Surrogacy and HIV: features of a clinical case in comorbid cancer

Introduction. A significant increase in the quality and increase in the life expectancy of HIV patients during treatment with antiretroviral drugs necessitates the implementation of the reproductive function in these patients. The participation of a surrogate mother in the treatment of infertility in HIV-infected potential parents, vided by the Russian legislation, requires additional solutions to a number of clinical and organizational problems. The aim was to substantiate a surrogacy program as a method of choice for the treatment of infertility in patients with HIV-positive status and comorbid cancer and also a multidisciplinary approach to organizing it on the example of a specific clinical situation and based on the analysis literature data.Materials. We report a case of using a surrogacy program for a married couple with a positive HIV status in the 4th stage of the disease using the husband's sperm and donor oocytes. The use of donor oocytes in this situation is due to the onset of menopause against the background of a comorbid severe cancer that required multiple courses of chemotherapy.Conclusion. Potential biological parents with a positive HIV status in stage 4 of the disease may have a comorbid oncological pathology, which in itself, as well as its treatment, contributes to a decrease in fertility, and for the future biological mother, it is an obstacle to independently carrying a pregnancy. In this regard, the surrogacy program is the method of choice for the treatment of infertility in this clinical situation. It is advisable for obstetricians-gynecologists (reproductologists) to inform the surrogate mother about the potential risks of infection with the participation of genetic parents with HIV-positive status at various stages of IVF and about preventive measures during gestation in conjunction with the infectious disease specialist of the regional centers for the prevention and control of AIDS.

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Gaps in the legal regulation of surrogacy in Ukraine and analysis of the experience of foreign countries

Legal horizons ◽

10.21272/legalhorizons.2020.i22.p76 ◽

2020 ◽

pp. 76-81

Author(s):

M.M. Novytska ◽

A.V. Kozhushko

Keyword(s):

Legal Regulation ◽

Legal Analysis ◽

Surrogate Mother ◽

Legal Cases ◽

National Courts ◽

State Register ◽

Foreign Countries ◽

Biological Parents ◽

Civil Status ◽

Genetic Parents

The article is devoted to the study of the legislation of Ukraine regulating the procedure of surrogacy and the main legal gaps in this area. In addition, a legal analysis and comparison of the legislation in the field of surrogacy in such foreign countries as Belarus, Kazakhstan, the Czech Republic, Israel, Sweden, the Netherlands, Nigeria, Finland, some US states. The main legal cases arising in Ukraine during and after the use of the surrogacy procedure, their causes and consequences are highlighted. The case law of national courts is given and analyzed. In particular, the procedure for legal regulation of the mechanism of registration and registration of a child born as a result of surrogacy needs to be improved in order to avoid the possibility of a surrogate mother entering information about herself as a child’s mother in the state register of civil status and further challenging maternity in court. A comparative analysis of the experience of foreign legal regulation of the institution of surrogacy and focused on their pros and cons. The basic provisions and principles which can be borrowed from experience of realization by foreign countries of procedure of surrogacy are offered. When creating regulations, a number of guarantee norms should be taken into account, which will be the basis for avoiding potential conflicts and negative situations. In particular, they include: the refusal of a surrogate mother to give the child to biological parents; the refusal of the biological parents to pick up the newborn child; cases of birth of two or more children; birth of a dead / sick child; the desire of the surrogate mother to terminate the pregnancy, the refusal of the genetic parents to perform their duties in terms of paying for the services of the surrogate mother. The conclusion about the necessity of the Ukrainian legislation in legal regulation and rationing of surrogacy by creation of the uniform profile regulatory act is carried out.

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‘There are no more secrets’: acceptability of a family-centered model of care for HIV positive children in Eswatini

BMC Health Services Research ◽

10.1186/s12913-020-05810-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Philisiwe N. Khumalo ◽

Leila Katirayi ◽

Kim Ashburn ◽

Caspian Chouraya ◽

Lydia Mpango ◽

...

Keyword(s):

Waiting Times ◽

Family Members ◽

Standard Of Care ◽

Antiretroviral Drugs ◽

Hiv Care ◽

Hiv Positive ◽

Hiv Status ◽

Retention In Hiv Care ◽

Family Centered ◽

Clinic Visits

Abstract Background HIV-positive children have lagged adults on retention in HIV care and viral suppression. To address this gap, Eswatini’s Ministry of Health started a pilot family-centered HIV care model (FCCM) targeting HIV-positive children under 20 years old and their families. Methods We conducted semi-structured in-depth interviews with 25 caregivers and 17 healthcare workers (HCWs) to assess acceptability of FCCM in four pilot FCCM health facilities in Hhohho region of Eswatini. Thematic analysis with inductive and deductive codes was used to identify salient themes. Results Caregivers and HCWs reported FCCM benefits including strengthening the family bond, encouragement for family members to disclose their HIV status and supporting each other in taking antiretroviral drugs. Caregivers reported that they spent fewer days in clinic, experienced shorter waiting times, and received better counseling services in FCCM compared to the standard-of-care services. FCCM implementation challenges included difficulty for families to attend clinic visits together (e.g., due to scheduling conflicts with weekend Teen Support Club meetings and weekday FCCM appointments). Both HCWs and caregivers mentioned difficulty in sharing sensitive health information in the presence of other family members. HCWs also had challenges with supporting caregivers to disclose HIV status to children and managing the larger group during clinic visits. Conclusions FCCM for HIV-positive children was acceptable to both caregivers and HCWs, and they supported scaling-up FCCM implementation nationally. However, special considerations should be made to address the challenges experienced by participants in attending clinic visits together as a family in order to achieve the full benefits of FCCM for HIV positive children.

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CLINICAL CASE OF SUCCESSFUL TREATMENT OF INFERTILITY IN A PATIENT WITH FAILURE IVF RESULTS IN ANAMNESIS

"Medical & pharmaceutical journal "Pulse" ◽

10.26787/nydha-2686-6838-2020-22-12-61-67 ◽

2020 ◽

pp. 61-67

Author(s):

Kalinkina O.B. ◽

Tezikov Yu.V. ◽

Lipatov I.S. ◽

Aravina O.R.

Keyword(s):

Assisted Reproductive Technologies ◽

Transvaginal Ultrasound ◽

Clinical Manifestations ◽

Reproductive Function ◽

Abnormal Uterine Bleeding ◽

Clinical Situation ◽

Reproductive Technologies ◽

Reproductive Age ◽

Deficiency Anemia ◽

Number Of Publications

Genital endometriosis is a disease of women of reproductive age, accompanied by infertility in 50% [1]. Adenomyosis can be considered as an endometriosis of the uterus. Histologically, this process is represented by ectopic, non-tumor endometrial glands, and stroma surrounded by hypertrophic and hyperplastic myometrium [2]. Adenomyosis is accompanied by pelvic pain of varying intensity as well as menstrual disorders [1]. The disease is accompanied by significant violations of reproductive function (infertility, unsuccessful attempts at pregnancy and miscarriage, abnormal uterine bleeding). Adenomyosis can be accompanied by a violation of the function of adjacent organs (such as the bladder, rectum). Often, one of the clinical manifestations of adenomyosis is the development of sideropenic syndrome, which is also caused by the development of chronic post-hemorrhagic iron deficiency anemia. This is accompanied by a deterioration in the general condition of patients, a decrease in their ability to work. Despite a large number of publications in Russian and foreign scientific sources devoted to this problem, reproductive doctors and obstetricians-gynecologists often underestimate the role of adenomyosis in pregnancy planning using assisted reproductive technologies. Without interpreting the anamnesis data obtained through an active survey, doctors do not prescribe additional methods for diagnosing this pathology, which is not complex and expensive. To confirm the diagnosis, a transvaginal ultrasound examination of the pelvic organs during the premenstrual period is sufficient. In cases that are difficult to diagnose, the MRI method of the corresponding anatomical area can be used. Underestimation of the clinical picture and under-examination of the patient did not allow prescribing timely correction of the pathology and led to unsuccessful attempts to implement the generative function using assisted reproductive technologies. The conducted examination with clarification of the cause of IVF failures and the prescribed reasonable treatment made it possible to achieve regression of endometriosis foci in this clinical situation, followed by the patient's ability to realize generative function.

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Prevalence of suicidal ideation and associated factors among HIV positive perinatal women on follow-up at Gondar town health institutions, Northwest Ethiopia: a cross-sectional study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03529-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Leul Belachew Zewdu ◽

Mebratu Mitiku Reta ◽

Niguse Yigzaw ◽

Koku Sisay Tamirat

Keyword(s):

Suicidal Ideation ◽

Unplanned Pregnancy ◽

Cross Sectional Study ◽

Hiv Positive ◽

Hiv Status ◽

Cross Sectional ◽

Factors Associated ◽

Gondar Town ◽

Perinatal Women ◽

Significant Factors

Abstract Background Suicidal behaviors cover a range or continuum of acts from suicidal ideations to a series of actions, commonly known as suicidal attempts or deliberate self-harms. Though different mental disorders related studies were conducted among HIV/AIDS patients, there is a scarcity of information about the magnitude and determinants of suicidal thoughts among perinatal women. Therefore, this study aimed to determine the prevalence of suicidal ideation and associated factors among HIV positive perinatal women in the study setting. Methods An institution-based cross-sectional study was conducted among perinatal women on treatment to the prevention of mother to child transmission of HIV/AIDS at Gondar town health facilities. A total of 422 HIV-positive perinatal women were selected systematically and the data collected through medical record review and interview using a Composite International Diagnostic Interview (CIDI) toolkit. A binary and multivariable logistic regression model was employed to identify factors associated with suicidal ideation. An Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was computed to see the strength of association between outcome and independent variables. Characteristics having less than 0.05 p-value had been taken as significant factors associated with the outcome of interest. Result The prevalence of suicidal ideation was found to be 8.2% (95% CI; 5.7 to 11.3) and with a standard error of 0.013. Perinatal depression (AOR=4.40, 95%CI: 1.63 11.85), not disclosed HIV status (AOR=3.73, 95%CI: 1.44 9.65), and unplanned pregnancy (AOR=2.75, 95%CI: 1.21 6.21) were significant factors associated with suicidal ideation. Conclusion The magnitude of suicidal ideation among HIV positive perinatal women was found to be low. Perinatal depression, non-disclosed HIV status, and unplanned pregnancy were factors significantly associated with suicidal ideation. This finding suggests the integration of mental health services with maternal and HIV support programs.

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Realities and challenges of breastfeeding policy in the context of HIV: a qualitative study on community perspectives on facilitators and barriers related to breastfeeding among HIV positive mothers in Baringo County, Kenya

International Breastfeeding Journal ◽

10.1186/s13006-021-00385-1 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Betty Mogesi Samburu ◽

Judith Kimiywe ◽

Sera Lewise Young ◽

Frederick Murunga Wekesah ◽

Milka Njeri Wanjohi ◽

...

Keyword(s):

Exclusive Breastfeeding ◽

Cultural Practices ◽

Health Workers ◽

Male Involvement ◽

Holistic Approach ◽

Antiretroviral Drugs ◽

Hiv Positive ◽

Community Perspectives ◽

Hiv Positive Mothers ◽

Facilitators And Barriers

Abstract Background Although recent policies have sought to increase the rates of exclusive breastfeeding (EBF) and continued breastfeeding for HIV exposed infants, few programs have considered the multiple social and cultural barriers to the practice. Therefore, to generate evidence for exclusive and continued breastfeeding policies in Kenya, we examined community perspectives on the facilitators and barriers in adherence to EBF for the HIV positive mothers. Methods Qualitative research was conducted in Koibatek, a sub-County in Baringo County Kenya, in August 2014 among 205 respondents. A total of 14 focus group discussions (n = 177), 14 In-depth Interviews and 16 key informant interviews were conducted. Transcribed data was analyzed thematically. NVivo version 10.0 computer qualitative software program was used to manage and facilitate the analysis. Results Facilitators to exclusive breastfeeding were perceived to include counselling at the health facility, desire to have a healthy baby, use of antiretroviral drugs and health benefits associated with breastmilk. Barriers to EBF included poor dissemination of policies, knowledge gap, misinterpretation of EBF, inadequate counselling, attitude of mother and health workers due to fear of vertical HIV transmission, stigma related to misconception and misinformation that EBF is only compulsory for HIV positive mothers, stigma related to HIV and disclosure, social pressure, lack of male involvement, cultural practices and traditions, employment, food insecurity. Conclusions There are multiple facilitators and barriers of optimal breastfeeding that needs a holistic approach to interventions aimed at achieving elimination of mother to child transmission. Extension of infant feeding support in the context of HIV to the community while building on existing interventions such as the Baby Friendly Community Initiative is key to providing confidential support services for the additional needs faced by HIV positive mothers.

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Low socioeconomic status is associated with self-reported HIV positive status among young MSM in Brazil and Peru

BMC Infectious Diseases ◽

10.1186/s12879-021-06455-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Thiago S. Torres ◽

Lara E. Coelho ◽

Kelika A. Konda ◽

E. Hamid Vega-Ramirez ◽

Oliver A. Elorreaga ◽

...

Keyword(s):

Socioeconomic Status ◽

Latin American ◽

Low Socioeconomic Status ◽

Low Income ◽

Sexual Attraction ◽

Hiv Positive ◽

Sociodemographic Characteristics ◽

Hiv Status ◽

Hiv Test ◽

Young Msm

Abstract Background Despite efforts to stop HIV epidemic in Latin America, new HIV cases continue to increase in the region especially among young MSM (YMSM). This study aims to assess if sociodemographic characteristics are associated with self-reported HIV positive status among YMSM from three Latin American countries. Methods Cross-sectional web-based survey advertised on dating apps (Grindr and Hornet) and Facebook in Brazil, Mexico and Peru. For this analysis, we included YMSM aged 18–24 years who self-reported their HIV status. We used multivariable logistic regression models for each country separately to verify if sociodemographic characteristics (race, education and income) were associated with HIV self-reported status after adjusting for behavior characteristics (sexual attraction and steady partner). Results Among 43,687 MSM who initiated the questionnaire, 27,318 (62.5%) reported their HIV status; 7001 (25.6%) of whom were YMSM. Most YMSM (83.4%) reported an HIV test in the past year, and 15.7% reported an HIV positive status in Peru, 8.4% in Mexico and 7.7% in Brazil. In adjusted models, low-income was associated with higher odds of self-reported HIV positive status in Brazil (aOR = 1.33, 95%CI: 1.01–1.75) and Peru (aOR = 1.56, 95%CI: 1.02–2.40), but not in Mexico. Lower education was associated with higher odds of self-reported HIV positive status only in Brazil (aOR = 1.35, 95%CI: 1.05–1.75). Conclusions In this large, cross-country study, self-reported HIV positive status among YMSM was high. Lower socioeconomic status was associated with higher odds of self-reported HIV positive status in Brazil and Peru. There is an urgent need for HIV prevention interventions targeting YMSM, and efforts to address low-income YMSM are especially needed in Peru and Brazil.

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1655. Extrapulmonary Tuberculosis in a Large Healthcare System

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1833 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S816-S816

Author(s):

Travis Denmeade ◽

William Smith ◽

Banks Kooken ◽

Michael Leonard

Keyword(s):

Health System ◽

Healthcare System ◽

Extrapulmonary Tuberculosis ◽

Retrospective Chart Review ◽

The United States ◽

Primary Objective ◽

Hiv Positive ◽

Hiv Status ◽

Southeastern Us ◽

Race Ethnicity

Abstract Background The US has seen a rise in the proportion of patients with extrapulmonary tuberculosis (TB) even though the yearly incidence of new TB cases has been in decline. The purpose of this study was to analyze incidence of extrapulmonary TB at Atrium Health, a large non-profit health system in the Southeastern US. Methods Retrospective chart review of 94 adult patients with culture confirmed extrapulmonary TB between 2008-2019. Individuals younger than 18 years were excluded from analysis. The primary objective was to examine incidence of extrapulmonary TB and compare it to that reported in the literature. Secondary objectives included determination of sites of extrapulmonary disease and associated patient characteristics including HIV status, race, ethnicity, and birthplace. Results 237 patients were identified as having confirmed TB infection from 2008-2019 in a retrospective analysis within the Atrium Health System. 94 (40%) were found to have extrapulmonary disease; 42 (45%) with concomitant pulmonary disease. The patients were 55% male, 40% African American, 21% Hispanic or Latino, and 51% US-born. Median age was 44 years (range 20-62). The most common sites of extrapulmonary TB were lymphatic (35%), pleural (24%), GI/Peritoneal (12%), CNS (10%), and Bone/Joint (10%). Lymphatic involvement was 40% cervical, 19% intrathoracic, and 16% axillary. 66% of skeletal disease was vertebral. Other sites included GU, pericardial, skin, and disseminated disease (5%). 37% were HIV positive, 18% with unknown HIV status as they were never tested. Information regarding patient’s race, ethnicity, and birthplace were unknown for 2 patients. The percentage of extrapulmonary cases were 29% in 2008, 39% in 2012, 38% in 2016, and 49% in 2019. Conclusion Lymphatic and pleural involvement were the most common extrapulmonary sites. Of those tested, 37% were HIV positive but there was a significant portion never tested showing a need for increased testing. The proportion of extrapulmonary TB cases since 2008 is higher at 40% compared to the 31% reported in the United States. There has been a rise in the proportion of extrapulmonary TB within our healthcare system and deserves further analysis. Disclosures All Authors: No reported disclosures

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Observational study of the populations accessing rapid point-of-care HIV testing in Winnipeg, Manitoba, Canada, through a retrospective chart review of site records

Sexually Transmitted Infections ◽

10.1136/sextrans-2017-053195 ◽

2017 ◽

Vol 94 (3) ◽

pp. 194-199 ◽

Cited By ~ 4

Author(s):

James Blain Johnston ◽

Joss N Reimer ◽

John L Wylie ◽

Jared Bullard

Keyword(s):

Viral Load ◽

Hiv Testing ◽

Clinical Outcomes ◽

Point Of Care ◽

Age Groups ◽

Linkage To Care ◽

Hiv Positive ◽

Hiv Status ◽

Viral Load Suppression ◽

Hiv Test

ObjectivesHIV point-of-care testing (POCT) has been available in Manitoba since 2008. This study evaluated the effectiveness of POCT at identifying individuals with previously unknown HIV status, its effects on clinical outcomes and the characteristics of the populations reached.MethodsA retrospective database review was conducted for individuals who received HIV POCT from 2011 to 2014. Time to linkage to care and viral load suppression were compared between individuals who tested positive for HIV using POCT and controls identified as positive through standard screening. Testing outcomes for labouring women with undocumented HIV status accessing POCT during labour were also assessed.Results3204 individuals received POCT (1055 females (32.9%) and 2149 males (67.1%)), being the first recorded HIV test for 2205 (68.8%). Males were more likely to be targeted with POCT as their first recorded HIV test (adjusted OR (AOR) 1.40). Between the two main test sites (Main Street Project (MSP) and Nine Circles Community Health Centre), MSP tested relatively fewer males (AOR 0.79) but a higher proportion of members of all age groups over 30 years old (AOR 1.83, 2.51 and 3.64 for age groups 30–39, 40–49 and >50, respectively). There was no difference in time to linkage to care (p=0.345) or viral load suppression (p=0.405) between the POCT and standard screening cohorts. Of 215 women presenting in labour with unknown HIV status, one was identified as HIV positive.ConclusionsPOCT in Manitoba has been successful at identifying individuals with previously unknown HIV-positive status. Demographic differences between the two main testing sites support that this intervention is reaching unique populations. Given that we observed no significant difference in time to clinical outcomes, it is reasonable to continue using POCT as a targeted intervention.MeSH termsHIV infection; rapid HIV testing; vertical infectious disease transmission; community outreach; service delivery; marginalised populations.

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