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Perinatal prevent HIV transmission

Karl Peltzer, Sibusiso Sifunda, Lissa N Mandell, Violeta J Rodriguez, Tae Kyoung Lee, Ryan Cook, Stephen M Weiss, Deborah L Jones
Introduction: This study aimed to assess fertility intentions (planning to have more children in the future) and associated factors among pregnant and postpartum HIV positive women in rural South Africa. Methods: In a longitudinal study, as part of a prevention of mother to child transmission (PMTCT) intervention trial, 699 HIV positive prenatal women, were systematically recruited and followed up at 6 months and 12 months postpartum (retention rate = 59.5%). Results: At baseline, 32...
2018: HIV/AIDS: Research and Palliative Care
Bernadette N Ng'eno, Timothy A Kellogg, Andrea A Kim, Anne Mwangi, Mary Mwangi, Joyce Wamicwe, George W Rutherford
Understanding how HIV is acquired can inform interventions to prevent infection. We constructed a risk profile of 10-24 year olds participating in the 2012 Kenya AIDS Indicator Survey and classified them as perinatally infected if their biological mother was infected with HIV or had died, or if their father was infected with HIV or had died (for those lacking mother's data). The remaining were classified as sexually infected if they had sex, and the remaining as parenterally infected if they had a blood transfusion...
January 1, 2018: International Journal of STD & AIDS
Pamela Musoke, Abigail Hatcher, Anna Joy Rogers, Lillian Achiro, Elizabeth Bukusi, Lynae Darbes, Zachary Kwena, Patrick Oyaro, Elly Weke, Janet M Turan
Male involvement in antenatal care has been shown to improve health outcomes for women and infants. However, little is known about how best to encourage male partners to support essential perinatal health activities. We explored men's perceptions of facilitators and barriers to involvement in antenatal care and HIV prevention including fears, hopes and challenges. Forty in-depth interviews were conducted with the male partners of HIV-positive and HIV-negative pregnant women in southwest Kenya. Most male partners believed engaging in pregnancy health-related activities was beneficial for keeping families healthy...
February 21, 2018: Culture, Health & Sexuality
Lisa Hamzah, Elizabeth Hamlyn
PURPOSE OF REVIEW: This review aims to summarize data in the last 18 months on the sexual and reproductive health of perinatally and horizontally infected adolescents and young people living with HIV (age 13-25 years) and to highlight some key issues faced by this group of adolescents as they reach puberty and sexual debut. RECENT FINDINGS: Adolescents and young people living with HIV are a growing cohort worldwide and a significant proportion engage in high-risk sexual activity, pose risk of onward HIV transmission, yet have poor access to sexual and reproductive health (SRH) services and lack the knowledge and support to advocate for their needs...
February 15, 2018: Current Opinion in HIV and AIDS
Lynn M Yee, Donna V McGregor, Sarah H Sutton, Patricia M Garcia, Emily S Miller
OBJECTIVE: To determine whether maternal disclosure of HIV serostatus is associated with uptake of perinatal HIV transmission prevention interventions. STUDY DESIGN: Retrospective cohort study of women living with HIV enrolled in a perinatal HIV clinic. Women who disclosed their HIV serostatus to sexual partner(s) prior to delivery were compared to non-disclosers. Multivariable logistic regression was performed. RESULTS: Of 209 women, 71.3% (N = 149) disclosed...
February 12, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
Rachel Kidman, Sharon Nachman, Janan Dietrich, Afaaf Liberty, Avy Violari
Repeated exposure to childhood adversity (abuse, neglect and other traumas experienced before age 18) can have lifelong impacts on health. For HIV-infected adolescents and youth, such impacts may include onward transmission of HIV. To evaluate this possibility, the current study measured the burden of childhood adversity and its influence on risky health behaviors among perinatally-infected adolescents and youth. We surveyed 250 perinatally-infected adolescents and youth (13-24 years) receiving care in Soweto, South Africa...
February 8, 2018: Child Abuse & Neglect
Amira Noori Baker, Angela Marie Bayer, Lenka Kolevic, Lizzete Najarro, Rolando Mario Viani, Jaime Gerardo Deville
BACKGROUND: Despite recommendations for disclosure of HIV status to children living with HIV (CLHIV), fewer than half of CLHIV at the Instituto Nacional de Salud del Niño (INSN) in Lima, Peru, have had disclosure. How and when the disclosure process for CLHIV should take place in Peru has not been studied. METHODS: We conducted a qualitative study at INSN to explore perceptions and experiences of 6 health care providers (HCPs), 14 disclosed and nondisclosed CLHIV (8-17 years), and their 14 caregivers regarding knowledge of illness, disclosure of HIV status, and appropriate disclosure approaches...
January 2018: Journal of the International Association of Providers of AIDS Care
Olayemi Osiyemi, Salih Yasin, Carmen Zorrilla, Ceyhun Bicer, Vera Hillewaert, Kimberley Brown, Herta M Crauwels
INTRODUCTION: Physiologic changes during pregnancy may impact the pharmacokinetics of drugs. In addition, efficacy and safety/tolerability concerns have been identified for some antiretroviral agents. METHODS: Human immunodeficiency virus (HIV)-1-infected pregnant women (18-26 weeks gestation) receiving the non-nucleoside reverse transcriptase inhibitor rilpivirine 25 mg once daily were enrolled in this phase 3b, open-label study examining the impact of pregnancy on the pharmacokinetics of rilpivirine when it is given in combination with other antiretroviral agents...
January 15, 2018: Infectious Diseases and Therapy
Mary G Fowler, Patricia Flynn, Jim Aizire
PURPOSE OF REVIEW: The purpose of this review is to describe recent clinical trial, laboratory and observational findings that highlight both the progress that can be achieved in elimination of new pediatric infections in international clinical trial settings among HIV-infected breastfeeding women while also describing recent safety concerns related to currently used antiretroviral regimens. The article will also address the ongoing adherence challenges for HIV-infected mothers in taking their antiretroviral drugs...
February 2018: Current Opinion in Pediatrics
Tara E Ness, Mary F Annese, Natalia Martinez-Paz, Kenton T Unruh, John D Scott, Brian R Wood
Mountain West AETC (AIDS Education and Training Center) ECHO (Extension for Community Healthcare Outcomes), a longitudinal HIV telemen-toring program, connects community providers and a multidisciplinary specialist team at the University of Washington. The program employs focused lectures and real-time case discussions to educate and support providers in low-resource and rural settings. We assessed the impact of the program on management of perinatal HIV through surveying community providers who participate, and reviewing cases presented by providers for consultation...
December 2017: AIDS Education and Prevention: Official Publication of the International Society for AIDS Education
Anna J Rogers, Eliud Akama, Elly Weke, Justin Blackburn, George Owino, Elizabeth A Bukusi, Patrick Oyaro, Zachary A Kwena, Craig R Cohen, Janet M Turan
INTRODUCTION: Repeat HIV testing during the late antenatal period is crucial to identify and initiate treatment for pregnant women with incident HIV infection to prevent perinatal HIV transmission and keep mothers alive. In 2012, the Kenya Ministry of Health adopted international guidelines suggesting that pregnant women be offered retesting three months after an initial negative HIV test. Our objectives were to determine the current rate of antenatal repeat HIV testing; identify successes, missed opportunities and factors associated with retesting; and estimate the incidence of HIV during pregnancy...
December 2017: Journal of the International AIDS Society
Amira N Baker, Angela M Bayer, Rolando M Viani, Lenka Kolevic, Myung-Shin Sim, Jaime G Deville
BACKGROUND: Data on pediatric HIV in Peru is limited. The National Institute of Child Health (Instituto Nacional de Salud del Niño: INSN) cares for the most HIV-infected children under age 18 in the country. We describe the outcomes of children seen at INSN's HIV clinic over the 10 years when antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT) interventions became available in 2004. METHODS: We conducted a retrospective review of INSN HIV clinic patients between 2003-2012...
December 8, 2017: Pediatric Infectious Disease Journal
Gertrude Mwalabu, Catrin Evans, Sarah Redsell
BACKGROUND: Young people living with perinatally-acquired HIV require age-appropriate support regarding sex and relationships as they progress towards adulthood. HIV affects both genders but evidence suggests that young women are particularly vulnerable to sexual abuse and more prone to engaging in sexual behaviours to meet their daily survival needs. This can result in poor sexual and reproductive health (SRH) outcomes. HIV services in Malawi provide support for young women's HIV-related clinical needs, but it is unclear whether there is sufficient provision for their SRH needs as they become adults...
December 8, 2017: BMC Women's Health
S Karbanova, L Cerveny, M Ceckova, Z Ptackova, L Jiraskova, S Greenwood, F Staud
INTRODUCTION: Zidovudine (AZT) and emtricitabine (FTC) are effective and well tolerated antiretroviral drugs, routinely used in the prevention of perinatal HIV transmission. However, precise mechanism(s) involved in their transfer from mother to fetus are not fully elucidated. Since both drugs are nucleoside analogues, we hypothesized that the mechanisms of their transplacental passage might include equilibrative nucleoside transporters, ENT1 and/or ENT2. METHODS: To address this issue, we performed in vitro accumulation assays in the BeWo placental trophoblast cell line, ex vivo uptake studies in fresh villous fragments isolated from human placenta and in situ dually perfused rat term placenta experiments...
December 2017: Placenta
Rachel Kidman, Avy Violari
BACKGROUND: As perinatal HIV-infected youth become sexually active, the potential for onward transmission becomes an increasing concern. In other populations, intimate partner violence (IPV) is a risk factor for HIV acquisition. We build on this critical work by studying the role of IPV in facilitating onward transmission among HIV-infected youth-an important step toward effective intervention. SETTING: Soweto, South Africa. METHODS: Self-report surveys were completed by 129 perinatal HIV-infected female youth (aged 13-24 years)...
January 1, 2018: Journal of Acquired Immune Deficiency Syndromes: JAIDS
Diana F Clarke, Martina Penazzato, Edmund Capparelli, Tim R Cressey, George Siberry, Nandita Sugandhi, Mark Mirochnick
Antiretroviral drugs are used in neonates for prevention and treatment of HIV infection. Use of antiretrovirals to prevent perinatal HIV transmission is well established. Early identification of neonates infected with HIV and rapid initiation of combination antiretroviral treatment during the neonatal period is now recommended by WHO and DHHS. However, few antiretrovirals are available in formulations suitable for neonates and there are limited safety and pharmacokinetic data for most antiretrovirals in neonates...
October 17, 2017: Expert Review of Clinical Pharmacology
Mubiana Inambao, William Kilembe, Lauren A Canary, Nancy L Czaicki, Matilda Kakungu-Simpungwe, Roy Chavuma, Kristin M Wall, Amanda Tichacek, Julie Pulerwitz, Ibou Thior, Elwyn Chomba, Susan A Allen
INTRODUCTION: Most HIV infections in Africa are acquired by married/cohabiting adults and WHO recommends couple's voluntary HIV counseling and testing (CVCT) for prevention. The handover from NGO-sponsored weekend CVCT to government-sponsored services in routine weekday antenatal care (ANC) and individual voluntary testing and counseling (VCT) services in Zambia's two largest cities from 2009-2015 is described. METHODS: Government clinic counselors were trained to provide CVCT, and along with community health workers they promoted CVCT services in their clinic and surrounding areas...
2017: PloS One
Andrew Mujugira, Jared Baeten, Lara Kidoguchi, Jessica Haberer, Connie Celum, Deborah Donnell, Kenneth Ngure, Elizabeth Bukusi, Nelly Mugo, Stephen Asiimwe, Josephine Odoyo, Edna Tindimwebwa, Nulu Bulya, Elly Katabira, Renee Heffron
BACKGROUND: People who are asymptomatic and feel healthy, including pregnant women, may be less motivated to initiate ART or achieve high adherence. We assessed whether ART initiation, and viral suppression 6, 12 and 24-months after ART initiation, were lower in HIV-infected members of serodiscordant couples who initiated during pregnancy or with higher CD4 counts. METHODS: We used data from the Partners Demonstration Project, an open-label study of the delivery of integrated PrEP and ART (at any CD4 count) for HIV prevention among high-risk HIV serodiscordant couples in Kenya and Uganda...
September 13, 2017: AIDS Research and Human Retroviruses
Rena C Patel, Elizabeth A Bukusi, Jared M Baeten
Among women living with HIV, half of the pregnancies are unintended. Effective contraception can prevent unintended pregnancies and consequently reduce maternal mortality and perinatal transmission of HIV. While contraceptive options available for all women also apply to women living with HIV, specific considerations exist to the use of contraception by women living with HIV. Areas covered: First, general principles guiding the use of contraception among women living with HIV are discussed, such as choice, method mix, relative effectiveness, and drug-drug interactions...
January 2018: Expert Opinion on Pharmacotherapy
Luis M Prieto, Carolina Fernández McPhee, Patricia Rojas, Diana Mazariegos, Eloy Muñoz, Maria José Mellado, África Holguín, María Luisa Navarro, María Isabel González-Tomé, José Tomás Ramos
BACKGROUND: An increasing number of perinatally HIV-infected women (PHIV) are reaching adulthood and becoming pregnant. Most PHIV women have been exposed to a high number of antiretroviral regimens, and they may have difficulties to achieve viral suppression. Psychosocial problems are not uncommon and could be an important barrier for treatment adherence. The effects of chronic HIV infection and long-term exposure to antiretroviral treatment of PHIV women cause concerns on the developing fetus...
2017: PloS One
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