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HIV-exposed infants

A L Wilkinson, S H Pedersen, M Urassa, D Michael, A Andreasen, J Todd, S M Kinung'hi, J Changalucha, J M McDermid
OBJECTIVES: HIV infection is associated with chronic systemic inflammation, with or without antiretroviral therapy. Consequences for fetal growth are not understood, particularly in settings where multiple maternal infections and malnutrition are common. The study was designed to examine maternal systemic circulating and umbilical cord blood cytokine concentrations in relation to birth anthropometry in a Tanzanian prospective cohort. METHODS: A 9-plex panel of maternal plasma cytokines in HIV-positive (n=44) and HIV-negative (n=70) mothers and the same cytokines in umbilical cord blood collected at delivery was assayed...
October 20, 2016: Tropical Medicine & International Health: TM & IH
Karidia Diallo, Surbhi Modi, Mackenzie Hurlston, Rachel Suzanne Beard, John N Nkengasong
Early diagnosis of HIV infection in infants and children remains a challenge in resource-limited settings, with approximately half of all HIV-exposed infants receiving virological testing for HIV by the recommended age of two months in 2015. In order to reduce morbidity and mortality among HIV-infected children and to close the treatment gap for HIV-infected children, there is an urgent need to evaluate existing programmatic and laboratory practices for early infant diagnosis and introduce strategies to improve identification of HIV-exposed infants and ensure access to systematic, early HIV testing with early linkage to treatment for HIV-infected infants...
October 19, 2016: AIDS Research and Human Retroviruses
Abel Kakuru, Paul Natureeba, Mary K Muhindo, Tamara D Clark, Diane V Havlir, Deborah Cohan, Grant Dorsey, Moses R Kamya, Theodore Ruel
BACKGROUND: HIV-exposed, uninfected (HEU) infants suffer high morbidity and mortality in the first year of life compared to HIV-unexposed, uninfected (HUU) infants, but accurate data on the contribution of malaria are limited. METHODS: The incidence of febrile illnesses and malaria were evaluated in a birth cohort of HEU infants. Infants were prescribed daily trimethoprim-sulfamethoxazole (TS) prophylaxis from 6 weeks of age until exclusion of HIV-infection after cessation of breastfeeding...
October 18, 2016: Malaria Journal
Stanzi M le Roux, Jennifer Jao, Kirsty Brittain, Tamsin K Phillips, Seun Olatunbosun, Agnes Ronan, Allison Zerbe, Elaine J Abrams, Landon Myer
OBJECTIVE: Tenofovir (TDF) affects bone health and is widely used in pregnancy but data are limited on the effects of TDF exposure in utero. We examined the association between duration of in utero TDF exposure and linear growth in HIV-exposed, uninfected (HEU) infants. DESIGN: A prospective cohort of pregnant women initiating TDF-containing regimens at primary care services in Cape Town, South Africa were enrolled and followed with their breastfeeding infants through 12 months postpartum...
October 14, 2016: AIDS
Kristen M Little, Allan W Taylor, Craig B Borkowf, Maria C B Mendoza, Margaret A Lampe, Paul J Weidle, Steven R Nesheim
OBJECTIVE: Using published, nationally representative estimates, we calculated the total number of perinatally HIV-exposed and -infected infants born during 1978-2010, the number of perinatal HIV cases prevented by interventions designed for the prevention of mother-to-child transmission (PMTCT), and the number of infants exposed to antiretroviral drugs during the prenatal and intrapartum periods. DESIGN: We calculated the number of infants exposed to antiretroviral drugs since 1994, and the number of cases of mother-to-child HIV transmission prevented from 1994-2010 using published data...
September 30, 2016: Pediatric Infectious Disease Journal
Jennifer Jao, Rohan Hazra, Claude A Mellins, Robert H Remien, Elaine J Abrams
INTRODUCTION: The tremendous success of antiretroviral therapy has resulted in a diminishing population of perinatally HIV-infected children on the one hand and a mounting number of HIV-exposed uninfected (HEU) children on the other. As the oldest of these HEU children are reaching adolescence, questions have emerged surrounding the implications of HEU status disclosure to these adolescents. This article outlines the arguments for and against disclosure of a child's HEU status. DISCUSSION: Disclosure of a child's HEU status, by definition, requires disclosure of maternal HIV status...
2016: Journal of the International AIDS Society
Bahaa Abu-Raya, Tobias R Kollmann, Arnaud Marchant, Duncan M MacGillivray
Infants born to human immunodeficiency virus (HIV) infected women are HIV-exposed but the majority remains uninfected [i.e., HIV-exposed uninfected (HEU)]. HEU infants suffer greater morbidity and mortality from infections compared to HIV-unexposed (HU) peers. The reason(s) for these worse outcomes are uncertain, but could be related to an altered immune system state. This review comprehensively summarizes the current literature investigating the adaptive and innate immune system of HEU infants. HEU infants have altered cell-mediated immunity, including impaired T-cell maturation with documented hypo- as well as hyper-responsiveness to T-cell activation...
2016: Frontiers in Immunology
K J Alcock, Amina Abubakar, Charles R Newton, Penny Holding
BACKGROUND: HIV infection has been associated with impaired language development in prenatally exposed children. Although most of the burden of HIV occurs in sub-Saharan Africa, there have not been any comprehensive studies of HIV exposure on multiple aspects of language development using instruments appropriate for the population. METHODS: We compared language development in children exposed to HIV in utero to community controls (N = 262, 8-30 months) in rural Kenya, using locally adapted and validated communicative development inventories...
October 12, 2016: BMC Research Notes
Qian Wang, Linhong Wang, Liwen Fang, Ailing Wang, Xi Jin, Fang Wang, Xiaoyan Wang, Yaping Qiao, Sheena G Sullivan, Shannon Rutherford, Lei Zhang
This study investigates the improvement of the prevention of mother-to-child transmission (PMTCT) of Human Immunodeficiency Virus (HIV) in China during 2004-2011. A clinic-based prospective study was conducted among HIV-positive pregnant women and their children in eight counties across China. Associated factors of mother-to-child transmission were analyzed using regression analysis. A total of 1,387 HIV+ pregnant women and 1,377 HIV-exposed infants were enrolled. The proportion of pregnant women who received HIV testing increased significantly from 45...
October 10, 2016: Scientific Reports
Sophie Desmonde, Tessa Goetghebuer, Claire Thorne, Valériane Leroy
PURPOSE OF REVIEW: The number of HIV-exposed but uninfected (HEU) infants exposed to both HIV and multiple antiretroviral drugs in utero and during prolonged breastfeeding is increasing in low-income countries where HIV prevalence is the highest. We review recent evidence on the effects of perinatal/postnatal exposure to maternal HIV and combined antiretroviral therapy (cART) on health outcomes of HEU children (mitochondrial and metabolic toxicity, adverse pregnancy outcomes, neurodevelopment, growth, infectious morbidity, and mortality)...
September 2016: Current Opinion in HIV and AIDS
Ameena E Goga, Thu-Ha Dinh, Debra J Jackson, Carl J Lombard, Adrian Puren, Gayle Sherman, Vundli Ramokolo, Selamawit Woldesenbet, Tanya Doherty, Nobuntu Noveve, Vuyolwethu Magasana, Yagespari Singh, Trisha Ramraj, Sanjana Bhardwaj, Yogan Pillay
BACKGROUND: Eliminating mother-to-child transmission of HIV (EMTCT), defined as ≤50 infant HIV infections per 100 000 live births, is a global priority. Since 2011 policies to prevent mother-to-child transmission of HIV (PMTCT) shifted from maternal antiretroviral (ARV) treatment or prophylaxis contingent on CD4 cell count to lifelong maternal ARV treatment (cART). We sought to measure progress with early (4-8 weeks postpartum) MTCT prevention and elimination, 2011-2013, at national and sub-national levels in South Africa, a high antenatal HIV prevalence setting ( ≈ 29%), where early MTCT was 3...
December 2016: Journal of Global Health
Nikhil Gupte, Aarti Kinikar, Katherine N McIntire, Ramesh Bhosale, Sandesh Patil, Nishi Suryavanshi, Vidya Mave, Vandana Kulkarni, Robert C Bollinger, Amita Gupta
Latest World Health Organization guidelines recommend weight-based nevirapine prophylaxis for all HIV-exposed infants in resource-limited settings, yet low birth weight (LBW) infants (< 2500 g) have been understudied. Using data from the NIH-funded India six-week extended-dose nevirapine (SWEN) study, a randomized clinical trial of SWEN versus single-dose nevirapine (SD) for prevention of breast-milk HIV-1 transmission, we examined the relative impact of SWEN among 737 mother-infant pairs stratified by infant birth weight...
2016: PloS One
Pili Kamenju, Enju Liu, Ellen Hertzmark, Donna Spiegelman, Rodrick Kisenge, Roland Kupka, Said Aboud, Karim P Manji, Christopher Duggan, Wafaie W Fawzi
Complementary feeding is crucial for improving child survival and promoting growth and development, particularly among HIV-exposed children who have higher risk of morbidity and mortality than their un-exposed peers. This prospective study employed an infant and child feeding index (ICFI) to measure complementary feeding and determine its association with nutritional status among 2092 HIV-exposed infants followed from 6 to 24 months of age in Dar es Salaam, Tanzania. The ICFI measured both quality and quantity of complementary feeding, including current breastfeeding status, food consistency, dietary diversity scores (DDS), food group frequency score, and meal frequency...
September 30, 2016: Maternal & Child Nutrition
Kenneth K Mugwanya, Craig W Hendrix, Nelly R Mugo, Mark Marzinke, Elly T Katabira, Kenneth Ngure, Nulu B Semiyaga, Grace John-Stewart, Timothy R Muwonge, Gabriel Muthuri, Andy Stergachis, Connie L Celum, Jared M Baeten
BACKGROUND: As pre-exposure prophylaxis (PrEP) becomes more widely used in heterosexual populations, an important consideration is its safety in infants who are breastfed by women taking PrEP. We investigated whether tenofovir and emtricitabine are excreted into breast milk and then absorbed by the breastfeeding infant in clinically significant concentrations when used as PrEP by lactating women. METHODS AND FINDINGS: We conducted a prospective short-term, open-label study of daily oral emtricitabine-tenofovir disoproxil fumarate PrEP among 50 HIV-uninfected breastfeeding African mother-infant pairs between 1-24 wk postpartum (ClinicalTrials...
September 2016: PLoS Medicine
A L Slogrove, L Frigati, D M Gray
With improved prevention of mother to child transmission of HIV, paediatric HIV disease is less common. However, the number of HIV exposed but uninfected infants is growing. Exposure to maternal HIV impacts infant respiratory health through an increase in known risk factors such as increased preterm birth and low birth weight, suboptimal breastfeeding, increased psychosocial stressors and increased exposure to infective pathogens. Exposure to the HIV virus and altered maternal immune environment result in immunologic changes in the infant that may contribute to respiratory disease risk...
August 19, 2016: Paediatric Respiratory Reviews
Myron J Levin, Jane C Lindsey, Susan S Kaplan, Werner Schimana, Jody Lawrence, Monica M McNeal, Mutsa Bwakura-Dangarembizi, Anthony Ogwu, Evans M Mpabalwani, Paul Sato, George Siberry, Margaret Nelson, Darcy Hille, Geoffrey A Weinberg, Adriana Weinberg
OBJECTIVE: Although many HIV-infected (HIV+) and HIV-exposed but uninfected (HEU) infants have received live rotavirus vaccines since the World Health Organization recommended universal administration of these vaccines to infants, there has been limited prospective information on their safety and immunogenicity in either group of infants. DESIGN/METHODS: We performed a randomized, double-blinded, placebo-controlled trial of the safety and immunogenicity of oral pentavalent rotavirus vaccine (RV5) administered to HIV+ and HEU infants in 4 African countries...
September 20, 2016: AIDS
Zemene Tigabu Kebede, Belaynew Wasie Taye
INTRODUCTION: Numerous challenges exist in provision of prevention of mother-to-child transmission of HIV (PMTCT) such as linking HIV exposed infants (HEI) and their mothers to chronic cares services, and tackling loss to follow up. Limited evidence exists in Ethiopian setting that explains the persisting high HIV infection rate among HEIs and extent of linkage to chronic care. The study assessed the proportion of HIV infection; children linked to chronic care and determinants of HIV infection among HEI in Northern Ethiopia...
2016: Pan African Medical Journal
Emily R Smith, Michael Hudgens, Anna D Sheahan, William C Miller, Stephanie Wheeler, Julie A E Nelson, Queen Dube, Annelies Van Rie
Introduction Rapid HIV serological tests are a cost-effective, point-of-care test among HIV exposed infants but cannot distinguish between maternal and infant antibodies. The lack of data on the timing of decay of maternal antibodies in young infants hinders the potential use of rapid tests in exposed infants. We aimed to determine the time to seroreversion for two commonly used rapid tests in a prospective cohort of HIV-exposed breastfeeding infants ages 3-18 months of life. Methods We collected data on the performance of two commonly used rapid tests (Determine and Unigold) in Malawi between 2008 and 2012 or at the University of North Carolina between 2014 and 2015...
September 8, 2016: Maternal and Child Health Journal
Bahaa Abu-Raya, Kinga K Smolen, Fabienne Willems, Tobias R Kollmann, Arnaud Marchant
The transfer of maternal immune factors to the newborn is critical for protection from infectious disease in early life. Maternally acquired passive immunity provides protection until the infant is beyond early life's increased susceptibility to severe infections or until active immunity is achieved following infant's primary immunization. However, as reviewed here, human immunodeficiency virus (HIV) infection alters the transfer of immune factors from HIV-infected mothers to the HIV-exposed newborns and young infants...
2016: Frontiers in Immunology
Maria Franca Pirillo, Giuseppe Liotta, Mauro Andreotti, Haswel Jere, Jean-Baptiste Sagno, Paola Scarcella, Sandro Mancinelli, Ersilia Buonomo, Roberta Amici, Maria Cristina Marazzi, Stefano Vella, Leonardo Palombi, Marina Giuliano
Antiretroviral therapy has been shown to reduce rates of congenital CMV infection. Little information is available on the possible impact of antiretroviral therapy on postnatal breastfeeding-associated CMV infection acquisition. A cohort of 89 HIV-infected mothers and their children was studied. Women received antiretroviral therapy from week 25 of gestation until 6 months postpartum or indefinitely if meeting the criteria for treatment. All women were evaluated for CMV IgG presence and CMV DNA in breast milk...
September 15, 2016: Medical Microbiology and Immunology
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