Effectiveness and safety of integrase inhibitors in HIV-infected pregnant women followed up in the Madrid Cohort

2019 ◽  
Author(s):  
Marta Illán Ramos ◽  
Diana Mazariegos ◽  
José Beceiro ◽  
Luis Escosa ◽  
Eloy Muñoz ◽  
...  
Keyword(s):  
Pregnant Women ◽  
First Trimester ◽  
Public Hospitals ◽  
Integrase Inhibitors ◽  
Hemodynamic Compromise ◽  
Cd4 Lymphocyte Count ◽  
Observational Cohort ◽  
Cd4 Lymphocyte ◽  
Mother To Child ◽  
Hiv 1

Abstract Background The risk of HIV-1 mother-to-child transmission (MTCT) is associated mainly with the gestational age at which antiretroviral therapy (AT) begins and HIV-1-RNA viral load (VL) at delivery. The importance of achieving virological supression during pregnancy, has led to an increased use of integrase inhibitors (INIs) in risky conditions. Our objective was to assess the safety and effectiveness in Madrid-Cohort of mothers-children exposed to INIs during pregnancy. Methods Retrospective, multicentric, observational, cohort study, of HIV-1-infected pregnant women exposed to INIs during pregnancy and their infants, from 2000 to 2017, from the nine public hospitals belonging to the Madrid Cohort. Maternal demographic characteristics, clinical data, HIV-1 infection features, AT regimens and changes of treatment during pregnancy were recorded. Blood count, biochemistry panel, HIV-1 VL and CD4+ lymphocyte counts/percentage at first trimester and at the last one near delivery were also collected. Results Sixty seven pregnant women exposed to INIs from the Madrid cohort (n: 1423) and their 68 children were identified (17.6% premature). Neonatal prophylaxis consited mostly on zidovudine (AZT) monotherapy, followed by combined prophylaxis with ‘triple therapy’. There were no cases of MTCT. Twenty women were diagnosed with HIV-1 in the current pregnancy. Of 43 women with AT before pregnancy, 65% received INI before conception. Raltegravir was the most commonly used (80.5%). The median lenght with INI at delivery was 148 days [interquartile rang (IR): 29-251]. Median CD4+ lymphocyte count increased from 428 cells/mL (IR: 310-642) in first trimester to 636 cells/mL (IR: 408-818) in the third. There was a statistically significant increase (p=0.02) of mothers with undetectable VL at delivery compared with first trimester. INIs were well tolerated, without any relevant adverse effect notification. There was no case of discontinued medication due to intolerance or toxicity. 11,7% of children had minor birth defects and one patient had ventricular septal defect without hemodynamic compromise. All of them evolved favourably. Conclusions INI seems safe and effective in prevention of MTCT. Antiretroviral regimens during pregnancy that include INI are increasingly being used. Our findings support the use of INI as intensification in pregnant women at high risk of MTCT.

scholarly journals Female perspectives of male partners’ inclusion in the prevention of mother-to-child HIV transmission programme in KwaZulu-Natal

Curationis ◽  
2016 ◽  
Vol 39 (1) ◽  
Author(s):  
Mondli Miya ◽  
Tennyson Mgutshini
Keyword(s):  
Pregnant Women ◽  
Hiv Transmission ◽  
Public Hospitals ◽  
Sub Saharan Africa ◽  
Child Health Services ◽  
Mother To Child Transmission ◽  
Male Partners ◽  
Child Transmission ◽  
Financial Investment ◽  
Mother To Child

Background: The South African government intervened by implementing the prevention of mother–to-child transmission programme (PMTCT) to curb the HIV transmission from mother to child during and after pregnancy. The PMTCT programme has been at the forefront of global prevention efforts since 1998. Without treatment, the risk of transmission ranges from one in five to one in two newborns; however, the risk of mother-to-child transmission can be reduced to as low as 2%–5% with evidenced interventions. Sub-Saharan Africa, and most particularly South Africa, is the most affected by the pandemic despite having the largest financial investment in PMTCT services across the continent.Objectives: The objectives of the study were to describe and explore the female perspectives of male inclusion in the prevention of mother-to-child HIV transmission programme in KwaZulu-Natal.Methodology: A qualitative, descriptive, explorative study was conducted through in-depth individual interview of pregnant women until data saturation.Results: The findings of the study revealed that the existing design of public hospitals was not wholly conducive to facilitating male inclusion in maternal and child health services. Resources were largely insufficient to support the participation of pregnant mothers and any attempts to support the inclusion of males needed to be based on a clear increase in service provision.Conclusion: The study recommended male partners’ inclusion in the prevention of mother- to-child HIV transmission to support effective management of HIV in pregnancy and PMTCT programmes. The inclusion of men will provide the holistic support needed by pregnant women on PMTCT programmes.

Incident and long-term HIV-1 infection among pregnant women in Brazil: Transmitted drug resistance and mother-to-child transmission

2016 ◽  
Vol 88 (11) ◽  
pp. 1936-1943 ◽  
Author(s):  
Yanna Andressa Ramos Lima ◽  
Ludimila Paula Vaz Cardoso ◽  
Mônica Nogueira da Guarda Reis ◽  
Mariane Martins Araújo Stefani
Keyword(s):  
Drug Resistance ◽  
Pregnant Women ◽  
Transmitted Drug Resistance ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Mother To Child ◽  
Hiv 1

Antiretroviral Therapy in Pregnant Women

2017 ◽  
Author(s):  
William R. Short ◽  
Jason J. Schafer
Keyword(s):  
Pregnant Women ◽  
Antiretroviral Drugs ◽  
Virologic Suppression ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Virologic Control ◽  
Treatment Changes ◽  
Mother To Child ◽  
Hiv 1 ◽  
Pregnancy Registry

Research has demonstrated that proper prevention strategies and interventions during pregnancy, labor, and delivery can significantly reduce the rate of mother-to-child transmission of HIV. Antiretroviral drugs (ARVs) should be initiated in all HIV-infected pregnant women regardless of CD4+ T cell count or HIV-1 RNA level. ARVs should be given in combination therapy, similar to nonpregnant patients, with the goal of complete virologic suppression. Treatment changes during pregnancy have been associated with the loss of virologic control and independently associated with mother-to-child transmission. All cases of prenatal antiretroviral exposure should be reported to the Antiretroviral Pregnancy Registry, which collects data on HIV-infected pregnant women taking ARVs with the goal of detecting any major teratogenic effects.

scholarly journals Influence of human immunodeficiency virus type 1 subtype on mother-to-child transmission

2003 ◽  
Vol 84 (3) ◽  
pp. 607-613 ◽  
Author(s):  
Natàlia Tàpia ◽  
Sandra Franco ◽  
Francesc Puig-Basagoiti ◽  
Clara Menéndez ◽  
Pedro Luis Alonso ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Pregnant Women ◽  
Human Immunodeficiency Virus Type ◽  
Virus Type ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Immunodeficiency Virus ◽  
Mother To Child ◽  
Hiv 1

The present study was designed to assess whether the subtype of human immunodeficiency virus type 1 (HIV-1) could affect the rate of HIV-1 mother-to-child transmission in a cohort of 31 HIV-1-seropositive pregnant Tanzanian women. In order to assign a subtype to the samples analysed, nucleotide sequencing of the HIV-1 long terminal repeat U3 and C2V3C3 envelope regions was performed from the sera of these 31 pregnant women. Except in three cases, amplification of both regions was achieved in all samples. Subtypes A (n=13, 46 %), C (n=6, 21 %) and D (n=2, 7 %), as well as a number (25 %) of A/C, C/A, D/A and C/D recombinant forms (n=3, 2, 1 and 1, respectively), were identified. Of the 31 HIV-1 seropositive pregnant women analysed, eight (26 %) transmitted HIV-1 to their infants. Among the eight transmitter mothers, four (4 of 13, 31 %) were infected with HIV-1 subtype A, one (1 of 6, 17 %) with HIV-1 subtype C, none (0 of 2, 0 %) with HIV-1 subtype D and three (3 of 7, 43 %) with HIV-1 subtype recombinant A/C. These findings show no significant differences in the mother-to-child transmissibility of HIV-1 subtypes A, C and D and detected recombinants forms.

scholarly journals Risk factors associated with low CD4+ lymphocyte count among HIV-positive pregnant women in Nigeria

2009 ◽  
Vol 106 (3) ◽  
pp. 227-231 ◽  
Author(s):  
Alash'le Abimiku ◽  
Pacha Villalba-Diebold ◽  
Jelpe Dadik ◽  
Felicia Okolo ◽  
Edwina Mang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Lymphocyte Count ◽  
Hiv Positive ◽  
Factors Associated ◽  
Cd4 Lymphocyte Count ◽  
Cd4 Lymphocyte

scholarly journals RISK FACTORS OF HIV-1 VERTICAL TRANSMISSION (VT) AND THE INFLUENCE OF ANTIRETROVIRAL THERAPY (ART) IN PREGNANCY OUTCOME

2014 ◽  
Vol 56 (2) ◽  
pp. 133-138 ◽  
Author(s):  
Maria F.M. Barral ◽  
Gisele R. de Oliveira ◽  
Rubens C. Lobato ◽  
Raul A. Mendoza-Sassi ◽  
Ana M.b. Martínez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prenatal Care ◽  
Pregnant Women ◽  
Pregnancy Outcome ◽  
Vertical Transmission ◽  
First Trimester ◽  
Antiretroviral Drugs ◽  
Vertical Transmission Of Hiv ◽  
Hiv 1 ◽  
In Pregnancy

In the absence of intervention, the rate of vertical transmission of HIV can range from 15-45%. With the inclusion of antiretroviral drugs during pregnancy and the choice of delivery route this amounts to less than 2%. However ARV use during pregnancy has generated several questions regarding the adverse effects of the gestational and neonatal outcome. This study aims to analyze the risk factors for vertical transmission of HIV-1 seropositive pregnant women living in Rio Grande and the influence of the use of ARVs in pregnancy outcome. Among the 262 pregnant women studied the rate of vertical transmission of HIV was found to be 3.8%. Regarding the VT, there was a lower risk of transmission when antiretroviral drugs were used and prenatal care was conducted at the referral service. However, the use of ART did not influence the outcome of pregnancy. However, initiation of prenatal care after the first trimester had an influence on low birth weight, as well as performance of less than six visits increased the risk of prematurity. Therefore, the risk factors analyzed in this study appear to be related to the realization of inadequate pre-natal and maternal behavior.

scholarly journals Nausea, vomiting and poor appetite during pregnancy and adverse birth outcomes in rural Nepal: an observational cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Amanda Regodón Wallin ◽  
James M Tielsch ◽  
Subarna K Khatry ◽  
Luke C Mullany ◽  
Janet A Englund ◽  
...  
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Pregnant Women ◽  
Birth Outcomes ◽  
First Trimester ◽  
Observational Cohort Study ◽  
Limited Resources ◽  
Poor Appetite ◽  
Observational Cohort ◽  
Rural Nepal

Abstract Background Nausea and vomiting are experienced by a majority of pregnant women worldwide. Previous studies have yielded conflicting results regarding their impact on birth outcomes and few studies have examined this relationship in settings with limited resources. We aimed to determine the effect of nausea, vomiting and poor appetite during pregnancy on birth outcomes in rural Nepal. Methods Observational cohort study using data collected in two randomized, community-based trials to assess the effect of influenza immunization during pregnancy on reproductive and respiratory outcomes among pregnant women and their offspring. Pregnant women in Sarlahi District, Nepal were recruited from 2011 to 2013. Exposure was defined as nausea, vomiting or poor appetite at any point during pregnancy and by trimester; symptoms were recorded monthly throughout pregnancy. Adverse outcomes were low birth weight (LBW), preterm birth and small for gestational age (SGA). Adjusted relative risks (aRR) with 95% CIs are reported from Poisson regressions with robust variance. Results Among 3,623 pregnant women, the cumulative incidence of nausea, vomiting or poor appetite was 49.5% (n = 1793) throughout pregnancy and 60.6% (n = 731) in the first trimester. Significantly higher aRRs of LBW and SGA were observed among women experiencing symptoms during pregnancy as compared to symptom free women (LBW: aRR 1.20; 95% CI 1.05 1.28; SGA: aRR 1.16; 95% CI 1.05 1.28). Symptoms in the first trimester were not significantly associated with any of the outcomes. In the second trimester, we observed significantly higher aRRs for LBW and SGA (LBW: aRR 1.17; 95% CI 1.01 1.36; SGA: aRR 1.16; 95% CI 1.05 1.29) and a significantly lower aRR for preterm birth (aRR 0.75; 95% CI 0.59 0.96). In the third trimester, we observed significantly higher aRRs for LBW and SGA (LBW: aRR 1.20; 95% CI 1.01 1.43; SGA: aRR 1.14; 95% CI 1.01 1.29). Conclusions Symptoms of nausea, vomiting or poor appetite during pregnancy are associated with LBW, SGA and preterm birth in a setting with limited resources, especially beyond the first trimester. Trial registration Prospectively registered at ClinicalTrials.gov on Dec 17, 2009 (NCT01034254).

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