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Vautrin M, Tombette F, Icard V, Leoz M, Trabaud MA, Ouziel A, Panetta L, Lemée V, Plantier JC, Moisan A. First evidence of a mother-to-child transmission of an HIV-1/MO intergroup recombinant form. Clin Microbiol Infect 2024; 30:691-693. [PMID: 38387501 DOI: 10.1016/j.cmi.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/07/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024]
Affiliation(s)
- Manon Vautrin
- Univ Rouen Normandie, Université de Caen Normandie, INSERM, Normandie Univ, DYNAMICURE UMR 1311, F-76000 Rouen, France
| | - Fabienne Tombette
- Univ Rouen Normandie, Université de Caen Normandie, INSERM, Normandie Univ, DYNAMICURE UMR 1311, CHU Rouen, Department of Virology, National Reference Center of HIV, F-76000 Rouen, France
| | - Vinca Icard
- Virology Department, Institut des Agents Infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Marie Leoz
- Univ Rouen Normandie, Université de Caen Normandie, INSERM, Normandie Univ, DYNAMICURE UMR 1311, F-76000 Rouen, France
| | - Mary-Anne Trabaud
- Virology Department, Institut des Agents Infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Antoine Ouziel
- Department of Pediatric Emergency & Pediatric Intensive Care, Hôpital Femme-Mère Enfant, Hospices Civils de Lyon, 69677 Bron cedex, France
| | - Luc Panetta
- Department of Pediatric Emergency & Pediatric Intensive Care, Hôpital Femme-Mère Enfant, Hospices Civils de Lyon, 69677 Bron cedex, France
| | - Véronique Lemée
- Univ Rouen Normandie, Université de Caen Normandie, INSERM, Normandie Univ, DYNAMICURE UMR 1311, CHU Rouen, Department of Virology, National Reference Center of HIV, F-76000 Rouen, France
| | - Jean-Christophe Plantier
- Univ Rouen Normandie, Université de Caen Normandie, INSERM, Normandie Univ, DYNAMICURE UMR 1311, CHU Rouen, Department of Virology, National Reference Center of HIV, F-76000 Rouen, France.
| | - Alice Moisan
- Univ Rouen Normandie, Université de Caen Normandie, INSERM, Normandie Univ, DYNAMICURE UMR 1311, CHU Rouen, Department of Virology, National Reference Center of HIV, F-76000 Rouen, France
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Chen Y, Mak LY, Tang MH, Yang J, Chow CB, Tan AM, Lyu T, Wu J, Huang Q, Huang HB, Cheung KS, Yuen MF, Seto WK. Immediate postpartum cessation of tenofovir did not increase risk of virological or clinical relapse in highly viremic pregnant mothers with chronic hepatitis B infection. JHEP Rep 2024; 6:101050. [PMID: 38699531 PMCID: PMC11063518 DOI: 10.1016/j.jhepr.2024.101050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 05/05/2024] Open
Abstract
Background & Aims Peripartum prophylaxis (PP) with tenofovir disoproxil fumarate (TDF) is the standard of care to prevent mother-to-child transmission of chronic hepatitis B (CHB) infection in mothers who are highly viremic. We investigated the maternal and infant outcomes in a large Chinese cohort of TDF-treated CHB pregnant participants. Methods In this prospective study, treatment-naive mothers with CHB and highly viremic (HBV DNA ≥200,000 IU/ml) but without cirrhosis were treated with TDF at 24-28 weeks of pregnancy. In accordance with Chinese CHB guidelines, TDF was stopped at delivery or ≥4 weeks postpartum. Serum HBV DNA and alanine aminotransferase were monitored every 6-8 weeks to determine virological relapse (VR). Infants received standard neonatal immunization, and HBV serology was checked at 7-12 months of age. Results Among 330 participants recruited (median age 30, 82.7% HBeAg+, median HBV DNA 7.82 log IU/ml), TDF was stopped at delivery in 66.4% and at ≥4 weeks in 33.6%. VR was observed in 98.3%, among which 11.6% were retreated with TDF. Timing of TDF cessation did not alter the risk of VR (99.0 vs. 96.9%), clinical relapse (19.5 vs. 14.3%), or retreatment (12.6 vs. 10.1%) (all p > 0.05). A similar proportion of patients developed alanine aminotransferase flare five times (1.1 vs. 2.1%; p = 0.464) and 10 times (0.5 vs. 0%; p = 0.669) above the upper limit of normal (ULN) in the early withdrawal and late withdrawal groups, respectively. No infants developed HBsAg-positivity. Conclusions PP-TDF and neonatal immunization were highly effective in preventing mother-to-child transmission of HBV in mothers who are highly viremic. Timing of cessation of PP-TDF did not affect the risk of VR or retreatment. Impact and Implications In pregnant mothers with chronic hepatitis B infection who are started on peripartum tenofovir to prevent mother-to-child-transmission (MTCT), the optimal timing for antiviral withdrawal during the postpartum period remains unknown. This prospective study demonstrates that stopping tenofovir immediately at delivery, compared with longer treatment duration of tenofovir, did not lead to an increased risk of virological relapse, retreatment, or transmission of the virus to the baby. Shortening the duration of peripartum antiviral prophylaxis from 12 weeks to immediately after delivery can be considered. The immediate withdrawal of peripartum tenofovir, combined with standard neonatal immunization schemes, is 100% effective in preventing MTCT among pregnant mothers with CHB who are highly viremic, with a high rate of vaccine response in infants.
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Affiliation(s)
- Yu Chen
- Department of Medicine, The University of Hong Kong – Shenzhen Hospital, Shenzhen, China
| | - Lung-Yi Mak
- Department of Medicine, The University of Hong Kong, Hong Kong, China
- State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, China
| | - Mary H.Y. Tang
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong, China
- Department of Obstetrics and Gynecology, The University of Hong Kong – Shenzhen Hospital, Shenzhen, China
| | - Jingyi Yang
- Department of Obstetrics and Gynecology, The University of Hong Kong – Shenzhen Hospital, Shenzhen, China
| | - Chun Bong Chow
- Department of Pediatrics, The University of Hong Kong – Shenzhen Hospital, Shenzhen, China
| | - Ai-Ming Tan
- Department of Medicine, The University of Hong Kong – Shenzhen Hospital, Shenzhen, China
| | - Tao Lyu
- Department of Medicine, The University of Hong Kong – Shenzhen Hospital, Shenzhen, China
| | - Juan Wu
- Department of Medicine, The University of Hong Kong – Shenzhen Hospital, Shenzhen, China
| | - Qingjuan Huang
- Department of Medicine, The University of Hong Kong – Shenzhen Hospital, Shenzhen, China
| | - Hai-Bo Huang
- Department of Pediatrics, The University of Hong Kong – Shenzhen Hospital, Shenzhen, China
| | - Ka-Shing Cheung
- Department of Medicine, The University of Hong Kong – Shenzhen Hospital, Shenzhen, China
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Man-Fung Yuen
- Department of Medicine, The University of Hong Kong – Shenzhen Hospital, Shenzhen, China
- Department of Medicine, The University of Hong Kong, Hong Kong, China
- State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, China
| | - Wai-Kay Seto
- Department of Medicine, The University of Hong Kong – Shenzhen Hospital, Shenzhen, China
- Department of Medicine, The University of Hong Kong, Hong Kong, China
- State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, China
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Nzuza S, Hadebe SI, Katz AA, Matjila M. Effects of individual drug and combination antiretroviral therapy on trophoblast proliferation. Eur J Obstet Gynecol Reprod Biol 2024; 298:66-73. [PMID: 38733775 DOI: 10.1016/j.ejogrb.2024.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/16/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Combination antiretroviral therapy (cART) has been reported to reduce perinatal transmission of human immunodeficiency virus (HIV) and improve maternal survival outcomes. Recent studies have associated in-utero exposure to cART drugs with adverse outcomes such as pre-eclampsia, preterm delivery, low birth weight and small-for-gestational-age births. However, the exact molecular mechanisms underlying cART-induced adverse pregnancy outcomes remain poorly defined. OBJECTIVES To investigate the effects of cART drugs on trophoblast proliferation in the HTR-8/SVneo cell line. STUDY DESIGN HTR-8/SVneo cells were exposed to tenofovir (0.983-9.83 µM), emtricitabine (0.809-8.09 µM) and efavirenz (0.19-1.09 µM), the individual drugs of the first-line single tablet cART regimen termed 'Atripla', and zidovudine (1.12-1.12 µM), lamivudine (0.65-6.5 µM), lopinavir (0.32-3.2 µM) and ritonavir (0.69-6.9 µM), the individual drugs of the second-line single tablet cART regimen termed 'Aluvia'. The cells were treated for 24, 48, 72 and 96 h, and trophoblast proliferation was assessed using a colorimetric 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltretrazolium bromide assay. RESULTS Two-way analysis of variance showed a significant dose-dependent decrease (p < 0.05) in trophoblast proliferation in response to individual and combined drug components of first- and second-line antiretroviral therapy. CONCLUSIONS First- and second-line cART drugs inhibit trophoblast proliferation, and may contribute to placenta-mediated adverse pregnancy outcomes in patients with HIV.
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Affiliation(s)
- Sanelisiwe Nzuza
- Nelson Mandela University, Faculty of Health Sciences, Department of Pharmacy, Port Elizabeth, South Africa.
| | - Silindile I Hadebe
- Nelson Mandela University, Faculty of Health Sciences, Department of Pharmacy, Port Elizabeth, South Africa
| | - Arieh A Katz
- Division of Medical Biochemistry and Structural Biology, Department of Integrative Biomedical Sciences, Institute of Infectious Disease and Molecular Medicine, SAMRC/UCT Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, South Africa
| | - Mushi Matjila
- Division of Medical Biochemistry and Structural Biology, Department of Integrative Biomedical Sciences, Institute of Infectious Disease and Molecular Medicine, SAMRC/UCT Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, South Africa; Department of Obstetrics and Gynaecology, Groote Schuur Hospital, Cape Town, South Africa
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Antabe R, Sano Y, Kangmennaang J. Knowledge of mother-to-child transmission of HIV among women living with HIV in Malawi. Int J STD AIDS 2024:9564624241246297. [PMID: 38676294 DOI: 10.1177/09564624241246297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
OBJECTIVES To reduce the incidence of mother-to-child transmission (MTCT) of HIV in Malawi, interventions have been created for women to be informed about the MTCT of HIV and for women living with HIV to be entered into the HIV care cascade to ensure safer deliveries. Our study aimed to examine the effectiveness of these strategies by exploring the determinants of adequate knowledge of MTCT of HIV among women living with HIV in Malawi. METHODS We used the 2015-16 Malawi Demographic and Health Survey data and applied logistics regression analysis to explore the determinants of adequate knowledge of MTCT of HIV among women living with HIV. RESULTS Our findings estimated that 75% of women living with HIV possessed adequate knowledge of MTCT of HIV. We also found that compared to those with no formal education, women with primary education (OR = 1.88, 95% CI = 1.04, 3.41) and secondary education or higher (OR = 2.61, 95% CI = 1.21, 5.62) were more likely to have adequate knowledge of MTCT of HIV. Furthermore, women who were resident in rural areas (OR = 2.97, 95% CI = 1.58, 5.57), were more likely to have adequate knowledge of MTCT of HIV relative to those in urban areas. Finally, women who had adequate HIV knowledge (OR = 1.85, 95% CI = 1.19, 2.89) and those who rejected the endorsement of HIV stigma and discrimination (OR = 2.30, 95% CI = 1.39, 3.81) were more likely to have adequate knowledge about the MTCT of HIV. CONCLUSION Based on our findings, there is an urgent need to offer women living with HIV in Malawi the opportunity to increase their knowledge of MTCT of HIV if the country is to make progress towards the elimination of MTCT of HIV as part of the overall strategy to contain new HIV infections in the country.
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Affiliation(s)
- Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, Toronto, ON, Canada
| | - Yujiro Sano
- Department of Sociology and Anthropology, Nipissing University, North Bay, ON, Canada
| | - Joseph Kangmennaang
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
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Saltini P, Tassis B, Ronchi A, Tagliabue C, Di Pietro G, Dellepiane RM, Muscatello A, Giacomelli A, Pugni L, Ferrazzi E, Bandera A, Bozzi G. Preventing HIV mother-to-child transmission in a vertically infected pregnant woman with multiclass drug resistance, role of bis-in-die dolutegravir and neonatal AZT prophylaxis: A case report. Heliyon 2024; 10:e23072. [PMID: 38163123 PMCID: PMC10754893 DOI: 10.1016/j.heliyon.2023.e23072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/18/2023] [Accepted: 11/26/2023] [Indexed: 01/03/2024] Open
Abstract
A suppressive antiretroviral therapy (ART) is necessary to prevent mother-to-child transmission (MTCT) of HIV during pregnancy. During this period, it is recommended to continue an ongoing safe and suppressive regimen, but history of multiclass drug-resistance (MDR) might need tailored, uncommon approaches posing tolerability and toxicity issues. This is the case of a 33 years of age, vertically infected woman with MDR HIV infection suppressed on a darunavir/cobicistat + atazanavir regimen switched during pregnancy to lamivudine + darunavir/ritonavir + dolutegravir 50 mg bis-in-die, maintaining complete viral suppression and delivering via caesarian section and without zidovudine (AZT) intrapartum prophylaxis a healthy HIV-negative newborn who received AZT post-exposure prophylaxis and showed regular growth patterns up to 2 years. Our case shows how archived MDR might complicate the preservation of HIV RNA suppression and highlights the importance of a tailored, multidisciplinary approach for pregnant women with MDR HIV and their newborns.
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Affiliation(s)
- Paola Saltini
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Università Degli Studi di Milano, Milan, Italy
| | - Beatrice Tassis
- Department of Woman, New-Born and Child, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Alice Ronchi
- Università Degli Studi di Milano, Milan, Italy
- Department of Woman, New-Born and Child, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Claudia Tagliabue
- Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giada Di Pietro
- Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rosa Maria Dellepiane
- Pediatric Intermediate Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Muscatello
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Giacomelli
- III Infectious Diseases Unit, Azienda Socio-Sanitaria Territoriale-Fatebenefratelli-Sacco, Milan, Italy
| | - Lorenza Pugni
- Neonatology and Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Ferrazzi
- Università Degli Studi di Milano, Milan, Italy
- Department of Woman, New-Born and Child, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Università Degli Studi di Milano, Milan, Italy
| | - Giorgio Bozzi
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Kasadha B, Tariq S, Freeman-Romilly N, Pope C, Namiba A, Nyatsanza F, Hinton L, Rai T. "We decided together": a qualitative study about women with HIV navigating infant-feeding decisions with the father of their children. BMC Pregnancy Childbirth 2024; 24:41. [PMID: 38184571 PMCID: PMC10770965 DOI: 10.1186/s12884-023-06198-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 12/13/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends that women with HIV breastfeed for a minimum of one year. In contrast, United Kingdom (UK) guidelines encourage formula feeding, but breastfeeding can be supported under certain circumstances. Infant-feeding decisions often involve personal and social networks. Currently, little research addresses how individuals with HIV in high-income countries navigate infant-feeding decisions with the father of their children. METHODS Semi-structured remote interviews were conducted with UK-based individuals with a confirmed HIV positive diagnosis who were pregnant or one-year postpartum, and two partners. Using purposive sampling, pregnant and postpartum participants were recruited through HIV NHS clinics and community-based organisations, and where possible, fathers were recruited via them. Data were analysed using thematic analysis and organised using NVivo 12. RESULTS Of the 36 women interviewed, 28 were postpartum. The majority were of Black African descent (n = 22) and born outside the UK. The key factors in women navigating HIV and infant-feeding discussions with respect to their baby's father were the latter's: (1) awareness of woman's HIV status; (2) relationship with the woman; (3) confidence in infant-feeding decision; (4) support and opinion about woman's infant-feeding intentions. Most women made a joint decision with biological fathers when in a long-term (> one year) relationship with them. Single women tended not to discuss their infant-feeding decision with the father of their child, often for safety reasons. CONCLUSION Women in ongoing relationships with the father of their child valued their support and opinions regarding infant-feeding. In contrast, single women chose not to involve the father for reasons of privacy and safety. Clinical teams and community-based organisations should support mothers in discussing infant-feeding decisions regardless of relationship status. When appropriate, they should also support discussions with their partners, but remain sensitive to circumstances where this may put women at risk.
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Affiliation(s)
- Bakita Kasadha
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Shema Tariq
- Institute for Global Health, University College London, London, UK
- Central and North West London NHS Foundation Trust, London, UK
| | | | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | - Lisa Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tanvi Rai
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Koumba Mavoungou DS, N'dilimabaka N, Elguero E, Kombila LB, Diane A, Koumba Moukouama SE, Moussa Y, Mouinga-Ondeme A, Aghokeng AF. Burden of hepatitis B virus infection in pregnant women attending antenatal clinics in the southern Gabon. IJID Reg 2023; 9:32-37. [PMID: 37841692 PMCID: PMC10569973 DOI: 10.1016/j.ijregi.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 10/17/2023]
Abstract
Objectives Hepatitis B virus (HBV) infection remains a public health threat in middle- and low-income countries, where mother-to-child transmission plays an important role. The aim of this study was to assess the burden of this infection among pregnant women in southern Gabon and the risk of vertical transmission. Methods The study was a prospective investigation conducted from April 2021 to January 2022. Study participants were pregnant women aged 18 and over attending antenatal clinics in Franceville. Blood samples were collected to test for HBV surface antigen, anti-hepatitis B core, hepatitis B e antigen, and anti-hepatitis B e markers and to assess HBV infection. Results We recruited 901 women with a median age of 26 years (interquartile range: 21-32). Overall prevalence of infection was 3.9% (confidence interval: 2.7-5.4%). 418/901 or 46.4% were anti-hepatitis B core positive. Among HBV surface antigen-positive women, 1/35 were hepatitis B e antigen-positive with a viral load >200,000 IU/ml. Over 64% of participants had no information about HBV infection, and none knew that the virus could be transmitted from mother to child. Conclusions This study reveals a low HBV prevalence in pregnant women in Gabon and a low risk of vertical transmission of the virus. However, the rate of exposure of the population to the virus remains high and calls for improving actions and interventions for potential elimination goals.
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Affiliation(s)
- Danielle S. Koumba Mavoungou
- Unité Emergence des Maladies Virales, Département de virologie, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
| | - Nadine N'dilimabaka
- Unité Emergence des Maladies Virales, Département de virologie, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
- Université des Sciences et Techniques de Masuku (USTM), Faculté des Sciences, Département de Biologie, Franceville, Gabon
| | - Eric Elguero
- MIVEGEC, Université de Montpellier, CNRS, IRD, Montpellier, France
| | - Linda Bohou Kombila
- Unité Emergence des Maladies Virales, Département de virologie, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
| | - Abdoulaye Diane
- Unité des Infections Rétrovirales et Pathologies Associées Département de virologie, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
| | - Schedy E. Koumba Moukouama
- Unité Emergence des Maladies Virales, Département de virologie, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
| | - Yaro Moussa
- Unité des Infections Rétrovirales et Pathologies Associées Département de virologie, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
| | - Augustin Mouinga-Ondeme
- Unité des Infections Rétrovirales et Pathologies Associées Département de virologie, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
- Unité Mixte de Recherche sur le VIH et les Maladies Infectieuses Associées Département de virologie, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF-SSM), Libreville, Gabon
| | - Avelin F. Aghokeng
- MIVEGEC, Université de Montpellier, CNRS, IRD, Montpellier, France
- Unité Mixte de Recherche sur le VIH et les Maladies Infectieuses Associées Département de virologie, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF-SSM), Libreville, Gabon
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Aliasi-Sinai L, Worthington T, Lange M, Kushner T. Maternal-to-Child Transmission of Hepatitis B Virus and Hepatitis Delta Virus. Clin Liver Dis 2023; 27:917-935. [PMID: 37778777 DOI: 10.1016/j.cld.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Maternal-to-child transmission of hepatitis B virus (HBV) and hepatitis delta virus (HDV) can lead to the risk of progressive liver disease in infants, but fortunately effective interventions exist to decrease transmission. Counseling on the risk of maternal-to-child transmission, care pathways to decrease transmission, and the implications of HBV and HDV on pregnancy outcomes are the key components of caring for pregnant people living with HBV and HDV.
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Affiliation(s)
| | - Theresa Worthington
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Marcia Lange
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, USA.
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Isa YS, Sicsic J, Njuguna H, Ward J, Chakroun M, El-Kassas M, Ramanampamonjy R, Chalal S, Vincent JP, Andersson M, Desalegn H, Fall F, Johannessen A, Matthews PC, Ndow G, Okeke E, Riches N, Seydi M, Sinkala E, Spearman CW, Stockdale A, Vinikoor MJ, Wandeler G, Sombié R, Lemoine M, Mueller JE, Shimakawa Y. Informing a target product profile for rapid tests to identify HBV-infected pregnant women with high viral loads: a discrete choice experiment with African healthcare workers. BMC Med 2023; 21:243. [PMID: 37403107 DOI: 10.1186/s12916-023-02939-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 06/13/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Elimination of mother-to-child transmission of hepatitis B virus (HBV) requires infant immunoprophylaxis and antiviral prophylaxis for pregnant women with high viral loads. Since real-time polymerase chain reaction (RT-PCR), a gold standard for assessing antiviral eligibility, is neither accessible nor affordable for women living in low-income and middle-income countries (LMICs), rapid diagnostic tests (RDTs) detecting alternative HBV markers may be needed. To inform future development of the target product profile (TPP) for RDTs to identify highly viremic women, we used a discrete choice experiment (DCE) and elicited preference and trade-off of healthcare workers (HCW) in Africa between the following four attributes of fictional RDTs: price, time-to-result, diagnostic sensitivity, and specificity. METHODS Through an online questionnaire survey, we asked participants to indicate their preferred test from a set of two RDTs in seven choice tasks with varying levels of the four attributes. We used mixed multinomial logit models to quantify the utility gain or loss generated by each attribute. We attempted to define minimal and optimal criteria for test attributes that can satisfy ≥ 70% and ≥ 90% of HCWs, respectively, as an alternative to RT-PCR. RESULTS A total of 555 HCWs from 41 African countries participated. Increases in sensitivity and specificity generated significant utility and increases in cost and time-to-result generated significant disutility. The size of the coefficients for the highest attribute levels relative to the reference levels were in the following order: sensitivity (β = 3.749), cost (β = -2.550), specificity (β = 1.134), and time-to-result (β = -0.284). Doctors cared most about test sensitivity, while public health practitioners cared about cost and midwives about time-to-result. For an RDT with 95% specificity, costing 1 US$, and yielding results in 20 min, the minimally acceptable test sensitivity would be 82.5% and the optimally acceptable sensitivity would be 87.5%. CONCLUSIONS African HCWs would prefer an RDT with the following order of priority: higher sensitivity, lower cost, higher specificity, and shorter time-to-result. The development and optimization of RDTs that can meet the criteria are urgently needed to scale up the prevention of HBV mother-to-child transmission in LMICs.
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Affiliation(s)
- Yasir Shitu Isa
- Institut Pasteur, Université Paris Cité, Unité d'Épidémiologie Des Maladies Émergentes, 25-28 Rue du Dr Roux, 75015, Paris, France
- EHESP French School of Public Health, Rennes, France
| | | | - Henry Njuguna
- Coalition for Global Hepatitis Elimination, Decatur, GA, USA
| | - John Ward
- Coalition for Global Hepatitis Elimination, Decatur, GA, USA
| | - Mohamed Chakroun
- Infectious Disease Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Mohamed El-Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Rado Ramanampamonjy
- Unité de Gastro-Entérologie, Hôpital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - Salim Chalal
- Institut Pasteur, Université Paris Cité, Unité d'Épidémiologie Des Maladies Émergentes, 25-28 Rue du Dr Roux, 75015, Paris, France
- Plateforme de Data Management, Institut Pasteur, Paris, France
| | - Jeanne Perpétue Vincent
- Institut Pasteur, Université Paris Cité, Unité d'Épidémiologie Des Maladies Émergentes, 25-28 Rue du Dr Roux, 75015, Paris, France
| | - Monique Andersson
- Division of Medical Virology, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
- Nuffield Division of Clinical Laboratory Science, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Hailemichael Desalegn
- Medical Department, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Fatou Fall
- Department of Hepatology and Gastroenterology, Hopital Principal de Dakar, Dakar, Senegal
| | - Asgeir Johannessen
- Department of Infectious Diseases, Vestfold Hospital, Tønsberg, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Philippa C Matthews
- The Francis Crick Institute, London, UK
- Division of Infection and Immunity, University College London, London, UK
- Department of Infectious Diseases, University College London Hospital, London, UK
| | - Gibril Ndow
- Medical Research Council Unit The Gambia, London School of Hygiene & Tropical Medicine, Fajara, The Gambia
- Department of Metabolism, Digestion & Reproduction, Imperial College London, London, UK
| | - Edith Okeke
- Faculty of Medical Sciences, University of Jos, Jos, Nigeria
| | - Nicholas Riches
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Moussa Seydi
- Service de Maladies Infectieuses Et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Edford Sinkala
- Department of Internal Medicine, University of Zambia, Lusaka, Zambia
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Alexander Stockdale
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, University of Liverpool, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Michael J Vinikoor
- Department of Internal Medicine, University of Zambia, Lusaka, Zambia
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roger Sombié
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Maud Lemoine
- Medical Research Council Unit The Gambia, London School of Hygiene & Tropical Medicine, Fajara, The Gambia
- Department of Metabolism, Digestion & Reproduction, Imperial College London, London, UK
| | - Judith E Mueller
- Institut Pasteur, Université Paris Cité, Unité d'Épidémiologie Des Maladies Émergentes, 25-28 Rue du Dr Roux, 75015, Paris, France
- EHESP French School of Public Health, Rennes, France
| | - Yusuke Shimakawa
- Institut Pasteur, Université Paris Cité, Unité d'Épidémiologie Des Maladies Émergentes, 25-28 Rue du Dr Roux, 75015, Paris, France.
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Bahri N, Khaksariyan Z, Khajavian N, Mohammadzadeh A. Educational needs assessment of medical and midwifery students about prevention of mother-to-child transmission of HIV: a cross-sectional study. Virusdisease 2023; 34:270-277. [PMID: 37408545 PMCID: PMC10317922 DOI: 10.1007/s13337-023-00825-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 05/01/2023] [Indexed: 07/07/2023] Open
Abstract
Mother-to-child transmission (MTCT), is an important way of acquired immune deficiency virus (AIDS) transmission. Medical and midwifery students need to have sufficient knowledge in terms of MTCT. The aim of this study was to evaluate the educational needs of these students regarding MTCT of HIV. This cross-sectional study was conducted on 120 medical (extern and intern) and midwifery Bachelor (semester 4 and above) and Master students in Gonabad University of Medical Sciences in 2019. The real needs questionnaire on MTCT AIDS and the perceived needs questionnaire on MTCT were used for need assessment evaluation. Majority of the participants were female (77.5%) and single (65%). Study participants included 48.3% medical and 51.7% midwifery students. High real educational need was reported by 63.5% of medical and 36.5% of midwifery students. More than half of the participants (59.2%) felt a great need for education on MTCT of HIV. OF the areas of real educational needs, the highest and lowest scores were related to the areas of prevention and symptoms, respectively. Students in higher semesters had the highest percentage of real need compared to other students (p = 0.015). The real need for MTCT of HIV prevention was higher among medical students compared to midwifery students (p = 0.004). The observed high real and perceived needs of students, especially in the higher semesters and the field of medicine, necessitates the re-examination of their educational curricula.
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Affiliation(s)
- Narjes Bahri
- Department of Midwifery, Faculty of Medicine, Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Zahra Khaksariyan
- Department of Midwifery, Faculty of Medicine, Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Nasim Khajavian
- Department of Epidemiology and Biostatistic, School of Health, Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Alireza Mohammadzadeh
- Department of Microbiology, Faculty of Medicine, Infectious Diseases Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
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Wang R, Zhu X, Zhang X, Liu H, Ji YL, Chen YH. Association of vitamin D and polymorphisms of its receptor with antiviral therapy in pregnant women with hepatitis B. World J Gastroenterol 2023; 29:3003-3012. [PMID: 37274802 PMCID: PMC10237097 DOI: 10.3748/wjg.v29.i19.3003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/28/2023] [Accepted: 04/24/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND The interruption of mother-to-child transmission (MTCT) is considered important to decrease the individual and population morbidity of hepatitis B virus (HBV) infection as well as the global burden of hepatitis B. Serum vitamin D (VD) is associated with hepatitis B.
AIM To assess whether baseline VD levels and single nucleotide polymorphisms of the VD receptor gene (VDR SNPs) are associated with the efficacy of tenofovir disoproxil fumarate (TDF) in the prevention of MTCT in pregnant women with high HBV viral loads.
METHODS Thirty-eight pregnant women who were at high risk for MTCT of HBV (those with an HBV DNA level ≥ 2 × 105 IU/mL during 12-24 wk of gestation) receiving antiviral therapy of TDF between June 1, 2019 and June 30, 2021 in Mianyang were included in this retrospective study. The women received 300 mg TDF once daily from gestational weeks 24-28 until 3 mo after delivery. To further characterize the clinical relevance of maternal serum HBV DNA levels, we stratified patients according to HBV DNA level as follows: Those with levels < 2 × 105 (full responder group) vs those levels ≥ 2 × 105 IU/mL (partial responder group) at delivery. Serum levels of 25-hydroxyvitamin D [25(OH)D], liver function markers, virological parameters, VDR SNPs and other clinical parameters were collected to analyze their association with the efficacy of TDF. The Mann-Whitney U test or t test was used to analyze the serum levels of 25(OH)D in different groups. Multiple linear regressions were utilized to analyze the determinants of the maternal HBV DNA level at delivery. Univariate and multivariate logistic regression analyses were employed to explore the association of targeted antiviral effects with various characteristics at baseline and delivery.
RESULTS A total of 38 pregnant women in Mianyang City at high risk for MTCT of HBV were enrolled in the study. The MTCT rate was 0%. No mother achieved hepatitis B e antigen or hepatitis B surface antigen (HBsAg) clearance at delivery. Twenty-three (60.5%) participants were full responders, and 15 (39.5%) participants were partial responders according to antiviral efficacy. The present study showed that a high percentage (76.3%) of pregnant women with high HBV viral loads had deficient (< 20 ng/mL) or insufficient (≥ 20 but < 31 ng/mL) VD levels. Serum 25(OH)D levels in partial responders appeared to be significantly lower than those in full responders both at baseline (25.44 ± 9.42 vs 17.66 ± 5.34 ng/mL, P = 0.006) and delivery (26.76 ± 8.59 vs 21.24 ± 6.88 ng/mL, P = 0.044). Serum 25(OH)D levels were negatively correlated with maternal HBV DNA levels [log(10) IU/mL] at delivery after TDF therapy (r = -0.345, P = 0.034). In a multiple linear regression analysis, maternal HBV DNA levels were associated with baseline maternal serum 25(OH)D levels (P < 0.0001, β = -0.446), BMI (P = 0.03, β = -0.245), baseline maternal log10 HBsAg levels (P = 0.05, β = 0.285) and cholesterol levels at delivery (P = 0.015, β = 0.341). Multivariate logistic regression analysis showed that baseline serum 25(OH)D levels (OR = 1.23, 95%CI: 1.04-1.44), maternal VDR Cdx2 TT (OR = 0.09, 95%CI: 0.01-0.88) and cholesterol levels at delivery (OR = 0.39, 95%CI: 0.17-0.87) were associated with targeted antiviral effects (maternal HBV DNA levels < 2 × 105 at delivery).
CONCLUSION Maternal VD levels and VDR SNPs may be associated with the efficacy of antiviral therapy in pregnant women with high HBV viral loads. Future studies to evaluate the therapeutic value of VD and its analogs in reducing the MTCT of HBV may be justified.
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Affiliation(s)
- Rui Wang
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xia Zhu
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xuan Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Huan Liu
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yu-Lin Ji
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yong-Hua Chen
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
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E B, Ko K, Kim R, Nagashima S, Ouoba S, Hussain MRA, Sato T, Chuon C, Abe K, Sugiyama A, Takahashi K, Akita T, Tung R, Ork V, Hossain MS, Saphonn V, Tanaka J. Residual risk of mother-to-child transmission of HBV despite timely Hepatitis B vaccination: a major challenge to eliminate hepatitis B infection in Cambodia. BMC Infect Dis 2023; 23:261. [PMID: 37101167 PMCID: PMC10131410 DOI: 10.1186/s12879-023-08249-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/13/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND In countries with intermediate or high hepatitis B virus (HBV) endemicity, mother-to-child transmission (MTCT) represents the main route of chronic HBV infection. There is a paucity of information on HBV MTCT in Cambodia. This study aimed to investigate the prevalence of HBV infection among pregnant women and its MTCT rate in Siem Reap, Cambodia. METHODS This longitudinal study included two parts, study-1 to screen HBsAg among pregnant women and study-2 to follow up babies of all HBsAg-positive and one-fourth of HBsAg-negative mothers at their delivery and six-month post-partum. Serum or dried blood spot (DBS) samples were collected to examine HBV sero-markers by chemiluminescent enzyme immunoassay (CLEIA), and molecular analyses were performed on HBsAg-positive samples. Structured questionnaires and medical records were used to examine the risk factors for HBV infection. MTCT rate was calculated by HBsAg positivity of 6-month-old babies born to HBsAg-positive mothers and ascertained by the homology of HBV genomes in mother-child pair at 6-month-old. RESULTS A total of 1,565 pregnant women were screened, and HBsAg prevalence was 4.28% (67/1565). HBeAg positivity was 41.8% and was significantly associated with high viral load (p < 0.0001). Excluding subjects who dropped out due to restrictions during COVID-19, one out of 35 babies born to HBsAg-positive mothers tested positive for HBsAg at 6 months of age, despite receiving timely HepB birth dose and HBIG, followed by 3 doses of HepB vaccine. Hence the MTCT rate was 2.86%. The mother of the infected baby was positive for HBeAg and had a high HBV viral load (1.2 × 109 copies/mL). HBV genome analysis showed 100% homology between the mother and the child. CONCLUSIONS Our findings illustrate the intermediate endemicity of HBV infection among pregnant women in Siem Reap, Cambodia. Despite full HepB vaccination, a residual risk of HBV MTCT was observed. This finding supports the recently updated guidelines for the prevention of HBV MTCT in 2021, which integrated screening and antiviral prophylaxis for pregnant women at risk of HBV MTCT. Furthermore, we strongly recommend the urgent implementation of these guidelines nationwide to effectively combat HBV in Cambodia.
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Affiliation(s)
- Bunthen E
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
- Payment Certification Agency (PCA), Ministry of Health, Phnom Penh, Cambodia
| | - Ko Ko
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Rattana Kim
- National Maternal and Child Health Center (NMCHC), Ministry of Health, Phnom Penh, Cambodia
| | - Shintaro Nagashima
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Serge Ouoba
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
- Unité de Recherche Clinique de Nanoro (URCN), Institut de Recherche en Sciences de La Santé (IRSS), Nanoro, Burkina Faso
| | - Md Razeen Ashraf Hussain
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Tomoki Sato
- Hiroshima City Funairi Citizens Hospital, Hiroshima, Japan
| | - Channarena Chuon
- Doctor Alliance of Union of Youth Federation of Cambodia (DAUYFC), Phnom Penh, Cambodia
| | - Kanon Abe
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Aya Sugiyama
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Kazuaki Takahashi
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Tomoyuki Akita
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | | | - Vichit Ork
- National Immunization Program (NIP), Ministry of Health, Phnom Penh, Cambodia
| | - Md Shafiqul Hossain
- Expanded Program On Immunization, World Health Organization Country Office, Phnom Penh, Cambodia
| | | | - Junko Tanaka
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
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Yang L, Cambou MC, Nielsen-Saines K. The End Is in Sight: Current Strategies for the Elimination of HIV Vertical Transmission. Curr HIV/AIDS Rep 2023; 20:121-130. [PMID: 36971951 DOI: 10.1007/s11904-023-00655-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE OF REVIEW The goal of this review is to highlight and interpret recent trends and developments in the diagnosis, treatment, and prevention of HIV vertical transmission from a clinical perspective. RECENT FINDINGS Universal third-trimester retesting and partner testing may better identify incident HIV among pregnant patients and result in early initiation of antiretroviral therapy to prevent vertical transmission. The proven safety and efficacy of integrase inhibitors such as dolutegravir may be particularly useful in suppressing viremia in pregnant persons who present late for ART treatment. Pre-exposure prophylaxis (PrEP) during pregnancy may play a role in preventing HIV acquisition; however, its role in preventing vertical transmission is difficult to elucidate. Substantial progress has been made in recent years to eliminate HIV perinatal transmission. Future research hinges upon a multipronged approach to improving HIV detection, risk-stratified treatment strategies, and prevention of primary HIV infection among pregnant persons.
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Affiliation(s)
- Lanbo Yang
- Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI, 02903, USA.
| | - Mary Catherine Cambou
- Division of Infectious Diseases, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Karin Nielsen-Saines
- Division of Pediatric Infectious Diseases, Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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Deng HMA, Romero N, Allard N, Rowe S, Yussf N, Cowie B. Uptake of perinatal immunoprophylaxis for infants born to women with a record of hepatitis B in Victoria (2009-2017). Vaccine 2023; 41:1726-1734. [PMID: 36759283 DOI: 10.1016/j.vaccine.2023.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/22/2022] [Accepted: 01/20/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Mother-to-child transmission (MTCT) of hepatitis B virus (HBV) remains one of the leading causes of transmission worldwide. An estimated 90 % of infants who are exposed to HBV and do not receive appropriate post exposure immunoprophylaxis will go on to develop chronic hepatitis B (CHB). In Australia, universal birth dose vaccination was adopted in 2000 and universal antenatal screening for hepatitis B was introduced in the 1990 s, however up to 10 % of women may have missed screening. There is no coordinated care or data collection that systematically reports the access to interventions to prevent mother-to-child transmission (PMTCT) for women with CHB. Therefore, the incidence rate of MTCT is unknown. METHODS We conducted retrospective data linkage of perinatal records, public health notification and hospital admission data to identify women with a record of HBV infection who had given birth to a live infant(s) in Victoria between 2009 and 2017. We assessed uptake of birth dose vaccination and hepatitis B immunoglobulin (HBIG) and explored factors associated with administration of birth dose recorded as administered within 7 days. RESULTS Among 690,052 live births, 6118 births (0.90 %) were linked to 4196 women with a record of HBV infection. 89.4 % of all Victorian infants (n = 616,879), and 96.8 % of infants linked to women with a positive record of CHB (n = 5,925) received birth dose within 7 days. Infants born in private hospitals had reduced odds of receiving birth dose when compared to public hospitals births (Victorian population, aOR = 0.67, 95 %CI = 0.66, 0.69; CHB linked records aOR = 0.17, 95 %CI = 0.11, 0.25). Of the 6118 infants linked to a positive maternal record of CHB, discrepant recording of maternal CHB status between the three datasets was identified in 72.4% of records and HBIG administration was recorded for only 2.3% of births. CONCLUSION An approach that involves coordinated care and integrates data collection for women with CHB and their infants is required to support the elimination of MTCT of hepatitis B in Victoria.
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Affiliation(s)
- Hui Min-Anna Deng
- WHO Collaborating Centre for Viral Hepatitis, Australia; Peter Doherty Institute of Infection and Immunity, Australia; University of Melbourne, Australia.
| | - Nicole Romero
- WHO Collaborating Centre for Viral Hepatitis, Australia; Peter Doherty Institute of Infection and Immunity, Australia; University of Melbourne, Australia; State Government Department of Health, Victoria, Australia
| | - Nicole Allard
- WHO Collaborating Centre for Viral Hepatitis, Australia; Peter Doherty Institute of Infection and Immunity, Australia
| | - Stacey Rowe
- State Government Department of Health, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Australia
| | - Nafisa Yussf
- WHO Collaborating Centre for Viral Hepatitis, Australia; Peter Doherty Institute of Infection and Immunity, Australia; University of Melbourne, Australia; State Government Department of Health, Victoria, Australia
| | - Benjamin Cowie
- WHO Collaborating Centre for Viral Hepatitis, Australia; Peter Doherty Institute of Infection and Immunity, Australia; University of Melbourne, Australia; State Government Department of Health, Victoria, Australia; Royal Melbourne Hospital, Melbourne, VIC, Australia
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Odagami M, Iwata A, Kubota K, Kurasawa K, Okuda M, Aoki S, Hirabuki T, Tujie T, Saji H, Hasegawa T, Kobayashi N, Ueda Y, Ishioka S, Enomoto T, Tsuji M, Shigeta H, Koike K, Tanaka H, Tsukinaga R, Hasegawa Y, Numazaki R, Ota H, Kase H, Ishikawa H, Saito Y, Yamawaki T, Miyagi E. Awareness of Infectious Disease Screening During Early Pregnancy and Knowledge About its Vertical Transmission in Japan: A Report from the Pregnant Women Health Initiative. Matern Child Health J 2023. [PMID: 36752905 DOI: 10.1007/s10995-023-03597-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVES We aimed to clarify the accuracy of pregnant women's knowledge and understanding regarding infectious disease screening in early pregnancy and clarify the roles that should be played by health care providers in promoting the health of pregnant women and their children. METHODS A cross-sectional questionnaire survey was conducted in 25 hospitals across Japan from May 2018 to September 2019. We compared the agreement rates regarding screening results for hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis, human T-cell leukemia virus-1 (HTLV-1), and cervical cytology in the medical records and understanding of their results by pregnant women. We then investigated whether participants had knowledge regarding the risk of mother-to child transmission in these diseases and factors associated with their knowledge. RESULTS We enrolled 2,838 respondents in this study. The rates of agreement for HBV and cervical cancer screening related to human papillomavirus infection were "substantial," those for syphilis was "moderate," and those for HCV and HTLV-1 were "fair," according to the Kappa coefficient. The rate of knowledge regarding mother-to-child transmission of syphilis was highest (37.0%); this rate for the other items was approximately 30%. Increased knowledge was associated with higher educational level and higher annual income. CONCLUSIONS FOR PRACTICE Pregnant women in Japan had generally good levels of understanding regarding their results in early-pregnancy infectious disease screening. However, they had insufficient knowledge regarding mother-to-child transmission of these diseases. Health care providers should raise awareness in infectious disease prevention among pregnant women and the general public, providing appropriate measures and implementing effective perinatal checkups and follow-ups for infectious diseases.
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Li M, Sun F, Bi X, Lin Y, Yang L, Jiang T, Deng W, Lu Y, Zhang L, Yi W, Xie Y. Effects of antiviral therapy and drug withdrawal on postpartum hepatitis in pregnant women with chronic HBV infection. Hepatol Int 2023; 17:42-51. [PMID: 36109430 DOI: 10.1007/s12072-022-10412-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/13/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the effect of antiviral therapy and drug withdrawal on the incidence of hepatitis B after delivery in pregnant women with chronic hepatitis B virus (CHB) infection who received tenofovir disoproxil fumarate (TDF) treatment. METHODS Eligible CHB pregnant women were enrolled, and received TDF at 32 weeks gestation. The drug was stopped immediately or at 6 weeks after delivery. The HBV biomarkers and clinical biochemical parameters were monitored during gestation and 24 weeks after delivery. RESULTS There were 264 women completed the observation, including 96 untreated subjects in control group. Among 168 treated subjects, 131 cases stopped drug immediately after delivery and 37 cases delayed the drug withdrawal at 6 weeks after delivery. The incidence of postpartum hepatitis in control, immediate drug withdrawal, and delayed drug withdrawal were 28.1% (27/96), 23.7% (31/131), and 24.3% (9/37), showing no significant difference (χ2 = 0.607, p = 0.738). No factor was found to be associated with the occurrence of postpartum hepatitis. It's noteworthy that 96.3% of postpartum hepatitis in control group and 92.3% of postpartum hepatitis in immediate drug withdrawal group occurred within 12 weeks after delivery. While in delayed drug withdrawal group, the rate of postpartum hepatitis occurred within 12 weeks after delivery was 77.7%. CONCLUSION Withdrawing antiviral drug immediately or at 6 weeks after delivery did not affect the incidence of postpartum hepatitis in CHB women, but delaying drug withdrawal might delay the onset of postpartum hepatitis. CLINICAL TRIAL REGISTRATION NUMBER NCT03214302.
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Affiliation(s)
- Minghui Li
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China.,Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, 100015, China
| | - Fangfang Sun
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Xiaoyue Bi
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Yanjie Lin
- Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, 100015, China
| | - Liu Yang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Tingting Jiang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Wen Deng
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Yao Lu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Lu Zhang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Wei Yi
- Department of Gynecology and Obstetrics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China.
| | - Yao Xie
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China. .,Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, 100015, China.
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Deynu M, Nutor JJ. Determinants of comprehensive knowledge on mother-to-child transmission of HIV and its prevention among childbearing women in Rwanda: insights from the 2020 Rwandan Demographic and Health Survey. BMC Public Health 2023; 23:5. [PMID: 36593470 PMCID: PMC9809025 DOI: 10.1186/s12889-022-14925-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/21/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Maternal knowledge on mother-to-child transmission (MTCT) and its prevention has been identified to enhance maternal testing and adherence to antiretroviral therapy (ART) regimen. Examining prevalence and associated factors on MTCT and its prevention among women provides empirical evidence for design and implementation of health strategies aimed at increasing MTCT knowledge and its elimination. This study therefore examined women's comprehensive knowledge and associated factors on MTCT and its prevention among childbearing women in Rwanda. METHODS Analysis was conducted on a weighted sample of 14,634 women from the 2020 Rwanda Demographic and Health Survey (RDHS). Dataset cleaning and missing value analysis was conducted. Chi square, bivariate and multivariable regression was then conducted in complex samples in SPSS. Alpha level set at p < 0.05 and at 95% Confidence Interval (95% CI). All analysis were adjusted for unequal probability sampling using survey weights. Bivariate and multivariable results were reported with crude and adjusted odds ratios. RESULTS The mean age was 29.2 years, SD-9.1. Prevalence of HIV testing and comprehensive knowledge on MTCT and its prevention among women in Rwanda was 79.6% and 65.1% respectively. Findings from this study showed that married women have higher odds (aOR = 1.18, 95% CI = 1.04-1.35) of comprehensive knowledge on MTCT and its prevention compared to those unmarried. Women who were living in southern (aOR = 1.23, 95%CI = 1.02-1.48) and eastern (aOR = 1.37, 95% CI = 1.13-1.66) parts of Rwanda were more likely to have adequate knowledge on MTCT of HIV and its prevention than those in Kigali. Also, women who received post-test counselling (aOR = 1.26, 95% CI = 1.01-2.11) have increased knowledge on MTCT than those who did not. Women with access to radio (aOR = 1.18, 95% CI = 1.06-1.32) and television (aOR = 1.25, 95% CI = 1.07-1.45) at least once a week were more likely to have adequate knowledge on MTCT and its prevention compared to those who do not in Rwanda. CONCLUSION There is inadequate knowledge on MTCT and its elimination among women of reproductive age in Rwanda. Strategies to enhance knowledge on MTCT and its prevention among childbearing women should be adopted through rigorous educational sensitization campaigns using local media such as radio and television. Health services that focus on prevention of MTCT must emphasize post-test counselling.
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Affiliation(s)
| | - Jerry John Nutor
- grid.266102.10000 0001 2297 6811Family Health Care Nursing Department, School of Nursing, University of California, San Francisco, 2 Koret Way, CA San Francisco, USA
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Corsi Decenti E, Salvatore MA, Mancon A, Portella G, Rocca A, Vocale C, Donati S. A large series of molecular and serological specimens to evaluate mother-to-child SARS-CoV-2 transmission: a prospective study from the Italian Obstetric Surveillance System. Int J Infect Dis 2023; 126:1-9. [PMID: 36368605 PMCID: PMC9640374 DOI: 10.1016/j.ijid.2022.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/19/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To assay the presence of the SARS-CoV-2 genome in vaginal, rectal, and placental swabs among pregnant women and in newborn nasopharyngeal swabs and to investigate the immunological response and maternal antibody transfer through the umbilical cord blood and milk of unvaccinated mothers. METHODS Vaginal, rectal, and placental specimens, maternal and neonatal serum, and milk were collected from a wide cohort of pregnant Italian women with confirmed SARS-CoV-2 infection admitted to the hospital between February 25, 2020 and June 30, 2021. Samples were tested in selected reference laboratories according to a shared interlaboratory protocol. RESULTS Among 1086 enrolled women, the SARS-CoV-2 positive rate detected in all specimens ranged from 0.7% to 8.4%. Respectively, 45.2% of maternal sera collected during pregnancy and 39.7% of those collected at birth tested positive for immunoglobulin G, whereas 50.5% tested positive among neonates. Nasopharyngeal swabs were positive in 0.8% of the newborns, and immunoglobulin G was detected in 3.0% of the milk samples. The highest immunological response was recorded within 30 days during pregnancy and within 60 days of birth and in the neonatal population. CONCLUSION Vertical transmission should be considered a rare event; although, a good maternal immunological response and antibodies transfer throughout the umbilical cord blood was detected.
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Affiliation(s)
- Edoardo Corsi Decenti
- Istituto Superiore di Sanità - Italian National Institute of Health, National Centre for Disease Prevention and Health Promotion, 00161 Rome, Italy,University of Rome Tor Vergata, Department of Biomedicine and Prevention, 00133 Rome, Italy
| | - Michele Antonio Salvatore
- Istituto Superiore di Sanità - Italian National Institute of Health, National Centre for Disease Prevention and Health Promotion, 00161 Rome, Italy,Corresponding author at: Michele Antonio Salvatore, Istituto Superiore di Sanità - Italian National Institute of Health, National Centre for Disease Prevention and Health Promotion, Viale Regina Elena 299, 00161 Rome, Italy. Tel: +39-0649904310
| | | | - Giuseppe Portella
- Federico II University of Naples, Dipartimento di Scienze Mediche Traslazionali, 80138 Naples, Italy
| | - Arianna Rocca
- Careggi University Hospital, Department of Experimental and Clinical Medicine, 50134 Florence, Italy
| | - Caterina Vocale
- Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) - University Hospital of Bologna, Microbiology Unit, 40138 Bologna, Italy
| | - Serena Donati
- Istituto Superiore di Sanità - Italian National Institute of Health, National Centre for Disease Prevention and Health Promotion, 00161 Rome, Italy
| | - Italian Obstetric Surveillance System COVID-19 Working GroupAlberiIrene7AnelliGaia Maria8BaltaroFederica9BisulliMaria10BrusaStefano11CataneoIlaria12CetinIrene13CuomoMarianna14RìPietro Dal15CerboLidia Di16FerrettiAlice17GismondoMaria Rita1819GrisoliaGianpaolo20LivioStefania21LocciMariavittoria22MalentacchiFrancesca23MecacciFederico24PaccaloniBarbara25PednaMaria Federica26PerroneEnrica27PignattiLucrezia28PirasMartina29PrimaveraAlessandra30SavasiValeria31SimeoneSerena32TaddeiFabrizio33TironiRoberta34TorriArianna35Department of Obstetrics and Gynaecology, Santa Chiara Hospital, 38122 Trento, ItalyDepartment of Biomedical and Clinical Sciences - University of Milan, via G.B. Grassi 74, 20157, Milan, ItalyUnit of Obstetrics and Gynecology, Grande Ospedale Metropolitano di Niguarda, 20162, Milan, ItalyObstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, ItalyDipartimento di Scienze Mediche Traslazionali, Federico II University of Naples, 80138, Naples, ItalyDepartment of Obstetrics and Gynecology, Ospedale Maggiore, 40133, Bologna, ItalyDepartment of Biomedical and Clinical Sciences, University of Milan, 20154, Milan, ItalyDepartment of Biomedical and Clinical Sciences - University of Milan, via G.B. Grassi 74, 20157, Milan, ItalyUnit of Obstetrics and Gynaecology, Santa Maria del Carmine Hospital, 38068, Rovereto, ItalyOspedale Infermi, 47923, Rimini, ItalyUnit of Obstetrics and Gynaecology, Azienda Unità Sanitaria Locale-IRCCS, 42123, Reggio Emilia, ItalyDepartment of Biomedical and Clinical Sciences - University of Milan, 20157, Milan, ItalyASST Fatebenefratelli Sacco - University Hospital L. Sacco, 20157, Milan, ItalyDepartment of Obstetrics and Gynaecology, Carlo Poma Hospital, 46100, Mantua, ItalyUnit of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20154, Milan, ItalyFederico II University of Naples, 80138, Naples, ItalySOD Microbiologia e Virologia, AOU Careggi, 50139, Florence, ItalyDepartment of Biomedical, Division of Obstetrics and Gynecology, Experimental and Clinical Sciences, University of Florence, 50134, Florence, ItalyUnit of Obstetrics and Gynaecology, Santa Maria della Scaletta Hospital, 40026, Imola, ItalyUnit of Microbiology, Greater Romagna Hub Laboratory, 47522, Pievesestina, Cesena, ItalyServizio Assistenza Territoriale, Direzione Generale Cura Della Persona, Salute e Welfare, Emilia‐Romagna Region, 40127, Bologna, ItalyDepartment of Obstetrics and Gynaecology, Maurizio Bufalini Hospital, 47521, Cesena, ItalyClinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS Reggio Emilia, 42122, Reggio Emilia, ItalyMicrobiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, ItalyUnit of Obstetrics and Gynaecology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, University of Milan, 20157, Milan, ItalyDepartment of Woman and Child's Health, Careggi University Hospital, 50141, Florence, ItalyDepartment of Obstetrics and Gynaecology, Santa Chiara Hospital, 38122, Trento, ItalyOspedale Manzoni, 23900, Lecco, ItalyUnit of Microbiology, Greater Romagna Hub Laboratory, 47522, Pievesestina, Cesena, Italy.
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Marjenberg Z, Wright C, Pooley N, Cheung KW, Shimakawa Y, Vargas-Zambrano JC, Vidor E. Hepatitis B surface antigen prevalence and the rates of mother-to-child transmission of hepatitis B virus after the introduction of infant vaccination programs in South East Asia and Western Pacific regions: a systematic review. Int J Infect Dis 2022; 124:65-75. [PMID: 36089151 DOI: 10.1016/j.ijid.2022.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Infant vaccination against the hepatitis B virus began in the World Health Organization South East Asia Region and the Western Pacific Region between 1983 and 2016. This systematic review examined the seroprevalence of hepatitis B surface antigen (HBsAg) in children and the rate of mother-to-child transmission (MTCT) in these regions between 1990 and 2020. METHODS MEDLINE and EMBASE were searched for articles published between January 1990 and September 2020, which reported seroprevalence of HBsAg in children aged 0-15 years and/or the rate of MTCT in the South East Asia Region and Western Pacific Region. A pragmatic review identified supporting information. This review was registered in the International Prospective Register of Systematic Reviews (#CRD42020211707). RESULTS Of 115 included studies, 77 (24 countries) reported HBsAg prevalence, and 38 (nine countries) reported MTCT. The seroprevalence of HBsAg ranged between 0.0% and 27.4%, with a decreasing trend over time in each country. MTCT rates were 0.0-5.2% in infants of mothers who are hepatitis B e antigen-negative and 2.7-53.0% in infants of mothers who are hepatitis B e antigen-positive. CONCLUSION After the introduction of infant hepatitis B virus vaccination programs, the countries in South East Asia Region and Western Pacific Region observed a reduction in HBsAg seroprevalence in children. Nevertheless, the risk of MTCT persists, emphasizing the importance of antenatal screening to identify high-risk pregnancies.
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Affiliation(s)
| | - Ciara Wright
- Maverex Limited, Newcastle upon Tyne, United Kingdom.
| | - Nick Pooley
- Maverex Limited, Newcastle upon Tyne, United Kingdom.
| | - Ka Wang Cheung
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China.
| | - Yusuke Shimakawa
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France.
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Liu Z, Chen Z, Cui F, Ding Y, Gao Y, Han G, Jia J, Li J, Li Z, Liu Y, Mao Q, Wang A, Wang W, Wei L, Xia J, Xie Q, Yang X, Yin X, Zhang H, Zhang L, Zhang W, Zhuang H, Dou X, Hou J. Management Algorithm for Prevention of Mother-to-child Transmission of Hepatitis B Virus (2022). J Clin Transl Hepatol 2022; 10:1004-1010. [PMID: 36304493 PMCID: PMC9547256 DOI: 10.14218/jcth.2022.00047] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/07/2022] [Accepted: 04/27/2022] [Indexed: 12/04/2022] Open
Abstract
The World Health Organization (WHO) has set the goal of eliminating hepatitis as a threat to public health by 2030. Blocking mother-to-child transmission (MTCT) of hepatitis B virus (HBV) is not only the key to eliminating viral hepatitis, but also a hot issue in the field of hepatitis B prevention and treatment. To standardize the clinical management of preventing MTCT of HBV and achieve zero HBV infection among infants, the Chinese Foundation for Hepatitis Prevention and Control organized experts to compile a management algorithm for prevention of MTCT of HBV based on the latest research progress and guidelines, including 10 steps of pregnancy management and postpartum follow-up, among which screening, antiviral treatment, and infant immunization are its core components.
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Affiliation(s)
- Zhihua Liu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhongdan Chen
- World Health Organization, Office of the WHO Representative in China, Beijing, China
| | - Fuqiang Cui
- School of Public Health, Peking University, Beijing, China
| | - Yang Ding
- Department of Infectious Diseases, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China
| | - Yunfei Gao
- Department of Gynecology and Obstetrics, Zengcheng Branch of Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Guorong Han
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of the Southeast University, Nanjing, Jiangsu, China
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jie Li
- School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Zengde Li
- Chinese Foundation for Hepatitis Prevention and Control, Beijing, China
| | - Yingxia Liu
- The Third People’s Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Qing Mao
- Department of Infectious Diseases, Southwest Hospital, Army Medical University, Chongqing, China
| | - Ailing Wang
- National Center for Women and Children’s Health, China CDC, Beijing, China
| | - Wei Wang
- Department of Health Care, Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen, Guangdong, China
| | - Lai Wei
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jianhong Xia
- Guangdong Maternal and Child Health Hospital, Guangzhou, Guangdong, China
| | - Qing Xie
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xizhong Yang
- Chinese Foundation for Hepatitis Prevention and Control, Beijing, China
| | - Xueru Yin
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Hua Zhang
- Department of Gynecology and Obstetrics, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Liaoyun Zhang
- Department of Infectious Diseases, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Wenhong Zhang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Hui Zhuang
- School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Xiaoguang Dou
- Department of Infectious Diseases, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China
- Correspondence to: Jinlin Hou, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China. ORCID: https://orcid.org/0000-0001-8230-8583. Tel/Fax: +86-20-61641941, E-mail: ; Xiaoguang Dou, Department of Infectious Diseases, Shengjing Hospital, China Medical University, Shenyang, Liaoning 110022, China. ORCID: https://orcid.org/0000-0003-1856-7331. Tel: +86-24-96615-62211, E-mail:
| | - Jinlin Hou
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Correspondence to: Jinlin Hou, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China. ORCID: https://orcid.org/0000-0001-8230-8583. Tel/Fax: +86-20-61641941, E-mail: ; Xiaoguang Dou, Department of Infectious Diseases, Shengjing Hospital, China Medical University, Shenyang, Liaoning 110022, China. ORCID: https://orcid.org/0000-0003-1856-7331. Tel: +86-24-96615-62211, E-mail:
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José Antonio MM, Mónica Grisel RM, Alberto CS, Carla Ileana AA, Luis Antonio UN, María de Los Angeles BS, Norma Angélica MJ, Mara Soraya RE, Víctor RP, Jesús Enrique GM. Maternal and neonatal risk factors associated with increased mother-to-child transmission of HIV-1 in Mexico: Results of a case-control study. Int J STD AIDS 2022; 33:1111-1118. [PMID: 36170571 DOI: 10.1177/09564624221124694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Maternal, obstetric and neonatal factors that increase the possibility of mother-to-child HIV transmission (MTCT) are known as mechanisms of transmission. Our aim was to determine the risk factors associated with MTCT in Mexico. METHODS We conducted a case-control study from March to December 2015. Cases were 60 mothers with HIV infection who transmitted HIV to their children, and controls were 120 mothers with HIV infection whose children tested negative for HIV. Data were extracted from medical records and a self-reported questionnaire for each participant. To determine associations with MTCT, odds ratios (ORs) and 95% confidence intervals (CI) were obtained with the chi-squared test and a logistic-regression modeling. RESULTS A total of 180 patients were included. HIV diagnosis for cases occurred after pregnancy in 88% of the patients, during pregnancy in 9%, and before pregnancy in 3% of patients. Among the controls, 38% of patients were diagnosed before pregnancy, 32% during pregnancy, and 30% after pregnancy. In multivariate analysis, the risk factors associated with MTCT were: absence of antiretroviral treatment during pregnancy (OR 5.21; 95% CI 1.24-16.11; p = 0.019); vaginal delivery (OR 3.2; 95% CI 1.27-8.26; p = 0.014); forceps-assisted delivery (OR 13.4; 95% CI 1.91-93.66; p = 0.009); breastfeeding (OR 6.23; 95% CI 2.27-17.05; p = <0.001) and the practice of mixed breastfeeding (OR 4.6; 95% CI 1.56-13.73; p = 0.006). CONCLUSIONS MTCT is preventable with early diagnosis; treatment initiation before pregnancy and avoidance breastfeeding could decrease the risk of transmitting HIV to their children.
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Affiliation(s)
- Mata-Marín José Antonio
- Infectious Diseases Department, Hospital de Infectología, 37767"La Raza" National Medical Center, IMSS, Mexico
| | | | - Chaparro-Sánchez Alberto
- Infectious Diseases Department, Hospital de Infectología, 37767"La Raza" National Medical Center, IMSS, Mexico
| | | | - Uribe-Noguez Luis Antonio
- Infectious Diseases Department, Hospital de Infectología, 37767"La Raza" National Medical Center, IMSS, Mexico
| | | | - Matías-Juan Norma Angélica
- Pediatric Infectious Diseases Department, Hospital de Infectología, "La Raza" National Medical Center, IMSS, Mexico
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Pan CQ, Zhu BS, Xu JP, Li JX, Sun LJ, Tian HX, Zhang XH, Li SW, Dai EH. Pregnancy and fetal outcomes of chronic hepatitis C mothers with viremia in China. World J Gastroenterol 2022; 28:5023-5035. [PMID: 36160645 PMCID: PMC9494928 DOI: 10.3748/wjg.v28.i34.5023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/09/2022] [Accepted: 08/25/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Data that assess maternal and infant outcomes in hepatitis C virus (HCV)-infected mothers are limited.
AIM To investigate the frequency of complications and the associated risk factors.
METHODS We performed a cohort study to compare pregnancy and fetal outcomes of HCV-viremic mothers with those of healthy mothers. Risk factors were analyzed with logistic regression.
RESULTS Among 112 consecutive HCV antibody-positive mothers screened, we enrolled 79 viremic mothers. We randomly selected 115 healthy mothers from the birth registry as the control. Compared to healthy mothers, HCV mothers had a significantly higher frequency of anemia [2.6% (3/115) vs 19.0% (15/79), P < 0.001] during pregnancy, medical conditions that required caesarian section [27.8% (32/115) vs 48.1% (38/79), P = 0.004], and nuchal cords [9.6% (11/115) vs 34.2% (27/79), P < 0.001]. In addition, the mean neonatal weight in the HCV group was significantly lower (3278.3 ± 462.0 vs 3105.1 ± 459.4 gms; P = 0.006), and the mean head circumference was smaller (33.3 ± 0.6 vs 33.1 ± 0.7 cm; P = 0.03). In a multivariate model, HCV-infected mothers were more likely to suffer anemia [adjusted odds ratio (OR): 18.1, 95% confidence interval (CI): 4.3-76.6], require caesarian sections (adjusted OR: 2.6, 95%CI: 1.4-4.9), and have nuchal cords (adjusted OR: 5.6, 95%CI: 2.4-13.0). Their neonates were also more likely to have smaller head circumferences (adjusted OR: 2.1, 95%CI: 1.1-4.3) and lower birth weights than the average (≤ 3250 gms) with an adjusted OR of 2.2 (95%CI: 1.2-4.0). The vertical transmission rate was 1% in HCV-infected mothers.
CONCLUSION Maternal HCV infections may associate with pregnancy and obstetric complications. We demonstrated a previously unreported association between maternal HCV viremia and a smaller neonatal head circumference, suggesting fetal growth restriction.
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Affiliation(s)
- Calvin Q Pan
- Center for Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
- Division of Gastroenterology and Hepatology, Department of Medicine, NYU Langone Health, NYU School of Medicine, Flushing, NY 11355, United States
| | - Bao-Shen Zhu
- Department of Obstetrics and Gynecology, The Fifth Hospital of Shijiazhuang, Hebei Medical University, Shijiazhuang 050021, Hebei Province, China
| | - Jian-Ping Xu
- Department of Obstetrics and Gynecology, The Fifth Hospital of Shijiazhuang, Hebei Medical University, Shijiazhuang 050021, Hebei Province, China
| | - Jian-Xia Li
- Department of Obstetrics and Gynecology, The Fifth Hospital of Shijiazhuang, Hebei Medical University, Shijiazhuang 050021, Hebei Province, China
| | - Li-Juan Sun
- Department of Obstetrics and Gynecology, The Fifth Hospital of Shijiazhuang, Hebei Medical University, Shijiazhuang 050021, Hebei Province, China
| | - Hong-Xia Tian
- Department of Obstetrics and Gynecology, The Fifth Hospital of Shijiazhuang, Hebei Medical University, Shijiazhuang 050021, Hebei Province, China
| | - Xi-Hong Zhang
- School of Public Health, North China University of Science and Technology, Tangshan 063210, Hebei Province, China
- Division of Liver Disease, Department of Medicine, The Fifth Hospital of Shijiazhuang, Hebei Medical University, Shijiazhuang 050021, Hebei Province, China
| | - Su-Wen Li
- Department of Obstetrics and Gynecology, The Fifth Hospital of Shijiazhuang, Hebei Medical University, Shijiazhuang 050021, Hebei Province, China
| | - Er-Hei Dai
- Division of Liver Disease, Department of Medicine, The Fifth Hospital of Shijiazhuang, Hebei Medical University, Shijiazhuang 050021, Hebei Province, China
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Fernández-Luis S, Lain MG, Serna-Pascual M, Domínguez-Rodríguez S, Kuhn L, Liberty A, Barnabas S, Lopez-Varela E, Otwombe K, Danaviah S, Nastouli E, Palma P, Cotugno N, Spyer M, Giannuzzi V, Giaquinto C, Violari A, Cotton MF, Nhampossa T, Klein N, Ramsagar N, van Rensburg AJ, Behuhuma O, Vaz P, Maiga AI, Oletto A, Naniche D, Rossi P, Rojo P, Tagarro A. Optimizing the World Health Organization algorithm for HIV vertical transmission risk assessment by adding maternal self-reported antiretroviral therapy adherence. BMC Public Health 2022; 22:1312. [PMID: 35804333 PMCID: PMC9264598 DOI: 10.1186/s12889-022-13543-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 05/05/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) risk assessment algorithm for vertical transmission of HIV (VT) assumes the availability of maternal viral load (VL) result at delivery and early viral control 4 weeks after initiating antiretroviral treatment (ART). However, in many low-and-middle-income countries, VL is often unavailable and mothers' ART adherence may be suboptimal. We evaluate the inclusion of the mothers' self-reported adherence into the established WHO-algorithm to identify infants eligible for enhanced post-natal prophylaxis when mothers' VL result is not available at delivery. METHODS We used data from infants with perinatal HIV infection and their mothers enrolled from May-2018 to May-2020 in Mozambique, South Africa, and Mali. We retrospectively compared the performance of the WHO-algorithm with a modified algorithm which included mothers' adherence as an additional factor. Infants were considered at high risk if born from mothers without a VL result in the 4 weeks before delivery and with adherence <90%. RESULTS At delivery, 143/184(78%) women with HIV knew their status and were on ART. Only 17(12%) obtained a VL result within 4 weeks before delivery, and 13/17(76%) of them had VL ≥1000 copies/ml. From 126 women on ART without a recent VL result, 99(79%) had been on ART for over 4 weeks. 45/99(45%) women reported suboptimal (< 90%) adherence. A total of 81/184(44%) infants were classified as high risk of VT as per the WHO-algorithm. The modified algorithm including self-adherence disclosure identified 126/184(68%) high risk infants. CONCLUSIONS In the absence of a VL result, mothers' self-reported adherence at delivery increases the number of identified infants eligible to receive enhanced post-natal prophylaxis.
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Affiliation(s)
- Sheila Fernández-Luis
- Centro de Investigação em Saúde de Manhiça (CISM), Bairro Cambeve, Rua 12, Distrito da Manhiça, CP 1929, Maputo, Mozambique. .,ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
| | | | - Miquel Serna-Pascual
- Pediatrics Department, Pediatric Research and Clinical Trials Unit (UPIC), Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain
| | - Sara Domínguez-Rodríguez
- Pediatrics Department, Pediatric Research and Clinical Trials Unit (UPIC), Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain
| | - Louise Kuhn
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Afaaf Liberty
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shaun Barnabas
- Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elisa Lopez-Varela
- Centro de Investigação em Saúde de Manhiça (CISM), Bairro Cambeve, Rua 12, Distrito da Manhiça, CP 1929, Maputo, Mozambique.,ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Siva Danaviah
- Africa Health Research Institute (AHRI), Durban, KwaZulu-Natal, South Africa
| | - Eleni Nastouli
- Great Ormond Street Institute for Child Health (GOS ICH), University College London (UCL), London, UK
| | - Paolo Palma
- Research Unit in Clinical Immunology and Vaccinology, Bambino Gesu' Children's Hospital, 00165, Rome, Italy.,Chair of Pediatrics, Department of Systems Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Nicola Cotugno
- Research Unit in Clinical Immunology and Vaccinology, Bambino Gesu' Children's Hospital, 00165, Rome, Italy.,Chair of Pediatrics, Department of Systems Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Moira Spyer
- Great Ormond Street Institute for Child Health (GOS ICH), University College London (UCL), London, UK
| | - Viviana Giannuzzi
- Fondazione per la Ricerca Farmacologica Gianni Benzi onlus, Valenzano, Italy
| | - Carlo Giaquinto
- Department of Mother and Child Health, University of Padova, Padova, Italy
| | - Avy Violari
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark F Cotton
- Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça (CISM), Bairro Cambeve, Rua 12, Distrito da Manhiça, CP 1929, Maputo, Mozambique.,Instituto Nacional de Saúde (INS), Mozambique, Maputo, Mozambique
| | - Nigel Klein
- Africa Health Research Institute (AHRI), Durban, KwaZulu-Natal, South Africa.,Great Ormond Street Institute for Child Health (GOS ICH), University College London (UCL), London, UK
| | - Nastassja Ramsagar
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Anita Janse van Rensburg
- Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Osee Behuhuma
- Africa Health Research Institute (AHRI), Durban, KwaZulu-Natal, South Africa
| | - Paula Vaz
- Fundação Ariel Glaser Contra o SIDA Pediátrico, Maputo, Mozambique
| | | | | | - Denise Naniche
- Centro de Investigação em Saúde de Manhiça (CISM), Bairro Cambeve, Rua 12, Distrito da Manhiça, CP 1929, Maputo, Mozambique.,ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Paolo Rossi
- Academic Department of Pediatrics, Children's Hospital Bambino Gesù, Rome, Italy
| | - Pablo Rojo
- Pediatrics Department, Pediatric Research and Clinical Trials Unit (UPIC), Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain
| | - Alfredo Tagarro
- Pediatrics Department, Pediatric Research and Clinical Trials Unit (UPIC), Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain.,Pediatrics Department, Hospital Universitario Infanta Sofía; Infanta Sofia University Hospital and Henares University Hospital Foundation for Biomedical Research and Innovation (FIIB HUIS HHEN), San Sebastián de los Reyes, Madrid, Spain.,Pediatrics Research Group, Universidad Europea de Madrid, Madrid, Spain
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24
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Breakwell L, Marke D, Kaiser R, Tejada-Strop A, Pauly MD, Jabbi S, Yambasu S, Kabore HJ, Stewart B, Sesay T, Samba TT, Hayden T, Kamili S, Jambai A, Drobeniuc J, Singh T, Tohme RA, Wasley A. Assessing the impact of the routine childhood hepatitis B immunization program and the need for hepatitis B vaccine birth dose in Sierra Leone, 2018. Vaccine 2022; 40:2741-2748. [PMID: 35361502 PMCID: PMC10406334 DOI: 10.1016/j.vaccine.2022.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 03/18/2022] [Accepted: 03/20/2022] [Indexed: 11/19/2022]
Abstract
Sierra Leone is highly endemic for hepatitis B virus (HBV) infection and thus recommends three doses of hepatitis B vaccine (HepB3) from 6 weeks of age but does not recommend a birth dose (HepB-BD) to prevent mother-to-child transmission (MTCT). We evaluated impact of the existing HepB3 schedule and risk for MTCT of HBV. We conducted a community-based serosurvey among 4-30-month-olds, their mothers, and 5-9-year-olds in three districts in Sierra Leone. Participants had an HBV surface antigen (HBsAg) rapid test; all HBsAg-positive and one HBsAg-negative mother per cluster were tested for HBV markers. We collected children's HepB3 vaccination history. Among 1889 children aged 4-30 months, HepB3 coverage was 85% and 20 (1·3% [95% CI 0·8-2·0]) were HBsAg-positive, of whom 70% had received HepB3. Among 2025 children aged 5-9 years, HepB3 coverage was 77% and 32 (1·6% [1·1-2·3]) were HBsAg-positive, of whom 56% had received HepB3. Of 1776 mothers, 169 (9·8% [8·1-11·7]) were HBsAg-positive. HBsAg prevalence was 5·9% among children of HBsAg-positive mothers compared to 0·7% among children of HBsAg-negative mothers (adjusted OR = 10·6 [2·8-40·8]). HBsAg positivity in children was associated with maternal HBsAg (p = 0·026), HBV e antigen (p < 0·001), and HBV DNA levels ≥ 200 000 IU/mL (p < 0·001). HBsAg prevalence was lower among children than mothers, for whom HepB was not available, suggesting routine infant HepB vaccination has lowered HBV burden. Since HBsAg positivity in children was strongly associated with maternal HBV infection and most of the HBsAg-positive children in the survey received HepB3, HepB-BD may prevent MTCT and chronic HBV infection.
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Affiliation(s)
- Lucy Breakwell
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Dennis Marke
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Reinhard Kaiser
- U.S. Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | | | - Matthew D Pauly
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | - Hyacinte J Kabore
- World Health Organization Regional Office for Africa, Brazzaville, People's Republic of Congo
| | - Brock Stewart
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Tom Sesay
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Thomas T Samba
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Tonya Hayden
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Saleem Kamili
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Amara Jambai
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Jan Drobeniuc
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Tushar Singh
- U.S. Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Rania A Tohme
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Annemarie Wasley
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
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25
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Humphrey JM, Songok J, Ofner S, Musick B, Alera M, Kipchumba B, McHenry MS, Carlucci JG, Park J, Mwangi W, Yiannoutsos C, Bakoyannis G, Wools-Kaloustian K. Retention in care and viral suppression in the PMTCT continuum at a large referral facility in western Kenya. AIDS Behav 2022. [PMID: 35467229 DOI: 10.1007/s10461-022-03666-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 11/20/2022]
Abstract
Medical records of pregnant and postpartum women living with HIV and their infants attending a large referral facility in Kenya from 2015 to 2019 were analyzed to identify characteristics associated with retention in care and viral suppression. Women were stratified based on the timing of HIV care enrollment: known HIV-positive (KHP; enrolled pre-pregnancy) and newly HIV-positive (NHP; enrolled during pregnancy). Associations with retention at 18 months postpartum and viral suppression (< 1000 copies/mL) were determined. Among 856 women (20% NHP), retention was 83% for KHPs and 53% for NHPs. Viral suppression was 88% for KHPs and 93% for NHPs, but 19% of women were missing viral load results. In a competing risk model, viral suppression increased by 18% for each additional year of age but was not associated with other factors. Overall, 1.9% of 698 infants with ≥ 1 HIV test result were HIV-positive. Tailored interventions are needed to promote retention and viral load testing, particularly for NHPs, in the PMTCT continuum.
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26
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Affiliation(s)
- Kim F Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
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27
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Du FZ, Zhang RL, Wang QQ. Eliminating Mother-to-Child Transmission of Syphilis: Chinese Practice before and during COVID-19 Pandemics. Chin Med Sci J 2022; 37:3903. [PMID: 35256043 PMCID: PMC9026954 DOI: 10.24920/003903] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 10/22/2021] [Indexed: 11/12/2022]
Abstract
Mother-to-child transmission (MTCT) of syphilis remains a leading cause of stillbirth and death among neonates in many developing countries. In 2007, WHO launched the global elimination of MTCT (EMTCT) of syphilis. Given the high burden of congenital syphilis, China subsequently released the specific national EMTCT policies and programs to reduce MTCT of syphilis. The congenital syphilis incidence rate per 100 000 live births in China has markedly decreased from 69.9 in 2013 to 11.9 in 2019. However, due to the global pandemic of COVID-19, the current measures for eliminating MTCT of syphilis are great challenged. In this article, we summarize the strategies and measures for the EMTCT of syphilis in China in the past 20 years, point out that we have made remarkable achievements due to the national health policy support and strong leadership of the government. In the context of COVID-19 pandemics, strengthening emergency response to the regional outbreaks of COVID-19 and adopting safe, rapid, early and high-quality clinical care to ensure that 100% of pregnant women receive prenatal syphilis testing services, ensuring the availability of Benzathine penicillin for the treatment, and strengthening the closed-loop management of pregnant women and newborns infected with syphilis are key measures to determine the effect of MTCT of syphilis. Lessons from China may be valuable for other countries that are planning to eliminate MTCT of syphilis.
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Affiliation(s)
- Fang-Zhi Du
- Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing 210042, China
| | - Rui-Li Zhang
- Department of Dermatology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - Qian-Qiu Wang
- Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing 210042, China
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28
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Gupta P, Khatana VP, Prabha R, Jha I, Singh M, Pandey AK, Kesri A. An observational study for appraisal of clinical outcome and risk of mother-to-child SARS-CoV-2 transmission in neonates provided the benefits of mothers' own milk. Eur J Pediatr 2022; 181:513-27. [PMID: 34379196 DOI: 10.1007/s00431-021-04206-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/06/2021] [Accepted: 07/09/2021] [Indexed: 10/25/2022]
Abstract
This observational study done during April-December 2020 at a tertiary-care hospital in Haryana (India) enrolled 152 SARS-CoV-2-exposed neonates. Among them, 150 neonates had perinatal SARS-CoV-2 exposure and 2 neonates had late postnatal exposure. Stable infant-mother dyads were roomed-in with precautions to support breastfeeding. Nasopharyngeal swabs collected from neonates were tested for SARS-CoV-2 by reverse transcriptase-polymerase chain reaction (RT-PCR) test. There was a high incidence of prematurity (23%), low birth weight (31%), intrauterine fetal distress (16%), perinatal asphyxia (6%), admission to neonatal intensive care unit (24%), and mortality (1.3%) among neonates with perinatal SARS-CoV-2 exposure. In this sub-group, 20 neonates tested positive for SARS-CoV-2 in nasopharyngeal swab sample(s). A recent official publication by the World Health Organization emphasizes that the perinatal SARS-CoV-2-exposed neonates found RT-PCR positive once in upper respiratory (non-sterile) sample must document viral persistence in another non-sterile sample for confirmation of mother-to-child virus transmission. With this approach, only one neonate was confirmed intrapartum transmission. A telephonic follow-up in discharged neonates at 1 month of age or 1 month postexposure recorded them all to be asymptomatic and doing well.Conclusion: Neonates with perinatal SARS-CoV-2 exposure constitute a high-risk group and it is not uncommon to get a positive RT-PCR report in upper respiratory sample(s) from these babies. Majority of them do not demonstrate viral persistence. Clinical outcomes are favorable in breastfed infants roomed-in with their asymptomatic-mild symptomatic SARS-CoV-2-infected mothers following appropriate safety protocols. What is Known: •Neonates with perinatal exposure suffer a high burden of morbidities and mortality. •Still, an uncertainty exists about rooming-in and breastfeeding among neonates born to SARS-CoV-2 positive mothers. What is New: •With the policy of mother-infant rooming-in and supporting breastfeeding, none of the neonate suffered clinical illness compatible with postnatal SARS-CoV-2 transmission and infection. •Around 13% perinatal exposed neonates demonstrated SARS-CoV-2 RNA in nasopharyngeal swab samples but the majority of them did not demonstrate viral persistence.
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29
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Simbaya J, Funjika P, Moonga A, Mwale J, Kankasa C. Feasibility of using infant testing during immunization to estimate HIV mother-to-child-transmission rates in Zambia. BMC Infect Dis 2021; 21:1239. [PMID: 34886792 PMCID: PMC8655713 DOI: 10.1186/s12879-021-06892-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 11/22/2021] [Indexed: 12/02/2022] Open
Abstract
Background This study piloted the feasibility of infant testing in immunization services as a strategy for estimating MTCT rates among the population of HIV exposed infants at national and subnational levels in Zambia. Methods The study recruited a cross-sectional nationally representative sample of 8042 caregiver-baby pairs in 38 high volume immunization sites in 7 towns across 3 provinces of Zambia. All mothers who brought their children below the age of one year for immunization at the study facilities were invited to participate in the study. All consenting mothers were interviewed and blood drawn from their babies for; rapid HIV antibody test to determine exposure and DNA PCR test for samples of all HIV-exposed babies to determine HIV infection. Results Of 8042 recruited caregiver–baby pairs, 1409 (17.5%) babies were HIV-exposed. Approximately 90.2% of all mothers of HIV exposed infants reported that they attended ANC visits more than two times and facility based deliveries stood at 91.6%. Exclusive breastfeeding among HIV exposed infants reduced with increase in age of infant; it was highest at 6 weeks (82.2%) followed by 10 weeks (74.0%) and 14 weeks (58.2%). MTCT rates were relatively lower than what was reported before in subnational studies and stood at 4.7% among Penta 1 seekers, 2.8% among Penta 2 seekers, 2.1% among Penta 3 seekers and 5.0% among Measles vaccination seekers. The overall MTCT rate stood at 3.8%. About 48.1% of HIV positive babies were male compared to 51.9% females. Babies of mothers below the age of 25 years accounted for almost half (51.9%) of all HIV infected babies in the study. Reported exclusive breastfeeding among HIV positive babies was 77.8% for Penta 1 seekers, 75.0% for Penta 2 seekers and 100% for Penta 3 seekers. Conclusions The study succeeded in estimating the MTCT rates using infant testing in immunization services, thereby demonstrating that it is feasible to use routine infant testing in immunization services as a strategy for estimating MTCT rates among the population of HIV-exposed infants in countries with high HIV burden and immunization coverage.
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Affiliation(s)
- Joseph Simbaya
- Institute of Economic and Social Research (University of Zambia), Munali Road, 10101, Lusaka, Zambia.
| | - Patricia Funjika
- Institute of Economic and Social Research (University of Zambia), Munali Road, 10101, Lusaka, Zambia
| | - Arthur Moonga
- Institute of Development and Research, Mosi-oa-Tunya Road, 10101, Lusaka, Zambia
| | - John Mwale
- Zambia National HIV/AIDS/TB Council, Independence Avenue, 10101, Lusaka, Zambia
| | - Chipepo Kankasa
- University Teaching Hospital HIV AIDS Program (UTH-HAP), Burma Road, 10101, Lusaka, Zambia
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30
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Li Y, Xiao Y, Li L, Song Y, Zhai X, Liu J, Duan Z, Yan L, Ding F, Liu J, Zhu L, Jiang J, Zou H, Li L, Liang C, Wang J, Li J. The dynamic changes of HBV quasispecies diversity in infancy after immunoprophylaxis failure: a prospective cohort study. Virol J 2021; 18:236. [PMID: 34844612 PMCID: PMC8628401 DOI: 10.1186/s12985-021-01707-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/17/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Previous works have observed that younger infants with chronic hepatitis B virus (HBV) infection are more responsive to antiviral treatment. However, the underlying mechanism remains unclear. In this study, the dynamic changes of HBV quasispecies in infants with immunoprophylaxis failure were investigated to provide virological explanations for clinical management on infantile antiviral therapy. METHODS Thirteen 7-month-old infants with immunoprophylaxis failure and their mothers were enrolled from a prospective cohort, and 8 of them were followed up to 3 years old. The sequences of HBV quasispecies were analyzed by the full-length genome clone-based sequencing, and compared among mothers and their infants at different ages. RESULTS The results revealed that the complexity, mutation frequency and genetic distance of HBV quasispecies decreased significantly at full-length, partial open reading frames and regulatory regions of HBV genome at nucleotide level in 7-month-old infants comparing with their mothers, whereas increased significantly to near the maternal level when infants grew up to 3 years old. Furthermore, similar changes were also found in Core, PreS2, RT and P regions of HBV genome at amino acid level, especially for potential NAs-resistant mutants in RT region and immune-escape mutants in Core and PreS2 regions. CONCLUSIONS This study uncovered the evolution of HBV quasispecies in infancy after mother-to-child transmission, which may provide the virological evidence for explaning that younger children are more responsive to antiviral therapy.
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Affiliation(s)
- Yi Li
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing, 100083, China
| | - Yiwei Xiao
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing, 100083, China
| | - Lili Li
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing, 100083, China
| | - Yarong Song
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing, 100083, China
| | - Xiangjun Zhai
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Jianxun Liu
- Zhengzhou Municipal Center for Disease Control and Prevention, Zhengzhou, 450053, China
| | - Zhongping Duan
- Beijing Youan Hospital, Capital Medical University, Beijing, 100054, China
| | - Ling Yan
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing, 100083, China
| | - Feng Ding
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing, 100083, China
| | - Jia Liu
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing, 100083, China
| | - Liguo Zhu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Jie Jiang
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Huaibin Zou
- Beijing Youan Hospital, Capital Medical University, Beijing, 100054, China
| | - Lingxiang Li
- Gongyi City Maternal and Child Health Hospital, Zhengzhou, 451200, China
| | - Caihong Liang
- Zhongmu County Maternal and Child Health Hospital, Zhengzhou, 451450, China
| | - Jie Wang
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing, 100083, China.
| | - Jie Li
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing, 100083, China.
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31
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Amaike C, Afolaranmi TO, Amaike BA, Agbo H, Abiodun O. Knowledge on mother-to-child transmission of HIV, and sexuality and fertility desires among people living with HIV in North-Central, Nigeria. Pan Afr Med J 2021; 40:64. [PMID: 34804332 PMCID: PMC8590253 DOI: 10.11604/pamj.2021.40.64.31455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/13/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction mother-to-child transmission (MTCT) is the transmission of HIV from a mother to the child during pregnancy, labour and breastfeeding. People living with HIV (PLHIV) are sexually active and also HIV can be transmitted while trying to achieve pregnancy involving unprotected hetero-sexual intercourse. Fertility desire among PLHIV is increasing due to improved quality of life and survival following commencement of anti-retroviral treatment and available reproductive health services. The objective of the study was to determine the association between knowledge on MTCT of HIV and sexuality and fertility desire. Methods this study was descriptive cross-sectional applying systematic sampling technique among PLHIV using semi-structured interviewer administered questionnaires. Data was analysed using SPSS version 23.0. Chi square test was used for statistical analysis. At 95% confidence interval a P-value of <0.05 was considered to be statistically significant. Results a total of 168 PLHIV were studied, 63.3% females and 36.7% males. Majority (81.5%) of the respondents were sexually active and 64.1% had fertility desire. On awareness of MTCT 62.5% had heard of MTCT but only 28.2% had good knowledge. No association was found between knowledge of MTCT and sexuality and fertility desire respectively. Conclusion PLHIV had high awareness but poor knowledge on MTCT of HIV, hence the need for healthcare workers to provide sexual and reproductive health counselling including information on MTCT to both male and female PLHIV during routine clinic visits.
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Affiliation(s)
- Chikwendu Amaike
- Department of Community Medicine, College of Health and Medical Sciences, Babcock University, Ilishan Remo, Ogun State, Nigeria.,Seventh-Day Adventist Hospital, Jengre, Plateau State, Nigeria
| | - Tolulope Olumide Afolaranmi
- Department of Community Medicine, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Blessing Adaku Amaike
- Department of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, University of Jos, Plateau State, Nigeria
| | - Hadiza Agbo
- Department of Community Medicine, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Olumide Abiodun
- Department of Community Medicine, College of Health and Medical Sciences, Babcock University, Ilishan Remo, Ogun State, Nigeria
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Etoori D, Rice B, Reniers G, Gomez-Olive FX, Renju J, Kabudula CW, Wringe A. Patterns of engagement in HIV care during pregnancy and breastfeeding: findings from a cohort study in North-Eastern South Africa. BMC Public Health 2021; 21:1710. [PMID: 34544409 PMCID: PMC8454048 DOI: 10.1186/s12889-021-11742-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eliminating mother-to-child transmission of HIV (MTCT) in sub-Saharan Africa is hindered by limited understanding of HIV-testing and HIV-care engagement among pregnant and breastfeeding women. METHODS We investigated HIV-testing and HIV-care engagement during pregnancy and breastfeeding from 2014 to 2018 in the Agincourt Health and Demographic Surveillance System (HDSS). We linked HIV patient clinic records to HDSS pregnancy data. We modelled time to a first recorded HIV-diagnosis following conception, and time to antiretroviral therapy (ART) initiation following diagnosis using Kaplan-Meier methods. We performed sequence and cluster analyses for all pregnancies linked to HIV-related clinic data to categorise MTCT risk period engagement patterns and identified factors associated with different engagement patterns using logistic regression. We determined factors associated with ART resumption for women who were lost to follow-up (LTFU) using Cox regression. RESULTS Since 2014, 15% of 10,735 pregnancies were recorded as occurring to previously (51%) or newly (49%) HIV-diagnosed women. New diagnoses increased until 2016 and then declined. We identified four MTCT risk period engagement patterns (i) early ART/stable care (51.9%), (ii) early ART/unstable care (34.1%), (iii) late ART initiators (7.6%), and (iv) postnatal seroconversion/early, stable ART (6.4%). Year of delivery, mother's age, marital status, and baseline CD4 were associated with these patterns. A new pregnancy increased the likelihood of treatment resumption following LTFU. CONCLUSION Almost half of all pregnant women did not have optimal ART coverage during the MTCT risk period. Programmes need to focus on improving retention, and leveraging new pregnancies to re-engage HIV-positive women on ART.
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Affiliation(s)
- David Etoori
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Brian Rice
- MeSH Consortium, Department of Public Health Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Georges Reniers
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Francesc Xavier Gomez-Olive
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Jenny Renju
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Alison Wringe
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Uchimaru K. [The current state and issues for HTLV-1 asymptomatic carrier management]. Rinsho Ketsueki 2021; 62:751-759. [PMID: 34349059 DOI: 10.11406/rinketsu.62.751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The number of HTLV-1 carriers is estimated using a proportion of anti-HTLV-1 antibody-positive blood donors. In Japan, approximately 820 thousand people carry HTLV-1. Strategies for the prevention of HTLV-1 infection include anti-HTLV-1 antibody screening of pregnant women and recommendation of formula feeding for mothers who are anti-HTLV-1 positive to prevent mother-to-child transmission of HTLV-1. However, mothers who cannot breastfeed grieve and mental health care for these mothers is important. The development of consulting systems for HTLV-1 carriers is also important. The development of basic institutional systems for consultation and follow-up of HTLV-1 carriers are increasing. A third important issue in HTLV-1 carrier management is the identification of high-risk carriers for ATL development. Based on registry systems, such as JSPFAD (Joint Study on Predisposing Factors of ATL Development), identification of risk factors, flow cytometric analysis, and detection of genome mutations using a target sequence technique have improved. The investigation of risk factors will reveal the mechanism of ATL development from HTLV-1 infected cells. The development of effective agents for pre-emptive and preventive therapy for ATL is expected through these research endeavors.
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Affiliation(s)
- Kaoru Uchimaru
- IMSUT Hospital, Institute of Medical Science, The University of Tokyo
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Mate A, Reyes-Goya C, Santana-Garrido Á, Sobrevia L, Vázquez CM. Impact of maternal nutrition in viral infections during pregnancy. Biochim Biophys Acta Mol Basis Dis 2021; 1867:166231. [PMID: 34343638 PMCID: PMC8325560 DOI: 10.1016/j.bbadis.2021.166231] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/05/2021] [Accepted: 07/23/2021] [Indexed: 12/11/2022]
Abstract
Other than being a physiological process, pregnancy is a condition characterized by major adaptations of maternal endocrine and metabolic homeostasis that are necessary to accommodate the fetoplacental unit. Unfortunately, all these systemic, cellular, and molecular changes in maternal physiology also make the mother and the fetus more prone to adverse outcomes, including numerous alterations arising from viral infections. Common infections during pregnancy that have long been recognized as congenitally and perinatally transmissible to newborns include toxoplasmosis, rubella, cytomegalovirus, and herpes simplex viruses (originally coined as ToRCH infections). In addition, enterovirus, parvovirus B19, hepatitis virus, varicella-zoster virus, human immunodeficiency virus, Zika and Dengue virus, and, more recently, coronavirus infections including Middle Eastern respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS) infections (especially the novel SARS-CoV-2 responsible for the ongoing COVID-19 pandemic), constitute relevant targets for current research on maternal-fetal interactions in viral infections during pregnancy. Appropriate maternal education from preconception to the early postnatal period is crucial to promote healthy pregnancies in general and to prevent and/or reduce the impact of viral infections in particular. Specifically, an adequate lifestyle based on proper nutrition plans and feeding interventions, whenever possible, might be crucial to reduce the risk of virus-related gestational diseases and accompanying complications in later life. Here we aim to provide an overview of the emerging literature addressing the impact of nutrition in the context of potentially harmful viral infections during pregnancy.
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Affiliation(s)
- Alfonso Mate
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, 41012 Sevilla, Spain; Epidemiología Clínica y Riesgo Cardiovascular, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain.
| | - Claudia Reyes-Goya
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, 41012 Sevilla, Spain
| | - Álvaro Santana-Garrido
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, 41012 Sevilla, Spain; Epidemiología Clínica y Riesgo Cardiovascular, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain
| | - Luis Sobrevia
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, 41012 Sevilla, Spain; Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Medical School (Faculty of Medicine), São Paulo State University (UNESP), Brazil; University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, QLD 4029, Australia; Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen (UMCG), 9713GZ Groningen, the Netherlands
| | - Carmen M Vázquez
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, 41012 Sevilla, Spain; Epidemiología Clínica y Riesgo Cardiovascular, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain
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Han Z, Zhang Y, Zhou J, Wang Q, Huang Y, Hou H. Risk of mother-to-child transmission of hepatitis B virus after fetal blood sampling: a report of six cases. BMC Infect Dis 2021; 21:716. [PMID: 34330230 PMCID: PMC8325253 DOI: 10.1186/s12879-021-06423-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) remains a major global public health problem worldwide; in endemic areas, mother-to-child transmission (MTCT) of HBV is the most common transmission route. Previous studies have shown that amniocentesis for prenatal diagnosis increases the risk of MTCT of HBV among highly viraemic mothers. However, no data is available on MTCT related fetal blood sampling (FBS) because of the paucity of cases or lack of attention. We present a case series of HBV-infected women who underwent FBS with or without antiviral therapy during pregnancy and discuss the risk of MTCT after FBS. CASE PRESENTATION Six hepatitis B surface antigen (HBsAg)-positive pregnant women who underwent FBS for prenatal diagnosis were retrospectively reviewed. Their infants were followed up with HBV serology parameters until at least 12 months of age. Among 6 cases, two hepatitis B e-antigen (HBeAg)-positive mothers had high viral loads > 7.0 log10 IU/mL, and one of them received antiviral therapy at 26+ 3 gestational weeks and achieved an anticipated level of 4.52 log10 IU/mL before FBS, while the other one did not receive any antiviral treatment. The other 4 cases were HBeAg-negative with low viral loads. Only a child born to the HBeAg-positive mother, who had no antiviral therapy with a viral load of 7.48 log10 IU/mL before FBS, was found to have MTCT with HBsAg persistently positive from birth to 12 months of age. The other 5 children were both HBsAg-negative and HBsAb-positive at the end of follow-up. CONCLUSIONS FBS may increase the risk of MTCT of HBV in women with HBeAg-positive and high viral loads; therefore, FBS should be avoided in this high-risk population. Maternal HBV serologic testing and awareness of the potential risk of MTCT should be recommended before FBS. Antiviral therapy may be effective to decrease the risk of MTCT after FBS in highly viraemic women.
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Affiliation(s)
- Zhenyan Han
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong Province, China
| | - Yuan Zhang
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong Province, China
| | - Jin Zhou
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong Province, China
| | - Qingqing Wang
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong Province, China
| | - Yonghua Huang
- Department of Obstetrics and Gynecology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-sen University, Jiangmen, 529030, Guangdong Province, China
| | - Hongying Hou
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong Province, China.
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Zhang X, Zou H, Chen Y, Zhang H, Tian R, Meng J, Zhu Y, Guo H, Dai E, Zhu B, Liu Z, Jin Y, Li Y, Feng L, Zhuang H, Pan CQ, Li J, Duan Z. The effects of increased dose of hepatitis B vaccine on mother-to-child transmission and immune response for infants born to mothers with chronic hepatitis B infection: a prospective, multicenter, large-sample cohort study. BMC Med 2021; 19:148. [PMID: 34253217 PMCID: PMC8276424 DOI: 10.1186/s12916-021-02025-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/04/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Appropriate passive-active immunoprophylaxis effectively reduces mother-to-child transmission (MTCT) of hepatitis B virus (HBV), but the immunoprophylaxis failure was still more than 5% under the current strategy. The study objective was to investigate the effects of high dose of HB vaccine on MTCT and immune response for infants born to hepatitis B surface antigen (HBsAg)-positive mothers. METHODS This was a prospective, multicenter, large-sample cohort study in four sites of China, and 955 pairs of HBsAg-positive mothers and their infants were enrolled in our investigation. The infants were given 10 μg or 20 μg HB vaccine (at age 0, 1, and 6 months) plus HB immunoglobulin (at age 0 and 1 month). Serum HBsAg, antibody to HBsAg (anti-HBs), and/or HBV DNA levels in the infants were determined at age 12 months. The safety of 20 μg HB vaccine was evaluated by adverse events and observing the growth indexes of infants. RESULTS Thirteen of 955 infants were HBsAg-positive at 12 months. Stratification analysis showed that immunoprophylaxis failure rates in the 20 μg group were not significantly different from the 10 μg group, whatever maternal HBV load was high or not. But the high dose of HB vaccine significantly reduced low-response rate (anti-HBs 10-100 IU/L) (P = 0.002) and middle-response rate (anti-HBs 100-1000 IU/L) (P = 0.022) and improved high-response rate (anti-HBs ≥ 1000 IU/L) (P < 0.0001) in infants born to mothers with HBV DNA < 5 log10 IU/mL. For infants born to mothers with HBV DNA ≥ 5 log10 IU/mL, 20 μg HB vaccine did not present these above response advantages. The 20 μg HB vaccine showed good safety for infants. CONCLUSIONS The 20 μg HB vaccine did not further reduce immunoprophylaxis failure of infants from HBsAg-positive mothers, but increased the high-response and decreased low-response rates for infants born to mothers with HBV DNA < 5 log10 IU/mL. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR-PRC-09000459.
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Affiliation(s)
- Xiaohui Zhang
- Artificial Liver Treatment Center, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, China
| | - Huaibin Zou
- Artificial Liver Treatment Center, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, China
| | - Yu Chen
- Artificial Liver Treatment Center, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, China
| | - Hua Zhang
- Department of Obstetrics and Gynecology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Ruihua Tian
- Department of Obstetrics and Gynecology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Jun Meng
- Department of Obstetrics and Gynecology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yunxia Zhu
- Department of Obstetrics and Gynecology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Huimin Guo
- Artificial Liver Treatment Center, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Erhei Dai
- Department of Liver Diseases, The Fifth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Baoshen Zhu
- Department of Liver Diseases, The Fifth Hospital of Shijiazhuang, Shijiazhuang, China
| | | | - Yanxia Jin
- Tongliao Infective Disease Hospital, Tongliao, China
| | - Yujie Li
- Department of Obstetrics and Gynecology, Taiyuan No. 3 Hospital, Taiyuan, China
| | - Liping Feng
- Department of Obstetrics and Gynecology, Taiyuan No. 3 Hospital, Taiyuan, China
| | - Hui Zhuang
- Department of Microbiology and Center of Infectious Disease, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Calvin Q Pan
- Division of Gastroenterology and Hepatology, Department of Medicine, New York University, Langone Health, NYU Grossman School of Medicine, New York, USA.
| | - Jie Li
- Department of Microbiology and Center of Infectious Disease, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China.
| | - Zhongping Duan
- Artificial Liver Treatment Center, Beijing Youan Hospital, Capital Medical University, Beijing, China. .,Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, China.
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Gosset A, Diallo MY, Betsem E, Schaeffer L, Meda N, Vray M, Sombie R, Shimakawa Y, Boyer S. Cost-effectiveness of adding a birth dose of hepatitis B vaccine in the Dafra district of the Hauts-Bassins Region in Burkina Faso (NéoVac Study). Vaccine 2021; 39:4659-4670. [PMID: 34238606 DOI: 10.1016/j.vaccine.2021.06.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND The World Health Organization (WHO) recommends a first hepatitis B vaccine dose within 24 h of birth (HepB-BD) to prevent mother-to-child transmission. Evidence for this strategy's economic value in Africa is limited. We assessed the costs and cost-effectiveness of adding HepB-BD to the current three-dose pentavalent schedule (HepB3) in the Dafra district of the Hauts-Bassins Region in Burkina Faso. METHODS Using a decision tree combined with a Markov model, we estimated the expected number of life-years (LY) and disability-adjusted life-years (DALYs) saved, incremental costs, and incremental cost-effectiveness ratios (ICER) of HepB-BD + HepB3 versus HepB3 alone in Dafra's 2017 birth cohort (n = 11,462). Institutional delivery rates, vaccine coverage, and vaccination costs from a health system perspective were estimated from field-collected data. We estimated the effectiveness of HepB-BD, age-specific transition probabilities, and horizontal transmission risks using data from previous African studies. Costs and health outcomes were discounted at an annual rate of 3%. We conducted one-way and probabilistic sensitivity analyses to assess uncertainty. RESULTS In the base-case analysis without discounting, HepB-BD + HepB3 yielded a net cost saving of US$18,979 and saved 163 DALYs compared with HepB3 alone. With discounting, HepB-BD + HepB3 compared with HepB3 resulted in an incremental cost of US$554 and 31 DALYs averted, translating into an ICER of US$18/DALY averted. In one-way sensitivity analyses, HepB-BD + HepB3 remained cost-effective (at the cost-effectiveness threshold of US$671 i.e. the Burkina Faso per-capita gross domestic product) for all parameter changes. However, results were very sensitive to variations in HepB-BD unit cost per vaccinated neonate and perinatal transmission risk in mothers carrying the hepatitis B e antigen. The probabilities of HepB-BD + HepB3 being cost-effective were 71.7% and 86.7%, at the cost-effectiveness thresholds of US$335 and US$671, respectively. CONCLUSION Introducing HepB-BD in Burkina Faso is likely to be cost-effective.
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Affiliation(s)
- Andréa Gosset
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Mamadou Yaya Diallo
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Edouard Betsem
- Laboratoire Mixte International de Vaccinologie (LAMIVAC), Bobo-Dioulasso, Burkina Faso; Agence de Médecine Préventive (AMP), Bobo-Dioulasso, Burkina Faso
| | - Laura Schaeffer
- Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France
| | | | - Muriel Vray
- Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France
| | - Roger Sombie
- Département d'Hépato-gastroentérologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Yusuke Shimakawa
- Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France.
| | - Sylvie Boyer
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
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Cerveny L, Murthi P, Staud F. HIV in pregnancy: Mother-to-child transmission, pharmacotherapy, and toxicity. Biochim Biophys Acta Mol Basis Dis 2021; 1867:166206. [PMID: 34197912 DOI: 10.1016/j.bbadis.2021.166206] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/18/2021] [Accepted: 06/11/2021] [Indexed: 12/15/2022]
Abstract
An estimated 1.3 million pregnant women were living with HIV in 2018. HIV infection is associated with adverse pregnancy outcomes and all HIV-positive pregnant women, regardless of their clinical stage, should receive a combination of antiretroviral drugs to suppress maternal viral load and prevent vertical fetal infection. Although antiretroviral treatment in pregnant women has undoubtedly minimized mother-to-child transmission of HIV, several uncertainties remain. For example, while pregnancy is accompanied by changes in pharmacokinetic parameters, relevant data from clinical studies are lacking. Similarly, long-term adverse effects of exposure to antiretrovirals on fetuses have not been studied in detail. Here, we review current knowledge on HIV effects on the placenta and developing fetus, recommended antiretroviral regimens, and pharmacokinetic considerations with particular focus on placental transport. We also discuss recent advances in antiretroviral research and potential effects of antiretroviral treatment on placental/fetal development and programming.
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Affiliation(s)
- Lukas Cerveny
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Padma Murthi
- Department of Medicine, School of Clinical Sciences, and Department of Pharmacology, Monash Biomedicine Discovery Institute Monash University, Clayton, Victoria, Australia; Hudson Institute of Medical Research, The Ritchie Centre, Clayton, Victoria, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
| | - Frantisek Staud
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic.
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Belopolskaya M, Avrutin V, Kalinina O, Dmitriev A, Gusev D. Chronic hepatitis B in pregnant women: Current trends and approaches. World J Gastroenterol 2021; 27:3279-3289. [PMID: 34163111 PMCID: PMC8218362 DOI: 10.3748/wjg.v27.i23.3279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/10/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023] Open
Abstract
Chronic hepatitis B (CHB) is a significant public health problem worldwide. The aim of the present review is to summarize the actual trends in the management of CHB in pregnant women. The prevalence of hepatitis B virus (HBV) infection in pregnant women is usually comparable to that in the general population in the corresponding geographic area. All women have to be screened for hepatitis B surface antigen (HBsAg) during pregnancy. Additional examinations of pregnant women with CHB may include maternal hepatitis B e antigen, HBV viral load, alanine aminotransferase level, and HBsAg level. The management of pregnancy depends on the phase of the HBV infection, which has to be determined before pregnancy. In women of childbearing age with CHB, antiviral therapy can pursue two main goals: Treatment of active CHB, and vertical transmission prevention. During pregnancy, tenofovir is the drug of choice in both cases. A combination of hepatitis B immunoglobulin and vaccine against hepatitis B should be administered within the first 12 h to all infants born to mothers with CHB. In such cases, there are no contraindications to breastfeeding.
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Affiliation(s)
- Maria Belopolskaya
- Polyclinical Department, Botkin's Infectious Disease Hospital, St-Petersburg 195067, Russia
- Chronic Viral Infectious Disease Lab, Institute of Experimental Medicine, St-Petersburg 197376, Russia
| | - Viktor Avrutin
- Institute for Systems Theory, University of Stuttgart, Stuttgart 70569, Baden-Wurttemberg, Germany
| | - Olga Kalinina
- Faculty of Biomedical Sciences, Almazov National Medical Research Centre, St-Petersburg 197341, Russia
| | - Alexander Dmitriev
- Department of Molecular Microbiology, Institute of Experimental Medicine, St-Petersburg 197376, Russia
| | - Denis Gusev
- Botkin's Infectious Disease Hospital, St-Petersburg 195067, Russia
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Garcia-Ruiz I, Sulleiro E, Serrano B, Fernandez-Buhigas I, Rodriguez-Gomez L, Sanchez-Nieves Fernandez D, Anton-Pagarolas A, Esperalba-Esquerra J, Frick MA, Camba F, Navarro-Jimenez A, Fernandez-Hidalgo N, Maiz N, Carreras E, Suy A. Congenital infection of SARS-CoV-2 in live-born neonates: a population-based descriptive study. Clin Microbiol Infect 2021; 27:1521.e1-1521.e5. [PMID: 34153457 PMCID: PMC8213522 DOI: 10.1016/j.cmi.2021.06.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 06/07/2021] [Accepted: 06/11/2021] [Indexed: 12/28/2022]
Abstract
Objective To evaluate the evidence of mother-to-child transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods This is a descriptive, multicentre, observational study in nine tertiary care hospitals throughout Spain. The study population was women with coronavirus disease 2019 during pregnancy. Mother-to-child transmission was defined as positive real-time RT-PCR of SARS-CoV-2 in amniotic fluid, cord blood, placenta or neonatal nasopharyngeal swabs taken immediately after birth. Results We included 43 women with singleton pregnancies and one with a twin pregnancy, as a result we obtained 45 samples of placenta, amniotic fluid and umbilical cord blood. The median gestational age at diagnosis was 34.7 weeks (range 14–41.3 weeks). The median interval between positive RT-PCR and delivery was 21.5 days (range 0–141 days). Fourteen women (31.8%, 95% CI 18.6%–47.6%) were positive at the time of delivery. There was one singleton pregnancy with SARS-CoV-2 RT-PCR positive in the placenta, amniotic fluid and umbilical cord blood (2.2%, 95% CI 0.1%–11.8%). Nasopharyngeal aspiration was performed on 38 neonates at birth, all of which were negative (0%, 95% CI 0%–9.3%). In 11 neonates the nasopharyngeal aspiration was repeated at 24–48 hours, and one returned positive (9.1%, 95% CI 0.2%–41.3%). Conclusions The presence of SARS-CoV-2 in placenta, amniotic fluid and cord blood shows that mother-to-child transmission is possible but uncommon.
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Affiliation(s)
- Itziar Garcia-Ruiz
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall D´Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Sulleiro
- Microbiology Department, Hospital Universitari Vall d'Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Berta Serrano
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall D´Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Irene Fernandez-Buhigas
- Department of Obstetrics and Gynaecology, University Hospital of Torrejon, Madrid, Spain; School of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Leire Rodriguez-Gomez
- Biocruces Bizkaia Health Research Institute. Osakidetza, Department of Obstetrics and Gynaecology, Hospital Universitario Cruces, UPV/EHU, Barakaldo, Bizkaia, Spain
| | | | - Andrés Anton-Pagarolas
- Microbiology Department, Hospital Universitari Vall d'Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juliana Esperalba-Esquerra
- Microbiology Department, Hospital Universitari Vall d'Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marie Antoinette Frick
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d' Hebron, Vall d' Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Fatima Camba
- Department of Neonatology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Nuria Fernandez-Hidalgo
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - Nerea Maiz
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall D´Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Elena Carreras
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall D´Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Suy
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall D´Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Segeral O, Phirum W, Khan O, Chea H, Sovann S, Nhoeung S, Chhim K, Yin S, Dim B, Yay C, Laurent D, Chhun S, Borand L. In-field Evaluation of SD Bioline HBsAg Whole Blood Rapid Test in Pregnant Women in Cambodia: the ANRS 12345 TA PROHM Study. Diagn Microbiol Infect Dis 2021; 101:115452. [PMID: 34243135 DOI: 10.1016/j.diagmicrobio.2021.115452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/04/2021] [Accepted: 06/06/2021] [Indexed: 11/16/2022]
Abstract
The objective is to assess the in-field performance of HBsAg whole blood rapid diagnosis test (RDT) as compared to plasmatic HBsAg RDT to diagnose HBV infection among pregnant women in Cambodia. Blood was collected on EDTA tubes from pregnant woman screened for the TA PROHM - ANRS 12345 study. Whole blood HBsAg RDT results were crossed compared with the plasmatic HBsAg RDT results, which was defined for this study as the gold standard. From December 2018 to May 2019, 4997 pregnant women were screened. The median age was 27.2 years old, 14% were screened in Phnom Penh and 86% in Siem Reap. Whole blood HBsAg RDT perform excellently with a sensitivity of 100% (95% CI, 98.7 - 100) and specificity of 100% (95% CI, 99.9 - 100). Whole blood HBs Ag RDT is as accurate as plasmatic one and could be used in remote areas.
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Affiliation(s)
| | | | - Ousa Khan
- Institut Pasteur du Cambodge, Epidemiology and Public Health Unit, Phnom Penh, Cambodia
| | - Hyna Chea
- Laboratory Department, Jayavarman VII Hospital, Siem Reap, Cambodia
| | - Saren Sovann
- Institut Pasteur du Cambodge, Epidemiology and Public Health Unit, Phnom Penh, Cambodia
| | - Sovann Nhoeung
- Institut Pasteur du Cambodge, Epidemiology and Public Health Unit, Phnom Penh, Cambodia
| | - Kearena Chhim
- Department of Maternity, Hôpital Calmette, Phnom Penh, Cambodia
| | - Song Yin
- Institut Pasteur du Cambodge, Epidemiology and Public Health Unit, Phnom Penh, Cambodia
| | - Bunnet Dim
- Institut Pasteur du Cambodge, Epidemiology and Public Health Unit, Phnom Penh, Cambodia
| | - Chantana Yay
- Direction Department, Jayavarman VII Hospital, Siem Reap, Cambodia
| | - Denis Laurent
- Direction Department, Jayavarman VII Hospital, Siem Reap, Cambodia
| | | | - Laurence Borand
- Institut Pasteur du Cambodge, Epidemiology and Public Health Unit, Phnom Penh, Cambodia
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42
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Mennecier A, Kankasa C, Fao P, Moles JP, Eymard-Duvernay S, Mwiya M, Kania D, Chunda-Liyoka C, Sakana L, Rutagwera D, Tassembedo S, Wilfred-Tonga MM, Mosqueira B, Tylleskär T, Nagot N, Van de Perre P. Design and challenges of a large HIV prevention clinical study on mother-to-child transmission: ANRS 12397 PROMISE-EPI study in Zambia and Burkina Faso. Contemp Clin Trials 2021; 105:106402. [PMID: 33872801 DOI: 10.1016/j.cct.2021.106402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
Post-natal HIV infection through breastfeeding remains a challenge in many low and middle-income countries, particularly due to non-availability of alternative infant feeding options and the suboptimal Prevention of Mother to Child Transmission of HIV-1 (PMTCT) cascade implementation and monitoring. The PROMISE-EPI study aims to address the latter by identifying HIV infected mothers during an almost never-missed visit for their infant, the second extended program on immunization visit at 6-8 weeks of age (EPI-2). The study is divided into 3 components inclusive of an open-label randomized controlled trial aiming to assess the efficacy of a responsive preventive intervention compared to routine intervention based on the national PMTCT guidelines for HIV-1 uninfected exposed breastfeeding infants. The preventive intervention includes: a) Point of care testing for early infant HIV diagnosis and maternal viral load; b) infant, single-drug Pre-Exposure Prophylaxis (PrEP) (lamivudine) if mothers are virally unsuppressed. The primary outcome is HIV-transmission rate from EPI-2 to 12 months. The study targets to screen 37,000 mother/infant pairs in Zambia and Burkina Faso to identify 2000 mother/infant pairs for the clinical trial. The study design and challenges faced during study implementation are described, including the COVID-19 pandemic and the amended HIV guidelines in Zambia in 2020 (triple-drug PrEP in HIV exposed infants guided by quarterly maternal viral load). The changes in the Zambian guidelines raised several questions including the equipoise of PrEP options, the standard of care-triple-drug (control arm in Zambia) versus the study-single-drug (intervention arm). Trial registration number (www.clinicaltrials.gov): NCT03869944. Submission category: Study Design, Statistical Design, Study Protocols.
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Affiliation(s)
- Anaïs Mennecier
- Pathogenesis and Control of Chronic and Emerging Infections, INSERM, University of Montpellier, Etablissement Français du Sang, Antilles University, CHU Montpellier, Montpellier, France.
| | - Chipepo Kankasa
- Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia
| | - Paulin Fao
- Centre MURAZ, Bobo-Dioulasso, Burkina Faso
| | - Jean-Pierre Moles
- Pathogenesis and Control of Chronic and Emerging Infections, INSERM, University of Montpellier, Etablissement Français du Sang, Antilles University, CHU Montpellier, Montpellier, France
| | - Sabrina Eymard-Duvernay
- Pathogenesis and Control of Chronic and Emerging Infections, INSERM, University of Montpellier, Etablissement Français du Sang, Antilles University, CHU Montpellier, Montpellier, France
| | - Mwiya Mwiya
- Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia
| | | | | | | | - David Rutagwera
- Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia
| | | | | | - Beatriz Mosqueira
- Pathogenesis and Control of Chronic and Emerging Infections, INSERM, University of Montpellier, Etablissement Français du Sang, Antilles University, CHU Montpellier, Montpellier, France
| | | | - Nicolas Nagot
- Pathogenesis and Control of Chronic and Emerging Infections, INSERM, University of Montpellier, Etablissement Français du Sang, Antilles University, CHU Montpellier, Montpellier, France
| | - Philippe Van de Perre
- Pathogenesis and Control of Chronic and Emerging Infections, INSERM, University of Montpellier, Etablissement Français du Sang, Antilles University, CHU Montpellier, Montpellier, France
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Abstract
This article defines neonatal herpes simplex virus (HSV) disease and describes the progress over the past 40 years that has revolutionized the management of HSV disease in neonates to improve their outcomes. These advancements include the introduction of acyclovir in the 1980s, polymerase chain reaction (PCR) for the detection of HSV DNA in the 1990s, and recommendations on managing infants born to mothers with active genital lesions. Despite these advancements, however, there remain high morbidity and mortality in affected neonates, with need for continued improvement. Areas of high interest include vaccine development and rapid PCR detection at time of delivery.
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Affiliation(s)
- Nicole L Samies
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Alabama at Birmingham, Children's Harbor Building 308, 1600 7th Avenue South, Birmingham, AL 35233-1711, USA.
| | - Scott H James
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Alabama at Birmingham, Children's Harbor Building 308, 1600 7th Avenue South, Birmingham, AL 35233-1711, USA
| | - David W Kimberlin
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Alabama at Birmingham, Children's Harbor Building 308, 1600 7th Avenue South, Birmingham, AL 35233-1711, USA
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44
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Tamandjou Tchuem CR, Andersson MI, Wiysonge CS, Mufenda J, Preiser W, Cleary S. Prevention of hepatitis B mother-to-child transmission in Namibia: A cost-effectiveness analysis. Vaccine 2021; 39:3141-51. [PMID: 33962836 DOI: 10.1016/j.vaccine.2021.04.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 03/18/2021] [Accepted: 04/20/2021] [Indexed: 12/16/2022]
Abstract
Despite access to a safe and effective vaccine, mother-to-child transmission (MTCT) of hepatitis B virus (HBV) persists in Africa. This is of concern since perinatally-infected infants are at highest risk of developing hepatocellular carcinoma, a life-threatening consequence of chronic HBV infection. While tools to prevent HBV MTCT are available, the cost implications of these interventions need consideration prior to implementation. A Markov model was developed to determine the costs and health outcomes of (1) universal HBV birth dose (BD) vaccination, (2) universal BD vaccination and targeted hepatitis B immunoglobulin (HBIG), (3) maternal antiviral prophylaxis using sequential HBV viral load testing added to HBV BD vaccination and HBIG, and (4) maternal antiviral prophylaxis using sequential HBeAg testing combined with HBV BD vaccination and HBIG. Health outcomes were assessed as the number of paediatric infections averted and disability-adjusted life years (DALYs) averted. Primary cost data included consumables, human resources, and hospital facilities. HBV epidemiology, transitions probabilities, disability weights, and the risks of HBV MTCT were extracted from the literature. Incremental cost-effectiveness ratios (ICERs) were calculated to compare successive more expensive interventions to the previous less expensive one. One-way sensitivity analyses were conducted to test the robustness of the model's outputs. At the Namibian cost/DALY averted threshold of US$3 142, the (1) BD vaccination + targeted HBIG, and (2) maternal antiviral prophylaxis with sequential HBeAg testing interventions were cost-effective. These interventions had ICERs equal to US$1909.03/DALY and US$2598.90/DALY averted, respectively. In terms of effectiveness, the maternal antiviral prophylaxis with sequential HBeAg testing intervention was the intervention of choice. The analysis showed that elimination of HBV MTCT is achievable using maternal antiviral prophylaxis with active and passive immunization. There is an urgent need for low cost diagnostic tests to identify those women who will most benefit from drug therapy to attain this laudable goal.
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45
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Palacio-Mejía LS, Hernández-Ávila JE, Molina-Vélez D, González-González L, Quezada-Sánchez AD, Hernández-Ávila M, Magis-Rodriguez C. Trends in Mortality due to HIV/AIDS in children in Mexico: Towards the elimination of mother-tochild transmission. Arch Med Res 2021; 52:746-754. [PMID: 33958214 DOI: 10.1016/j.arcmed.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/29/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
AIM OF THE STUDY To examine mortality trends in children under 15 years of age due to HIV/AIDS in Mexico and describe their differences by insurance coverage. METHODS Time series analysis of deaths from 1990-2019 through a Bayesian poisson regression model with linear splines and knots in 1994, 1997, and 2003. RESULTS Overall, we observed a reduction in the mortality rate due to HIV from 2003 onwards, except in the group of 10-14 years. In the population covered with Social Security, mortality rates decreased in all age groups. However, in the group without Social Security or with Popular Security (subsidized system), mortality rates significantly decreased only for children below 5 years. of age. CONCLUSIONS Health insurance through the contributory system is associated with faster and larger reductions in HIV related infant mortality. Universal access to health insurance was not sufficient to close the gap in HIV-mortality among children under 15 years of age in Mexico.
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Affiliation(s)
| | | | - Diana Molina-Vélez
- Center for Evaluation and Surveys Research. National Institute of Public Health
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46
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Peters RP, Feucht UD, de Vos L, Ngwepe P, McIntyre JA, Klausner JD, Medina-Marino A. Mother-to-child transmission of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis in HIV-infected pregnant women in South Africa. Int J STD AIDS 2021; 32:799-805. [PMID: 33769901 DOI: 10.1177/0956462421990218] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sexually transmitted infections (STIs) can be transmitted from mother to neonate. We determined the frequency of mother-to-child transmission (MTCT) of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis to the newborn nasopharynx. METHODS This study was nested in a cohort study of etiologic testing versus syndromic management for STIs among pregnant women living with human immunodeficiency virus in South Africa. Mothers were tested for STIs using the GeneXpert platform within 60 days after delivery. Nasopharyngeal swabs were obtained from newborns of mothers with a positive STI test; these were then tested by Xpert® on the same day based on the maternal STI diagnosis. RESULTS We tested nasopharyngeal swabs from 85 STI-exposed newborns; 74 (87%) were tested within 2 weeks after birth (median five; range 2-12 days). MTCT frequency of any STI was 30/74 (41%); 43% (23/53) for C. trachomatis, 29% (2/7) for N. gonorrhoeae, and 24% (6/25) for T. vaginalis. Also, 4/11 (36%) swabs obtained between 14 and 60 days after delivery tested positive for STI. CONCLUSIONS There was a high frequency of MTCT of STIs to the nasopharynx of newborns in our setting. The impact of nasopharyngeal colonization and the benefits of STI testing on newborn health remain to be determined.
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Affiliation(s)
- Remco Ph Peters
- Foundation for Professional Development, Research Unit, East London, South Africa.,Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa.,Department of Medical Microbiology, Maastricht University Medical Centre, CAPRHI School of Public Health and Primary Care, Maastricht, South Africa
| | - Ute D Feucht
- Gauteng Department of Health, Pretoria, Tshwane District Clinical Specialist Team, Tshwane District Health Services, South Africa.,Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, Department of Paediatrics, University of Pretoria, Pretoria, South Africa.,Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Lindsey de Vos
- Foundation for Professional Development, Research Unit, East London, South Africa
| | - Phuti Ngwepe
- Foundation for Professional Development, Research Unit, East London, South Africa
| | - James A McIntyre
- Main Office, Anova Health Institute, Johannesburg, South Africa.,School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jeffrey D Klausner
- David Geffen School of Medicine, Division of Infectious Diseases: Global Health, University of California Los Angeles, Los Angeles, CA, USA.,Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Andrew Medina-Marino
- Foundation for Professional Development, Research Unit, East London, South Africa.,Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
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47
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Fuente-Soro L, Fernández-Luis S, López-Varela E, Augusto O, Nhampossa T, Nhacolo A, Bernardo E, Burgueño B, Ngeno B, Couto A, Guambe H, Tibana K, Urso M, Naniche D. Community-based progress indicators for prevention of mother-to-child transmission and mortality rates in HIV-exposed children in rural Mozambique. BMC Public Health 2021; 21:520. [PMID: 33731061 PMCID: PMC7970736 DOI: 10.1186/s12889-021-10568-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/03/2021] [Indexed: 12/17/2022] Open
Abstract
Background Eliminating mother-to-child HIV-transmission (EMTCT) implies a case rate target of new pediatric HIV-infections< 50/100,000 live-births and a transmission rate < 5%. We assessed these indicators at community-level in Mozambique, where MTCT is the second highest globally.. Methods A cross-sectional household survey was conducted within the Manhiça Health Demographic Surveillance System in Mozambique (October 2017–April 2018). Live births in the previous 4 years were randomly selected, and mother/child HIV-status was ascertained through documentation or age-appropriate testing. Estimates on prevalence and transmission were adjusted by multiple imputation chained equation (MICE) for participants with missing HIV-status. Retrospective cumulative mortality rate and risk factors were estimate by Fine-Gray model. Results Among 5000 selected mother-child pairs, 3486 consented participate. Community HIV-prevalence estimate in mothers after MICE adjustment was 37.6% (95%CI:35.8–39.4%). Estimates doubled in adolescents aged < 19 years (from 8.0 to 19.1%) and increased 1.5-times in mothers aged < 25 years. Overall adjusted vertical HIV-transmission at the time of the study were 4.4% (95% CI:3.1–5.7%) in HIV-exposed children (HEC). Pediatric case rate-infection was estimated at 1654/100,000 live-births. Testing coverage in HEC was close to 96.0%; however, only 69.1% of them were tested early(< 2 months of age). Cumulative child mortality rate was 41.6/1000 live-births. HIV-positive status and later birth order were significantly associated with death. Neonatal complications, HIV and pneumonia were main pediatric causes of death. Conclusions In Mozambique, SPECTRUM modeling estimated 15% MTCT, higher than our district-level community-based estimates of MTCT among HIV-exposed children. Community-based subnational assessments of progress towards EMTCT are needed to complement clinic-based and modeling estimates. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10568-4.
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Affiliation(s)
- Laura Fuente-Soro
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique. .,Barcelona Institute for Global Health, Barcelona, Spain. .,ISGlobal, Barcelona Institute for Global Health, Rossello, 132, 08036, Barcelona, Spain.
| | - Sheila Fernández-Luis
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Barcelona Institute for Global Health, Barcelona, Spain
| | - Elisa López-Varela
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Barcelona Institute for Global Health, Barcelona, Spain
| | - Orvalho Augusto
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Instituto Nacional de Saúde, Maputo, Mozambique
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Edson Bernardo
- Manhiça District Health Services, Maputo, Mozambique.,Vanderbilt Institute for Global Health, Nashville, Tennessee, USA
| | | | - Bernadette Ngeno
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | - Aleny Couto
- Ministério da Saúde de Moçambique, Maputo, Mozambique
| | - Helga Guambe
- Ministério da Saúde de Moçambique, Maputo, Mozambique
| | | | - Marilena Urso
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Denise Naniche
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Barcelona Institute for Global Health, Barcelona, Spain
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48
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Lu Y, Song Y, Zhai X, Zhu F, Liu J, Chang Z, Li Y, Xiao Y, Li L, Liu M, Liu J, Duan Z, Zou H, Zhuang H, Wang J, Li J. Maternal hepatitis B e antigen can be an indicator for antiviral prophylaxis of perinatal transmission of hepatitis B virus. Emerg Microbes Infect 2021; 10:555-564. [PMID: 33682609 PMCID: PMC8018376 DOI: 10.1080/22221751.2021.1899055] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
As a high-risk factor of perinatal HBV transmission, the potential role of maternal hepatitis B e antigen (HBeAg) to guide antiviral prophylaxis has not yet been fully reported. This large prospective cohort study enrolled 1177 hepatitis B surface antigen (HBsAg)-positive pregnant women without antiviral treatment and their newborns. HBeAg, HBsAg, and viral load in maternal serum collected before delivery were measured. All the newborns were given standard passive-active immunoprophylaxis within 12 h after birth, and post-vaccination serologic testing was performed at 7 (±7d) months of age. The results revealed that 20 of the 1177 infants (1.70%) were immunoprophylaxis failure, and all their mothers were HBeAg positive. Maternal quantitative HBeAg was positively correlated with viral load (r = 0.83; P < .0001) and quantitative HBsAg (r = 0.68; P < .0001). The area under the receiver operating characteristic curve (AUC) for predicting immunoprophylaxis failure by maternal HBeAg was comparable to that by maternal viral load (0.871 vs 0.893; P = .441) and HBsAg (0.871 vs 0.871; P = .965). The optimal cutoff value of maternal quantitative HBeAg to predict perinatal infection was 2.21 log10 PEI U/mL, and the sensitivity and specificity was 100.0% and 74.5%, respectively. According to maternal viral load >2 × 105 IU/mL, the sensitivity and specificity of maternal qualitative HBeAg to identify the risk of HBV MTCT for pregnant women and determine the necessity for antiviral prophylaxis was 95.5% and 92.6%, respectively. This study showed that maternal HBeAg can be a surrogate marker of HBV DNA for monitoring and evaluating whether antiviral prophylaxis is necessary for preventing perinatal HBV transmission.
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Affiliation(s)
- Ying Lu
- Department of Microbiology & Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, People's Republic of China
| | - Yarong Song
- Department of Microbiology & Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, People's Republic of China
| | - Xiangjun Zhai
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, People's Republic of China
| | - Fengcai Zhu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, People's Republic of China
| | - Jianxun Liu
- Zhengzhou Municipal Center for Disease Control and Prevention, Zhengzhou, People's Republic of China
| | - Zhanjun Chang
- Zhengzhou Municipal Center for Disease Control and Prevention, Zhengzhou, People's Republic of China
| | - Yi Li
- Department of Microbiology & Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, People's Republic of China
| | - Yiwei Xiao
- Department of Microbiology & Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, People's Republic of China
| | - Lili Li
- Department of Microbiology & Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, People's Republic of China
| | - Minmin Liu
- Department of Microbiology & Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, People's Republic of China
| | - Jia Liu
- Department of Microbiology & Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, People's Republic of China
| | - Zhongping Duan
- Beijing Youan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Huaibin Zou
- Beijing Youan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hui Zhuang
- Department of Microbiology & Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, People's Republic of China
| | - Jie Wang
- Department of Microbiology & Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, People's Republic of China
| | - Jie Li
- Department of Microbiology & Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, People's Republic of China
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49
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Mandelbrot L, Kieffer F, Wallon M, Winer N, Massardier J, Picone O, Fuchs F, Benoist G, Garcia-Meric P, L'Ollivier C, Paris L, Piarroux R, Villena I, Peyron F. [Toxoplasmosis in pregnancy: Practical Management]. ACTA ACUST UNITED AC 2021; 49:782-791. [PMID: 33677120 DOI: 10.1016/j.gofs.2021.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Indexed: 11/28/2022]
Abstract
The burden of congenital toxoplasmosis has become small in France today, in particular as a result of timely therapy for pregnant women, fetuses and newborns. Thus, the French screening and prevention program has been evaluated and recently confirmed despite a decline over time in the incidence of toxoplasmosis. Serological diagnosis of maternal seroconversion is usually simple but can be difficult when the first trimester test shows the presence of IgM, requiring referral to an expert laboratory. Woman with confirmed seroconversion should be referred quickly to an expert center, which will decide with her on treatment and antenatal diagnosis. Although the level of proof is moderate, there is a body of evidence in favor of active prophylactic prenatal treatment started as early as possible (ideally within 3 weeks of seroconversion) to reduce the risk of maternal-fetal transmission, as well as symptoms in children. The recommended therapies to prevent maternal-fetal transmission are: (1) spiramycin in case of maternal infection before 14 gestational weeks; (2) pyrimethamine and sulfadiazine (P-S) with folinic acid in case of maternal infection at 14 WG or more. Amniocentesis is recommended to guide prenatal and neonatal care. If fetal infection is diagnosed by PCR on amniotic fluid, therapy with P-S should be initiated as early as possible or continued in order reduce the risk of damage to the brain or eyes. Further research is required to validate new approaches to preventing congenital toxoplasmosis.
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Affiliation(s)
- L Mandelbrot
- AP-HP hôpital Louis-Mourier service de gynécologie-obstétrique, 178, rue des Renouillers, 92700 Colombes France; Université de Paris, Paris, France; Inserm IAME-U1137, Paris, France; FHU PREMA, Paris, France.
| | - F Kieffer
- FHU PREMA, Paris, France; Assistance Publique-hôpitaux de Paris, hôpital Armand Trousseau, Service de néonatologie, Paris, France
| | - M Wallon
- Hospices Civils de Lyon, hôpital de la Croix-Rousse, service de parasitologie-Mycologie Médicale, Lyon, France; INSERM U1028-CNRS UMR 5292, université Claude-Bernard, université Lyon-1, Bron, France
| | - N Winer
- Centre hospitalier universitaire de Nantes, service de gynécologie-obstétrique, et NUN, INRA, UMR 1280, Phan Université de Nantes, 44000 Nantes, France
| | - J Massardier
- INSERM U1028-CNRS UMR 5292, université Claude-Bernard, université Lyon-1, Bron, France; Hospices civils de Lyon, hôpital de la Croix-Rousse, service de gynécologie-obstétrique, Lyon, France
| | - O Picone
- AP-HP hôpital Louis-Mourier service de gynécologie-obstétrique, 178, rue des Renouillers, 92700 Colombes France; Université de Paris, Paris, France; Inserm IAME-U1137, Paris, France; FHU PREMA, Paris, France
| | - F Fuchs
- Service de gynécologie obstétrique CHU de Montpellier, Hopital Arnaud de Villeneuve, 371, avenue du Doyen Gaston-Giraud, 34295 Montpellier Cedex 5, France; Inserm, CESP Centre de recherche en Epidémiologie et Santé des Populations, U1018, Reproduction et Développement de l'enfant, 94807 Villejuif, France; Institut Desbrest d'epidemiologie et de santé publique, UMR inserm - université de Montpellier, Montpellier, France
| | - G Benoist
- Obstetrics and gynecology, Caen university Hospital, 14000 Caen, France
| | - P Garcia-Meric
- Assistance Publique-hôpitaux de Marseille, service de médecine néonatale, hôpital de la Conception, Marseille, France
| | - C L'Ollivier
- Aix Marseille Université, IRD, AP-HM, SSA, VITROME, IHU Méditerranée Infection, Marseille, France
| | - L Paris
- Assistance Publique-hôpitaux de Paris, hôpital Pitié-Salpêtrière, service de Parasitologie, Paris, France
| | - R Piarroux
- Assistance Publique-hôpitaux de Paris, hôpital Pitié-Salpêtrière, service de Parasitologie, Paris, France; Sorbonne Université, IPLESP UMR 1136, inserm, Paris, France
| | - I Villena
- Service de parasitologie-mycologie, centre national de référence de la toxoplasmose, centre de ressources biologiques toxoplasma, CHU Reims, Reims, France; EA 7510, laboratoire parasitologie-mycologie, université Reims Champagne -Ardenne, Reims, France
| | - F Peyron
- Hospices Civils de Lyon, hôpital de la Croix-Rousse, service de parasitologie-Mycologie Médicale, Lyon, France; INSERM U1028-CNRS UMR 5292, université Claude-Bernard, université Lyon-1, Bron, France
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Banze AR, Homo BP, Mussá TN, Baltazar CS, Boothe MA. Evaluation of prevention of mother-to-child transmission national health information system for HIV/AIDS, in southern region of Mozambique, April to November 2016. Pan Afr Med J 2021; 38:26. [PMID: 33777294 PMCID: PMC7955592 DOI: 10.11604/pamj.2021.38.26.24255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/10/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Mozambique has a generalized HIV epidemic, among pregnant women, HIV prevalence is estimated at 15.8% with a vertical transmission rate of 14%, more than double global targets. We evaluate electronic national health information system (SIS-MA) performance to verify if the data flow procedures met its objectives and evaluated the prevention of mother-to-child transmission (PMTCT) surveillance system to access its attributes and usefulness. Methods we conducted a descriptive, cross-sectional evaluation of the PMTCT surveillance system in eight facilities in Gaza and Inhambane provinces using the centers for disease control and prevention guidelines (2001). For data quality, we cross-referenced patient registries from health facilities against the SIS-MA. We also interviewed 34 health technicians, using a Likert scale, to assess the following attributes of the PMTCT surveillance system: simplicity, stability, flexibility, acceptability, timeliness and data quality, usefulness of the system and knowledge of PMTCT. Results regarding the simplicity measure, we verified that the registry books contain more than 30 variables. The system was 83% flexible in maintaining functionality with the introduction of new health facilities in the system. The completeness of the data was 50% and concordance of data from the register book and monthly reports was 89%. Conclusion the PMTCT SIS-MA is useful in supporting the collection, analysis, interpretation and continuous and systematic dissemination of health data that are used to define and monitor public health policies in Mozambique. However, continued efforts are needed to improve data quality to ensure that the SIS-MA can adequately monitor the PMTCT program and contribute to reduced vertical transmission.
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Affiliation(s)
- Auria Ribeiro Banze
- Mozambique Field Epidemiology and Laboratory Training Program, National Institute of Health, Maputo, Mozambique.,National Institute of Health, Maputo, Mozambique
| | - Benilde Pedro Homo
- Program for the Prevention of Mother to Child Transmission, National Directorate of Public Health, Ministry of Health, Maputo, Mozambique
| | - Tufária Nazimo Mussá
- Department of Microbiology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | | | - Makini Aida Boothe
- Global Health Sciences, University of California, San Francisco, Maputo, Mozambique
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