73%) having viral suppression at baseline. Four (12%) were diagnosed in pregnancy, with a median baseline viral load of 9616 copies/mL (range 8370-165 000). Viral suppression was achieved by 16 (100%), 24 (75%) and 26 (74%) women in the first, second and third trimesters, respectively. No vertical transmission occurred. This combination was well tolerated, with adverse drug effects that did not result in discontinuation or change in therapy. Most women maintained >75% adherence to once-daily DRV/r at all times during pregnancy. CONCLUSIONS Ritonavir-boosted darunavir 800/100 mg daily appears to be an appropriate dosing strategy for pregnant women living with HIV who are able to maintain optimal adherence.
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Affiliation(s)
- Nikolina Gacic
- Children's and Women's Health Centre of British Columbia, Vancouver, British Columbia, Canada
| | - Karen Tulloch
- Children's and Women's Health Centre of British Columbia, Vancouver, British Columbia, Canada
- Oak Tree Clinic, BC Women's Hospital, Vancouver, British Columbia, Canada
- Women's Health Research Institute, BC Women's Hospital, Vancouver, British Columbia, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Deborah Money
- Children's and Women's Health Centre of British Columbia, Vancouver, British Columbia, Canada
- Oak Tree Clinic, BC Women's Hospital, Vancouver, British Columbia, Canada
- Women's Health Research Institute, BC Women's Hospital, Vancouver, British Columbia, Canada
| | - Stacey Tkachuk
- Children's and Women's Health Centre of British Columbia, Vancouver, British Columbia, Canada
- Oak Tree Clinic, BC Women's Hospital, Vancouver, British Columbia, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Bitnun A, Sauvé L, Fanella S. Reducing perinatal infection risk in newborns of mothers who received inadequate prenatal care. Paediatr Child Health 2023; 28:307-323. [PMID: 37484040 PMCID: PMC10362956 DOI: 10.1093/pch/pxad014] [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: 11/25/2021] [Accepted: 11/23/2022] [Indexed: 07/25/2023] Open
Abstract
Inadequate prenatal care increases risk for maternal infections going undetected and untreated, putting both the mother's health and that of her infant at risk. When pregnant women present late to care, routine testing that impacts infant management should include: hepatitis B surface antigen (HBsAg); serology for hepatitis C virus (HCV), human immunodeficiency virus (HIV), and syphilis; and testing for Chlamydia trachomatis and Neisseria gonorrhoeae. If the mother was not tested before or after delivery and is not available for testing, the infant should undergo testing for HIV, HBV, HCV, and syphilis. Testing for C. trachomatis and N. gonorrhoeae should be undertaken if the infant develops compatible clinical manifestations. Rapid turnaround of test results for HIV, HBV, and syphilis is optimal because preventive treatment decisions are time-sensitive. Early and effective preventive interventions are available for newborns at risk for HIV, HBV, syphilis, or gonorrhea. Close clinical follow-up and follow-up testing of infants born to mothers with inadequate prenatal care are warranted, as not all infections can be fully excluded perinatally.
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Affiliation(s)
- Ari Bitnun
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario, Canada
| | - Laura Sauvé
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario, Canada
| | - Sergio Fanella
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario, Canada
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Bitnun A, Sauvé L, Fanella S. La réduction du risque d'infection périnatale chez les nouveau-nés de mères dont les soins prénatals étaient inappropriés. Paediatr Child Health 2023; 28:307-323. [PMID: 37484035 PMCID: PMC10362960 DOI: 10.1093/pch/pxad015] [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: 11/25/2021] [Accepted: 11/23/2022] [Indexed: 07/25/2023] Open
Abstract
Le risque que des infections maternelles ne soient ni décelées ni traitées augmente lorsque les soins prénatals sont inappropriés, ce qui met la santé de la mère et de son nouveau-né à risque. Lorsqu'une femme enceinte se présente tardivement pour recevoir des soins, les tests systématiques qui influent sur la prise en charge du nouveau-né devraient inclure l'antigène de surface de l'hépatite B (AgHBs), la sérologie du virus de l'hépatite C (VHC), du virus de l'immunodéficience humaine (VIH) et de la syphilis, de même que le dépistage de la Chlamydia trachomatis et de la Neisseria gonorrhoeae. Si la mère ne s'est pas soumise aux dépistages avant ou après l'accouchement et qu'elle n'est pas disponible pour s'y soumettre, il faudrait procéder au dépistage du VIH, du virus de l'hépatite B (VHB), du VHC et de la syphilis chez le nouveau-né. Le dépistage de la C. trachomatis et de la N. gonorrhoeae est toutefois réservé aux cas où le nouveau-né démontre des manifestations cliniques compatibles avec ces infections. Il est optimal d'obtenir rapidement les résultats du dépistage du VIH, du VHB et de la syphilis, car l'utilisation des traitements préventifs est circonscrite dans le temps. Il existe des interventions préventives précoces et efficaces pour les nouveau-nés à risque de VIH, de VHB, de syphilis ou de gonorrhée. Un suivi clinique étroit et des tests de suivi s'imposent auprès des nouveau-nés de mères dont les soins prénatals étaient inappropriés, car il est impossible d'exclure pleinement toutes les infections pendant la période périnatale.
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Affiliation(s)
- Ari Bitnun
- Société canadienne de pédiatrie, comité des maladies infectieuses et d'immunisation, Ottawa (Ontario)Canada
| | - Laura Sauvé
- Société canadienne de pédiatrie, comité des maladies infectieuses et d'immunisation, Ottawa (Ontario)Canada
| | - Sergio Fanella
- Société canadienne de pédiatrie, comité des maladies infectieuses et d'immunisation, Ottawa (Ontario)Canada
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Carvalho S, Lee T, Tulloch KJ, Sauve LJ, Samson L, Brophy JC, Bitnun A, Singer J, Money D, Kakkar F, Boucoiran I. Prescribing patterns of antiretroviral treatments during pregnancy for women living with HIV in Canada 2004-2020: A surveillance study. HIV Med 2023; 24:130-138. [PMID: 35699235 DOI: 10.1111/hiv.13346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND While treatment guidelines for HIV in adults have evolved rapidly with the advent of new antiretroviral (ARV) treatment, those for the prevention of vertical HIV transmission in pregnancy have evolved more slowly due to safety and efficacy concerns. Here we describe Canadian prescribing patterns for ARV treatments during pregnancy and compare them to perinatal HIV prescribing guidelines of the United States Department of Health and Human Services (HHS), that are commonly used in Canada and include recommendations for newly commercialized therapies. METHODS The Canadian Perinatal HIV Surveillance Program (CPHSP) captures annual medical data on mothers living with HIV and their infants from 23 sites across Canada. Women from this cohort who received an ARV treatment during pregnancy and who gave birth between 2004 and 2020 were included in the study. ARV treatments were designated as 'preferred/alternative' as per HHS HIV perinatal guidelines, or 'other than preferred/alternative'. RESULTS We identified 3673 pregnancies from 2720 women. The proportion of women that conceived while on ARV treatment increased from 29% in 2003 to 90% in 2020. Other than preferred/alternative ARV treatments were received in 1112 (30%) of pregnancies and this was significantly associated with having initiated ARV treatment before conception. CONCLUSION In Canada during the study period, a high number of women were prescribed an other than preferred/alternative ARV treatment during pregnancy. Further optimization of ARV treatment in women of childbearing age living with HIV is warranted.
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Affiliation(s)
- Sabrina Carvalho
- Faculty of Pharmacy, Université de Montréal, and Research Centre of the Saint-Justine University Hospital, Université de Montréal, Montreal, Quebec, Canada
| | - Terry Lee
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Karen J Tulloch
- Department of Pharmacy, British Columbia Women's Hospital and Health Centre and Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Laura J Sauve
- Department of Pediatrics, British Columbia Women's Hospital and Health Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lindy Samson
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Jason C Brophy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Ari Bitnun
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Joel Singer
- Department of Health Care and Epidemiology, University of British Columbia and CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Deborah Money
- Department of Obstetrics and Gynecology, British Columbia Women's Health Research Institute and Women's Hospital and Health Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fatima Kakkar
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Isabelle Boucoiran
- School of Public Health, Université de Montréal, and Department of Obstetrics and Gynecology, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
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Nicolau IA, Shokoohi M, McBane JE, Pogany L, Popovic N, Nicholson V, Hillier S, Aran N, Brophy J, Burt K, Cox J, de Pokomandy A, Kakkar F, Kelly D, Kerkerian G, Kogilwaimath S, Kroch A, Dias Lima V, Linthwaite B, Mbuagbaw L, McClarty L, Turvey S, Owino M, Martin C, Hogg RS, Loutfy M. A two-day workshop reviewing Canadian provincial and national HIV care cascade indicators, reporting, challenges, and recommendations. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2022; 7:247-268. [PMID: 36337608 PMCID: PMC9629730 DOI: 10.3138/jammi-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/31/2022] [Accepted: 04/02/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The HIV care cascade is an indicators-framework used to assess achievement of HIV clinical targets including HIV diagnosis, HIV care initiation and retention, initiation of antiretroviral therapy, and attainment of viral suppression for people living with HIV. METHODS The HIV Care Cascade Research Development Team at the CIHR Canadian HIV Trials Network Clinical Care and Management Core hosted a two-day virtual workshop to present HIV care cascade data collected nationally from local and provincial clinical settings and national cohort studies. The article summarizes the workshop presentations including the indicators used and available findings and presents the discussed challenges and recommendations. RESULTS Identified challenges included (1) inconsistent HIV care cascade indicator definitions, (2) variability between the use of nested UNAIDS's targets and HIV care cascade indicators, (3) variable analytic approaches based on differing data sources, (4) reporting difficulties in some regions due to a lack of integration across data platforms, (5) lack of robust data on the first stage of the care cascade at the sub-national level, and (6) inability to integrate key socio-demographic data to estimate population-specific care cascade shortfalls. CONCLUSION There were four recommendations: standardization of HIV care cascade indicators and analyses, additional funding for HIV care cascade data collection, database maintenance and analyses at all levels, qualitative interviews and case studies characterizing the stories behind the care cascade findings, and employing targeted positive-action programs to increase engagement of key populations in each HIV care cascade stage.
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Affiliation(s)
- Ioana A Nicolau
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mostafa Shokoohi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Joanne E McBane
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lisa Pogany
- Public Health Agency of Canada (PHAC), Ottawa, Ontario, Canada
| | - Nashira Popovic
- Public Health Agency of Canada (PHAC), Ottawa, Ontario, Canada
| | - Valerie Nicholson
- Communities, Alliances & Networks (CAAN), Montreal, Quebec, Canada
- British Columbia Centre for Excellence in HIV/AIDS Care (BC-CfE), Vancouver, British Columbia, Canada
| | - Sean Hillier
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Niloufar Aran
- British Columbia Centre for Excellence in HIV/AIDS Care (BC-CfE), Vancouver, British Columbia, Canada
| | - Jason Brophy
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Kimberley Burt
- HIV Program, Eastern Health, St. John’s, Newfoundland, Canada
| | - Joseph Cox
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Quebec, Canada
- McGill University, Montreal, Quebec, Canada
| | - Alexandra de Pokomandy
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Quebec, Canada
- McGill University, Montreal, Quebec, Canada
| | - Fatima Kakkar
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Centre de Recherche, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Deborah Kelly
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Department of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Geneviève Kerkerian
- Infectious Diseases Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Siddharth Kogilwaimath
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Abigail Kroch
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | - Viviane Dias Lima
- British Columbia Centre for Excellence in HIV/AIDS Care (BC-CfE), Vancouver, British Columbia, Canada
| | - Blake Linthwaite
- Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Quebec, Canada
| | - Lawrence Mbuagbaw
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Maureen Owino
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Committee for Accessible AIDS Treatment, Toronto, Ontario, Canada
- York University, Toronto, Ontario, Canada
| | - Carrie Martin
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Communities, Alliances & Networks (CAAN), Montreal, Quebec, Canada
- Concordia, Montreal, Quebec, Canada
| | - Robert S Hogg
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS Care (BC-CfE), Vancouver, British Columbia, Canada
- Simon Fraser University, Vancouver, British Columbia, Canada
| | - Mona Loutfy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
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Higher Hospitalization Rates in Children Born HIV-exposed Uninfected in British Columbia, Canada, Between 1990 and 2012. Pediatr Infect Dis J 2022; 41:124-130. [PMID: 34711783 DOI: 10.1097/inf.0000000000003365] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Compared with children who are HIV-unexposed and uninfected (CHUU), children who are HIV-exposed and uninfected (CHEU) experience more clinical complications. We investigated hospitalizations among CHEU by antenatal antiretroviral therapy (ART) exposure, in British Columbia, Canada. METHODS This retrospective controlled cohort study used administrative health data from 1990 to 2012. CHEU and CHUU were matched 1:3 for age, sex and maternal geographical area of residence. We determined adjusted odds ratios (aORs) via conditional logistic regression, adjusting for maternal risk factors. RESULTS A total of 446 CHEU and 1333 CHUU were included. Compared with CHUU, more CHEU experienced one or more lifetime hospitalization (47.3% vs. 29.8%), one or more neonatal hospitalization (40.4% vs. 27.6%), and any intensive care unit admission (28.5% vs. 9.2%). In adjusted analyses, CHEU experienced higher odds of any lifetime hospitalization (aOR 2.30, 95% confidence interval 1.81-2.91) and neonatal hospitalization (aOR 2.14, 95% confidence interval 1.68-2.73), compared with CHUU. There was, however, no difference in infection-related hospitalizations (9.0% vs. 7.5%), which were primarily respiratory tract infections among both CHEU and CHUU. CHEU whose mothers-initiated ART preconception showed lower odds of infection-related hospitalizations than children whose mothers initiated ART during pregnancy or received no ART. CONCLUSIONS CHEU experienced increased odds of hospitalization relative to CHUU. A substantial number of CHEU hospitalizations occurred within the neonatal period and were ICU admissions. Initiating ART preconception may reduce the risk of infection-related hospitalizations. These findings reinforce the benefit of ART in pregnancy and the need for ongoing pediatric care to reduce hospitalizations.
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Shoemaker ES, Saiyin T, Smith S, Loutfy M, Darling L, Walker M, Hawken S, Begum J, Bibeau C, Bertozzi B, Fraleigh A, Kwaramba G, Johnson K, Cousineau A, Kendall CE. Patterns of cesarean birth among women living with HIV in Ontario: A cross-sectional, population-level study. Birth 2021; 48:357-365. [PMID: 33733473 DOI: 10.1111/birt.12545] [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] [Received: 04/01/2020] [Revised: 07/10/2020] [Accepted: 02/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND In Canada, as is found globally, women of reproductive age are a growing demographic of persons living with HIV. Combination antiretroviral therapy (cART) treatment enables women living with HIV (WLWH) to become pregnant without perinatal transmission, and they are increasingly planning to become pregnant. Since 2014, Canadian guidelines no longer recommend routine elective cesarean birth (CB) for women who are virally suppressed and receiving cART. It is unknown whether their obstetric care has changed since this update. Our objective was to describe trends in cesarean births among WLWH in Ontario, Canada, over a 12-year period. METHODS Our research is co-led and codesigned with WLWH. We conducted a retrospective population-level cohort study using linked health administrative databases at ICES (formally, the Institute for Clinical and Evaluative Sciences). Participants were all women who gave birth in Ontario, between 2006/07 and 2017/18. We assessed their intrapartum characteristics and used multivariable regression to determine an association between HIV status and CB, controlling for sociodemographic and clinical variables. RESULTS Since 2014, the overall proportion of CB among WLWH remained stable and was higher than among women without HIV (39.9% vs 29.0%, P < 0.001). In addition, the proportion of primary CB decreased between 2006 and 2010 and between 2014 and 2018 (28.5%-19.3%), whereas the proportion of repeat CB increased (13.1%-20.5%, P = 0.013). CONCLUSIONS Because of decreasing HIV-related indications for CB, more practitioners may be following the guidelines for first-time mothers. Currently, no guidelines exist for care of WLWH with a previous CB, and opportunities for vaginal birth may be missed in this population.
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Affiliation(s)
- Esther S Shoemaker
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada.,ICES, Ottawa, ON, Canada
| | - Tana Saiyin
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Stephanie Smith
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Mona Loutfy
- ICES, Ottawa, ON, Canada.,Infectious Disease Clinician Scientist, Departments of Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Liz Darling
- ICES, Ottawa, ON, Canada.,Department of Midwifery, McMaster University, Hamilton, ON, Canada
| | - Mark Walker
- Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, ON, Canada
| | - Steven Hawken
- ICES, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Christine Bibeau
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Breklyn Bertozzi
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Annette Fraleigh
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Gladys Kwaramba
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Kerrigan Johnson
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Ashlee Cousineau
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Claire E Kendall
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada.,ICES, Ottawa, ON, Canada
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11
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Choudhury B, Stadnyk M, Freire Jijon D, McLaughlin L, Kanji JN, Charlton C, Smyczek P, Vaudry W, Houston S, Tse-Chang A, Hawkes MT. Pregnancy Among HIV-Serodiscordant Couples: Case Report of Vertical Transmission and Retrospective Case Series. Curr HIV Res 2021; 19:269-276. [PMID: 33390144 DOI: 10.2174/1570162x18999201231211658] [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: 07/26/2020] [Revised: 11/27/2020] [Accepted: 11/28/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND HIV transmission during pregnancy and breastfeeding among serodiscordant heterosexual couples represents an ongoing barrier to the elimination of vertical transmission of HIV-1 infection in Canada. OBJECTIVE To report a case of vertical HIV transmission during breastfeeding and examine the prevalence of risk factors for HIV transmission in the pregnancy and postpartum periods among serodiscordant couples where the male partner is HIV positive and female partner HIV negative. METHODS Case report and retrospective chart review of HIV-serodiscordant pregnant couples over an eight-year period in Edmonton, Canada. RESULTS We report a case of maternal primary HIV infection during the postpartum period and vertical transmission to a nursing infant that went undetected until the infant presented with AIDS. We also report a series of 41 serodiscordant pregnant couples identified by our public health nurse between 2008 and 2016. Among HIV-infected male partners, 20 (49%) had a detectable viral load (VL) during their partner's pregnancy and during breastfeeding, with median peak VL 4,700 copies/mL (range 49-120,000) and 5,100 copies/mL (range 40-120,000) during pregnancy and breastfeeding, respectively. None of the female partners seroconverted during pregnancy, but three seroconverted at 1.8, 2.4, and 6.9 years after delivery. No vertical transmission occurred. CONCLUSION Despite concerted attempts to minimize HIV transmission during pregnancy and breastfeeding in our well-resourced setting, residual transmission risk remains due to non-suppressed viral load within many HIV-serodiscordant pregnant couples.
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Affiliation(s)
| | - Maria Stadnyk
- STI Clinic, Edmonton General Hospital, Edmonton, Canada
| | | | - Luke McLaughlin
- Department of Medicine, Division of Infectious Diseases, University of Alberta, Edmonton, Canada
| | - Jamil N Kanji
- Department of Medicine, Division of Infectious Diseases, University of Alberta, Edmonton, Canada
| | - Carmen Charlton
- Public Health Laboratory, Alberta Precision Laboratories, University of Alberta Hospital, Edmonton, Canada
| | - Petra Smyczek
- STI Clinic, Edmonton General Hospital, Edmonton, Canada
| | - Wendy Vaudry
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Stan Houston
- Department of Medicine, Division of Infectious Diseases, University of Alberta, Edmonton, Canada
| | - Alena Tse-Chang
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Michael T Hawkes
- Department of Pediatrics, University of Alberta, Edmonton, Canada
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12
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Hannan J, Etowa JB, Babatunde S, Stephens CN, Barfield L, Galarza MG, Alharbi MM, Reid V, Etowa EB, Phillips JC. Determinants of Adherence to National Infant Feeding Guidelines by Black Mothers Living with HIV. Ethn Dis 2021; 31:31-40. [PMID: 33519153 DOI: 10.18865/ed.31.1.31] [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: 11/18/2022] Open
Abstract
Objective Worldwide, 160,000 children were newly infected with HIV in 2018; half of these were infected through breastfeeding. Infant feeding guidelines are distinct depending on each country's resources and national or sub-national guidelines. Because of divergent guidelines, the best infant feeding approach to prevent mother-to-child transmission can become unclear. The purpose of this study was to examine the sociocultural and psychosocial factors related to adherence to infant feeding guidelines through a city-level, North-South comparison of Black mothers living with HIV in Nigeria, Canada, and the United States. Design Using a cross-sectional multi-country survey, a convenience sample of 690 mothers were recruited from June 2016 - December 2019. Socio-cultural and psychosocial factors influencing infant feeding practices were measured. Results Using binary logistic regression, infant feeding attitudes (OR = 1.10), motherhood experiences (OR = 1.08), low hyper-vigilance score (OR = .93), paternal support (OR = 1.10) and perception that the health care provider supported adherence to infant feeding guidelines (OR = 2.43) were associated with guideline adherence. Mothers who had cultural beliefs that were inconsistent with infant feeding guidelines and mothers with low incomes (OR = 2.62) were less likely adherent with their country's guidelines. Conclusion City-level factors were not found to influence adherence to infant feeding guidelines; however, socio-cultural and psychosocial factors at community, family and individual levels were significant. Policy formulation and targeted interventions must be cognizant of cultural expectations of motherhood and mindful of psychosocial determinants of adherence to infant feeding guidelines.
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Affiliation(s)
- Jean Hannan
- Florida International University Nicole Wertheim College of Nursing and Health Sciences, Miami, FL, United States
| | | | - Seye Babatunde
- University of Port Harcourt, Centre for Health and Development, Port Harcourt, Rivers, Nigeria
| | - Colleen N Stephens
- Florida International University Nicole Wertheim College of Nursing and Health Sciences, Miami, FL, United States
| | - Latisha Barfield
- Florida International University Nicole Wertheim College of Nursing and Health Sciences, Miami, FL, United States
| | - Marta G Galarza
- University of Miami Miller School of Medicine, Department of Pediatrics, Miami, FL, United States
| | - Majed M Alharbi
- Florida International University Nicole Wertheim College of Nursing and Health Sciences, Miami, FL, United States
| | - Valrie Reid
- Florida International University Nicole Wertheim College of Nursing and Health Sciences, Miami, FL, United States
| | - Egbe B Etowa
- University of Ottawa School of Nursing, Ottawa, ON, Canada
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13
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Haddad N, Weeks A, Robert A, Totten S. HIV in Canada-surveillance report, 2019. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2021; 47:77-86. [PMID: 33679250 PMCID: PMC7927910 DOI: 10.14745/ccdr.v47i01a11] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) is a global public health issue. HIV has been nationally notifiable in Canada since 1985. The Public Health Agency of Canada (PHAC) monitors trends in new HIV diagnoses. OBJECTIVES The objective of this surveillance report is to provide an overview of the epidemiology of reported HIV cases in 2019 in Canada. The report highlights 10-year trends (2010-2019). Data on HIV diagnosed through Immigration Medical Exams (IME) and trends in perinatal transmission of HIV are also presented. METHODS PHAC monitors HIV through the HIV/AIDS Surveillance System, a passive, case-based system that collates non-nominal data submitted voluntarily by all Canadian provinces and territories. Descriptive analyses were conducted on national data. IME data were obtained from Immigration, Refugees and Citizenship Canada (IRCC), and data on HIV-exposed pregnancies were obtained through the Canadian Perinatal HIV Surveillance Program. RESULTS In 2019, a total of 2,122 HIV diagnoses were reported in Canada (5.6 per 100,000 population). Saskatchewan reported the highest provincial diagnosis rate at 16.9 per 100,000 population. The 30 to 39-year age group had the highest HIV diagnosis rate at 12.7 per 100,000 population. While the rates for both males and females fluctuated in the past decade, since 2010 the rates among males decreased overall, while the rate among females increased slightly. As in previous years, the diagnosis rate for males in 2019 was higher than that for females (7.9 versus 3.4 per 100,000 population, respectively). The highest proportion of all reported adult cases with known exposure were gay, bisexual and other men who have sex with men (gbMSM, 39.7%), followed by cases attributed to heterosexual contact (28.3%) and among people who inject drugs (PWID, 21.5%). The number of migrants who tested positive for HIV during an IME conducted in Canada was 626. The one documented perinatal HIV transmission related to a mother who had not received antepartum or intrapartum antiretroviral therapy prophylaxis. CONCLUSION The number and rate of reported HIV cases in Canada has remained relatively stable over the last decade, with minor year-to-year variations. As in previous years, the gbMSM and PWID populations represent a high proportion of HIV diagnoses, although a sizable number of cases were attributed to heterosexual contact. It is important to routinely monitor trends in HIV in light of pan-Canadian commitments to reduce the health impact of sexually transmitted and blood-borne infections by 2030.
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Affiliation(s)
- Nisrine Haddad
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - Ashley Weeks
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - Anita Robert
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - Stephanie Totten
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
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14
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Young JM, Bitnun A, Read SE, Smith ML. Early academic achievement of HIV-exposed uninfected children compared to HIV-unexposed uninfected children at 5 years of age. Child Neuropsychol 2021; 27:532-547. [PMID: 33461418 DOI: 10.1080/09297049.2021.1871891] [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
HIV-exposed uninfected (HEU) children may be at-risk for poorer academic achievement compared to HIV-unexposed uninfected (HUU) children due to in utero and perinatal exposure to HIV and/or anti-retroviral (ARV) medication. Understanding the risk factors for academic underachievement is important for implementing timely intervention and academic supports. HEU (N = 110, mean (SD) age 5.59 (0.22) years) and HUU (N = 43, mean (SD) age 5.73 (0.64) years) children completed assessments of general intelligence (WPPSI-III) and academic achievement (WRAT-4). Parent interviews and medical record reviews were used to obtain sociodemographic and maternal health data. HUU children scored significantly higher than HEU children on single word reading (p = 0.006), math calculation skills (p = 0.003), Verbal IQ, Performance IQ, Full Scale IQ, and Processing Speed (all WPPSI-III measures p < 0.001). Verbal IQ at 3-4 years predicted academic achievement at 5-6 years of age, yet sociodemographic and medical factors did not. These findings demonstrate that HEU children obtained significantly lower scores of intellectual, reading, and math abilities during early childhood. Addressing these early gaps before HEU children enter primary school will be critical for optimizing their learning and academic potential.
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Affiliation(s)
- Julia M Young
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Neurosciences and Mental Health Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ari Bitnun
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Stanley E Read
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Mary Lou Smith
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Neurosciences and Mental Health Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto Mississauga, Mississauga, Ontario, Canada
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15
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Plitt SS, Smith TR, Berry W, Osman M, Senthilselvan A, Charlton CL. Examination of a Canadian provincial prenatal HIV screening program: 2010 to 2014. Canadian Journal of Public Health 2020; 111:555-561. [PMID: 32016920 DOI: 10.17269/s41997-019-00281-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 12/03/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Universal prenatal screening in the Canadian province of Alberta employs an 'opt-out' HIV screening strategy. We examined all women giving birth in the province and determined the frequency and characteristics of women having and not having HIV screening. METHODS All livebirths in Alberta from January 1, 2010 to December 31, 2014 were compiled from the Vital Statistics database and linked to HIV screening data to determine maternal demographic and prenatal care characteristics. Correlates associated with prenatal HIV screening, opting out of HIV screening, and not having any prenatal communicable disease screening were determined by multivariable statistics. RESULTS Of the 256,280 live births, 94.2% had prenatal HIV screening, 1.9% declined prenatal HIV screening, and 3.9% had no record of any prenatal communicable disease testing. Compared with those who had HIV screening, those who opted out of prenatal HIV screening were more likely to be over 40 years of age (adjusted odds ratio (AOR), 2.83 [2.12-3.78]) and less likely to be single (AOR, 0.67 [0.62-0.73]) and First Nations (AOR, 0.67 [0.56-0.82]). Those who received no prenatal communicable disease screening were less likely to be over 40 years of age (AOR, 0.81 [0.69-0.95]) and more likely to be single (AOR, 1.27 [1.21-1.33]) and have received no prenatal care (AOR, 6.78 [6.40-7.19]). Both the HIV decliners and prenatal non-testers were more likely to have used a midwife (AOR, 4.52 [3.83-5.35] and AOR, 2.44 [2.03-2.92], respectively). CONCLUSION Demographic and prenatal care characteristics differ by a pregnant woman's prenatal screening status. Policies to improve HIV screening coverage should take these variations into account.
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Affiliation(s)
- Sabrina S Plitt
- Public Health Agency of Canada, Ottawa, ON, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Trenton R Smith
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Warren Berry
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | | | - Carmen L Charlton
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada. .,Public Health Laboratory, 2B3.07 WMC, University of Alberta Hospitals, 8440 - 112 Street, Edmonton, Alberta, T6G 2J2, Canada.
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16
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Money D, Lee T, O'Brien C, Brophy J, Bitnun A, Kakkar F, Boucoiran I, Alimenti A, Vaudry W, Singer J, Sauve LJ. Congenital anomalies following antenatal exposure to dolutegravir: a Canadian surveillance study. BJOG 2019; 126:1338-1345. [PMID: 31188522 DOI: 10.1111/1471-0528.15838] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Dolutegravir is recommended worldwide as a first-line antiretroviral therapy (ART) for individuals living with HIV. A recent study reported increased rates of neural tube defects in infants of dolutegravir-treated women. This study examined rates of congenital anomalies in infants born to women living with HIV (WLWH) in Canada. DESIGN The Canadian Perinatal HIV Surveillance Programme captures surveillance data on pregnant WLWH and their babies and was analysed to examine the incidence of congenital anomalies. SETTING Paediatric HIV clinics. POPULATION Live-born infants born in Canada to WLWH between 2007 and 2017. METHODS Data on mother-infant pairs, including maternal ART use at conception and during pregnancy, are collected by participating sites. MAIN OUTCOME MEASURES Congenital anomalies. RESULTS Of the 2423 WLWH, 85 (3.5%, 95% CI 2.85-4.36%) had non-chromosomal congenital anomalies. There was no evidence of a significant difference in rates of congenital anomalies between women who were on ART in their first trimester (3.9%, CI 1.7-7.6%) or later in the pregnancy (3.9%, 95% CI 2.6-5.6%). Four of the 80 (5.0%, 95% CI 1.4-12.3%) neonates born to WLWH on dolutegravir during the first trimester had congenital anomalies, none were neural tube defects (95% CI 0.00-3.10%). CONCLUSION Despite recent evidence raising a safety concern, this analysis found no signal for increased congenital anomalies. TWEETABLE ABSTRACT Five percent of the infants of Canadian women living with HIV on dolutegravir at conception had congenital anomalies; none had neural tube defects.
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Affiliation(s)
- D Money
- Women's Hospital and Health Centre of British Columbia, University of British Columbia, Vancouver, BC, Canada
| | - T Lee
- CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
| | - C O'Brien
- BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - J Brophy
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - A Bitnun
- Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - F Kakkar
- CHU Ste-Justine, Université de Montréal, Montréal, QC, Canada
| | - I Boucoiran
- Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - A Alimenti
- Women's Hospital and Health Centre of British Columbia, University of British Columbia, Vancouver, BC, Canada
| | - W Vaudry
- Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - J Singer
- CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
| | - L J Sauve
- Women's Hospital and Health Centre of British Columbia, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
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17
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Abstract
Background Human immunodeficiency virus (HIV) is a global public health issue with an estimated 1.8 million people newly infected in 2017. Objective To provide a descriptive overview of reported cases of HIV in Canada by geographic location, sex, age group, exposure category and race/ethnicity, from 1985-2017, with a focus on the most recent data. Methods The Public Health Agency of Canada (PHAC) monitors HIV through the national HIV/AIDS Surveillance System, which is a passive, case-based system that collates non-nominal data voluntarily submitted and validated by all Canadian provinces and territories. Additional data sources presented here include data on immigration-related medical screening for HIV by Immigration, Refugees and Citizenship Canada and data on infants perinatally-exposed to HIV submitted by the Canadian Perinatal HIV Surveillance Program. Data were collated, tables and figures were prepared and descriptive statistics were applied by PHAC and validated by each province and territory. Results A total of 2,402 new HIV diagnoses were reported in 2017 in Canada; an increase of 3% compared with 2016 and an increase of 17.1% since 2014. The national diagnosis rate increased slightly, from 6.4 per 100,000 population in 2016 to 6.5 per 100,000 population in 2017. In 2017, while Ontario continued to account for the highest number (n=935) and proportion (38.9%) of reported HIV cases, Saskatchewan reported the highest provincial diagnosis rate (15.5 per 100,000 population). In 2017, the diagnostic rate for males at 9.9 per 100,000 population was higher than for females at 3.2 per 100,000 population. As in 2016, the 30-39 year age group had the highest HIV diagnosis rate at 14.8 per 100,000 population. The "gay, bisexual and other men who have sex with men" exposure category continued to represent almost half (46.4%) of all reported HIV cases in adults. In 2017, the absolute number of HIV-positive migrants entering Canada increased to a total number of 835 migrants. One mother-to-child HIV transmission was confirmed in a mother who did not receive any perinatal antiretroviral therapy and two transmissions were confirmed in mothers who did receive perinatal antiretroviral therapy. Conclusion Similar to the annual changes that have been reported since 2014, the number and rate of reported HIV cases in Canada in 2017 increased slightly compared with 2016. Additional data and analysis are needed to determine the extent to which these findings reflect an increase in HIV transmission, an increase in HIV testing, changes in reporting practices and an increase in the number of HIV-positive people migrating to Canada.
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18
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Haddad N, Li JS, Totten S, McGuire M. Vaccine safety surveillance in Canada: Reports to CAEFISS, 2017. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2018; 44:324-330. [PMID: 31517950 PMCID: PMC6390815 DOI: 10.14745/ccdr.v44i12a04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Canada has a comprehensive vaccine safety surveillance system that includes both passive and active surveillance of vaccines administered in Canada. OBJECTIVES To provide 1) a descriptive analysis of the adverse events following immunization (AEFI) reports for vaccines administered in Canada, 2) a descriptive review of health care utilization and outcome following an AEFI and 3) an analysis of serious adverse events (SAEs). METHODS Data was obtained from the Canadian Adverse Events Following Immunization Surveillance System (CAEFISS), which includes both passive and active surveillance. Descriptive analyses were conducted of AEFI reports arising from vaccines administered from January 1, 2017 to December 31, 2017 and received by April 30, 2018. Data elements included AEFIs, demographics, health care utilization, outcome, and seriousness of adverse events. RESULTS There were 2,960 AEFI reports submitted to CAEFISS from across Canada for vaccines administered in 2017. The AEFI reporting rate was 12.6/100,000 doses distributed (8.1/100,000 population) in Canada for vaccines administered in 2017 and was found to be inversely proportional to age. The majority of reports (91%) were non-serious events, primarily involving vaccination site reactions such as rash, and allergic events. Overall, there were 253 SAE reports, for a reporting rate of 1.1/100,000 doses distributed in 2017. Of the SAE reports, the most common primary AEFIs were seizure (n=58, 23%), followed by anaphylaxis (n=33, 13%). There were no unexpected vaccine safety issues identified or increases in frequency or severity of expected adverse events. CONCLUSION Canada's continuous monitoring of the safety of marketed vaccines in 2017 did not identify any increase in the frequency or severity of AEFIs, previously unknown AEFIs or areas that required further investigation or research. Vaccines marketed in Canada continue to have an excellent safety profile.
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Affiliation(s)
- N Haddad
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - JS Li
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - S Totten
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - M McGuire
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
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