HIV-infected Women Of Reproductive Age Research Articles

Sero-prevalence and determinants of Hepatitis B among a cohort of HIV-infected women of reproductive age in Nigeria.

IntroductionSub-Saharan Africa houses over two-thirds of the 37 million people living with human immunodeficiency virus (HIV) globally and of this, 5–20% are co-infected with Hepatitis B virus (HBV). This is double jeopardy, especially for women of reproductive age in these settings, who can transmit both viruses vertically as well as horizontally to their children. The objectives of this study were to investigate the prevalence and determinants of HBV among women of reproductive age living with HIV.MethodsThis was a cross-sectional study of HIV-infected women of reproductive age in Benue State, Nigeria. Participants were eligible for the study if they were HIV-infected women (ages 18–45 years) receiving care from any of the selected study sites. A global rapid hepatitis B surface antigen (HBsAg) antibody test strip was used to test for HBsAg in plasma. A pretested questionnaire was used to collect data on sociodemographic, clinical and lifestyle characteristics of participants. We estimated prevalence of HBV infection and used multivariable logistic regression to determine factors associated with the infection at a significance level of <0.05.ResultsA total of 6577 women were screened for HBsAg. The prevalence of HBV was 10.3% (95% CI: 9.5–10.9%). Age, parity and male partner’s HIV status were found to be associated with having HBV infection. Compared to women older than 40 years, the odds of HBV infection increased significantly with increasing age until age 35 years and decreased significantly with increasing parity (versus no parity). Women with HIV-infected partners and those without a partner had higher odds of HBV infection compared to women with HIV-negative partners.ConclusionHBV is hyperendemic among HIV-infected women of reproductive age in North Central Nigeria. Specific programs targeting HBV testing, vaccination and treatment of all women of reproductive age need to be developed in this resource-limited, high-need setting.

Niveles de estrés en pacientes mexicanas embarazadas seropositivas al VIH

IntroductionA significant proportion of HIV-infected women of reproductive age wish to become pregnant, even when they know the risk for their health and for their children, as well as the probability of vertical transmission of the infection. During this process, stress produces adverse neonatal events, affecting mother-child relationship. Therefore, it is important to determine the stress level of these patients. ObjectiveTo determine the stress levels in HIV positive pregnant patients of the National Institute of Perinatology, Mexico. Material and methodAn observational, cross-sectional, descriptive study was carried out on 73 HIV-positive pregnant patients, and the stress level was evaluated using the Nowack test. ResultsThe areas comprising the Nowack stress profile were within the limits of a healthy population, with the exception of type «A» behaviours (internalized anger, expressed anger, time haste, work speed, impatience, search for improvement, bad driving of vehicles, distrust, anger, hostility), and ARC reagents (substance abuse, alcohol and tobacco use), whose scores were lower than the average, acting as protective resources against this type of behaviour. ConclusionsThe majority of HIV-positive pregnant patients presented a level of stress within the average of the healthy population. This is probably associated with the feeling of control that represents the fact of being attached to a first-level institution receiving integrated care.

Prevalence and Factors Associated with Contraceptive Use among HIV-Infected Women of Reproductive Age Attending Infectious Disease Clinic at Gulu Regional Referral Hospital, Northern Uganda.

Background Reproductive planning by HIV-infected women is essential, as it helps to prevent transmission of HIV to their unborn babies. Integrating contraceptive services to routine HIV care significantly increases the use of modern contraceptive methods, thus reducing vertical transmission of HIV. Objectives To determine the prevalence and factors associated with contraceptive use among HIV-infected women attending Infectious Disease Clinic (IDC) at Gulu Regional Referral Hospital (GRRH) in Northern Uganda. Methodology A hospital-based cross-sectional study was performed. We used simple random sampling to recruit HIV-infected women receiving routine care from IDC, GRRH, into our study. Sample size was estimated using modified Kish-Leslie formula and semistructured questionnaire was used for data collection. Data was entered into EpiData version 3.1 and analysed using Stata v11.0. We used logistic regression model to assess the associations and any factor with p≤0.05 was considered statistically significant. Results The prevalence of contraceptive use was found to be 36% (95% CI 31 – 40%). Factors which promoted contraceptive use were as follows: being married (aOR=2.68, 95% CI 1.54-4.65, p<0.001) and monthly income of $35 -250 (aOR= 2.38, 95% CI: 1.39- 4.09, p=0.002). Factors that hindered contraceptive use were having no child (nulliparity) (aOR= 0.16; 95% CI: 0.05-0.49; p=0.002) and age range of 31-49 years (aOR= 0.53; 95% CI: 0.33 - 0.84; p=0.007). Conclusion In this study, just over a third of sexually active HIV-infected women reported use of modern contraceptives. This is a low level of usage and, therefore, clinicians and stakeholders should sensitise HIV-infected women on the importance of contraceptive use in the fight against HIV/AIDS and encourage them to use contraceptives to avoid vertical transmission of HIV through unintended pregnancy.

Prevalence of Abnormal Cervical And Vaginal Cytology In HIV-Infected Women Over The Age Of 65 [5N

INTRODUCTION: HIV-infected women are 10-11 times more likely to develop abnormal cervical cytology compared with HIV uninfected women, elevating the need for Pap smear surveillance. While guidelines for screening exist for HIV-infected women of reproductive age, there is inadequate data to guide care for women over 65. Our research evaluates the prevalence of abnormal cervical cytology/CIN and invasive neoplasia in HIV-infected women over the age of 65 with no history of abnormal Paps to aid in the creation of screening recommendations for this demographic. METHODS: This is a retrospective chart review of records from 2000-2015, from an urban low-income setting. We screened 254 patients, 70 of whom met inclusion criteria: HIV+, age over 65, with at least one pap test after age 65, lacking abnormal cervical/vaginal cytology screening, and lacking history of hysterectomy for non-benign reasons. RESULTS: Of included patients, 17.1% had at least one abnormal pap smear: 41.7% ASCUS/HPV+, 75.0% LSIL, 25.0% HSIL, with 25.0% patients having more than one abnormal result. Of those with abnormal pap, 66.7% had abnormal pathology on follow-up biopsy: 33.3% CIN/VAIN1, 16.7% CIN/VAIN2, 16.7% CIN/VAIN3. No patients had invasive cancer. Median time to first pap test after age 65 was 14.7 months. No demographic factors were significantly associated with abnormal pap. Higher viral load at time of testing was positively associated with abnormal pap. CONCLUSION: Our findings of high rates of abnormal pap tests and subsequent high rates of abnormal pathology suggest that pap tests in women over age 65 may be indicated.

Factors associated with discussion of sexual activity and contraception in women with HIV

ObjectivesContraceptive use is important for reproductive-aged women living with HIV to plan and optimise safety of pregnancies. Clinicians play a vital role in counselling patients about contraception and safe sexual...

HIV INFECTION AND HIV-ASSOCIATED TUBERCULOSIS IN CHILDREN IN UKRAINE

The article presents data on the epidemiology of HIV infection and co-infection with HIV/TB in children in Ukraine. Along with the increasing number of HIV-infected women of reproductive age and their children, it is mentioned the growth of tuberculosis among HIV-infected children. The problems of adequate monitoring and management of these patients, in particular with regard to the prevention of tuberculosis among them are described. There are made conclusions about the need to improve the delivery system of TB care for children born by HIV-infected mothers.

Discussing Childbearing with HIV-infected Women of Reproductive Age in Clinical Care: A Comparison of Brazil and the US

Despite long term access to highly active antiretroviral therapy in Brazil and the US, little is known about women's communication with their HIV provider regarding childbearing or the unmet need for reproductive counseling. We utilized identical survey questions to collect data from HIV-infected women of reproductive age in Rio de Janeiro (n = 180) and Baltimore (n = 181). We conducted univariate analyses to compare findings between samples of women and multivariate logistic regression to determine factors associated with childbearing desires, childbearing intentions, and provider communication among the combined sample of women (n = 361). Over one-third of women in Rio de Janeiro and nearly one-half of women in Baltimore reported the desire for future childbearing. Nevertheless, the majority of women in clinical care had not discussed future childbearing with their HIV provider. Even in countries with an advanced approach to HIV care, we found low and inadequate communication between providers and female patients about childbearing.

Randomised, placebo-controlled trial to evaluate co-trimoxazole to reduce mortality and morbidity in HIV-infected post-natal women in Zambia (TOPAZ)

To evaluate the role of prophylactic trimethoprim-sulfamethoxazole (co-trimoxazole) antibacterial prophylaxis in reducing morbidity and mortality in HIV-infected post-natal women in southern Africa. Double-blind placebo-controlled trial. HIV-infected women with WHO stage 2 or 3 HIV disease who had recently delivered in the Department of Obstetrics and Gynaecology at the University Teaching Hospital, Lusaka, Zambia were randomised to receive daily co-trimoxazole (cotox) or matched placebo daily for the duration of the trial. Participants were followed up for a minimum of 1 year. Primary outcome measures were mortality from any cause or hospital admission and serious adverse events. Of 600 women randomised, follow-up information was available from 355 (180 cotox, 175 placebo) participants. Thirty-six (17 cotox, 19 placebo) women died during the trial, and another 11 (5 cotox, 6 placebo) were admitted to hospital. There was no significant difference in the combined event rates between the two treatment arms: HR = 0.82, 95% CI (0.46, 1.45), P = 0.49; morbidity was reduced over a range of symptoms. Secondary analyses of the outcome in babies indicated some evidence of reduced mortality in those whose mothers were allocated cotox. Follow-up rates were poor; there was no evidence that co-trimoxazole prophylaxis reduced mortality or hospital admission rates, although fewer symptoms were reported in the cotox arm. Cotox was safe and well tolerated.

Do HIV-Infected Women Want to Discuss Reproductive Plans with Providers, and Are Those Conversations Occurring?

The purpose of the study is to assess frequency and determinants of discussions between HIV-infected women and their HIV providers about childbearing plans, and to identify unmet need for reproductive counseling. We conducted a cross-sectional, audio computer-assisted self-interview (ACASI) among 181 predominately African American HIV-infected women of reproductive age receiving HIV clinical care in two urban health clinics. We used descriptive statistics to identify unmet need for reproductive counseling by determining the proportion of women who want to, but have not, discussed future reproductive plans with their primary HIV care provider. Multivariate analysis determined which factors were associated with general and personalized discussions about pregnancy. Of the 181 women interviewed, 67% reported a general discussion about pregnancy and HIV while 31% reported a personalized discussion about future childbearing plans with their provider. Of the personalized discussions, 64% were patient initiated. Unmet reproductive counseling needs were higher for personalized discussions about future pregnancies (56%) than general discussions about HIV and pregnancy (23%). Younger age was the most powerful determinant of provider communication about pregnancy. A significant proportion of HIV-infected women want to talk about reproductive plans with their HIV provider; however, many have not. HIV care providers and gynecologists can address this unmet communication need by discussing reproductive plans with all women of childbearing age so that preconception counseling can be provided when appropriate. Providers will miss opportunities to help women safely plan pregnancy if they only discuss reproductive plans with younger patients.

Hormonal Contraception and Metabolic Outcomes in Women With or at Risk for HIV Infection

The use of hormonal contraception (HC) is increasing in HIV-infected women. Both HC and HIV infection have been associated with adverse metabolic outcomes. We investigated the association of progestin-only and combined (estrogen/progestin) HC with disorders of glucose and lipid metabolism in HIV-infected and uninfected women. Linear mixed models evaluated the association of HC type with fasting high density lipoprotein, low density lipoprotein, triglycerides, the homeostasis model assessment estimate of insulin resistance (HOMA-IR), and glucose in 885 HIV-infected and 408 HIV-uninfected women from the Women's Interagency HIV Study seen between October 2000 and September 2005. Compared with non-HC users, progestin-only HC was independently associated with lower HDL [-3 mg/dL; 95% confidence interval (CI) -5, -1 in HIV-infected and -6 mg/dL; 95% CI: -9, -3 in HIV-uninfected women] and greater HOMA-IR (+0.86; 95% CI: 0.51-1.22 and +0.56; 95% CI: 0.12-1.01). Combined HC was associated with higher HDL (+5 mg/dL; 95% CI: 2-7 and +5 mg/dL; 95% CI: 3-7). HIV-infected women using progestin-only HC have lower HDL and greater HOMA-IR than HIV-infected non-HC users. Combined HC may be preferred in HIV-infected women of reproductive age at risk for cardiovascular disease, but interactions with antiretroviral therapy that may impair contraceptive efficacy have been reported. Alternative HC methods that minimize adverse outcomes but maintain efficacy require further study.

Understanding High Fertility Desires and Intentions Among a Sample of Urban Women Living with HIV in the United States

To assess childbearing motivations, fertility desires and intentions, and their relationship with key factors, we conducted a cross-sectional survey among 181 HIV-infected women of reproductive age (15-44years) receiving clinical care at two urban health clinics. Fertility desires (59%) and intentions (66% of those who desired a child) were high among this predominately African American sample of women, while the proportion with accurate knowledge of mother-to-child transmission (MTCT) was low (15%). Multivariate regression analyses identified factors significantly associated with the intention to have a child. Notably, age and parity did not remain significant in the adjusted model. The discrepancies between expressed desires and intentions for future childbearing, and the strong role of perceived partner desire for childbearing emphasize the need for universal reproductive counseling to help women living with HIV navigate their reproductive decisions and facilitate safe pregnancies and healthy children.

Do HIV-infected women want to discuss fertility plans with providers, and are those conversations occurring?

HIV-infected women of reproductive age in the United States face the decision of if, when and how to conceive a child. Due to the potential to significantly reduce transmission risk to the partner during conception and to the infant during pregnancy and delivery, HIV-infected women have a heightened need for guidance from HIV care providers and gynecologists prior to becoming pregnant.

Effect of pregnancy on HIV disease progression and survival among women in rural Uganda

To investigate the effect of pregnancy on HIV disease progression and survival among HIV-infected women in rural Uganda, prior to the introduction of anti-retroviral therapy (ART). From a clinical cohort established in 1990, we selected records from HIV-infected women of reproductive age. We conducted two analyses: (1) all HIV-infected cases contributing to analysis of CD4 decline, using a linear regression model with random intercepts and slopes; (b) incident cases with known date of seroconversion contributed to analyses of median time to CD4 <200 cells/microl, AIDS and death. A total of 139 women were included in the analysis of CD4 decline. Women who subsequently became pregnant had higher CD4 counts at enrolment and had a slower CD4 decline than those who did not become pregnant. In women who became pregnant, CD4 decline was faster after pregnancy than before (P < 0.0001). The survival analyses showed no significant differences between women who became pregnant and those who did not with respect to median time to CD4 count <200, AIDS or death. The initial comparative immunological advantage possessed by fertile women before they become pregnant is subsequently lost as a result of their pregnancy. Women should be informed about the potential negative effect of pregnancy on their immunological status and should be offered contraception. In resource-limited settings, women determined to become pregnant should be given priority for ART if eligible.

Family Functioning and Motivation for Childbearing among HIV-Infected Women at Increased Risk for Pregnancy

This study examined family composition and functioning in a cohort of HIV-infected women of reproductive age living in the southern United States. Participants were predominantly single (82.2%), African American women (86.7%) with annual incomes of less than $10,000 (65.5%), with a mean age of 31.2 years. Using the Family Apgar Scale as a measure of perceived family functioning, women reported that their families functioned moderately well. Multiple regression analysis showed that level of education, life satisfaction, and coping through avoidance and coping by seeking social support were positively associated with family functioning. In contrast, a history of interpersonal verbal violence and a history of drug use were negatively associated with family functioning. These six factors accounted for 26% of the variance. Study findings support the need for comprehensive nursing interventions that include addressing family issues if HIV-infected women are to be provided quality care.

Resurgence of active tuberculosis among pregnant women.

To determine the frequency of active tuberculosis during pregnancy in two hospitals located in an area where tuberculosis is epidemic and to describe its course and association with human immunodeficiency virus (HIV) infection. We reviewed and analyzed the medical records of 16 pregnant women diagnosed with tuberculosis between 1985-1992 at Kings County Hospital (n = 12) and Saint Vincent's Hospital (n = 4) in New York City. Ten of the 16 pregnant women with proven active tuberculosis had pulmonary tuberculosis, two had tuberculous meningitis, and one each had mediastinal, renal, gastrointestinal, and pleural tuberculosis. Eleven were tested for HIV, and seven were seropositive. One HIV-infected patient with pulmonary tuberculosis died of respiratory failure. In the 6 years between 1985-1990, five cases of active tuberculosis during pregnancy were identified (12.4 per 100,000 deliveries). During the 2 years of 1991-1992, 11 cases were recorded (94.8 per 100,000 deliveries). Cases of active tuberculosis are increasing among pregnant women in epidemic communities and are associated with HIV infection. Early tuberculin skin test screening with appropriate preventive therapy should reduce morbidity due to tuberculosis in HIV-infected women of reproductive age. Identification of pregnant women with tuberculosis requires a high index of suspicion.