HIV-infected Women Research Articles

First Report of HPV Genotyping and Distribution in People Living with and Without HIV from Iran and the Middle East.

In people living with human immune deficiency (PLHIV), the rates of human papillomavirus (HPV) infection, mixed types, and high-risk (HR) strains increase, while the virus clearance is prevented. Here, we report HPV genotyping in PLHIVs from Iran and the Middle East region for the first time. HPV genotyping in referring individuals from different provinces to our laboratory was evaluated over 2023-2024. For this, the HPV types in specimens were detected through the INNO- LiPA HPV genotyping kit. Statistical analysis was conducted with a 95% confidence interval (95%CI) and P < 0.05. Accordingly, 481 subjects from various provinces participated in this study. The rate of HPV infection was 45.7%, of which 14% were HIV-infected women referred from all provinces. The most prevalent types included 6, 51, and 18, but not 16 HR types. Mixed infections in dually infected women were significantly more than in HPV-infected ones. The HPV+/HIV+ subgroup had the lowest median age. The prevalence of HPV types and mixed infection in PLHIVs was congruent with the previous reports, except for the low rate of type 16 infection, perhaps due to the healthy nature of our subjects. Only HIV+/HPV+ cases' age was similar to the previous reports, perhaps because of sample collection and study designs. Among all factors, age and gender affected the HPV type distribution notably. The current study corroborated the results of many prior reports, demonstrating the considerable impact of HIV status on HPV distribution. The authors recommend implementing a national HPV vaccination and more comprehensive reports of HPV genotyping in PLHIVs.

Does knowledge impact adherence?: correlation between HIV-infected pregnant women's knowledge of WHO-recommended PMTCT guidelines and their adherence to the PMTCT program in India

ABSTRACT WHO’s 2013 PMTCT guidelines recommended lifelong antiretroviral therapy (ART) for HIV-infected pregnant and breastfeeding women, exclusive breastfeeding (EBF), nevirapine prophylaxis (NVP) and early infant diagnosis (EID) for HIV-exposed-breastfed infants. We examined the association between knowledge and adherence to these guidelines among 550 HIV-infected pregnant women in Maharashtra, India. Knowledge of PMTCT guidelines was assessed using a structured-questionnaire during enrollment. Adherence to ART, NVP, and EBF was assessed using structured questionnaires during post-partum home visits at 2 weeks, 2, and 6 months respectively. EID adherence at 6 weeks was assessed by weekly infants’ HIV testing clinical record review. We used Fisher's exact test to assess the association between correct knowledge and subsequent adherence and logistic regression to estimate the odds ratios. The results showed that women’s correct responses to specific questions of each PMTCT guideline correlated with subsequent adherence. For instance, awareness of duration and place to obtain ART was associated with a higher likelihood of taking ART at delivery (aOR = 1.93, p = 0.02 and aOR = 3.91, p < 0.01 respectively). Similarly, women knowing only breastmilk should be given to infants for 6 months showed highest adherence to EBF (aOR = 2.59, p = 0.02). Women who correctly knew the reason for infant NVP administration were more adherent to it at 6 weeks (aOR = 1.77; p = 0.03). Women aware of mother-to-child HIV transmission during delivery had highest adherence to EID at 6 weeks (aOR 3.58, p = 0.01). Gaps were identified in women's detailed knowledge of and adherence to each PMTCT guideline. Suboptimal adherence to ART (n = 389, 71%), EBF (n = 179, 33%), NVP (n = 428, 78%), and EID at 6 weeks (n = 369, 67%) was found. Our study suggests providing a comprehensive knowledge of each guideline through the PMTCT program’s education strategies can enhance adherence among HIV-infected women.

Heightened expression of type I interferon signaling genes in CD4+ T cells from acutely HIV-1–infected women is associated with lower viral loads

Heightened expression of type I interferon signaling genes in CD4+ T cells from acutely HIV-1–infected women is associated with lower viral loads

Analysis on rate of adverse pregnancy outcomes in HIV-infected pregnant women and influencing factors in some regions of China, 2017-2023

Objective: To understand the incidence of adverse pregnancy outcome in HIV-infected pregnant women and influencing factors in China and provide reference for the improvement of the health status of HIV-infected pregnant women and their newborns. Methods: Based on a mother-child cohort of HIV-infected pregnant women and children (PMTCT-MC-2005) established in Guangxi Zhuang Autonomous Region, Yunnan Province and Xinjiang Uygur Autonomous Region, this study enrolled pregnant women with or without HIV infection as study subjects from January 2017 to June 2023, a total of 1 646 pregnant women (558 HIV-infected and 1 088 HIV-uninfected) were included, and 34 cases with missing data were excluded. The χ2 test was used to analyze the difference in the incidence adverse pregnancy outcome between two groups, and used logistic regression model to identify the influencing factors of adverse pregnancy outcome in HIV-infected pregnant women. Results: A total of 1 612 pregnant women were included in the study, in whom 541 were infected with HIV and 1 071 were not infected with HIV. The incidence of adverse pregnancy outcome was 18.8% (303/1 612), the incidence of adverse pregnancy outcome was 33.1% (179/541) in the HIV-infected pregnant women and 11.6% (124/1 071) in the pregnant women without HIV infection. The results of multivariable logistic regression analysis showed that the influencing factors of adverse pregnancy outcome were age <35 years at delivery (aOR=0.64, 95%CI: 0.43-0.95) compared with the age ≥35 years and the duration of antiviral treatment over 10 years (aOR=0.43, 95%CI: 0.23-0.79) compared with less than one year. Conclusions: The incidence of adverse pregnancy outcome in HIV-infected pregnant women was high in some regions of China during 2017-2023. It is necessary for HIV-infected women to get pregnancy at appropriate time based on antiretroviral treatment effect and strengthen self-care to reduce the incidence of adverse pregnancy outcome.

Prevalence of dyslipidemia and influencing factors in HIV-infected people before starting antiretroviral therapy in China, 2018-2023

Objective: To investigate the prevalence of baseline dyslipidemia in HIV-infected people before starting antiviral therapy (ART) in China. Methods: The data were collected from HIV/AIDS ART database of Chinese Disease Prevention and Control Information System. A national sample of HIV- infected people who initiated ART from 2018 to 2023 was used to collect baseline information, including sociodemographic characteristics and laboratory test results. According to the Chinese Lipid Management Guidelines (2023) and the National Cholesterol Education Program Adult Treatment Panel Ⅲ guidelines, triglyceride (TG) ≥1.7 mmol/L or total cholesterol (TC) ≥5.2 mmol/L were identified as dyslipidemia. Statistical analysis was performed with software SAS 9.4. An unconditional logistic regression model was used to analyze the factors influencing TG and TC abnormalities in HIV-infected patients before ART. Results: A total of 359 952 adults infected with HIV were included in this study, the prevalence rate of dyslipidemia was 38.41% (138 263/359 952). The abnormal rates of TG and TC were 31.40% (113 041/359 952) and 13.75% (49 494/359 952), respectively. In all age groups except for the 25-44 age groups, the abnormal rates of TG and TC were higher in HIV-infected women than in HIV-infected men. In HIV-infected patients, women, those aged 45-64 years, those lived in northeast region, those had heterosexual transmission, and those with BMI ≥28.0 kg/m2, CD4+T lymphocytes counts ≥500 cells/µl had higher rates of baseline dyslipidemia (all P<0.05). Conclusions: The abnormal rate of TG in HIV-infected people before ART was higher in China from 2018 to 2023, especially in HIV-infected women, and the abnormal rate of TG and TC increased with age. Attention should be paid to the clinical diagnosis and ART selection in the treatment of HIV infection.

Hepatitis B infection (HBsAg and HBeAg) status among women attending antenatal care at public healthcare facilities of South Africa, 2017.

Eight years after WHO adopted a resolution to eliminate hepatitis B by the year 2030, the disease remains a global public health concern, with vertical transmission of HBV being a major obstacle to this goal. Our study aimed to determine the HBV infection status of pregnant women in South Africa at a national level to evaluate the risk of vertical transmission and provide evidence for public health decision-making. We conducted HBsAg testing on 1,942 HIV-uninfected and 2,312 HIV-infected pregnant women from South Africa's public health sector in 2017, followed by HBeAg testing on HBsAg-positive samples. Our data were stratified by five-year age groups and province. The overall HBV prevalence was 11.24% (478/4,254), significantly higher among HIV-infected women (15.83%) compared to HIV-uninfected women (5.77%, p = 0.007). HBV prevalence was highest among women 40-44 years (14.00%) and in Limpopo Province (19.35%). Coinfection rates of HIV-HBV ranged from 14.00% to 17.00% among women 15-44 years, and provincially, rates were highest in Limpopo, North West, and Western Cape Provinces (>20%). HBeAg prevalence among HBsAg positive women was 9.48%, with higher rates among HIV infected women (11.29%) compared to HIV-uninfected women (7.34%, p = 0.7931). HBeAg prevalence was highest among women 15-19 (10.81%), 20-24 (11.88%) and 40-44 years (25.00%), and provincially, highest in North West (26.67%). Our findings highlight the significant prevalence of HBV infection among pregnant women in 2017, emphasising concerns about vertical transmission, particularly given the high prevalence of HBeAg among HBsAg-positive women. We advocate for the prompt implementation of a universal birth dose of the HBV vaccine in South Africa to augment existing vaccination schedules and mitigate the risk of vertical transmission, thereby advancing progress towards WHO elimination targets.

Anthropometric measurements as predictors of nutritional status in black South African women during pregnancy.

Nutritional risk assessment is an essential component of primary health care screening, especially for pregnant women. The aim of this study was to investigate the relationship between maternal body mass index (BMI) and maternal anthropometric measurements in black South African pregnant women, both with and without human immunodeficiency virus (HIV). A cross-sectional observational study design was used. Two hundred black South African pregnant women were recruited of which 90 were HIV-infected and 110 were HIV-uninfected. The anthropometric measurements assessed included mid-upper arm circumference (MUAC), tricep skinfold (TSF), subscapular skinfold (SSF), mid-arm muscle circumference (MAMC), wrist circumference (WC), frame size, and BMI. Maternal age was significantly associated with changes in maternal anthropometric measurements. Maternal BMI was significantly correlated with other maternal anthropometric measurements including MUAC, TSF, SSF, MAMC, WC, and frame size. The anthropometric measurements that were found to be accurate for assessing obesity in pregnancy included TSF (≥20.75 mm), SSF (≥21.75 mm), MAMC (≥25.23 cm), and WC (≥16.25 cm). Additionally, SSF (≥15.75 mm) and MAMC (≥23.35 cm) could be used to assess for overweight nutritional status. Lastly, frame size could be used to assess for underweight (≥10.05) and normal (≥9.95) nutritional status. No significant anthropometric differences were observed between the HIV-infected pregnant women and the HIV-uninfected pregnant women in this study. Surrogate anthropometric measurements offer a simple solution for assessing nutritional status in pregnant women. MUAC was the most accurate method for identifying overweight and obesity. Furthermore, maternal HIV status did not affect the anthropometric measurements.

High Risk of HPV Related Preneoplastic and Neoplastic Vulvar Lesions in Women Living With HIV.

We aimed to investigate the epidemiology of human papilloma virus (HPV)-related preneoplastic and neoplastic vulvar lesions in a large cohort of women living with HIV (WLWH). We retrospectively selected 1,796 WLWH who had a gynecological examination, cervical cytology, high-risk (HR-) HPV test, vulvoscopy, and colposcopy with targeted biopsies when necessary between 1987 and 2020 at 2 Italian institutions. Univariable and multivariable regression analyses were carried out to test the association of the anamnestic and clinical data with the development of precancerous and cancerous lesions. At baseline, 348 (19.4%) of 1,796 WLWH had genital warts, 30 (1.7%) had vulvar high-grade intraepithelial neoplasia (VHSIL), and 2 (0.1%) had squamous cell carcinoma of the vulva. Among 895 WLWH who had more than 1 year of follow-up, we found 40 (4.5%) new cases of VHSIL and 7 (0.8%) cases of vulvar cancer. The cumulative incidence of VHSIL and vulvar cancer was respectively 0.56 and 0.10 per 100 person-years. Risk factors independently associated with the development of vulvar HSIL and cancer included history of injection drug use (p < .01), genital warts at baseline (p < .001), HR-HPV test positivity at diagnosis (p < .001), and severe immunodepression (CD4 cell count <200 cells/mL) at diagnosis (p < .01). WLWH are at high risk of vulvar high-grade intraepithelial neoplasia and cancer, especially those with severe immunodepression. A careful inspection of vulva, perineum and anus, possibly with the aid of colposcopy, should become part of the surveillance protocol of HIV-infected women.

Determinants of anaemia among pregnant women in Central Region, Ghana

Background/Aims In Ghana, anaemia in pregnancy is a major public health problem. As part of the Central Regional Health Directorate's mandate to address determinants of anaemia among pregnant women, this study aimed to assess the prevalence of anaemia and factors that influence its occurrence in Central Region. Methods This cross-sectional study involved 391 pregnant women aged 15–45 years old at ≥36 weeks' gestation from 12 randomly selected district hospitals and polyclinics in the Central Region. Data on their anaemia status and sociodemographic characteristics were collected between May and June 2022. Univariate and multivariate regression analyses were used to explore the relationship between anaemia and influencing factors. Results Overall, 47.1% of participants had anaemia, which was significantly associated with age (χ2=10.3, P=0.036). In multivariate analysis, pregnant women aged 21–25 years were significantly less likely (adjusted odds ratio=0.32, P=0.017) to experience anaemia compared to younger women. Conclusions Anaemia among pregnant women in the Central Region of Ghana is high, and age is a significant influencing factor. Several steps can be taken to lower the prevalence of anaemia, beginning with continuous public education on the importance of early antenatal care and nutrition during pregnancy. Other behaviours that may improve haemoglobin concentration include abstaining from alcoholic beverages and traditional herbal medicines, eating nutritious meals, increasing prophylaxis against malaria and intestinal worms and ensuring HIV-infected women are taking antivirals. Implications for practice The high prevalence of anaemia poses a major public health challenge, necessitating urgent coordinated efforts and resource allocation. Collaborative initiatives across sectors are vital for enhancing access to iron-rich foods and health services. A strong data system is essential for informed policymaking and implementing evidence-based strategies.

Digital cervicography using mobile phones with real-time consultation (DCRC) to improve performance of Visual Inspection with Acetic Acid (VIA) in cervical cancer screening of HIV-infected women. A cross-sectional study.

Visual Inspection with Acetic Acid (VIA) has been adopted for cervical cancer screening in Kenya and other Low-Middle Income Countries despite providing suboptimal results among HIV-infected women. It is mostly performed by nurses in health centers. Innovative ways of improving the performance of VIA in HIV-infected women are desired. To establish the feasibility of screening with VIA and Digital Cervicography with Real-time Consultation (VIA-DCRC), and compare its performance to screening with VIA alone among HIV+women. This was a cross-sectional analytical study of two hundred HIV+women. There were two groups of women who underwent either VIA or VIA/DCRC cervical cancer screening arms. In the VIA/DCRC arm, a trained nurse did the VIA, captured an image of the cervix, uploaded it, and electronically shared it in real-time with three blinded study consultants (gynecologic oncologists) who separately assessed the digital image and classified it as VIA/DCRC positive or negative. Any two opinions of the gynecologic oncologists that concurred were considered as the final diagnosis.All participants who screened positive underwent colposcopy and biopsy prior to treatment. Tissues obtained were subjected to histopathological examination. A fraction (15%) of those who screened negative for VIA and VIA/ DCRC had random cervical biopsies taken at 12 and 6o'clock positions. We estimated the measures of accuracy using the Bayesian method. The mean age was 39.7 +/- 10.7years. Average CD4+count and plasma viral load (log base 10) were 492.2 (SD: 255.3) cells per mm3, and 2.6 (SD: 0.7) copies per ml respectively. None of the women was a smoker.The median (IQR) time taken for at least one gynecologic oncologist to respond to a digital consultation was 2.0 (IQR 1.0, 4.0) minutes, range: 1.0 - 47.0.Overall, 60.5% were diagnosed with cervical pre-malignancies (VIA: 23.1% (95% Credible Bounds (CB): 10.1, 37.5), VIA/DCRC: 37.5% (95% CB: 26.6, 50.1)).VIA sensitivity, specificity, positive predictive value and negative predictive value were 28.1% (95% CB: 11.2, 6.8), 97.8% (95% CB: 93.0, 99.7), 79.8% (95% CB: 47.3, 96.8), and 80.4% (95% CB: 71.0, 87.5) while that of VIA/DCRC was 69.3% (95% CB: 47.8, 89.7), 87.9% (95% CB: 76.3, 94.4), 77.6% (95% CB: 61.9, 89.3), and 80.3% (95% CB: 70.2, 88.9) respectively. Compared to the VIA/DCRC group, there was evidence of better sensitivity, comparable negative predictive value, but poor specificity, RR: 2.46 (95% CB: 1.06, 6.26), RR: 1.65 (95% CB: 1.00, 3.50), and RR: 0.90 (95% CB: 0.78, 0.98) respectively. Cervical cancer screening in HIV+women using VIA/DCRC is feasible and it significantly improves the sensitivity, and comparable negative predictive value of VIA in diagnosing the presence of cervical pre-malignancies by more than double, and 65% respectively.

Integrase strand transfer inhibitors resistance-associated mutations in HIV-infected pregnant women.

To date, no data exist regarding the prevalence of integrase inhibitor (INSTI) resistance-associated mutations (HIVDRM) in HIV-infected pregnant women (HPW) in Latin America. We describe the prevalence and transmissibility of integrase HIVDRM in a historical cohort of INSTI-naïve HPW from Argentina (n=56) with Next Generation Sequencing (NGS). Bioinformatics analysis was performed by HyDRA software for 20%, 10%, 5%, 2%, and 1% sensitivity thresholds. We calculated the mutational viral load for each INSTI-HIVDRM, considering those with >1000 c/mL as of high risk of transmissibility. The predominant HIV subtype was BF (78.5%). Major HIVDRM were not detected with the population sequencing 20% filter. With a 1% threshold, the prevalence increased to 8.9%; Y143C/S, E92G, E138K, and T66I mutations were found. The median (range) mutational load (expressed in c/mL) was: 355 (50.2-11705); with only 1 case >1000 c/mL Accessory mutations (G163R/K, T97A) were detected mostly with a 20% sensitivity threshold with an overall prevalence of 23.2%; the median (IQR) mutational load was: 23929 (4009-63158) c/mL; all of them above 1000 c/mL. Our results show evidence of the presence of major INSTI-HIVDRM as aleatory mutations and a high frequency of accessory mutations with potential transmissibility in HPW.

TRICOMONÍASE COMO UM FATOR DE RISCO PARA INFECÇÃO PELO HIV EM MULHERES: REVISÃO DA LITERATURA

This paper addresses trichomoniasis as a risk factor for HIV infection in women, highlighting the relevance of this topic in public health. The main objective is to investigate the association between Trichomonas vaginalis infection and the increased risk of HIV infection, contributing to the understanding of the dynamics involving these infections. To achieve this objective, we utilized a qualitative research methodology, consisting of a literature review in databases such as PubMed, SciELO, and Google Scholar, analyzing articles published between 1999 and 2024. The results indicate a significant prevalence of co-infection by Trichomonas vaginalis and HIV among women, revealing geographical differences and worrying rates, especially in vulnerable populations, such as those with multiple sexual partners or without access to adequate health services. The evidence suggests that trichomoniasis not only facilitates the transmission of HIV but can also complicate the treatment of the virus infection, as inflammation and lesions caused by trichomoniasis increase susceptibility to HIV infection. We conclude that trichomoniasis worsens public health issues, emphasizing the need for integrated prevention and treatment strategies. It is essential for health policies to address co-infection comprehensively, promoting awareness, early diagnosis, and effective treatment, as well as ensuring access to health services, especially for vulnerable populations. The paper highlights the importance of a multidisciplinary approach to tackle these challenges and improve outcomes for affected women.

Sustained immune activation and impaired epithelial barrier integrity in the ectocervix of women with chronic HIV infection.

Chronic systemic immune activation significantly influences human immunodeficiency virus (HIV) disease progression. Despite evidence of a pro-inflammatory environment in the genital tract of HIV-infected women, comprehensive investigations into cervical tissue from this region remain limited. Similarly, the consequences of chronic HIV infection on the integrity of the female genital epithelium are poorly understood, despite its importance in HIV transmission and replication. Ectocervical biopsies were obtained from HIV-seropositive (n = 14) and HIV-seronegative (n = 47) female Kenyan sex workers. RNA sequencing and bioimage analysis of epithelial junction proteins (E-cadherin, desmoglein-1, claudin-1, and zonula occludens-1) were conducted, along with CD4 staining. RNA sequencing revealed upregulation of immunoregulatory genes in HIV-seropositive women, primarily associated with heightened T cell activity and interferon signaling, which further correlated with plasma viral load. Transcription factor analysis confirmed the upregulation of pro-inflammatory transcription factors, such as RELA, NFKB1, and IKZF3, which facilitates HIV persistence in T cells. Conversely, genes and pathways associated with epithelial barrier function and structure were downregulated in the context of HIV. Digital bioimage analysis corroborated these findings, revealing significant disruption of various epithelial junction proteins in ectocervical tissues of the HIV-seropositive women. Thus, chronic HIV infection associated with ectocervical inflammation, characterized by induced T cell responses and interferon signaling, coupled with epithelial disruption. These alterations may influence HIV transmission and heighten susceptibility to other sexually transmitted infections. These findings prompt exploration of therapeutic interventions to address HIV-related complications and mitigate the risk of sexually transmitted infection transmission.

Association between anaemia and aflatoxin B1 and fumonisin B1 exposure in HIV-infected and HIV-uninfected pregnant women from Harare, Zimbabwe.

Aflatoxin B1 (AFB1) and fumonisin B1 (FB1) are poisons that contaminate poorly stored staple foods in resource-limited settings. Antenatal AFB1 and FB1 exposure may cause anaemia. We aimed to determine the associations of urinary aflatoxin M1 (AFM1) and FB1, biomarkers of AFB1 and FB1 exposure, respectively, with erythrocyte parameters and anaemia. A retrospective cross-sectional study was conducted in 68 HIV-infected and 61 HIV-uninfected pregnant women ≥ 20 weeks gestational age in Harare, Zimbabwe. AFM1 and FB1 were measured in urine via competitive ELISA, and levels were grouped into tertiles. The erythrocyte parameters assessed were haemoglobin (Hb), mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, red blood cell (RBC), haematocrit (HCT), and red blood cell distribution width. Associations of urinary AFM1 and FB1 with erythrocyte parameters, and anaemia were assessed in a multiple regression controlled for potential confounders. The presence of FB1 in urine decreased Hb levels in all women (β= -0.98, 95% CI: -1.94, 0.02) and HIV-uninfected (β= -1.99, 95% CI: -3.71, -0.26). FB1 tertile 3 decreased Hb levels (β= -0.88, 95% CI: -1.74, 0.01) and HCT levels (β= -2.65, 95% CI: -5.26, 0.03) in HIV-infected. AFM1 tertile 2 decreased RBC levels in HIV-infected (β= -0.34, 95% CI: -0.71, -0.03). The presence of FB1 in urine increased anaemia risk in HIV-uninfected (OR: 10.68 95% CI: 1.02, 112.34). AFM1 tertile 2 increased macrocytic anaemia risk in HIV-infected (OR: 13.72, 95% CI: 0.92, 203.55). There is need to ensure food safety through monitoring and nutritional interventions to improve maternal-infant health outcomes.

Determinants of HIV infection at 18 months of age among HIV-exposed infants in the context of PMTCT interventions in southern Ethiopia.

Mother-to-child transmission (MTCT) of HIV accounts for over 90% of annual HIV infections among children under the age of 15. Despite the introduction of the Option B+ strategy in Ethiopia in 2013, the rate of MTCT of HIV at 18 months was 15% in 2020. This study aimed to identify determinants of HIV infection among HIV-exposed infants (HEIs) in the context of prevention of MTCT (PMTCT) care in southern Ethiopia. We conducted a retrospective facility-based study of 299 mother-baby pairs (HIV-infected women and their HEIs up to 18 months) enrolled in PMTCT care at three health facilities in Wolaita Sodo town, southern Ethiopia, from September 2015 to October 2021. Data was collected from medical charts and PMTCT registers. Logistic regression was used to identify determinants of HIV infection among HEIs. At enrolment into PMTCT care, most women were already on ART (75.3%) and in clinical stage I (89.6%) according to the World Health Organization's algorithm. Overall, 13 (4.3%, 95% CI: 2.5%-7.4%) HEIs were HIV-infected; the level was higher among HEIs born at home (17.9% (95% CI: 7.6%-36.5%). Being born to HIV-positive women with late WHO clinical stage (III and IV) of HIV (AOR = 9.1, 95%CI: 2.4, 34.5), being born at home (AOR = 4.8, 95%CI: 1.1-20.7), being born to women newly diagnosed with HIV (AOR = 4.8, 95%CI: 1.3-17.4), and low infant adherence to cotrimoxazole prophylaxis (AOR = 5.4, 95%CI: 1.4-20.4) increased the odds of MTCT. HIV infection levels among breastfeeding HEIs in PMTCT care was <5%, meeting the WHO transmission rate targets. Strengthening PMTCT care to expand community-based PMTCT interventions such as improving women's and communities' awareness of HIV, PMTCT and promoting male involvement would reduce reduce HIV infection among children to reach the 95-95-95 targets to end HIV in Ethiopia.

Prevalence and predictors of precancerous cervical lesions among women living with HIV in Libreville, Gabon

BackgroundHIV-infected women are at an increased risk of developing precancerous cervical lesions (PCL) than non-infected women. In Gabon, no data exists on the prevalence of PCL among women living with HIV. The aim of this study was to assess the prevalence and risk factors associated with the development of PCL among HIV-positive women in Libreville, Gabon.MethodologiesThis was a retrospective study carried out within the Gynecology and Obstetrics Department of University Hospital Center of Libreville (CHUL) from January to August 2016. It included women registered at the HIV Clinic of Nkembo, and screened for PCL or cervical cancer (CC). Descriptive statistics were used to characterize sociodemographic data and the prevalence of PCL. The chi square and odd-ratio tests were used to evaluate the associations between PCL, CD4 count, antiretroviral use, age at first sexual intercourse, number of sexual partner tobacco, and contraception use.ResultsAmong the 115 HIV-positive women recruited, 33 (28.70%; SD ± 0.45) were diagnosed with PCL. 79.1% of them were on antiretroviral therapy (ART), and the mean CD4 cell count value was 411.74 cells/mm3 (SD ± 241.77). Being on ART, age, number of sexual partners, contraceptive use and smoking were not risk-factors linked with the development of PCL. CD4 cell count was the only associated risk-factors (p-value: 0.02).ConclusionThe incidence of PCL among HIV-infected is high in Libreville, Gabon, especially among those with baseline CD4 counts < 200 cells/mm3. This study recommends screening for cervical cancer for all HIV-infected women.

Bridging Data Gaps: Predicting Sub-national Maternal Mortality Rates in Kenya Using Machine Learning Models.

Introduction Maternal mortality remains a critical global health issue, with ongoing efforts to reduce its incidence as part of international health priorities. Kenya, a sub-Saharan country that has a disproportionate number of maternal mortality is likely to miss this target unless evidence-based interventions are deployed. The paucity of reliable maternal health data calls for the development of alternative predictive models to complement the impaired civil registration system and the aperiodic national surveys. Methods We utilized DHS surveys from several Sub-Saharan African countries to estimate parameters for predicting Kenya's maternal mortality rate (MMR) in the absence of recent Kenya Demographic and Health Survey (KDHS) data. We developed a multiple linear regression model using supervised machine learningusing the R-programming suite. Our model leverages machine learning techniques to analyze regional trends and predict sub-national MMR variations. We then applied the model to predict MMR for Kenyan counties using the data for the KDHS 2022 survey. Results Using Pearson's correlation, we observed a significant positive correlation between MMR and total fertility (r = 0.32, p = 0.025) and a significant negative correlation between MMR and maternal age at first birth (r = -0.40, p = 0.005). Additionally, a significant correlation was observed with the cumulative percentage of mothers attending post-natal clinics, the prevalence of thinness (r = 0.77, p < 0.001), HIV infection in women (r = 0.20, p = 0.164), and physical violence during pregnancy. The model estimate of national MMR in 2022 was 367 deaths per 100,000 live births, ranging from 49 deaths per 100,000 live births in Kisii County to 1794 deaths per 100,000 live births in Turkana County. Conclusion Although MMR in Kenya displayed a general downward trend, our model's estimates for DHS 2022 indicate an increase compared to the 2019 National Census and Housing Survey estimate of 355 deaths per 100,000 live births. This rise may be attributed to COVID-19-related maternal deaths during the same period. The integration of predictive models to inform interventions and resource allocation could play a crucial role in enhancing maternal healthcare outcomes in Kenya.

The Impact of Antiretroviral Therapy on Birth Outcomes: A Retrospective Cohort Study

Objective: This study aimed to evaluate the impact of highly active antiretroviral therapy (HAART) on pregnancy outcomes at a major tertiary hospital in Abuja, Nigeria. Design: A cohort study was conducted. Methods: HIV-infected pregnant women who initiated HAART during pregnancy for the prevention of mother-to-child transmission (pMTCT) were recruited, alongside a randomly selected group of HIV-uninfected pregnant women. Results: A total of 489 pregnant women participated, including 237 HIV-infected and 252 HIV-uninfected women. HAART initiation during pregnancy was significantly associated with higher mean birth weights (p = 0.0007). While there were 30 cases of low birth weight in the HIV-infected group compared to 21 in the HIV-uninfected group, HAART was not significantly associated with low birth weight (OR 1.59, p = 0.1182). There were 6 stillbirths in the HIV-infected group and 5 in the uninfected group, with no significant association between HIV status and stillbirth (OR 1.28, p = 0.6836). However, 29 preterm deliveries occurred in the HIV-infected group compared to 8 in the uninfected group, showing a strong association between HIV infection and preterm deliveries despite HAART initiation (OR 4.25, p = 0.0002). Conclusion: HIV-infected women receiving HAART during pregnancy have a significantly reduced risk of low birth weight but face an increased risk of preterm delivery.

Analysis of ICAM-1 rs3093030, VCAM-1 rs3783605, and E-Selectin rs1805193 Polymorphisms in African Women Living with HIV and Preeclampsia.

Intercellular adhesion molecule-1 (ICAM-1), vascular adhesion molecule-1 (VCAM-1), and E-selectin are cell adhesion molecules that play a significant role in inflammation and are implicated in the pathophysiology of preeclampsia development and HIV infection. More specifically, the immune expression of ICAM-1, VCAM-1, and E-selectin within cyto- and syncytiotrophoblast cells are dysregulated in preeclampsia, indicating their role in defective placentation. This study investigates the associations of ICAM-1, VCAM-1, and E-selectin gene variants (rs3093030, rs3783605, and rs1805193, respectively) with preeclampsia comorbid with HIV infection in women of African ancestry. It also examines the susceptibility to preeclampsia development and the effect of highly active antiretroviral therapy (HAART). A total of 405 women were enrolled in this study. Out of these women, 204 were preeclamptic and 201 were normotensive. Clinical characteristics were maternal age, weight, blood pressure (systolic and diastolic), and gestational age. Whole blood was collected, DNA was extracted, and genotyping of the ICAM-1 (rs3093030 C>T), VCAM-1(rs3783605 A>G), and E-selectin (rs1805193 A>C) gene polymorphisms was performed. Comparisons were made using the Chi-squared test. Our results demonstrated that preeclamptic women exhibited a higher frequency of analyzed variants, in contrast to those with the duality of preeclampsia and HIV infection. Additionally, the C allele of the ICAM-1 (rs3093030 C>T) and G allele of the VCAM-1 (rs3783605 A>G) genes were found to have a greater role in the co-morbidity and may be considered as a risk factor for preeclampsia development in women of African ancestry. In contrast, the SNP of rs1805193 of the E-selectin gene indicated that A>C was only significantly associated with HIV infection and not with preeclampsia. These findings highlight a strong association of the rs3093030 SNP of the ICAM-1 gene and of the VCAM-1 rs3783605 gene with the development of preeclampsia, indicating their role in the defective trophoblast invasion of preeclampsia. Sub-group analysis further reveals an association of the AA genotype with late-onset preeclampsia, a less severe form of disease indicating differing genetic predispositions between early and late-onset forms.

Gestantes vivendo com HIV e crianças expostas ao HIV em Santa Catarina, dados epidemiológicos de 2015 a 2021

Vertical transmission is the transmission of an infection or disease from the mother to her fetus in the womb or newborn during childbirth. The main routes of contagion are pregnancy, childbirth and breastfeeding. To prevent transmission, all pregnant women should be investigated and monitored during the gestational period, at the time of delivery and in the puerperium. The follow-up of pregnant women in prenatal care includes the performance of several laboratory tests to identify the presence of infectious agents of vertical transmission, such as the Human Immunodeficiency Virus (HIV), guiding the treatment of the pregnant woman and avoiding infection of the fetus, also providing guidance on the possibilities of prevention. Considering the high number of HIV cases in the state of Santa Catarina, especially in the Alto Vale Itajaí region, the present study aims to present the epidemiological profile of HIV/AIDS indicators of the population of the state of Santa Catarina, specifically pregnant women and children exposed to HIV, in the period from 2015 to 2021. It is an epidemiological, retrospective, descriptive and analytical study of a historical series, also presenting information on the factors involved in vertical transmission of HIV and prevention strategies. The parameters evaluated in this study, collected from the Epidemiological Indicators Panel of the Department of Chronic Conditions Diseases and Sexually Transmitted Infections, were: number of children exposed to HIV, age of children exposed to HIV, number of HIV-infected pregnant women (GVHIV) and monitoring of these in relation to HIV viral load (CV) and CD4+ T lymphocyte count (CD4+) at the beginning of antiretroviral therapy. Although the systematization of the number of pregnant women with HIV and children exposed to the virus in the state of Santa Catarina shows annual differences in the period evaluated, the trend line referring to the number of GVHIV shows a small increase over the years, while the trend line for the number of children exposed to the virus reveals a slight decrease, which can be elucidated by the expansion of the health team and the improvement in surveillance in the prevention of vertical transmission of HIV that has occurred over the years. The percentage of pregnant women with HIV VC lower than 50 copies/mL showed a gradual increase in the years evaluated, while the percentage with VC greater than 50 copies/mL showed a decrease. During the period evaluated in this study, less than 50% of the GVHIV had a CD4+ count and, among these, approximately 20% had CD4+ less than 350 cells/mm³ at the beginning of antiretroviral therapy. Failure to perform CD4+ counts may be related to an increase in the number of pregnant women with a VC of less than 50 copies/mL. Thus, CD4+ counts would be performed primarily in pregnant women with VC greater than 50 copies/mL and part of them with greater depletion of this cell type. In summary, this study shows the evolution of the treatment and follow-up offered to GVHIV and, consequently, to their children. It also reinforces the importance of prevention, diagnosis, treatment and prenatal follow-up strategies.