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Hiv in pregnancy

Stevenson K Chea, Tabitha W Mwangi, Kennedy K Ndirangu, Osman A Abdullahi, Patrick K Munywoki, Amina Abubakar, Amin S Hassan
BACKGROUND: Home delivery, referring to pregnant women giving birth in the absence of a skilled birth attendant, is a significant contributor to maternal mortality, and is encouragingly reported to be on a decline in the general population in resource limited settings. However, much less is known about home delivery amongst HIV-infected women in sub-Saharan Africa (sSA). We described the prevalence and correlates of home delivery among HIV-infected women attending care at a rural public health facility in Kilifi, Coastal Kenya...
2018: PloS One
Rachel Sullivan Robinson, Michael Kunnuji, Yusra Ribhi Shawar, Jeremy Shiffman
Mississippi and Nigeria are two socially conservative places unlikely to prioritise sexuality education. Nonetheless, Mississippi passed a bill in 2011 mandating all school districts to offer sexuality education, and Nigeria approved a national sexuality education curriculum in 2001. To identify the factors that drove the process of prioritisation of sexuality education in each context, we conducted more than 70 semi-structured interviews with nongovernmental organisations/nonprofits, donor organisations and federal and state ministries involved in the prioritisation and implementation of sexuality education in Mississippi and Nigeria...
March 20, 2018: Global Public Health
Charbel El Bcheraoui, Paola Zúñiga-Brenes, Diego Ríos-Zertuche, Erin B Palmisano, Claire R McNellan, Sima S Desai, Marielle C Gagnier, Annie Haakenstad, Casey Johanns, Alexandra Schaefer, Bernardo Hernandez, Emma Iriarte, Ali H Mokdad
BACKGROUND: To propose health system strategies to meeting the World Health Organization (WHO) recommendations on HIV screening through antenatal care (ANC) services, we assessed predictors of HIV screening, and simulated the impact of changes in these predictors on the probability of HIV screening in Guatemala, Honduras, Mexico (State of Chiapas), Nicaragua, Panama, and El Salvador. METHODS: We interviewed a representative sample of women of reproductive age from the poorest Mesoamerican areas on ANC services, including HIV screening...
March 20, 2018: Population Health Metrics
Alinane L Nyondo-Mipando, Angela F Chimwaza, Adamson S Muula
BACKGROUND: The perception of male involvement (MI) in maternal child health services is multifaceted and differs among varying programs and populations. In the Prevention of Mother to Child Transmission (PMTCT) context, MI includes men's attendance at antenatal care (ANC) clinics, undertaking an HIV tests within the ANC and financial and psychological support. Contexualising the definition of MI is fundamental in the development of MI in PMTCT policy and interventions. The objective of this study was to explore the perceptions of men, women and health care workers on male partner involvement in PMTCT services in Malawi...
March 20, 2018: BMC Health Services Research
Rada M Savic, Prasanna Jagannathan, Richard Kajubi, Liusheng Huang, Nan Zhang, Moses Were, Abel Kakuru, Mary K Muhindo, Norah Mwebaza, Erika Wallender, Tamara D Clark, Bishop Opira, Moses Kamya, Diane V Havlir, Philip J Rosenthal, Grant Dorsey, Francesca T Aweeka
Background: Dihydroartemsinin-piperaquine is highly efficacious as intermittent preventive therapy for malaria during pregnancy (IPTp). Determining associations between piperaquine exposure, malaria risk, and adverse birth outcomes informs optimal dosing strategies. Methods: HIV-uninfected pregnant women were enrolled in a placebo-controlled trial of IPTp at 12-20 weeks gestation and randomized to: sulfadoxine-pyrimethamine every 8 weeks (n=106), dihydroartemsinin-piperaquine every 8 weeks (n=94), or dihydroartemsinin-piperaquine every 4 weeks (n=100) during pregnancy...
March 14, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Sumona Chaudhury, Gloria K Mayondi, Paige L Williams, Jean Leidner, Roger Shapiro, Modiegi Diseko, Gbolahan Ajibola, Penny Holding, Vicki Tepper, Joseph Makhema, Chipo Petlo, George R Seage, Shahin Lockman, Betsy Kammerer
OBJECTIVE: Conflicting data exist regarding the impact of in utero exposure to maternal combination antiretrovirals. We compared neurodevelopmental outcomes between HIV-exposed/uninfected (HEU) children exposed in utero to 3-drug combination antiretroviral therapy (ART) versus zidovudine (ZDV) monotherapy. DESIGN: Prospective study of child neurodevelopment, nested within two cohorts of HIV-infected mothers and their children in Botswana (one observational, one interventional)...
March 15, 2018: AIDS
Matthew Quaife, Fern Terris-Prestholt, Robyn Eakle, Maria A Cabrera Escobar, Maggie Kilbourne-Brook, Mercy Mvundura, Gesine Meyer-Rath, Sinead Delany-Moretlwe, Peter Vickerman
INTRODUCTION: A number of antiretroviral HIV prevention products are efficacious in preventing HIV infection. However, the sexual and reproductive health needs of many women extend beyond HIV prevention, and research is ongoing to develop multi-purpose prevention technologies (MPTs) that offer dual HIV and pregnancy protection. We do not yet know if these products will be an efficient use of constrained health resources. In this paper, we estimate the cost-effectiveness of combinations of candidate multi-purpose prevention technologies (MPTs), in South Africa among general population women and female sex workers (FSWs)...
March 2018: Journal of the International AIDS Society
Stephanie A Grilo, Marina Catallozzi, Craig J Heck, Sanyukta Mathur, Neema Nakyanjo, John S Santelli
Understanding how couples perceive a recent unintended pregnancy in the context of HIV infection and high levels of gender inequality may provide insights for prevention of undesired pregnancy. We used data from 24 in-depth interviews with 8 HIV-serodiscordant and 4 seroconcordant couples living in rural Uganda and interviewed separately; between 15 and 49 years and one or both identified the pregnancy as unintended. A dyadic analysis was performed to understand each partner's perspectives on experiences of a specific pregnancy...
March 14, 2018: Global Public Health
Wolfgang Miehsler, Clemens Dejaco, Hans-Peter Gröchenig, Harry Fuchssteiner, Christoph Högenauer, Lili Kazemi-Shirazi, Harald Maier, Andreas Mayer, Alexander Moschen, Walter Reinisch, Wolfgang Petritsch, Reingard Platzer, Pius Steiner, Herbert Tilg, Harald Vogelsang, Heimo Wenzl, Gottfried Novacek
Anti-TNFα-antibodies have revolutionized the therapy of inflammatory bowel diseases and other immune-mediated inflammatory diseases. Due to the increasing application of these substances, the Working Group of Inflammatory Bowel Diseases of the Austrian Association of Gastroenterology and Hepatology intended to update their consensus report on the safe use of Infliximab (published in 2010) and to enlarge its scope to cover all anti-TNFα-antibodies. The present consensus report summarizes the current evidence on the safe use of anti-TNFα-antibodies and covers the following topics: general risk of infection, bacterial infections (i...
March 2018: Zeitschrift Für Gastroenterologie
Ahizechukwu C Eke, Nahida Chakhtoura, Angela Kashuba, Brookie M Best, Craig Sykes, Jiajia Wang, Alice M Stek, Elizabeth Smith, Samantha Calabrese, Edmund V Capparelli, Mark Mirochnick
BACKGROUND: Concentrations of antiretrovirals (ARVs) in the genital tract play a key role in pre-exposure prophylaxis. This study aims to describe rilpivirine (Edurant) concentrations in the genital tract in pregnant and postpartum women. METHODS: International Maternal Pediatric Adolescent AIDS Clinical Trials Protocol P1026s is an ongoing, prospective study of antiretroviral pharmacokinetics (PK) in HIV infected pregnant women that include a cohort receiving rilpivirine combination regimen...
March 8, 2018: Journal of Acquired Immune Deficiency Syndromes: JAIDS
Kristina Adachi, Jiahong Xu, Bonnie Ank, D Heather Watts, Margaret Camarca, Lynne M Mofenson, Jose Henrique Pilotto, Esau Joao, Glenda Gray, Gerhard Theron, Breno Santos, Rosana Fonseca, Regis Kreitchmann, Jorge Pinto, Marisa M Mussi-Pinhata, Daisy Maria Machado, Mariana Ceriotto, Mariza G Morgado, Yvonne J Bryson, Valdilea G Veloso, Beatriz Grinsztejn, Mark Mirochnick, Jack Moye, Karin Nielsen-Saines
BACKGROUND: Congenital cytomegalovirus (CMV) infection (cCMV) is an important cause of hearing loss and cognitive impairment. Prior studies suggest that HIV-exposed children are at higher risk of acquiring cCMV. We assessed the presence, magnitude, and risk factors associated with cCMV among infants born to HIV-infected women, who were not receiving antiretrovirals during pregnancy. METHODS: cCMV and urinary CMV load were determined in a cohort of infants born to HIV-infected women not receiving antiretrovirals during pregnancy...
March 9, 2018: Pediatric Infectious Disease Journal
L Carey, C Desouza, A Moorcroft, A Elgalib
The aim of this study was to describe the obstetrical and virological outcomes in HIV-infected pregnant women who delivered at a district general hospital in south London in the period from 2008 to 2014. Our review identified 137 pregnancies; most (60%, 63/105) of them were unplanned. The commonest mode of delivery was spontaneous vaginal delivery (SVD) (42%, 48/114) followed by emergency Caesarean section (32%, 36/114). Gestational age at delivery was ≥37 weeks in most (84%, 91/106) of the cases. Maternal HIV VL at or closest to delivery was undetectable (<40 copies/mL), <400 copies/mL and >1000 copies/mL in 73% (94/129), 90% (116/129) and 6% (8/129) of the pregnancies, respectively...
March 12, 2018: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
Javon Prophet, Kalifa Kelly, Julian Domingo, Helen Ayeni, Xaviera Pascale Djoko Mekouguem, Breana Dockery, Farida Allam, Manvir Kaur, Javon Artis, Kiara K Spooner, Jason L Salemi, Omonike A Olaleye, Hamisu M Salihu
OBJECTIVE: The relationship between sickle cell disease (SCD) and severe pre-eclampsia is poorly established. It is also unknown whether the occurrence of HIV infection among women with SCD modifies their risk level for severe pre-eclampsia. We hypothesized that pregnant women with SCD are at an elevated risk for severe pre-eclampsia as a result of heightened endothelial damage; and the combination of SCD-HIV augments the inflammatory processes of endothelial damage leading to amplified risk for severe pre-eclampsia...
January 2018: Pregnancy Hypertension
Karl Krupp, Caitlyn D Placek, Meredith Wilcox, Kavitha Ravi, Vijaya Srinivas, Anjali Arun, Purnima Madhivanan
OBJECTIVE: According to the World Health Organization, about half of all pregnant women in India suffer from some form of anemia. While poor nutrition is the most common cause, social factors, such as gender and religion, also impact anemia status. This study investigates the relationship between anemia and socioeconomic and health-related factors among pregnant women in Mysore, India. DESIGN: Prospective cohort study conducted between January 2009 and 2012 SETTING: 144 rural villages ten or more kilometers outside of Mysore City received integrated antenatal care and HIV testing services provided by mobile medical clinic in their communities...
February 20, 2018: Midwifery
Stein Schalkwijk, Rob Ter Heine, Angela C Colbers, Alwin D R Huitema, Paolo Denti, Kelly E Dooley, Edmund Capparelli, Brookie M Best, Tim R Cressey, Rick Greupink, Frans G M Russel, Mark Mirochnick, David M Burger
BACKGROUND: Reducing the dose of efavirenz can improve safety, reduce costs, and increase access for patients with HIV infection. According to the World Health Organization, a similar dosing strategy for all patient populations is desirable for universal roll-out; however, it remains unknown whether the 400 mg daily dose is adequate during pregnancy. METHODS: We developed a mechanistic population pharmacokinetic model using pooled data from women included in seven studies (1968 samples, 774 collected during pregnancy)...
March 8, 2018: Clinical Pharmacokinetics
Kerry A Thomson, James Hughes, Jared M Baeten, Grace John-Stewart, Connie Celum, Craig R Cohen, Kenneth Ngure, James Kiarie, Nelly Mugo, Renee Heffron
Background: Understanding the absolute and relative risk of HIV-1 acquisition during pregnancy and postpartum can inform HIV-1 prevention strategies for women. Methods: We used a complementary log-log model and data from 2,751 HIV-1 serodiscordant couples to compare the probability of women's HIV-1 acquisition risk per sex act during early pregnancy, late pregnancy, postpartum, and non-pregnant periods. Results: At total of 686 pregnancies were identified and 82 incident HIV-1 infections occurred...
March 5, 2018: Journal of Infectious Diseases
Aletheia Soares Sampaio, Ana Lucia Ribeiro de Vasconcelos, Clarice Neuenschwander Lins de Morais, George Tadeu Nunes Diniz, Anna Lígia de Castro Figueiredo, Sílvia Maria Lucena Montenegro
INTRODUCTION: The functioning of the immune system during pregnancy is altered in both human immunodeficiency virus (HIV)-infected and uninfected women. Unfavorable socioeconomic conditions have been indicative of higher morbidity and mortality and worsening of the immune system. The aim of this study was to correlate social status with levels of interleukin (IL)-10 (non-inflammatory) and interferon-gamma (IFN-γ; inflammatory) cytokines. METHODS: A cross-sectional study was conducted with three groups of women: 33 pregnant HIV-infected (G1); 40 non-pregnant, HIV-infected (G2); and 35 pregnant, HIV-uninfected...
January 2018: Revista da Sociedade Brasileira de Medicina Tropical
Dvora Joseph Davey, Elise Farley, Yolanda Gomba, Thomas Coates, Landon Myer
BACKGROUND: HIV acquisition in pregnancy and breastfeeding contributes significantly toward pediatric HIV infection. However, little is known about how sexual behavior changes during pregnancy and postpartum periods which will help develop targeted HIV prevention and transmission interventions, including pre-exposure prophylaxis (PrEP). METHODS: Cross-sectional study in HIV-infected and uninfected pregnant and postpartum women in Cape Town, South Africa. Interviewers collected survey data on demographic, sexual behaviors, and alcohol use among pregnant and post-partum women...
2018: PloS One
Martin Marufu Gazimbi, Monica Akinyi Magadi
This study contributes to the dialogue on the prevention of mother-to-child HIV transmission (PMTCT) through the use of HIV and antenatal care (ANC) integrated services. The determinants of antenatal HIV testing in Zimbabwe were explored. Multilevel logistic regression models were applied to data for 8471 women from 406 clusters who gave birth in the 5 years preceding Zimbabwe Demographic and Health Surveys conducted in 2005/6 and 2010/11. The uptake of antenatal HIV testing was found to be determined by a wide range of individual-level factors relating to women's economic and demographic status, as well as HIV-related factors, including HIV awareness and stigma within the community...
March 6, 2018: Journal of Biosocial Science
Anneli Uusküla, Mait Raag, Sigrid Vorobjov, Don Des Jarlais
BACKGROUND: Despite increasing contraceptive availability, unintended pregnancy remains a global problem. Developing strategies to reverse this trend and increasing occurrence of withdrawal syndrome among newborn children of females currently injecting drugs warrants special attention. The knowledge base on the uptake of effective contraception among females who inject drugs (FWID) is scant. We aimed to examine the prevalence of and factors associated with the use of non-condom contraceptives among sexually active FWID with the focus on effective contraception...
March 5, 2018: Harm Reduction Journal
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