Use of Antiretroviral Therapy in Children and Pregnant Women

Abstract Background SARS-CoV-2 binding receptor ACE2 and the spike protein priming protease TMPRSS2 are co-expressed in human placentae. It is unknown whether their expression is altered in the context of HIV infection and antiretroviral therapy (ART). Methods We compared mRNA levels of SARS-CoV-2 cell-entry mediators ACE2, TMPRSS2 and L-SIGN (an alternative entry receptor) by qPCR in 105 placentae: 45 from pregnant women with HIV (WHIV) exposed to protease inhibitor (PI)-based ART, 17 from WHIV on non-PI-based ART, and 43 from HIV-uninfected women. Results ACE2 levels were lower, while L-SIGN levels were higher in placentae from WHIV on PI-based ART as compared to those on non-PI-based ART and to HIV-uninfected women. TMPRSS2 levels were similar between groups. Black race was significantly associated with lower expression of ACE2 and higher expression of L-SIGN. ACE2 levels were significantly higher in placentae of female fetuses. Discussion We have identified pregnant women of Black race and WHIV who are on PI-based ART to have relatively lower expression of placental ACE2 than those of White race and HIV-uninfected women. This effect may potentially contribute to altered susceptibility to COVID-19 in these women, either favorably; by reduced viral entry, or detrimentally; by loss of ACE2 protection against hyperinflammation.

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231 The effect of antiretroviral therapy regimens on gestational weight gain in pregnant women with HIV

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2020.12.253 ◽

2021 ◽

Vol 224 (2) ◽

pp. S152-S153

Author(s):

Naima T. Joseph ◽

Glen Satten ◽

Rachel Williams ◽

Martina Badell ◽

Anandi Sheth

Keyword(s):

Weight Gain ◽

Antiretroviral Therapy ◽

Pregnant Women ◽

Gestational Weight Gain ◽

Gestational Weight ◽

Women With Hiv

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Social Vulnerability among Foreign-Born Pregnant Women and Maternal Virologic Control of HIV

American Journal of Perinatology ◽

10.1055/s-0040-1721714 ◽

2020 ◽

Author(s):

Ashish Premkumar ◽

Lynn M. Yee ◽

Lia Benes ◽

Emily S. Miller

Keyword(s):

Antiretroviral Therapy ◽

Pregnant Women ◽

Median Time ◽

Social Vulnerability ◽

Viral Suppression ◽

Foreign Born ◽

Women Living With Hiv ◽

Virologic Control ◽

Clinical Records ◽

Living With Hiv

Objective The aim of this study was to assess whether social vulnerability among foreign-born pregnant women living with HIV is associated with maternal viremia during pregnancy. Study Design This retrospective cohort study included all foreign-born pregnant women living with HIV who received prenatal care in a multidisciplinary prenatal clinic between 2009 and 2018. A licensed clinical social worker evaluated all women and kept detailed clinical records on immigration status and social support. Social vulnerability was defined as both living in the United States for less than 5 years and reporting no family or friends for support. The primary outcome was evidence of viral non-suppression after achievement of initial suppression. Secondary outcomes were the proportion of women who required > 12 weeks after starting antiretroviral therapy to achieve viral suppression, median time to first viral suppression (in weeks) after initiation of antiretroviral therapy, and the proportion who missed ≥ 5 doses of antiretroviral therapy. Bivariable analyses were performed. Results A total of 111 foreign-born women were eligible for analysis, of whom 25 (23%) were classified as socially vulnerable. Social and clinical characteristics of women diverged by social vulnerability categorization but no differences reached statistical significance. On bivariable analysis, socially-vulnerable women were at increased risk for needing > 12 weeks to achieve viral suppression (relative risk: 1.78, 95% confidence interval: 1.18–2.67), though there was no association with missing ≥ 5 doses of antiretroviral therapy or median time to viral suppression after initiation of antiretroviral therapy. Conclusion Among foreign-born, pregnant women living with HIV, markers of virologic control during pregnancy were noted to be worse among socially-vulnerable women. Insofar as maternal viremia is the predominant driver of perinatal transmission, closer clinical surveillance and support may be indicated in this population. Key Points

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Increased risk of hepatotoxicity in HIV-infected pregnant women receiving antiretroviral therapy independent of nevirapine exposure

AIDS ◽

10.1097/qad.0b013e32832e34b1 ◽

2009 ◽

Vol 23 (18) ◽

pp. 2425-2430 ◽

Cited By ~ 30

Author(s):

David W Ouyang ◽

David E Shapiro ◽

Ming Lu ◽

Susan B Brogly ◽

Audrey L French ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Pregnant Women ◽

Increased Risk

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Treating pregnant women with highly active antiretroviral therapy

Future HIV Therapy ◽

10.2217/17469600.1.2.215 ◽

2007 ◽

Vol 1 (2) ◽

pp. 215-222

Author(s):

Katherine M Coyne ◽

Rachael Jones ◽

David Hawkins

Keyword(s):

Antiretroviral Therapy ◽

Pregnant Women ◽

Highly Active Antiretroviral Therapy ◽

Highly Active

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Persistent Chlamydia trachomatis, Neisseria gonorrhoeae or Trichomonas vaginalis positivity after treatment among human immunodeficiency virus-infected pregnant women, South Africa

International Journal of STD & AIDS ◽

10.1177/0956462419898612 ◽

2020 ◽

Vol 31 (4) ◽

pp. 294-302 ◽

Cited By ~ 1

Author(s):

Andrew Medina-Marino ◽

Maanda Mudau ◽

Noah Kojima ◽

Remco PH Peters ◽

Ute D Feucht ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Antiretroviral Therapy ◽

Chlamydia Trachomatis ◽

Neisseria Gonorrhoeae ◽

Antenatal Care ◽

Pregnant Women ◽

Trichomonas Vaginalis ◽

Repeat Testing ◽

Care Visit ◽

Immunodeficiency Virus

The objective of this study is to assess the predictors and frequency of persistent sexually transmitted infection (STI) positivity in human immunodeficiency virus (HIV)-infected pregnant women treated for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) or Trichomonas vaginalis (TV) infection. We enrolled HIV-infected pregnant women attending their first antenatal care visit and tested them for urogenital CT, NG and TV infection using Xpert® CT/NG and TV assays (Cepheid, Sunnyvale, CA). Those testing positive were treated. Participants either notified partners to seek treatment or were given extra medication to deliver to partners for treatment. Repeat testing was conducted approximately 21 days post-treatment or treatment initiation. Among 427 participants, 172 (40.3%) tested positive for any STI. Of the 136 (79.1%) that returned for repeat testing, 36 (26.5%) tested positive for the same organism: CT = 27 (26.5%), NG = 1 (6.3%), TV = 11 (16.7%). Persistent CT positivity was independently associated with having more than one sex partner in the preceding 12 months (adjusted-prevalence ratio [aPR] = 3.03, 95% CI: 1.44–6.37) and being newly diagnosed with HIV infection during the first antenatal care visit compared to those currently on antiretroviral therapy (aPR = 3.97, 95% CI: 1.09–14.43). Persistent TV positivity was associated with not knowing if a partner sought treatment following STI disclosure (aPR = 12.6, 95% CI: 2.16–73.5) and prior diagnosis of HIV but not currently on antiretroviral therapy. (aPR = 4.14; 95% CI: 1.25–13.79). We identified a high proportion of HIV-infected pregnant women with persistent CT or TV positivity after treatment. To decrease the risk of re-infection, enhanced strategies for partner treatment programmes are needed to improve the effectiveness of STI screening and treatment in pregnancy. The relationship between not being on antiretroviral therapy and persistent STI positivity needs further study.

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Population-based survey of HIV sero-status and vertical transmission among naive pregnant women in Sokoto, Nigeria

Asian Journal of Medical Sciences ◽

10.3126/ajms.v6i3.11530 ◽

2014 ◽

Vol 6 (3) ◽

pp. 49-57 ◽

Cited By ~ 2

Author(s):

Fiekumo Igbida Buseri ◽

Charity Ngozi Okonkwo

Keyword(s):

Antiretroviral Therapy ◽

Pregnant Women ◽

Vertical Transmission ◽

Statistical Significance ◽

Demographic Data ◽

Age Groups ◽

P Value ◽

Full Time ◽

Cross Sectional ◽

Significant Difference

Background: This study aims at investigating the seroprevalence of HIV infection among status naive pregnant women and probable vertical transmission in Sokoto, Nigeria.Materials and Methods: This cross-sectional study examined 13,026 apparently healthy pregnant women aged between 14 and 45 years and 312 mother-baby pairs in 4 different hospital settings in Sokoto State, North West, Nigeria between March, 2011 and February, 2013. The babies were aged between 8 and 16 months. HIV screening was performed using qualitative rapid tests and ELISA and HIV-DNA polymerase chain reaction (PCR) techniques. Measurement of CD4+ T-lymphocytes was carried out by the BD FACScount System. All seropositive pregnant women were immediately placed on triple antiretroviral therapy (ART) throughout the duration of the pregnancy and beyond.Results: An overall 2.4% prevalence of HIV-1 infection among the pregnant women and 20.5% incident of mother-to-child transmission were found. Of the seropositive pregnant women, 75.0% were full-time house wives, 13.8% and 11.2% were traders and civil servants respectively; of which, 70.2% were within the ages of 14 and 27 years (youthful predominance). Pearson’s χ2analysis did not show any statistically significant difference in the Mean values in the 4 health facilities (χ2 =2.084, df=3, P-value=0.555). Similarly, no significant difference in HIV seropositivity in the demographic data of the pregnant women were observed (P>0.05). Infection was recorded in all age groups but there was no statistical significance between age groups and infection (P = 0.833). Of the 64 seropositive babies, 62 (92.5%) contracted HIV from antiretroviral therapy non-adherence mothers (χ2 =271.457, df=1, P<0.01), OR=1506.6 (95%CI=285.5-7950.4). Conclusion: This study found high prevalence of vertical transmission due to ART non-adherence. Intervention initiatives should, therefore, focus seriously on ART non-adherence. DOI: http://dx.doi.org/10.3126/ajms.v6i3.11530Asian Journal of Medical Sciences Vol.6(3) 2015 49-57

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