No association between early antiretroviral therapy during pregnancy and plasma levels of angiogenic factors: a cohort study

Abstract Background: Early antiretroviral therapy (ART) during pregnancy has dramatically reduced the risk of perinatal HIV transmission. However, studies have shown an association between premature delivery and the use of ART during pregnancy (particularly protease inhibitor (PI)-based therapies), which could be explained by placental dysfunction. The objective of this study was to evaluate the association of ART (class, duration of exposure and time of initiation) with placental function by using angiogenic factors placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) as biomarkers. Methods: Clinical and biological data from 159 pregnant women living with HIV were analyzed. Levels of each biomarker were measured in the first and second trimester of pregnancy. After logarithmic transformation, we compared these using generalized estimating equations according to (a) the type of ART; (b) the duration of exposure to ART; and (c) the time of initiation of ART. Results: After adjusting for variables such as ethnicity, maternal age, gestational age, body mass index, parity, smoking status, and sex of the fetus, we found no significant association between the class of ART (PI-based or not) and serum concentrations of PlGF or sFlt-1. Furthermore, no significant association was found between biomarker levels and the duration of ART exposure or the timing of ART initiation (pre- or post-conception). Conclusions: This study suggests that first and second trimester angiogenic factor levels are not significantly associated with ART, regardless of the duration or type (with or without PI). These observations seem reassuring when considering the use of ART during early pregnancy.

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No association between early antiretroviral therapy during pregnancy and plasma levels of angiogenic factors: a cohort study

10.21203/rs.2.13379/v2 ◽

2019 ◽

Author(s):

Ameyo Djeha ◽

Sylvie Girard ◽

Helen Trottier ◽

Fatima Kakkar ◽

Hugo Soudeyns ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Hiv Transmission ◽

Smoking Status ◽

Biological Data ◽

Angiogenic Factors ◽

Angiogenic Factor ◽

Premature Delivery ◽

Second Trimester ◽

Art Initiation ◽

Perinatal Hiv

Abstract Background: Early antiretroviral therapy (ART) during pregnancy has dramatically reduced the risk of perinatal HIV transmission. However, studies have shown an association between premature delivery and the use of ART during pregnancy (particularly protease inhibitor (PI)-based therapies), which could be explained by placental dysfunction. The objective of this study was to evaluate the association of ART (class, duration of exposure and time of initiation) with placental function by using angiogenic factors placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) as biomarkers. Methods: Clinical and biological data from 159 pregnant women living with HIV were analyzed. Levels of each biomarker were measured in the first and second trimester of pregnancy. After logarithmic transformation, we compared these using generalized estimating equations according to (a) the type of ART; (b) the duration of exposure to ART; and (c) the time of initiation of ART. Results: After adjusting for variables such as ethnicity, maternal age, gestational age, body mass index, parity, smoking status, and sex of the fetus, we found no significant association between the class of ART (PI-based or not) and serum concentrations of PlGF or sFlt-1. Furthermore, no significant association was found between biomarker levels and the duration of ART exposure or the timing of ART initiation (pre- or post-conception). Conclusions: This study suggests that first and second trimester angiogenic factor levels are not significantly associated with ART, regardless of the duration or type (with or without PI). These observations seem reassuring when considering the use of ART during early pregnancy.

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Antiretroviral therapy for prevention of HIV transmission: implications for Europe

Eurosurveillance ◽

10.2807/1560-7917.es2013.18.48.20647 ◽

2013 ◽

Vol 18 (48) ◽

Cited By ~ 9

Author(s):

V Cambiano ◽

J O’Connor ◽

A N Phillips ◽

A Rodger ◽

R Lodwick ◽

...

Keyword(s):

Antiretroviral Therapy ◽

People Who Inject Drugs ◽

Hiv Transmission ◽

Controlled Trial ◽

Population Level ◽

Hiv Infections ◽

Cd4 Count ◽

Art Initiation ◽

Sex With Men ◽

Randomised Controlled

The aim of this review is to summarise the evidence on the population-level effect of antiretroviral therapy (ART) in preventing HIV infections, and to discuss potential implications in the European context of recommending starting ART when the CD4 count is above 350 cells/mm3. The ability of ART to reduce the risk of HIV transmission has been reported in observational studies and in a randomised controlled trial (HPTN 052), in which ART initiation reduced HIV transmission by 96% within serodiscordant couples. As yet, there is no direct evidence for such an effect among men having sex with men or people who inject drugs. HPTN 052 led international organisations to develop recommendations with a higher CD4 threshold for ART initiation. However, there remains a lack of strong evidence of clinical benefit for HIV-positive individuals starting ART with CD4 count above 350 cells/mm3. The main goal of ART provision should be to increase ART coverage for all those in need, based on the current guidelines, and the offer of ART to those who wish to reduce infectivity; increased HIV testing is therefore a key requirement. Other proven prevention means such as condom use and harm reduction for people who inject drugs remain critical.

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Two-Dose Intrapartum/Newborn Nevirapine and Standard Antiretroviral Therapy to Reduce Perinatal HIV TransmissionA Randomized Trial

JAMA ◽

10.1001/jama.288.2.189 ◽

2002 ◽

Vol 288 (2) ◽

pp. 189 ◽

Cited By ~ 249

Author(s):

Alejandro Dorenbaum

Keyword(s):

Antiretroviral Therapy ◽

Randomized Trial ◽

Hiv Transmission ◽

Perinatal Hiv

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Perinatal HIV Transmission Prevention: Challenges among Women Living with HIV in sub-Saharan Africa

International Journal of MCH and AIDS (IJMA) ◽

10.21106/ijma.404 ◽

2020 ◽

Vol 9 (3) ◽

pp. 354-359

Author(s):

Elizabeth Armstrong-Mensah ◽

Krystal Ruiz ◽

Aminata Fofana ◽

Victoria Hawley

Keyword(s):

Antiretroviral Therapy ◽

Sex Education ◽

Hiv Transmission ◽

Public Health Problem ◽

Sub Saharan Africa ◽

Creative Commons ◽

Perinatal Hiv ◽

Transmission Prevention ◽

Sub Saharan ◽

Hiv Transmission Prevention

About 86 percent of the estimated 160,000 children newly-infected with the human immunodeficiency virus (HIV) live in sub-Saharan Africa. Despite global efforts to reduce perinatal HIV transmission, this phenomenon continues to be a public health problem in sub-Saharan Africa. This paper discusses challenges associated with perinatal HIV transmission prevention in sub-Saharan Africa and offers strategies for the way forward. These strategies include safe sex education and behavioral change, increased access to integrated antenatal care, training of unskilled traditional birth attendants into formal delivery systems, access to antiretroviral therapy, and investing in virologic testing. Key words: • HIV • Perinatal • Antiretroviral Therapy • Mother to Child HIV Transmission • HIV Prevention • Sub-Saharan Africa Copyright © 2020 Armstrong-Mensah, et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

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Southern African HIV Clinicians Society adult antiretroviral therapy guidelines: Update on when to initiate antiretroviral therapy

Southern African Journal of HIV Medicine ◽

10.4102/sajhivmed.v16i1.428 ◽

2015 ◽

Vol 16 (1) ◽

Cited By ~ 7

Author(s):

Graeme Meintjes ◽

John Black ◽

Francesca Conradie ◽

Sipho Dlamini ◽

Gary Maartens ◽

...

Keyword(s):

Antiretroviral Therapy ◽

New England ◽

Hiv Transmission ◽

Clinical Indication ◽

Optimal Timing ◽

Cd4 Counts ◽

The Public ◽

Art Initiation ◽

Randomised Controlled ◽

Early Antiretroviral Treatment

The most recent version of the Southern African HIV Clinicians Society’s adult antiretroviral therapy (ART) guidelines was published in December 2014. In the 27 August 2015 edition of the New England Journal of Medicine, two seminal randomised controlled trials that addressed the optimal timing of ART in HIV-infected patients with high CD4 counts were published: Strategic timing of antiretroviral therapy (START) and TEMPRANO ANRS 12136 (Early antiretroviral treatment and/or early isoniazid prophylaxis against tuberculosis in HIV-infected adults). The findings of these two trials were consistent: there was significant individual clinical benefit from starting ART immediately in patients with CD4 counts higher than 500 cells/μL rather than deferring until a certain lower CD4 threshold or clinical indication was met. The findings add to prior evidence showing that ART reduces the risk of onward HIV transmission. Therefore, early ART initiation has the public health benefits of potentially reducing both HIV incidence and morbidity. Given this new and important evidence, the Society took the decision to provide a specific update on the section of the adult ART guidelines relating to when ART should be initiated.

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Mother to child human immunodeficiency virus (HIV) transmission: what HIV-infected women think. Our experience in Rome, Italy

International Journal of STD & AIDS ◽

10.1258/095646202760159675 ◽

2002 ◽

Vol 13 (8) ◽

pp. 551-553

Author(s):

E Visconti ◽

Lucia Pastore Celentano ◽

Salvatore Marinaci ◽

Giancarlo Scoppettuolo ◽

Enrica Tamburrini

Keyword(s):

Antiretroviral Therapy ◽

Highly Active Antiretroviral Therapy ◽

Hiv Transmission ◽

Childbearing Age ◽

Highly Active ◽

Perinatal Hiv ◽

Significant Difference ◽

Immunodeficiency Virus ◽

Risk Rate ◽

Mother To Child

Objectives: To investigate the knowledge of the risk of HIV vertical transmission as well as the feeling about the new therapy in reducing that rate. Methods: We included 152 HIV-infected women. A self reported questionnaire was administered from September to December 2000. Results: About the risk rate of transmitting HIV to their baby, 21 (13.8%) women indicated 100%; 67 (44.1%) 50-80%; 35 (23%) 10-50% and only 22 women (14.5%) answered the correct value of less than 5%. Regarding the effect of highly active antiretroviral therapy, 82 women (53.9%) considered therapy effective in reducing vertical HIV transmission, while 63 women (41.4%) considered therapy powerless in preventing mother to child HIV transmission. Any statistically significant difference in sociodemographic, clinical, viroimmunological characteristics and antiretroviral therapy emerged between the groups. Conclusions: Our data highlight the importance of providing appropriate counselling about perinatal HIV transmission to all childbearing age HIV infected women.

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An anesthesiologist’s view of problems in HIV-positive patients

Perioperaciina Medicina ◽

10.31636/prmd.v1i1.9 ◽

2018 ◽

Vol 1 (1) ◽

pp. 66-69

Author(s):

E. V. Grigimalsky ◽

A. I. Garga ◽

A. V. Tarasov ◽

I. N. Dovgiy ◽

N. N. Budnyk

Keyword(s):

Antiretroviral Therapy ◽

Hiv Transmission ◽

Toxic Hepatitis ◽

Perioperative Period ◽

Hiv Positive ◽

Childbearing Age ◽

Infected People ◽

Perinatal Hiv ◽

Ensure Patient Safety ◽

Serum Transaminases

Currently, HIV infection is becoming epidemic. More than 42% of HIV-infected people in the world are women of childbearing age. With the onset of antiretroviral therapy, chemoprophylaxis during pregnancy, and planned cesarean section, the risk of perinatal HIV transmission decreases to 1–2%. However, various side effects such as anemia, neutropenia, thrombocytopenia, fatty liver dystrophy, toxic hepatitis, acute pancreatitis, increased serum transaminases, changes in biochemical parameters of liver function, impaired glucose tolerance, and hypocoagulation may occur in the context of antiretroviral therapy. This poses to the anesthesiologist a number of new tasks to ensure patient safety during the perioperative period.

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Prevention of mother-to-child HIV transmission: from the first stages to the possibility of elimination

Journal of obstetrics and women s diseases ◽

10.17816/jowd696107-116 ◽

2021 ◽

Vol 69 (6) ◽

pp. 107-116

Author(s):

Olga L. Mozalyova ◽

Anna V. Samarina

Keyword(s):

Antiretroviral Therapy ◽

Highly Active Antiretroviral Therapy ◽

Hiv Transmission ◽

Transmission Rate ◽

Preventive Treatment ◽

Transmission Risk ◽

Mother To Child Transmission ◽

Child Transmission ◽

Perinatal Hiv ◽

Mother To Child

Despite the success in reducing mother-to-child HIV transmission rate worldwide, the problem of perinatal HIV transmission is still relevant. Sexual activity nowadays is the predominant way of transmission, therefore the number of HIV cases among women growths. This leads to an increased number of pregnancies and childbirth in HIV-infected women. Better preventive treatment has decreased the transmission risk to 1% or less. Despite this, the Russian Federation is still not among the countries where the elimination of mother-to-child transmission has been recorded. This review article focuses on the main stages of mother-to-child transmission prevention from the time that no antiretroviral therapy was available to the current stage, when highly active antiretroviral therapy is used during pregnancy, childbirth and for the treatment of newborns. The research provides a comparative analysis of modern national and international clinical recommendations for the prevention of mother-to-child HIV transmission.

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