HIV-infected Women Of Childbearing Age Research Articles

Analysis of the Mediation Effects of Adverse Mental Health Outcomes in HIV-Infected Women of Childbearing Age from Multiple Perspectives Including Discrimination Perception.

To Analysis of the mediation effects of adverse mental health outcomes in HIV-infected women of childbearing age from multiple perspectives including discrimination perception, social capital, and other factors. A cross-sectional survey was conducted among 553 people in Xinjiang region of China using Survey scale. AMOS was used to identify factors that influenced the "discrimination perception/mental resilience/social capital-depression-poor mental health outcomes" pathway. A total of 44.85% and 42.13% of the study participants had anxiety and depression symptoms, as perceived discrimination increased, the higher the level of depression in HIV-infected women of childbearing age. Correlation coefficient among depression with poor mental health outcomes was also significant. Psychological resilience, social capital and depression have mediating effects on perceived discrimination and poor mental health outcomes, discrimination perception had an indirect effect on depression through social capital and an indirect effect on adverse mental health outcomes through depression and psychological resilience. The modified model has a good fitting effect. Discrimination perception was shown to affect adverse mental health outcomes by impacting mental resilience, depression, and social capital. The findings suggest the need for measures to reduce adverse mental health outcomes by decreasing discrimination perception, increasing social capital, and enhancing psychological resilience.

Seroprevalence and risk factors of Toxoplasmosis among HIV infected women of child-bearing age attending care and treatment clinics in Dar es Salaam, Tanzania.

Toxoplasmosis in HIV-infected women of child-bearing age (HIV-WCB) increases the risk for congenital toxoplasmosis, leading to many complications. However, its magnitude is unknown in this population. Objectives: The study aimed to determine the prevalence and factors associated with toxoplasmosis among HIV-WCB. This was a cross-sectional study conducted from July to August 2020 among HIV- WCB attending care and treatment clinic (CTC) at Muhimbili National Hospital and Mnazi Mmoja hospital. Questionnaire and TORCH rapid test were used to obtain data and serological testing respectively. Data analysis was done using statistical package for social sciences (SPSS) version 20. Overall, 29.7% of the study participants were positive for anti-T. gondii IgG, whereas none tested positive for IgM. Multivariate analysis showed that the probability of being infected with T. gondii increased by 57.1% for participants who consumed raw vegetables (p=0.005, aOR=0.43, 95%CI = 1.24-8.77). Other common risk factors such as undercooked meat consumption, source of drinking water, and cat ownership at home showed no association. A high number of HIV-WCB have not developed immunity to T. gondii in the study area. Introduction of routine screening during antenatal visits for pregnant women and further epidemiological studies are warranted in the country.

Analysis of the prevalence and severity of clinical manifestations of papillomavirus infection in HIV-infected women of childbearing age

Objective: to determine the prevalence and severity of clinical and cytological manifestations of papillomavirus infection in HIV-infected women of childbearing age in relation to immunological and virological parameters.Materials and methods. Statistical data were obtained through direct randomised inclusion of 182 HIV-infected women of fertile age who were being followed up at the AIDS Centre during their initial gynaecological examinations. Statistical processing of the findings was carried out using IBM SPSS Statistics software.Results and discussion. The results of the study showed a high detection rate of chronic papillomavirus infection of high carcinogenic risk (HPV HRS) among HIV-infected women, which is a prognostically unfavorable factor for the development of pathological changes in the cervix and was confirmed in a study by extended colposcopy. It was found that the concentration of HPV VKR increases against the background of a decrease in the immune status, and there is an indirect relationship between the level of HIV viral load and the concentration of HPV VKR.Conclusion. The feasibility of HPV vaccination among HIV-infected girls and women aged 9–45 has been demonstrated.

Preconception use of cART by HIV-positive pregnant women increases the risk of infants being born small for gestational age.

BackgroundThe benefits of combination anti-retroviral therapy (cART) in HIV-positive pregnant women (improved maternal health and prevention of mother to child transmission [pMTCT]) currently outweigh the adverse effects due to cART. As the variety of cART increases, however, the question arises as to which type of cART is safest for pregnant women and women of childbearing age. We studied the effect of timing and exposure to different classes of cART on adverse birth outcomes in a large HIV cohort in the Netherlands.Materials and methodsWe included singleton HEU infants registered in the ATHENA cohort from 1997 to 2015. Multivariate logistic regression analysis for single and multiple pregnancies was used to evaluate predictors of small for gestational age (SGA, birth weight <10th percentile for gestational age), low birth weight and preterm delivery.ResultsA total of 1392 children born to 1022 mothers were included. Of these, 331 (23.8%) children were SGA. Women starting cART before conception had an increased risk of having a SGA infant compared to women starting cART after conception (OR 1.35, 95% CI 1.03−1.77, p = 0.03). The risk for SGA was highest in women who started a protease inhibitor-(PI) based regimen prior to pregnancy, compared with women who initiated PI-based cART during pregnancy. While the association of preterm delivery and preconception cART was significant in univariate analysis, on multivariate analysis only a non-significant trend was observed (OR 1.39, 95% CI 0.94−1.92, p = 0.06) in women who had started cART before compared to after conception. In multivariate analysis, the risk of low birth weight (OR 1.34, 95% CI 0.94−1.92, p = 0.11) was not significantly increased in women who had started cART prior to conception compared to after conception.ConclusionIn our cohort of pregnant HIV-positive women, the use of cART prior to conception, most notably a PI-based regimen, was associated with intrauterine growth restriction resulting in SGA. Data showed a non-significant trend in the risk of PTD associated with preconception use of cART compared to its use after conception. More studies are needed with regard to the mechanisms taking place in the placenta during fetal growth in pregnant HIV-positive women using cART. It will only be with this knowledge that we can begin to understand the potential impact of HIV and cART on the fetus, in order to be able to determine the optimal individualised drug regimen for HIV-infected women of childbearing age.

Cost-minimization comparison of darunavir plus ritonavir and lopinavir/ritonavir in HIV-1 infected treatment-naïve women of childbearing age

Background:Guidelines from the Department of Health and Human Services in the US recommend ritonavir-boosted lopinavir (LPV/r) as a preferred protease inhibitor (PI) for HIV-positive antiretroviral-naїve pregnant women. These guidelines also cite ritonavir-boosted darunavir (DRV + RTV) as an alternative PI in this clinical scenario. The purpose of this analysis was to compare economic outcomes for regimens based on these two treatments.Study design:An existing discrete event simulation (DES) model was adapted to conduct a cost-minimization analysis comparing the two regimens in HIV-infected women of childbearing age (WOCBA), from the perspective of a healthcare payer in the US.Methods:The DES model was used to represent disease states, health events, healthcare encounters, pregnancy, and treatment choices in HIV-infected WOCBA starting treatment with regimens based on either LPV/r or DRV + RTV. It also incorporated parameters for individual patient characteristics, and for antiretroviral (ARV) treatment effectiveness, treatment sequencing, clinical progression, and resource use. Potential events included scheduled physician visits; viral suppression; viral rebound; AIDS-related complications; CHD events; treatment discontinuation and switching; ARV treatment side-effects (SE); and death. The primary outcomes were discounted 5-year and 10-year healthcare costs. Alternative scenarios considered different rates of switching from DRV + RTV to LPV/r upon conception.Results:Compared with DRV + RTV, LPV/r was associated with similar clinical outcomes while offering savings at the 5- and 10-year horizons (of $24,904 and $43,502 per patient, respectively), and in extensive sensitivity analyses. The main driver of the savings was the difference in cost between PIs.Conclusions:Starting HIV-infected ARV-treatment-naїve WOCBA on an LPV/r-based regimen is cost-saving and provides similar patient outcomes compared to a DRV + RTV-based regimen.

Antiretroviral therapy, pregnancy, and birth defects: a discussion on the updated data

An increasing number of HIV-infected women of childbearing age are initiating antiretroviral therapy (ART) worldwide. This review aims to discuss updated data of the eligible ART regimens and their role in inducing birth defects in utero. Zidovudine and lamivudine plus a non-nucleoside reverse-transcriptase inhibitor or protease inhibitor (PI) is the first-line regimen applied. The role of zidovudine exposition monotherapy or associated with other ART in inducing birth defects remains inconclusive. The main organ systems involved are genitourinary and cardiovascular. For HIV-infected pregnant women, World Health Organization (WHO) guidelines up to 2010 recommend the same group of drugs that are prescribed to nonpregnant women. The exception is efavirenz, which has been associated with an increase in the risk of teratogenicity. Increased rates of birth defects were found in large cohorts and computational studies conducted recently in infants exposed to efavirenz-containing regimens. The combination of zidovudine and lamivudine and lopinavir/ritonavir is one of the most used ART regimens for prevention of mother-to-child-transmission. Conflicting data about the role of PI exposure in utero and birth defects have been reported. However, a reduced number of studies evaluating the role of PI in inducing birth defects in women are available. An association between prematurity and PI exposure in pregnancy was extensively described. Some questions arise due to the tendency of initiating ART early in the life of HIV-infected individuals or those at risk of infection. Longtime exposure to different ART regimens and the potential effect of birth-defect induction in pregnancy are not completely understood. Developing regions harbor the highest numbers of women of reproductive age exposed to ART. Most of the largest and expressive data come from developed countries, and could not be sufficiently representative of pregnant women living in developing countries.

Quantifying the risks and benefits of efavirenz use in HIV-infected women of childbearing age in the USA.

The aim of the study was to quantify the benefits (life expectancy gains) and risks (efavirenz-related teratogenicity) associated with using efavirenz in HIV-infected women of childbearing age in the USA. We used data from the Women's Interagency HIV Study in an HIV disease simulation model to estimate life expectancy in women who receive an efavirenz-based initial antiretroviral regimen compared with those who delay efavirenz use and receive a boosted protease inhibitor-based initial regimen. To estimate excess risk of teratogenic events with and without efavirenz exposure per 100,000 women, we incorporated literature-based rates of pregnancy, live births, and teratogenic events into a decision analytic model. We assumed a teratogenicity risk of 2.90 events/100 live births in women exposed to efavirenz during pregnancy and 2.68/100 live births in unexposed women. Survival for HIV-infected women who received an efavirenz-based initial antiretroviral therapy (ART) regimen was 0.89 years greater than for women receiving non-efavirenz-based initial therapy (28.91 vs. 28.02 years). The rate of teratogenic events was 77.26/100,000 exposed women, compared with 72.46/100,000 unexposed women. Survival estimates were sensitive to variations in treatment efficacy and AIDS-related mortality. Estimates of excess teratogenic events were most sensitive to pregnancy rates and number of teratogenic events/100 live births in efavirenz-exposed women. Use of non-efavirenz-based initial ART in HIV-infected women of childbearing age may reduce life expectancy gains from antiretroviral treatment, but may also prevent teratogenic events. Decision-making regarding efavirenz use presents a trade-off between these two risks; this study can inform discussions between patients and health care providers.

Treatment Change in Pregnancy Is a Significant Risk Factor for Detectable HIV-1 RNA in Plasma at End of Pregnancy

Purpose: To investigate the risk factors for an HIV-1 RNA plasma viral load above 400 copies/mL in the third trimester of pregnancy. Methods: Data from a large national study were used. The possible determinants were assessed in univariate analyses and in a multivariate logistic regression model in order to adjust for possible confounders. Results: Among 662 pregnancies followed between 2001 and 2008, 131 (19.8%) had an HIV-1 plasma copy number above 400/mL at the third trimester of pregnancy. In the multivariate analysis, the variables significantly associated with this occurrence were earlier calendar year (adjusted odds ratio [AOR] per additional calendar year, 0.70; 95% CI, 0.63–0.77; P < .001), lower CD4 count at enrollment (AOR per 100 cells lower, 1.18; 95% CI, 1.09–1.27; P < .001), HIV-1 RNA levels above 400 copies per mL at enrollment (AOR, 2.23; 95% CI, 1.50–3.33; P < .001), and treatment modification during pregnancy (AOR, 1.66; 95% CI, 1.07–2.57; P = .024). Conclusions: Treatment changes in pregnancy significantly increase the risk of an incomplete viral suppression at the end of pregnancy. In HIV-infected women of childbearing age, proper preconception care, which includes the preferential prescription of regimens with the best safety profile in pregnancy, is likely to prevent an incomplete viral suppression at the end of pregnancy.

Mother-to-Child Transmission of HIV in the United States

With the rise in the number of HIV-infected women of childbearing age in the United States, nurses are increasingly likely to be caring for such women. Although the exact mechanism of mother-to-child HIV transmission is unknown, experts believe that it can occur during any of three stages: before birth by microtransfusion of maternal blood across the placenta, during labor and delivery by exposure to maternal cervicovaginal secretions and blood, and after birth through breastfeeding. Treating pregnant women with highly active antiretroviral therapy dramatically reduces the risk of such transmission, but little is known about long-term effects of such therapy on the children. This article reviews the literature on the risk of mother-to-child HIV transmission in the United States and the factors that influence that risk, details current practice recommendations, and discusses implications for nursing.

Epidemiologic modeling to evaluate prevention of mother-infant HIV transmission in Ontario.

To evaluate the impact of the Ontario HIV screening program to reduce mother-infant HIV transmission, this study estimated the proportion of preventable transmissions that were prevented. Using an iterative spreadsheet model, incidences of HIV infection, AIDS, and AIDS mortality in Ontario women were estimated by exposure category. The number of HIV-infected infants born to HIV-infected mothers was then estimated from conception and abortion rates of HIV-infected women of childbearing age and surveillance data. Finally, the proportion of HIV-infected mothers who received antiretroviral prophylaxis (ARP) was assessed. HIV prevalence in 2001 among women of childbearing age was 1.05 per 1000. From 1984-2001, 764 infants were born to HIV-infected mothers and 180 were infected. From mid-1994-2001, 214 (39%) of the estimated 544 HIV-infected mothers were diagnosed; almost all received ARP. Of 118 preventable infections among infants born in this period, 39 (33%) were prevented. In 2001, only 46% of preventable infections were prevented and 11 preventable transmissions occurred. HIV prevalence among women in Ontario increased >4-fold from 1990 to 2001. Fewer than half of HIV-infected mothers received ARP and preventable HIV infections continue to occur. Measures to further increase uptake of prenatal HIV screening must be instituted.

Pregnancy and progression to AIDS: results of the French prospective cohorts. SEROGEST and SEROCO Study Groups.

To investigate whether pregnancy accelerates HIV-1 disease progression. In two large French SEROCO and SEROGEST prospective cohorts of HIV infected patients, the progression to AIDS in 365 women with a known date of HIV-1 seroconversion was examined by comparing those who delivered after HIV infection (n = 241) with those who did not become pregnant while HIV-infected (n = 124). The crude relative risk of developing AIDS associated with pregnancy was 0.7 [95% confidence interval (CI), 0.4-1.2]. Adjustment for age at seroconversion, the CD4+ cell percentage at entry, and the method used to date seroconversion did not modify the results (adjusted relative risk, 0.7; 95% CI 0.4-1.2). No deleterious effect of pregnancy on progression from seroconversion to AIDS was found. This result has important implications for the counselling of HIV-infected women of child-bearing age.

HIV Testing of Pregnant Women in Colorado 455

Background In Colorado there are 0.4 per 1000 HIV-infected women of childbearing age compared to a national prevalence of 1.6 per 1000 women. The ACTG 076 study demonstrated a reduction in vertical transmission of HIV to newborns with the use of zidovudine. The US Public Health Service has recommended routine HIV counseling and voluntary testing for all pregnant women and Congress has amended the Ryan White CARE Act to require that at least 95% of pregnant women have been tested for HIV. Objectives: Describe: 1) provider practices of HIV testing and counseling of pregnant women 2) provider attitudes towards HIV testing of pregnant women 3) the barriers providers perceive to HIV testing of pregnant women 4) provider knowledge about the use of zidovudine to decrease vertical transmission of HIV. Methods: Cross-sectional survey mailed to family practitioners, obstetricians, and nurse midwives who provide prenatal care to pregnant women in Colorado. Data entry and statistical analysis with Epi Info 6.04. Results: Overall response rate of health care providers surveyed was 48%; 120 obstetricians and 197 family practitioners that provided prenatal care were evaluable. Greater than 90% of providers test for HIV infection in pregnant women yet only half always test. Twenty five percent of providers do not test for HIV because they perceive their patients to be without risk factors. When offered HIV testing 90% of women will accept. Half of all providers are very uncomfortable with caring for HIV-infected women and overall only 30% have ever cared for an HIV-infected pregnant woman. Only 75% of providers are familiar with the use of zidovudine to interrupt vertical transmission of HIV to the newborn. Seventy five percent of providers feel that all pregnant women should be tested for HIV regardless of stated risk behaviors. Conclusions: Greater than 90% of providers state they test for HIV infection in pregnant women; 75% think all pregnant women should be tested regardless of risk factors yet only 50% of providers always test. Despite public health education efforts, 25% of health care providers that provide prenatal care in Colorado do not regularly test all pregnant women for HIV infection and 25% do not know about the use of zidovudine to interrupt vertical transmission of HIV to the newborn.

Human Immunodeficiency Virus: Seroprevalence in Parturients in Rural South Carolina

To establish the prevalence of human immunodeficiency virus (HIV) in the population of childbearing women in a rural South Carolina community, a blinded seroprevalence survey was conducted using all cord blood samples collected during a one-year period at a signal hospital. There were 1,811 live births (57% white, 43% black) during that period. Of the 1,365 samples collected and tested, six (0.44%) were HIV-positive by enzyme-linked immunosorbent assay, and three (0.22%) were confirmed by Western blot analysis. Based on these percentages, we estimate that there are approximately 80 HIV-infected women of childbearing age among the 180,000 residents of our health district. Although the seroprevalence of HIV in our parturients is low, it is somewhat higher than that reported from other rural areas. We therefore recommend counseling and voluntary blood testing for HIV antibodies, with informed consent, for all pregnant women living within our health district.