Breastfeeding by Women Living With Human Immunodeficiency Virus in a Resource-Rich Setting: A Case Series of Maternal and Infant Management and Outcomes

2019 ◽  
Vol 9 (2) ◽  
pp. 228-231 ◽  
Author(s):  
N Nashid ◽  
S Khan ◽  
M Loutfy ◽  
J MacGillivray ◽  
M H Yudin ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Transmission ◽  
Healthcare Providers ◽  
Case Series ◽  
Virologic Suppression ◽  
Combination Antiretroviral Therapy ◽  
Breastfed Infants ◽  
Women Living With Hiv ◽  
Immunodeficiency Virus ◽  
Living With Hiv

Abstract The reduction in human immunodeficiency virus (HIV) transmission through breastmilk with maternal combination antiretroviral therapy (cART) has led many pregnant women living with HIV and healthcare providers to question exclusive formula feeding in resource-rich settings. Here, we describe cART prophylaxis in 3 breastfed infants whose mothers had sustained virologic suppression; all 3 of these infants remained uninfected.

scholarly journals Patterns of changing pregnancy intentions among women living with HIV in Canada

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lashanda Skerritt ◽  
Angela Kaida ◽  
Nadia O’Brien ◽  
Ann N. Burchell ◽  
Gillian Bartlett ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Healthcare Providers ◽  
Undetectable Viral Load ◽  
Subsequent Pregnancy ◽  
Reproductive Age ◽  
Pregnancy Intentions ◽  
Women Living With Hiv ◽  
Living With Hiv ◽  
Health Cohort Study

Abstract Background Women with an undetectable viral load can become pregnant and have children with no risk of HIV transmission to their sexual partners and low risk of transmission to their infants. Contemporary pregnancy intentions of women living with HIV in Canada are poorly understood, evidenced by high rates of unintended pregnancy and low uptake of contraceptives. Methods We used longitudinal survey data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) to measure and compare pregnancy intentions (Yes vs No vs Unsure) at baseline, 18-months and 36-months follow-up (from 2013 to 2018) among women living with HIV of reproductive age (16–49 years) and potential. We used Sankey diagrams to depict changes in pregnancy intentions over time and multivariable logistic regression to examine the relationship between pregnancy intention within 2 years and subsequent pregnancy. Results At baseline, 41.9% (119/284) of women intended to become pregnant, 43.3% did not, and 14.8% were unsure. Across 36-months of follow-up, 41.9% (119/284) of women changed their pregnancy intentions, with 25% changing from intending to not intending to become pregnant and 13.1% vice versa. Pregnancy intentions were not strongly associated with subsequent pregnancy between baseline and 18-months (aOR 1.44; 95% CI 0.53, 3.72) or between 18 and 36-months (aOR 2.17; 95% CI 0.92, 5.13). Conclusions Our findings underscore the need for healthcare providers to engage in ongoing discussions with women living with HIV to support their dynamic pregnancy intentions.

Human Papillomavirus Vaccination Prior to Loop Electroexcision Procedure Does Not Prevent Recurrent Cervical High-grade Squamous Intraepithelial Lesions in Women Living With Human Immunodeficiency Virus: A Randomized, Double-blind, Placebo-controlled Trial

2020 ◽  
Author(s):  
Cynthia Firnhaber ◽  
Avril Swarts ◽  
Vuyokazi Jezile ◽  
Masango Mulongo ◽  
Bridgette Goeieman ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Human Immunodeficiency Virus ◽  
Human Papillomavirus ◽  
Hpv Vaccination ◽  
High Grade ◽  
Double Blind ◽  
Women Living With Hiv ◽  
Immunodeficiency Virus ◽  
Living With Hiv ◽  
Intraepithelial Lesions

Abstract Background Women living with human immunodeficiency virus (HIV), especially in sub-Saharan Africa, are at high risk for cervical high-grade squamous intraepithelial lesions (HSIL) and cervical cancer. These women have high HSIL recurrence rates after loop electroexcision procedure (LEEP). Retrospective studies suggest that human papillomavirus (HPV) vaccination improves response to treatment of cervical HSIL. Methods We performed a double-blind, randomized clinical trial enrolling 180 women living with HIV in Johannesburg, South Africa, diagnosed with cervical HSIL by colposcopic biopsy. Women received quadrivalent HPV vaccine or placebo (1:1) at entry, week 4, and week 26. LEEP was performed at week 4. Colposcopic-directed biopsies and cervical cytology were performed at weeks 26 and 52. The primary endpoint, cervical HSIL by histology or cytology at either week 26 or 52, was compared between arms using χ 2 analysis. Results Participant characteristics included median age of 39 years and median CD4 count 489 cells/μL, and 94% had HIV suppression. One hundred seventy-four women completed the vaccine/placebo series and had evaluable results at week 26 or 52. The proportion experiencing the primary endpoint was similar in the vaccine and placebo groups (53% vs 45%; relative risk, 1.18 [95% confidence interval, .87–1.6]; P = .29). HSIL recurrence was associated with a LEEP biopsy result of HSIL and detection of HSIL at the margins of the LEEP sample. Conclusions This study did not support HPV vaccination to prevent recurrent HSIL after LEEP in women living with HIV. Recurrent HSIL was high despite virologic suppression. Improved treatments are needed for HSIL to reduce the burden of cervical cancer among women living with HIV.

scholarly journals All-Cause Mortality and Serious Non-AIDS Events in Adults With Low-level Human Immunodeficiency Virus Viremia During Combination Antiretroviral Therapy: Results From a Swedish Nationwide Observational Study

2020 ◽  
Author(s):  
Olof Elvstam ◽  
Gaetano Marrone ◽  
Patrik Medstrand ◽  
Carl Johan Treutiger ◽  
Anders Sönnerborg ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Clinical Outcomes ◽  
Virologic Suppression ◽  
Combination Antiretroviral Therapy ◽  
Low Level ◽  
Immunodeficiency Virus ◽  
All Cause Mortality ◽  
The Impact

Abstract Background The impact of low levels of human immunodeficiency virus (HIV) RNA (low-level viremia [LLV]) during combination antiretroviral therapy (cART) on clinical outcomes is unclear. We explored the associations between LLV and all-cause mortality, AIDS, and serious non-AIDS events (SNAEs). Methods We grouped individuals starting cART 1996–2017 (identified from the Swedish InfCare HIV register) as virologic suppression (VS; <50 copies/mL), LLV (repeated viral load, 50–999 copies/mL), and nonsuppressed viremia (NSV; ≥1000 copies/mL). Separately, LLV was subdivided into 50–199 and 200–999 copies/mL (reflecting different definitions of virologic failure). Proportional-hazard models (including sex, age, pre-ART CD4 count and viral load, country of birth, injection drug use, treatment experience and interruptions, and an interaction term between viremia and time) were fitted for the study outcomes. Results A total of 6956 participants were followed for a median of 5.7 years. At the end of follow-up, 60% were categorized as VS, 9% as LLV, and 31% as NSV. Compared with VS, LLV was associated with increased mortality (adjusted hazard ratio [aHR], 2.2; 95% confidence interval [CI], 1.3–3.6). This association was also observed for LLV 50–199 copies/mL (aHR, 2.2; 95% CI, 1.3–3.8), but was not statistically significant for LLV 200–999 copies/mL (aHR, 2.1; 95% CI, .96–4.7). LLV 50–999 copies/mL was not linked to increased risk of AIDS or SNAEs, but in subanalysis, LLV 200–999 copies/mL was associated with SNAEs (aHR, 2.0; 95% CI, 1.2–3.6). Conclusions In this population-based cohort, LLV during cART was associated with adverse clinical outcomes.

Medical Assistance in Death as a Unique Opportunity to Advance Human Immunodeficiency Virus Cure Research

2019 ◽  
Vol 69 (6) ◽  
pp. 1063-1067 ◽  
Author(s):  
Teslin S Sandstrom ◽  
Stephanie C Burke Schinkel ◽  
Jonathan B Angel
Keyword(s):  
Human Immunodeficiency Virus ◽  
Healthcare Providers ◽  
Tissue Donation ◽  
Viral Reservoir ◽  
Medical Assistance ◽  
Body Tissues ◽  
Immunodeficiency Virus ◽  
Hiv Research ◽  
Living With Hiv ◽  
Hiv Cure Research

AbstractThe inability to sample deep-tissue reservoirs in individuals living with human immunodeficiency virus (HIV) has greatly hindered accurate estimates of viral reservoir size and distribution. Animal models and collection of tissues during autopsies of HIV-positive individuals are 2 proposed solutions to this problem. Each, however, has its limitations. In this Viewpoint, we argue that tissue donation following medical assistance in death (MAiD) will form an invaluable resource for the characterization of the viral reservoir in the context of current HIV cure research. In support, we discuss a recent instance in which an individual living with HIV chose to donate their body/tissues to HIV research prior to undergoing MAiD at our institution. Going forward, we hope this will help provide support to individuals in their decisions around tissue donation following MAiD, while highlighting how healthcare providers, by complying with such wishes, can affect patient satisfaction in the last days of life.

scholarly journals Lack of HIV RNA test result is a barrier to breastfeeding among women living with HIV in Botswana

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Gloria Katuta Mayondi ◽  
Aamirah Mussa ◽  
Rebecca Zash ◽  
Sikhulile Moyo ◽  
Arielle Issacson ◽  
...  
Keyword(s):  
Infant Feeding ◽  
Hiv Transmission ◽  
Healthcare Providers ◽  
Feeding Method ◽  
Hiv Rna ◽  
Women Living With Hiv ◽  
Feeding Choice ◽  
Infant Feeding Decisions ◽  
Living With Hiv ◽  
Mother To Child

Abstract Background Botswana updated its antiretroviral treatment (ART) guidelines in May 2016 to support breastfeeding for women living with HIV (WLHIV) on ART who have documented HIV RNA suppression during pregnancy. Methods From September 2016 to March 2019, we evaluated feeding method at discharge among WLHIV at eight government maternity wards in Botswana within the Tsepamo Study. We validated the recorded feeding method on the obstetric record using the prevention of mother-to-child transmission of HIV (PMTCT) counsellor report, infant formula dispensing log or through direct observation. Available HIV RNA results were recorded from the obstetric record, and from outpatient HIV records (starting February 2018). In a subset of participants, we used electronic laboratory records to verify whether an HIV RNA test had occurred. Univariable and multivariable logistic regression analyses were performed to identify factors associated with infant feeding choice. Results Among 13,354 WLHIV who had a validated feeding method at discharge, 5303 (39.7%) chose to breastfeed and 8051 (60.3%) chose to formula feed. Women who had a documented HIV RNA result in the obstetric record available to healthcare providers at delivery were more likely to breastfeed (50.8%) compared to women who did not have a documented HIV RNA result (35.4%) (aOR 0.59; 95% CI 0.54, 0.65). Among women with documented HIV RNA, 2711 (94.6%) were virally suppressed (< 400 copies/mL). Breastfeeding occurred in a substantial proportion of women who did not meet criteria, including 46 (30.1%) of 153 women with HIV RNA > 400 copies/mL, and 134 (27.4%) of 489 women with no reported ART use. A sub-analysis of electronic laboratory records among 150 women without a recorded result on the obstetric record revealed that 93 (62%) women had an HIV RNA test during pregnancy. Conclusions In a setting of long-standing use of suppressive ART, with majority of WLHIV on ART from the time of conception, requiring documentation of HIV RNA suppression in the obstetric record to inform infant feeding decisions is a barrier to breastfeeding but unlikely to prevent a substantial amount of HIV transmission.

scholarly journals Medical and Islamic Perspectives on Human Immunodeficiency Virus Infection and its Prevention

2020 ◽  
Vol 18 (2) ◽  
Author(s):  
Abdullah F ◽  
Hashi AA ◽  
Said AH ◽  
Mat Nor MB
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Healthcare Providers ◽  
Immune Deficiency Syndrome ◽  
Epidemiological Data ◽  
Deficiency Syndrome ◽  
People Living With Hiv ◽  
Immunodeficiency Virus ◽  
Living With Hiv ◽  
Hiv Aids

Human Immunodeficiency Virus (HIV) that causes Acquired Immune Deficiency Syndrome (AIDS) is one of the world’s most serious health and nation-state destructions. It creates long-term economic and psychosocial impact on the lives of individuals, families and communities. Since the first reported case of HIV/AIDS in Malaysia in 1986, its prevalence has escalated significantly. As of December 2017, there are over 115,263 reported cases of HIV infections in the country and over 40,000 people died from HIV/AIDS.1 Although many religious people regarded HIV infection as a divine punishment for their sins of sexual promiscuity, Islamic teaching emphasises the prevention of the disease and care for people living with HIV or AIDS. It is imperative to discuss the Islamic perspectives in providing ways to prevent the spread of HIV and support to people living with HIV (PLHIV). This article focuses on epidemiological data; highlight the burden of HIV infection/AIDS in Malaysia and its impact on the society, HIV infection from medical perspective and its preventive measures from Islamic viewpoints. A good teamwork among healthcare providers and religious leaders is compulsory as it may improve the preventive strategies to curb the disease in the country.

scholarly journals Importance of Prospective Studies in Pregnant and Breastfeeding Women Living With Human Immunodeficiency Virus

2019 ◽  
Vol 69 (7) ◽  
pp. 1254-1258 ◽  
Author(s):  
Angela Colbers ◽  
Mark Mirochnick ◽  
Stein Schalkwijk ◽  
Martina Penazzato ◽  
Claire Townsend ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Pregnant Women ◽  
Clinical Care ◽  
Antiretroviral Drugs ◽  
New Drugs ◽  
European Medicines Agency ◽  
Controlled Clinical Trial ◽  
Women Living With Hiv ◽  
Immunodeficiency Virus ◽  
Living With Hiv

Abstract Recently, the US Food and Drug Administration and European Medicines Agency issued warnings on the use of dolutegravir and darunavir/cobicistat for treatment of pregnant women living with human immunodeficiency virus (HIV). It took 3–5 years to identify the risks associated with the use of these antiretroviral drugs, during which time pregnant women were exposed to these drugs in clinical care, outside of controlled clinical trial settings. Across all antiretroviral drugs, the interval between registration of new drugs and first data on pharmacokinetics and safety in pregnancy becoming available is around 6 years. In this viewpoint, we provide considerations for clinical pharmacology research to provide safe and effective treatment of pregnant and breastfeeding women living with HIV and their children. These recommendations will lead to timelier availability of safety and pharmacokinetic information needed to develop safe treatment strategies for pregnant and breastfeeding women living with HIV, and are applicable to other chronic disease areas requiring medication during pregnancy.

scholarly journals PERCEPÇÕES DE MULHERES VIVENDO COM O VÍRUS DA IMUNODEFICIÊNCIA HUMANA ACERCA DA IMPOSSIBILIDADE DE AMAMENTAR

2016 ◽  
Vol 7 (2) ◽  
pp. 7 ◽  
Author(s):  
Valéria Linder ◽  
Simone Edi Chaves ◽  
Márcia Rejane Strapasson
Keyword(s):  
Human Immunodeficiency Virus ◽  
Public Hospital ◽  
Educational Strategies ◽  
Porto Alegre ◽  
Women Living With Hiv ◽  
Technical Procedure ◽  
Immunodeficiency Virus ◽  
Investigación Cualitativa ◽  
Las Mujeres ◽  
Living With Hiv

Objetivo: conhecer a percepção de mulheres vivendo com o Vírus da Imunodeficiência Humana (HIV) acerca da impossibilidade de amamentar. Metodologia: pesquisa qualitativa realizada em uma maternidade de hospital público de Porto Alegre/RS em 2014, com 10 mulheres portadoras do vírus que se encontravam no período de puerpério imediato. Para a análise dos dados, utilizou-se a análise de conteúdo. Resultados: emergiram quatro categorias temáticas: orientação de não amamentar apenas como um procedimento técnico; dificuldade das mulheres em revelar seu diagnóstico; percepções das mulheres vivendo com HIV sobre as orientações fornecidas pela equipe de enfermagem e sentimento das mulheres vivendo com HIV em não amamentar. Conclusão: destaca-se a necessidade da implementação de estratégias educativas nos serviços de saúde que qualifiquem a formação da equipe de enfermagem para o cuidado à mulher vivendo com HIV.Descritores: HIV, Direitos da mulher; Aleitamento materno; Assistência integral à saúde da mulher.PERCEPTIONS OF LIVING WOMEN WITH HUMAN IMMUNODEFICIENCY VIRUS ABOUT BREASTFEEDING INABILITYObjective: to know the perception of women living with the Human Immunodeficiency virus (HIV) about impossibility of breastfeeding. Methodology: qualitative research conducted in a public hospital maternity Porto Alegre/RS between February and March 2014. The study included 10 women with the virus who were in the immediate postpartum period. For data analysis we used the content analysis. Results: the analysis emerged four thematic categories: the guidance of not breastfeeding only as a technical procedure; the difficulty of women to reveal their diagnosis; perceptions of women living with HIV on the guidelines provided by the nursing team and the feeling of women with HIV in not breastfeeding. Conclusion: the study highlights the need to implement educational strategies in health services that qualify the training of nursing staff to care for the carrier of the virus wife.Descriptors: HIV; Women’s rights; Breastfeeding; Full assistance to women’s health.PERCEPCIONES DE LAS MUJERES QUE VIVEN CON EL VIRUS DE INMUNODEFICIENCIA HUMANA SOBRE LA INCAPACIDAD LACTANCIAObjetivo: conocer la percepción de las mujeres que viven con el virus de inmunodeficiencia humana (VIH) respecto la imposibilidad de amamantar. Metodología: investigación cualitativa llevada a cabo en un hospital público de maternidad Porto Alegre/RS entre febrero y marzo de 2014. El estudio incluyó 10 mujeres con el virus que estaban en el período posparto. Para análisis de datos se utilizó el análisis de contenido. Resultados: el análisis emergieron cuatro categorías temáticas: no amamantar orientación sólo como un procedimiento técnico; la dificultad de las mujeres para revelar su diagnóstico; percepciones de las mujeres que viven con el VIH en las directrices proporcionadas por el equipo de enfermería y el sentimiento de las mujeres con VIH no amamantar. Conclusión: el estudio pone de relieve la necesidad de implementar estrategias educativas en los servicios de salud que califican la formación del personal de enfermería para el cuidado de las mujeres que viven con el VIH.Descriptores: VIH; Derechos de las mujer; Lactancia materna; Atención integral de la salud de la mujer.

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