Antiretroviral Therapy in Pregnant Women

2019 ◽  
pp. 281-286
Author(s):  
William R. Short ◽  
Jason J. Schafer
Keyword(s):  
Clinical Trials ◽  
Pregnant Women ◽  
Hiv Transmission ◽  
Pediatric Aids ◽  
Women Living With Hiv ◽  
Pivotal Study ◽  
Aids Clinical Trials ◽  
Living With Hiv ◽  
Mother To Child ◽  
Over Time

Upon completion of this chapter, the reader should be able to describe the appropriate management of antiretrovirals for pregnant women living with HIV. Over time, research has demonstrated that proper prevention strategies and interventions during pregnancy, labor, and delivery can significantly reduce the rate of mother-to-child transmission (MTCT) of HIV. In 1994, a pivotal study in the field of HIV medicine, the Pediatric AIDS Clinical Trials Group 076, demonstrated that the use of zidovudine (ZDV) monotherapy during pregnancy substantially reduced the risk of HIV transmission to infants by 67% (...

scholarly journals HIV Status and Contraceptive Utilization among Women in Cameroon

2019 ◽  
Vol 18 ◽  
pp. 232595821982659 ◽  
Author(s):  
Henna Budhwani ◽  
Kristine Ria Hearld ◽  
Jodie Dionne-Odom ◽  
Simon Manga ◽  
Kathleen Nulah ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Hiv Transmission ◽  
Multivariate Analyses ◽  
Hiv Status ◽  
Improve Population Health ◽  
Women Living With Hiv ◽  
Contraceptive Utilization ◽  
Living With Hiv ◽  
Mother To Child ◽  
Hiv Negative

Objective: We examined patterns of contraceptive utilization by HIV status among women in Cameroon, hypothesizing that women living with HIV would utilize contraception at higher rates than their HIV-negative peers. Methods: Deidentified, clinical data from the Cameroon Baptist Convention Health Services (2007-2013) were analyzed (N = 8995). Frequencies compared outcomes between women living with HIV (15.1%) and uninfected women. Multivariate analyses examined associates of contraceptive utilization and desire to become pregnant. Results: Contraceptive utilization was associated with higher education, living with HIV, monogamy, and higher parity ( P < .001). Women living with HIV had 66% higher odds of using contraceptives than their negative peers (odds ratio [OR]: 1.66, confidence interval [CI]: 1.45-1.91, P < .001). Polygamous women had 37% lower odds of using contraceptives compared to monogamous women (OR: 0.63, 95% CI: 0.52-0.75, P < .001). Conclusion: Increasing contraceptive utilization in resource-constrained settings should be a priority for clinicians and researchers. Doing so could improve population health by reducing HIV transmission between partners and from mother to child.

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 Pharmacokinetics and Safety of Stavudine in HIV‐Infected Pregnant Women and Their Infants: Pediatric AIDS Clinical Trials Group Protocol 332

2004 ◽  
Vol 190 (12) ◽  
pp. 2167-2174 ◽  
Author(s):  
Nancy A. Wade ◽  
Jashvant D. Unadkat ◽  
Sharon Huang ◽  
David E. Shapiro ◽  
Anita Mathias ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Pregnant Women ◽  
Pediatric Aids ◽  
Aids Clinical Trials

scholarly journals Social concerns related to HIV status disclosure and participation in the prevention of mother-to-child transmission of HIV care among pregnant women in Kenya

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Björn Nordberg ◽  
Erin E. Gabriel ◽  
Edwin Were ◽  
Eunice Kaguiri ◽  
Anna Mia Ekström ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Hiv Disclosure ◽  
Hiv Status ◽  
Lower Odds ◽  
Women Living With Hiv ◽  
Social Concerns ◽  
Hiv Status Disclosure ◽  
Living With Hiv ◽  
Status Disclosure ◽  
Mother To Child

Abstract Background Social concerns about unintentional HIV status disclosure and HIV-related stigma are barriers to pregnant women’s access to prevention of mother-to-child transmission of HIV (PMTCT) care. There is limited quantitative evidence of women’s social and emotional barriers to PMTCT care and HIV disclosure. We aimed to investigate how social concerns related to participation in PMTCT care are associated with HIV status disclosure to partners and relatives among pregnant women living with HIV in western Kenya. Methods A cross-sectional study, including 437 pregnant women living with HIV, was carried out at enrolment in a multicentre mobile phone intervention trial (WelTel PMTCT) in western Kenya. Women diagnosed with HIV on the day of enrolment were excluded. To investigate social concerns and their association with HIV disclosure we used multivariable-adjusted logistic regression, adjusted for sociodemographic and HIV-related characteristics, to estimate odds ratios (OR) and 95% confidence intervals (CI). Results The majority (80%) had disclosed their HIV status to a current partner and 46% to a relative. Older women (35–44 years) had lower odds of disclosure to a partner (OR = 0.15; 95% CI: 0.05–0.44) compared to women 18–24 years. The most common social concern was involuntary HIV status disclosure (reported by 21%). Concern about isolation or lack of support from family or friends was reported by 9%, and was associated with lower odds of disclosure to partners (OR = 0.33; 95% CI: 0.12–0.85) and relatives (OR = 0.37; 95% CI: 0.16–0.85). Concern about separation (reported by 5%; OR = 0.17; 95% CI: 0.05–0.57), and concern about conflict with a partner (reported by 5%; OR = 0.18; 95% CI: 0.05–0.67), was associated with lower odds of disclosure to a partner. Conclusions Compared to previous reports from Kenya, our estimated disclosure rate to a partner is higher, suggesting a possible improvement over time in disclosure. Younger pregnant women appear to be more likely to disclose, suggesting a possible decreased stigma and more openness about HIV among younger couples. Healthcare providers and future interventional studies seeking to increase partner disclosure should consider supporting women regarding their concerns about isolation, lack of support, separation, and conflict with a partner. PMTCT care should be organized to ensure women’s privacy and confidentiality.

Reduction of Maternal–Infant Transmission of HIV Type 1 With Zidovudine Treatment

2021 ◽  
pp. 26-31
Author(s):  
Eliza Rodrigue McElwee ◽  
Pooja K. Mehta
Keyword(s):  
Neonatal Death ◽  
Hiv Transmission ◽  
Historical Context ◽  
Pediatric Aids ◽  
Zidovudine Treatment ◽  
Structural Abnormalities ◽  
Aids Clinical Trials ◽  
Mother To Child ◽  
Current Guidelines

This article summarizes the landmark results of Pediatric AIDS Clinical Trials Group Protocol 076. Pregnant women between 14 and 34 weeks with a CD4 count above 200 and no indication for antiretroviral therapy were randomized to zidovudine treatment or placebo. Zidovudine was shown to reduce HIV transmission from mother to child by 67.5%. Zidovudine treatment was not associated with neonatal death, premature birth, fetal growth or structural abnormalities. The majority of maternal adverse effects were obstetric complications that were not associated with either placebo or intervention groups. It reviews study design, findings, and limitations. This study is then situated in historical context and in reference to current guidelines.

scholarly journals Comprehensive nationwide analysis of mother-to-child HIV transmission in Finland from 1983 to 2013

2018 ◽  
Vol 146 (10) ◽  
pp. 1301-1307 ◽  
Author(s):  
I. Aho ◽  
P. Kivelä ◽  
M. Kaijomaa ◽  
H.-M. Surcel ◽  
M. Ristola ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Sexual Transmission ◽  
Easy Access ◽  
Hiv Positive ◽  
Hiv Diagnosis ◽  
Women Living With Hiv ◽  
Similar Good ◽  
Low Prevalence ◽  
Living With Hiv ◽  
Mother To Child

AbstractHIV-positive children are still born in Europe despite low mother-to-child transmission (MTCT) rates. We aimed to clarify the remaining barriers to the prevention of MTCT. By combining the national registers, we identified all women living with HIV delivering at least one child during 1983–2013. Of the 212 women delivering after HIV diagnosis, 46% were diagnosed during the pregnancy. In multivariate analysis, age >30 years (P = 0.001), sexual transmission (P = 0.012), living outside of the metropolitan area (P = 0.001) and Eastern European origin (P = 0.043) were risk factors for missed diagnosis before pregnancy. The proportion of immigrants increased from 18% before 1999 to 75% during 2011–2013 (P < 0.001). They were diagnosed during the pregnancy equally to natives and achieved similar, good treatment results. No MTCT occurred when the mother was diagnosed before the delivery. In addition, 12 women had delivered in 2 years prior their HIV diagnosis, most before implementation of the national screening of pregnant women. Three of these children were infected, the last one in 2000. Our data demonstrate that complete elimination of MTCT is feasible in a high-income, low-prevalence country. This requires ongoing universal screening in early pregnancy and easy access to antiretroviral therapy to all HIV-positive people.

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