HIV-infected Mothers Research Articles

Mother-to-Child HIV Transmission among Pregnant Women in a City with the Highest Rates of HIV in Brazil.

Most of the HIV pediatric infections are acquired through mother-to-child transmission (MTCT). Porto Alegre is a state capital of Brazil that had a HIV MTCT rate of 4.1% in 2013 and the highest rate of HIV-infected pregnant women in the country during 2018. Zidovudine and nevirapine have been used in Brazil for high-risk newborns since 2012. The aim of the study was to investigate HIV MTCT rate and the factors associated with HIV transmission at a hospital that is a reference center for HIV-infected mothers in Porto Alegre, after the introduction of this policy. This retrospective cohort study included all HIV-exposed infants born between February 2013 and December 2016 at the Hospital de Clínicas de Porto Alegre. Student's t-test or Fisher's exact test was used to compare variables between HIV-infected and uninfected groups of newborns. Poisson's regression with robust variance was used to determine the factors associated with HIV MTCT. A total of 375 newborns were exposed to HIV, with an outpatient loss of 14.4% (n = 54). The HIV MTCT rate was 2.18% (n = 7), with four infected during the intrauterine period. The risk factors for MTCT were no prenatal care (relative risk [RR] = 9.4; 95% confidence interval [CI]: 2.0-44.3), late maternal HIV diagnosis in the peripartum period (RR = 16.3; 95% CI: 3.6-73.0), syphilis infection during pregnancy (RR = 9.3; 95% CI: 2.1-40.3), maternal viral load >1,000 copies/mL in the third trimester or peripartum period (RR = 9.5; 95% CI: 1.7-50.5), and lack of or inappropriate antiretroviral therapy during pregnancy (RR = 8.2; 95% CI: 1.6-41.4). MTCT rate was 2.18%. With the institution of two-drug prophylaxis for high-risk newborns, persistent cases HIV MTCT were predominantly found among women with absence of antenatal care, late HIV diagnosis, syphilis coinfection, high viral load, and inadequate ARV therapy during pregnancy. Although zidovudine and nevirapine were administered postnatally to high-risk newborns, this regimen could not prevent transplacental transmission. · Most of the HIV pediatric infections are acquired through mother-to-child transmission.. · The study investigated HIV MTCT rate and the factors associated with HIV transmission in Brazil.. · HIV MTCT rate was 2.18% and most of them were infected during the intrauterine period..

Non Detection of HIV-1 Proviral DNA in PBMCs of the Neonates Born to Iranian HIV-Infected Mothers in PMTCT Program

Background: Early diagnosis of immunodeficiency virus-1 infection in children and access to treatment for this infection is critical in decreasing infant mortality. Objectives: The aim of the current survey was to determine the presence of HIV-1 genomic RNA in plasma and proviral DNA in peripheral blood mononuclear cell (PBMC) specimens of neonates born to HIV-infected mothers. Methods: From March 2014 to February 2018, 73 neonates born to HIV-1-infected mothers covered by the prevention of mother-to-child transmission (PMTCT) program were enrolled in this study to compare two different diagnostic methods. After the extraction of viral RNA of plasma and genomic DNA of PBMC specimens, HIV-1 RNA and proviral DNA was tested by amplification of the long terminal repeat (LTR) region of HIV-1 using real-time PCR. Results: Out of 73 evaluated infants, 41 infants (56.2%) were male. The average age of the mothers with HIV-1 infection was 30.7 ± 5.2 (range: 19–47) years. The results revealed that none of the infants were infected with HIV-1, and also all were negative for HIV-1 genomic RNA in plasma specimen and proviral DNA of HIV-1 in PMBC samples. During the present study, 20 infants born to HIV-1 positive mothers who were not included in the PMTCT project were accidentally identified. Four infants (20%) out of these 20 infants were infected with HIV, all were infected with CRF35-AD of HIV, and none carried variants with surveillance drug-resistant mutations. Conclusions: The results of the present study showed that two molecular methods of detecting HIV infection (presence of genomic RNA of HIV-1 in plasma and proviral DNA of HIV-1 in PBMC specimens) are completely in agreement with each other, and the PMTCT program is possibly an effective program.

Killer-Cell Immunoglobulin-Like Receptors (KIR) in HIV-Exposed Infants in Cameroon.

The biological reason(s) behind persistent mother-to-child transmission (MTCT) of HIV (albeit at reduced rate compared to the preantiretroviral therapy era) in spite of the successful implementation of advanced control measures in many African countries remains a priority concern to many HIV/AIDS control programs. This may be partly due to differences in host immunogenetic factors in highly polymorphic regions of the human genome such as those encoding the killer-cell immunoglobulin-like receptor (KIR) molecules which modulate the activities of natural killer cells. The primary aim of this study was to determine the variants of KIR genes that may have a role to play in MTCT in a cohort of infants born to HIV-infected mothers in Yaoundé, Cameroon. We designed a cross-sectional study to molecularly determine the frequencies of 15 KIR genes in 14 HIV-exposed infected (HEI), 39 HIV-exposed/uninfected (HEU), and 27 HIV-unexposed/uninfected (HUU) infants using the sequence specific primer polymerase chain reaction (PCR-SSP) method. We found that all 15 KIR genes were present in our cohort. The frequency of KIR2DL1 was significantly higher in the unexposed (control) group than in the HIV-exposed group (OR = 0.22, P = 0.006). Stratifying analysis by infection status but focusing only on exposed infants revealed that KIR2DL5, KIR2DS1, and KIR2DS5 were significantly overrepresented among the HIV-exposed/uninfected compared to infected infants (OR = 0.20, P = 0.006). Similarly, the frequencies of KIR2DS1, KIR2DS5, and KIR2DL5 were significantly different between infants perinatally infected with HIV (HIV+ by 6 months of age) and HIV-negative infants. Our study demonstrates that KIR genes may have differential effects with regard to MTCT of HIV-1.

Evaluation of infants with HIV-infected mothers and perinatal transmission in Turkey: A single-center experience.

OBJECTIVE:The most common route of HIV infection in children is through perinatal transmission. In this study, we aimed to evaluate the characteristics of infants with HIV-infected mothers and perinatal HIV transmission.METHODS:We conducted a retrospective, single-center study of HIV-exposed infants in between December 2017 and October 2019 in a Marmara University Pendik Training and Research Hospital.RESULTS:A total of 18 infants were examined. All babies were born by cesarean section, and none of them were breastfed. Seventeen mothers were diagnosed with HIV before pregnancy. These mothers had received antiretroviral therapy (ART) during pregnancy, and their viral loads before delivery were negative. An antiretroviral prophylaxis with oral zidovudine was started in all infants within their 1st day of birth and continued for at least 6 weeks. All infants were tested for their HIV viral load within the first 48 h of birth, with negative results, and 12 infants were tested for anti-HIV antibodies at the 18th month, again with negative results. In this study, we determined that none of the infants had been infected with HIV.CONCLUSION:Our findings highlight the importance of initiating ART for all HIV-infected pregnant women and the importance of protection modalities during pregnancy, delivery, and the postnatal period for the prevention of perinatal transmission of HIV.

The morphological specifics of the stromal and parenchymal liver components of 6-12-months old children from hiv-mono-infected mothers

To determine the morphological specifics of the stromal and parenchymal liver components of 6-12-months old children from HIV-mono-infected mothers. Materials and methods. The morphometric investigation included 87 liver tissue biopsies of 6-12-months old dead children from HIV-mono-infected mothers. All morphometric parameters of the parenchymal and stromal liver components were calculated using the Avtandilov`s microscopic morphometric grid, which was consisted of 100 equidistant points. It was inserted into the microscope`s ocular tube with a total × 200 microscope magnification. The number of points that were found on the corresponding types of parenchymal and stromal liver components was calculated. In every case, it was selected 10 random microscopic areas and then all data were obtained, calculated and presented as percentages. Results. Morphometric parameters of hepatocytes: mononuclear hepatocytes – 90.2±7.6 % [control – 93.5±7.1], two-nuclear hepatocytes – 9.8±1.2 % [control – 6.5±1.2], TMHC (two-/mononuclear hepatocytes coefficient) – 0.10±0.02 [control – 0.06±0.01], hepatocytes with fat vacuoles – 19.6±2.1 % [control – 0.5±0.2]. Parenchymal and stromal liver components: parenchyma – 56.1±3.3 % [control – 74.2±4.3], stroma (including blood vessels and bile ducts) – 43.9±3.7 % [control – 25.8±2.6], SPI (stroma/parenchyma index) – 0.78±0.02 [control – 0.34±0.01]. Morphometric parameters of all of the liver components: hepatocytes – 56.1±3.3 % [control – 74.2±4.3], portal tracts – 26.4±2.1 % [control – 3.1±0.6], central veins – 8.1±1.2 % [control – 9.3±1.4], sinusoids – 7.3±1.2 % [control – 10.5±1.3], bile ducts – 2.1±0.1 % [control – 2.9±0.2]. Expression level parameters: fibronectin – 73.2±4.2 % [control – 17.3±2.5], collagen type I – 15.9±1.2 % [control – 9.7±1.9], collagen type III – 20.1±2.6 % [control – 10.1±0.9], collagen type IV – 7.3±0.2 % [control – 5.9±0.2]. Conclusions. It was established, that in the liver of 6-12-months old children from HIV-mono-infected mothers, the parenchymal component of the liver showed the signs of its significant reduction, increase of regenerative activity of hepatocytes, and fatty degeneration of hepatocytes with a certain sign of reactive steatohepatitis. Also, it was established, that the stromal component of the liver of children from HIV-infected mothers showed the signs of its progressive proliferation and collagenization due to increased production and accumulation of fibronectin, type I, type III collagens in the stroma of portal tracts and newly formed septa, and the signs of hepatic sinusoid capillarization due to type IV collagen accumulation in the space of Disse of the hepatic sinusoids.

Mixed cytomegalovirus genotypes in HIV-positive mothers show compartmentalization and distinct patterns of transmission to infants.

Cytomegalovirus (CMV) is the commonest cause of congenital infection and particularly so among infants born to HIV-infected women. Studies of congenital CMV infection (cCMVi) pathogenesis are complicated by the presence of multiple infecting maternal CMV strains, especially in HIV-positive women, and the large, recombinant CMV genome. Using newly developed tools to reconstruct CMV haplotypes, we demonstrate anatomic CMV compartmentalization in five HIV-infected mothers and identify the possibility of congenitally transmitted genotypes in three of their infants. A single CMV strain was transmitted in each congenitally infected case, and all were closely related to those that predominate in the cognate maternal cervix. Compared to non-transmitted strains, these congenitally transmitted CMV strains showed statistically significant similarities in 19 genes associated with tissue tropism and immunomodulation. In all infants, incident superinfections with distinct strains from breast milk were captured during follow-up. The results represent potentially important new insights into the virologic determinants of early CMV infection.

Receipt of infant HIV DNA PCR test results is associated with a reduction in retention of HIV-exposed infants in integrated HIV care and healthcare services: a quantitative sub-study nested within a cluster randomised trial in rural Malawi

BackgroundRetention of HIV-infected mothers in integrated HIV and healthcare facilities is effective at reducing mother-to-child-transmission (MTCT) of HIV. In the context of Option B+, we examined maternal and HIV-exposed infant retention across three study arms to 18 months postpartum: mother-and-infant clinics (MIP), MIP with short-messaging service (MIP + SMS) and standard of care (SOC). In particular, we focused on the impact of mothers receiving an infant’s HIV PCR test result on maternal and infant study retention.MethodsA quantitative sub-study nested within a cluster randomised trial undertaken between May 2013 and August 2016 across 30 healthcare facilities in rural Malawi enrolling HIV-infected pregnant mothers and HIV-exposed infants on delivery, was performed. Survival probabilities of maternal and HIV-exposed infant study retention was estimated using Kaplan-Meier curves. Associations between mother’s receiving an infant’s HIV test result and in particular, an infant’s HIV-positive result on maternal and infant study retention were modelled using time-varying multivariate Cox regression.ResultsFour hundred sixty-one, 493, and 396 HIV-infected women and 386, 399, and 300 HIV-exposed infants were enrolled across study arms; MIP, MIP + SMS and SOC, respectively. A total of 47.5% of mothers received their infant’s HIV test results < 5 months postpartum. Receiving an infant’s HIV result by mothers was associated with a 70% increase in infant non-retention in the study compared with not receiving an infant’s result (HR = 1.70; P-value< 0.001). Receiving a HIV-positive result was associated with 3.12 times reduced infant retention compared with a HIV-negative result (P-value< 0.001). Of the infants with a HIV-negative test result, 87% were breastfed at their final study follow-up.ConclusionsReceiving an infant’s HIV test result was a driving factor for reduced infant study retention, especially an infant’s HIV-positive test result. As most HIV-negative infants were still breastfed at their last follow-up, this indicates a large proportion of HIV-exposed infants were potentially at future risk of MTCT of HIV via breastfeeding but were unlikely to undergo follow-up HIV testing after breastfeeding cessation. Future studies to identify and address underlying factors associated with infant HIV testing and reduced infant retention could potentially improve infant retention in HIV/healthcare facilities.Trial registrationPan African Clinical Trial Registry: PACTR201312000678196.

The effectiveness of the using moveable games, metered running, breathing exercises in the physical therapy of orphans born to HIV-infected mothers

Aim: to develop and experimentally substantiate the method of physical education for orphans born to HIV-infected mothers, based on the use of moveable games for the development of physical qualities, metered running, breathing exercises in orphanage conditions.&#x0D; Material and methods: 28 children of 5-6 years old took part in the experiment. The experimental group included orphans born to HIV-infected mothers (14 children). The control group consisted of orphans with poor health (14 children). The research was carried out on the basis of the health care institution "Regional specialized children's home" Green Gai "for orphans and children left without parental care. The experiment lasted for 12 months, at the beginning and at the end of the experiment anthropometric studies, functional state testing (spirography, Genchi's test, Stange's test), physical fitness tests (running from a high start at 30 meters, a long jump from the spot, throwing a ball from - for the head, standing)&#x0D; Results: An experimental method of physical education for orphans in an orphanage, born to HIV-infected mothers, was developed and implemented. The technique includes the use of moveable games for the development of physical qualities, dosed running exercises and complexes of respiratory gymnastics, taking into account the age characteristics of children of preschool age. A significant improvement (p&lt;0,05) in the indicators of physical development, functional state and physical fitness of children in the experimental group was shown in comparison with the control group.&#x0D; Conclusions: As a result of using the proposed method, it was possible to reduce the incidence of acute respiratory infections in children born to HIV-infected mothers from 8-10 to 4-3 times a year. It has been established that the simplicity and availability of the developed methods of organizing physical education allows them to be used not only by specialists in the field of physical education of preschool children, but also by educators of preschool institutions.

Stigma toward small babies and their mothers in Ghana: A study of the experiences of postpartum women living with HIV.

Infants born to HIV-infected mothers are more likely to be low birthweight (LBW) than other infants, a condition that is stigmatized in many settings worldwide, including sub-Saharan Africa. Few studies have characterized the social-cultural context and response to LBW stigma among mothers in sub-Saharan Africa or explored the views of women living with HIV (WLHIV) on the causes of LBW. We purposively sampled thirty postpartum WLHIV, who had given birth to either LBW or normal birthweight infants, from two tertiary hospitals in Accra, Ghana. Using semi-structured interviews, we explored women’s understanding of the etiology of LBW, and their experiences of caring for a LBW infant. Interviews were analyzed using interpretive phenomenology. Mothers assessed their babies' smallness based on the baby's size, not hospital-recorded birthweight. Several participants explained that severe depression and a loss of appetite, linked to stigma following an HIV diagnosis during pregnancy, contributed to infants being born LBW. Women with small babies also experienced stigma due to the newborns' "undesirable" physical features and other people's unfamiliarity with their size. Consequently, mothers experienced blame, reluctance showing the baby to others, and social gossip. As a result of this stigma, women reported self-isolation and depressive symptoms. These experiences were layered on the burden of healthcare and infant feeding costs for LBW infants. LBW stigma appeared to attenuate with increased infant weight gain. A few of the women also did not breastfeed because they thought their baby's small size indicated pediatric HIV infection. Among WLHIV in urban areas in Ghana, mother and LBW infants may experience LBW-related stigma. A multi-component intervention that includes reducing LBW incidence, treating antenatal depression, providing psychosocial support after a LBW birth, and increasing LBW infants’ weight gain are critically needed.

Perinatal outcomes on mortality and influencing factors among HIV-infected mothers in Sichuan province

Objective: To explore the influencing factors on perinatal mortality of pregnant women with HIV infection to reduce the mother-to-child transmission in Sichuan province. Methods: In this study, 4 786 perinatal infants of the HIV-infected pregnant women were included. Related data on perinatal epidemiology was reported by all the 183 medical and health care institutions where the HIV prevention of mother-to-child transmission program was initiated in 2005-2016. Univariate χ(2) test and multivariate logistic regression methods were used to analyze the perinatal mortality outcomes and influencing factors. Results: The overall perinatal mortality rate was 25.7‰ (123/4 786) among HIV-infected pregnant women, with annual downwarding trend (trend χ(2)=32.220, P=0.000). Perinatal mortality rate appeared the highest (χ(2)=4.130, P=0.042), with more fetal deaths and stillbirths and less early neonatal death within 7 days in Liangshan county (χ(2)=29.626, P=0.000). Results from the multivariate logistic regression analysis showed that fewer pregnant numbers would contribute to the, lower perinatal mortality rate (1-2 pregnancies OR=0.417, 95%CI: 0.184-0.943; 3-4 pregnancies OR=0.447, 95%CI: 0.223-0.895). Perinatal deaths were more likely to be prevented if LPV/r protease inhibitor-based triple antiviral therapy was provided (OR=0.530, 95%CI: 0.285- 0.986) or delivery was taken place in the hospital (hospital of municipal-level and above OR=0.222, 95%CI:0.098-0.499; county-level hospital OR=0.282, 95%CI: 0.166-0.480; township-level hospital OR=0.134, 95%CI: 0.031-0.586) among HIV-infected pregnant women. However, premature delivery or neonatal asphyxia would increase the risk of perinatal mortality (premature delivery OR=8.285, 95%CI: 5.073-13.533; neonatal asphyxia OR=9.624, 95%CI: 4.625-20.028). Conclusions: The perinatal mortality rate of HIV-infected pregnant women appeared significantly higher than that in the province or the whole country. Strategies involving LPV/r-based triple antiviral therapy, promotion of hospital delivery, reducing the incidence rates of premature deliveries and neonatal asphyxia, should be strengthened.

Growth and Neurodevelopment Outcomes in HIV-, Tenofovir-, and Efavirenz-Exposed Breastfed Infants in the PMTCT Option B+ Program in Malawi.

Pregnant and breastfeeding women in Option B+ in Malawi received antiretroviral drugs (ARVs) containing efavirenz (EFV) and tenofovir disoproxil fumarate (TDF). However, effects on growth, renal, bone metabolism, and neurodevelopment of long-term exposure to low doses of these drugs through breast milk in HIV-exposed infants are unclear. Prospective cohorts of TDF-and-EFV-exposed and TDF-and-EFV-unexposed breastfed infants of HIV-infected and HIV-uninfected mothers in Option B+ were recruited in 2:1 ratio, respectively, followed from birth to 18 months. Infants with low birth weight, premature birth, and congenital abnormalities were excluded. Anthropometrics were assessed at birth, 6 weeks, 3, 6, 12, and 18 months. Neurodevelopment assessments used the Bayley Scales of Infant and Toddler Development III from 6 weeks. Creatinine, alkaline phosphatase, and phosphorus were assessed at 3, 6, and 12 months. Of 260 HIV-and-ARV-exposed and 125 HIV-and-ARV-unexposed infants enrolled at birth, 87% and 57%, 78% and 59%, 77% and 54%, 73% and 51%, and 65% and 43% completed 6-weeks, 3, 6, 12, and 18 months visits, respectively. There were no significant differences in the mean Z-scores for length-for-age, weight-for-age, weight-for-length, mid-upper arm circumference-for-age, and head circumference-for-age between groups except at 6-weeks for length-for-age. No bone fractures occurred. Neurodevelopment outcomes were similar between groups. Of creatinine, alkaline phosphatase, and serum phosphate measurements, 1.7%, 2.6%, and 3.3% reached any toxicity levels grades 1-4, respectively, with no differences between groups. Long-term exposure to EFV and TDF through breastfeeding in infants of HIV-infected mothers does not seem to result in significant growth, neurodevelopment, renal, or bone adverse outcomes. Data support safety of breastfeeding through 18 months within the Option B+ program.

Minimum Acceptable Diet and Associated Factors Among HIV-Exposed Children Aged 6-24 Months in Debre Tabor Town, Ethiopia.

IntroductionMinimum acceptable diet is a composite indicator of minimum dietary diversity and minimum meal frequency. World Health Organization’s newborn child feeding and HIV guidelines suggestbeginning complementary nourishments at six months, and breastfeeding for HIV-exposed children. HIV infected mothers may be more sensitive on feeding practices to protect their children from contracting the disease. On the other hand, HIV infection is associated with higher risk food insecurity which may affect feeding practices of children. But in Ethiopia, there is lack of evidence on extent of minimum acceptable diet of HIV-exposed children. Therefore, the objective of this study was to assess minimum acceptable diet and associated factors among HIV-exposed 6–24 months aged children.MethodsAn institution-based cross-sectional study was conducted in health institutions of Debre Tabor town. The study was conducted on 287 mother-child pairs attending antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT) at public health facilities. Descriptive statistics like frequency, proportions, mean and standard deviation were computed. Multi-variable logistic regression was run to identify independent predictors of the outcome variable (minimum acceptable diet). A p-value <0.05 was used to declare statistical significance.ResultsAbout 76% (95% CI: 70.8–80.8) and 58.2% (95% CI: 53.0–68.3) children were fed with appropriate meal frequency and recommended dietary diversity, respectively. One hundred (34.8%) (95% CI: 29.3–40.4) of children were fed a minimum acceptable diet and 59.9% (95% CI: 54.0–65.9) of children consumed iron rich or fortified food. Out of the total, 203 (71.0%) (95% CI: 66.1–76.2) of the mothers had good knowledge on minimum dietary diversity and meal frequency feeding practices. In multi-variable logistic regression poor knowledge with AOR = 0.32, 95% CI: 0.17–0.58, maternal workload with AOR = 0.38, 95% CI: 0.19–0.75 and inadequate information about child feeding from health care providers with AOR = 0.46, 95% CI: 0.26–0.81 were statistically significant predictors of minimum acceptable diet.ConclusionThe study revealed that the proportion of children who received minimal acceptable diet was lower than that of WHO recommendation for good practice. Knowledge, maternal workload and information related to complementary feeding were associated with low minimum acceptable diet.

The prevalence of latent and acute toxoplasmosis in HIV-infected pregnant women: A systematic review and meta-analysis

ObjectiveHIV in pregnancy is not only important for mother-to-child HIV transmission, but also it assumes additional importance because HIV increases susceptibility to opportunistic infections, leading to increased morbidity and mortality in mothers and neonates. Toxoplasmosis is one of the most important opportunistic infections in HIV-infected pregnant women. The present study was undertaken to assess the prevalence of latent toxoplasmosis (LT) and acute toxoplasmosis (AT) infection in HIV-infected pregnant women. MethodsPubMed/MEDLINE, Scopus, Web of Science, EMBASE and SciELO were searched to identify relevant studies. A random-effects model was used to estimate the overall and subgroup-pooled prevalences across studies. Heterogeneity between studies was assessed via the I2 test. ResultsA total of 14 articles that included 3256 subjects in nine countries met the inclusion criteria. The overall prevalence rates of LT and AT in HIV-infected pregnant women were 45.7% (95% CI, 32.3–59.7%) and 1.1% (95% CI, 0.4–3.2%), respectively. The findings indicate that, worldwide, approximately 559,000 and 13,450 HIV-infected pregnant women are affected by LT and AT, respectively. From this review, it is estimated that approximately 3432 babies annually could be born with congenital toxoplasmosis (CT) from HIV-infected pregnant mothers. ConclusionsThe present study indicates that a large number of HIV-infected mothers are affected by LT and AT. This can lead to adverse complications such toxoplasmic encephalitis in mothers and CT in neonates. Our results suggest a need for screening programs using well-validated diagnostic platforms for both LT and AT for all HIV-infected pregnant women.

Temporal trend and risk factors for mother-to-child HIV transmission in Southern Brazil, 2007-2017

Abstract Background HIV infection affects women of childbearing age, and unplanned pregnancies among those infected are prevalent. This fact increases the potential risk for mother-to-child transmission during pregnancy, childbirth or postpartum through breastfeeding. The Brazilian Ministry of Health recommends anti-HIV testing for all pregnant women. Access to antiretroviral therapy is available through prenatal and maternity care, and breastfeeding is contraindicated. The detection rate of pregnant women living with HIV in Brazil has increased by 23.8% in the last ten years. The aim of this study was to estimate the incidence of seroconversion of HIV infection in children exposed to mother-to-child transmission and examine associated risk factors for the period 2007-2017 in Santa Catarina, Brazil. Methods A historical cohort study was conducted using secondary data related to the notifications of HIV-infected pregnant woman and follow-up of HIV-exposed infants. Odds ratios were used to estimate the risk of infection. Results We identified 5,554 HIV-infected pregnant women and 4,559 HIV-exposed infants, 130 of whom had confirmed seroconversion, which corresponds to a rate of 2.9%. Antiretroviral use during pregnancy [OR = 9.31 (5.97-14.52) p &amp;lt; 0.001] and breastfeeding [OR = 3.10 (1.34-7.20) p = 0.008] were found to be independent risk factors for seroconversion. Between 2007 and 2017, there was a 78.3% increase in the number of HIV-infected pregnant women, but the seroconversion rate among infants reduced by 20.4%. Conclusions The study concluded that, between 2007 and 2017, the HIV seroconversion rate was 2.9% among live births, with a tendency to decrease. Seroconversion was associated with not using antiretroviral therapy during pregnancy and breastfeeding. These data reveal gaps in prenatal care regarding adherence to treatment and follow-up of HIV-infected mothers, resulting in new HIV infections among children that could otherwise be prevented. Key messages Vertical transmission of HIV is a public health challenge, which requires strategies for surveillance and quality care. This study may provide relevant information to promote public health policies, with quality care for pregnant women and children living with HIV/AIDS.

Association of maternal and infant inflammation with neurodevelopment in HIV-exposed uninfected children in a South African birth cohort

HIV-exposed uninfected (HEU) children may have altered immune regulation and poorer neurodevelopment outcomes compared to their HIV-unexposed (HU) counterparts. However, studies investigating the association of maternal and infant inflammation with neurodevelopment in HEU children are limited and longitudinal data are lacking. This study investigated serum inflammatory markers in women living with HIV vs. HIV-uninfected women during pregnancy and in their children, as well as associations with neurodevelopmental outcomes at two years of age in an African birth cohort study. A sub-group of mother–child dyads from the Drakenstein Child Health Study had serum inflammatory markers measured at ≈26 week’s gestation (n = 77 HIV-infected mothers; n = 190 HIV-uninfected mothers), at 6–10 weeks (n = 63 HEU infants and n = 159 HU infants) and at 24–28 months (n = 77 HEU children and n = 190 HU children). Serum inflammatory markers [granulocyte–macrophage colony-stimulating factor (GM-CSF), interferon-γ (IFN-γ), interleukin IL-1β, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12p70, IL-13, tumor necrosis factor-α (TNF-α), neutrophil gelatinase-associated lipocalin (NGAL) and metalloproteinase-9 (MMP-9)] were analyzed with a multiplex bead array and ELISA assays. The Bayley Scales of Infant and Toddler Development, third edition, was used to assess neurodevelopment at 24–28 months. After correcting for multiple comparisons, HIV infection during pregnancy was associated with lower serum levels of inflammatory markers in mothers at 26 weeks gestation (GM-CSF and MMP-9, p < 0.05) and HEU children at 6–10 weeks (IFN-γ and IL-1β, p < 0.01), and at 24–28 months (IFN-γ, IL-1β, IL-2 and IL-4, p < 0.05) compared to HIV-uninfected mothers and HU children. In HEU infants at 6–10 weeks, inflammatory markers (GM-CSF, IFN-γ, IL-10, IL-12p70, IL-1β, IL-2, IL-4, IL-6 and NGAL, all p < 0.05) were associated with poorer motor function at two years of age. This is the first study to evaluate the associations of follow-up immune markers in HEU children with neurodevelopment. These findings suggest that maternal HIV infection is associated with immune dysregulation in mothers and their children through two years of age. An altered immune system in HEU infants is associated with poorer follow-up motor neurodevelopment. These data highlight the important role of the immune system in early neurodevelopment and provide a foundation for future research.

Increased Expression on Innate Immune Factors in Placentas From HIV-Infected Mothers Concurs With Dampened Systemic Immune Activation.

Innate immunity is one of the main protection mechanisms against viral infections, but how this system works at the maternal-fetal interface, especially during HIV infection, is still poorly known. In this study, we investigated the relationship between pregnancy and innate mechanisms associated with HIV immunity by evaluating the expression of DAMPs, inflammasome components and type I/III IFNs in placenta and serum samples from HIV-infected mothers and exposed newborns. Our results showed that most of these factors, including HMGB1, IL-1, and IFN, were increased in placental villi from HIV-infected mothers. Curiously, however, these factors were simultaneously repressed in serum from HIV-infected mothers and their exposed newborns, suggesting that pregnancy could restrict HIV immune activation systemically but preserve the immune response at the placental level. An effective local antiviral status associated with a suppressed inflammatory environment can balance the maternal immune response, promoting homeostasis for fetal development and protection against HIV infection in neonates.

Characteristics of HIV/ Malaria co-infected mothers who did not access early infant diagnosis for their HIV-exposed infants in Benin-City, Nigeria

Background: Perinatally-acquired HIV infections rapidly lead to death within one to two years of life. Early infant diagnosis (EID) is the key to early identification with the prompt commencement of treatment. This has been shown to reduce morbidity and mortality. In Nigeria, only 21% of HIV-infected infants are on ARTs. Objective: To determine the characteristics of HIV/Malaria co-infected mothers who did not access EID for their HIV- exposed infants. Methods: HIV infected mothers were recruited from three hospitals during the last trimester of pregnancy and were tested for peripheral and placental malaria at delivery. Socio-demographic and some clinical characteristics were obtained using a proforma. Following delivery, the babies were commenced on the Prevention of Mother to Child Transmission (PMTCT) protocol for HIV including prophylactic Nevirapine therapy, infant feeding counselling and performance of DNA PCR at 6-8 weeks of life. Mothers whose infants did not have DNA PCR results were categorized as having not accessed EID services. Results: Of the 162 infants, only 101 (62.4%) had a DNA PCR test done. The mean age of mothers who did not access EID (31.84±4.8 years) was significantly higher than for mothers who accessed EID (30.58±3.09 years) (p&lt;0.0001). Mothers with low levels of education (p = 0.006), cohabiting mothers (p = 0.0067) and HIV serodiscordant couples (p = 0.0029) were more likely not to access EID. Conclusion: Education, marital status and HIV serodiscordance are significant determinants of accessing EID services. Assessment of these factors at first contact with a pregnant HIV-infected woman allows risk categorisation for default from EID.

Knowledge, Attitude and Practice Survey of the Recommended Infant Feeding Guidelines for HIV Positive Mothers by Primary Health Care Workers in Uyo, Nigeria

Background: Safe and appropriate feeding is a key intervention that can prevent mother to child transmission of HIV. This study aimed at determining the level of knowledge, attitude and current practice of primary health care (PHC) workers in Uyo of the recommended infant feeding guidelines for infants of HIV-infected mothers.&#x0D; Methodology: This was an analytical cross-sectional study carried out among 130 primary health care workers in 15 PHCs in Uyo metropolis, Akwa Ibom State, Nigeria. Data was collected using self-administered questionnaires in English and analyzed using the Statistical Package for Social Sciences (SPSS) version 25.0.&#x0D; Results: Nineteen (14.6%) and 111 (85.4%) respondents had a fair and poor level of knowledge of MTCT of HIV and infant feeding options respectively. One hundred and six (81.5%) and 100 (76.9%) respondents had received training on PMTCT of HIV and infant feeding counselling for HIV-infected mothers respectively. The majority of respondents exhibited positive attitude regarding infant feeding options for HIV exposed babies. One hundred and twenty (92.3%) considered it correct for an HIV-infected woman to breastfeed her baby and 125 (96.2%) considered breast milk alone adequate food for babies in the first 6 months of life. Predictor of negative attitude was lack of training on infant feeding counseling (OR 15, P=0.02, 95%CI 1.64-138.07). Most 107 (82.3%) cited exclusive breastfeeding with introduction of complementary feeds at 6 months as the most common method accepted by their clients.&#x0D; Conclusion: Gaps in the knowledge of PHC workers in Uyo on MTCT and Infant feeding options and practice were identified which can be addressed by qualitative training, effective monitoring and supportive supervision.

Vitamin D status, nutrition and growth in HIV-infected mothers and HIV-exposed infants and children in Botswana.

Poor vitamin D status is a global health problem and common in patients with human immunodeficiency virus (HIV) in high-income countries. There is less evidence on prevalence of vitamin D deficiency and nutrition and growth in HIV-infected and -exposed children in low- and middle-income countries. To determine the vitamin D status in Batswana HIV-infected mothers and their children, differences among HIV-infected mothers and between HIV-exposed and -infected infants and children, and associations between vitamin D and disease-related outcomes, nutrition, and growth. This was a cross-sectional study of HIV+ mothers and HIV-exposed infants and unrelated children (1-7.9 years). Serum 25-hydroxyvitamin D (25(OH)D) was measured, among other nutritional indicators, for mothers, infants and children. Vitamin D status for HIV-infected mothers and children, and an immune panel was assessed. History of HIV anti-retroviral medications and breastfeeding were obtained. Data were collected prior to universal combination antiretroviral therapy in pregnancy. Mothers (n = 36) had a mean serum 25(OH)D of 37.2±12.4ng/mL; 11% had insufficient (<20ng/mL), 17% moderately low (20.0-29.9ng/mL) and 72% sufficient (≥30ng/mL) concentrations. No infants (n = 36) or children (n = 48) were vitamin D insufficient; 22% of HIV- and no HIV+ infants had moderately low concentrations and 78% of HIV- and 100% of HIV+ infants had sufficient status, 8% of HIV- and no HIV+ children had moderately low concentrations and 92% of HIV- and 100% HIV+ children had sufficient concentrations. HIV+ children had significantly lower length/height Z scores compared to HIV- children. Length/height Z score was positively correlated with serum 25(OH)D in all children (r = 0.33, p = 0.023), with a stronger correlation in the HIV+ children (r = 0.47 p = 0.021). In mothers, serum 25(OH)D was positively associated with CD4% (r = 0.40, p = 0.016). Results showed a low prevalence of vitamin D insufficiency in Botswana. Growth was positively correlated with vitamin D status in HIV-exposed children, and HIV+ children had poorer linear growth than HIV- children.

The Impact of Maternal Human Immunodeficiency Virus Infection on the Burden of Respiratory Syncytial Virus Among Pregnant Women and Their Infants, Western Kenya.

BackgroundRespiratory syncytial virus (RSV) is an important cause of respiratory illness worldwide; however, burden data on mother–infant pairs remain sparse in sub-Saharan Africa, where human immunodeficiency virus (HIV) is prevalent. We evaluated the impact of maternal HIV infection on the burden of RSV among mothers and their infants in western Kenya.MethodsWe enrolled pregnant women (≤20 weeks’ gestation) and followed them and their newborns weekly for up to 3–6 months postpartum, to document cases of acute respiratory illness (ARI). Nasal/oropharyngeal swabs were collected and tested for RSV using polymerase chain reaction. Analyses were stratified by maternal HIV status and incidence was computed per 1000 person-months.ResultsCompared to RSV-negative ARI cases, RSV-positive cases were associated with cough, apnea, and hospitalization among infants. RSV incidence per 1000 person-months among mothers was 4.0 (95% confidence interval [CI], 3.2–4.4), and was twice that among the HIV-infected mothers (8.4 [95% CI, 5.7–12.0]) compared to the HIV-uninfected mothers (3.1 [95% CI, 2.3–4.0]). Among infants, incidence per 1000 person-months was 15.4 (95% CI, 12.5–18.8); incidence did not differ by HIV exposure or prematurity.ConclusionsHIV infection may increase the risk of RSV illness among pregnant women. Future maternal RSV vaccines may have added benefit in areas with high HIV prevalence.