Human Immunodeficiency Virus Infected Mothers Research Articles

Awareness and Knowledge of Human Immunodeficiency Virus Transmission and Prevention from Mother to Child: A Cross-Sectional Study among Female Sex Workers

Human Immunodeficiency Virus (HIV) can be transferred during pregnancy from the infected mother to the fetus through the placenta or to her infant during delivery or breastfeeding. Objective: To evaluate awareness and understanding of HIV transmission and prevention from mother to child among female sex workers having and expecting pregnancy. Methods: It is a cross-sectional survey conducted in three cities: Lahore, Faisalabad and Islamabad, Pakistan. A sample size of 150 was considered as per convenience and collected using the snowball sampling technique. The data was collected using a specially designed questionnaire which was pilot tested by 10 health experts. The female sex workers of fertile age group 15-49 years who were pregnant or expecting pregnancy in the future were included. The female sex worker who was infertile or was on birth control was excluded from the study. Data were analysed with the help of the SPSS version 22. Results: The minimum and maximum age of female sex workers was 15 and 49 years respectively, with a mean age of 31.7±7.76 years. The female sex workers responded that 63(42%) know the mother-to-child transmission while the majority 87(58%) do not know that HIV infected mothers can transmit HIV to their children. The responses regarding mother-to-child transmission show that 61(21.3%) know about the trans-placental route, 100(35%) vaginal delivery, 58(20.3%) cesarean section, and 25(8.7%) breastfeeding. The response regarding the prevention of HIV from mother to a child shows that only 59(25.8%) prefer cesarean section, 29(12.7%) prefer no breastfeeding and very few 21(9.2%) prefer the use of antiretroviral therapies among infected women and children. Conclusions: In conclusion, the female sex workers were unaware of the prevention of HIV from breastfeeding and vaginal delivery. Moreover, they were unaware of precautions such as cesarean section and the usage of anti-retroviral therapies for infected mothers before delivery.

Maternal HIV Infection as a Risk Factor for Primary Epstein-Barr Virus Infection in Kenyan Infants.

Human immunodeficiency virus (HIV) infection is known to be associated with EBV shedding in saliva suggesting an increased risk of EBV transmission to infants born to mothers with HIV at an earlier age. In this study we investigated (i) whether maternal HIV status was a risk factor for EBV in blood at delivery or for shedding in saliva and breast milk of 6- and 10-weeks post-partum mothers, (ii) if there was a difference in EBV strains shed between HIV+ and HIV- mothers, and (iii) if maternal HIV status was a determinant of EBV viral load in their infants. Samples were collected as part of a prospective cohort study that followed HIV-positive (HIV+) and HIV-negative (HIV-) pregnant women in Western Kenya through delivery and post-partum period. EBV viral load in blood was found to be significantly higher in mothers with HIV (p-value = 0.04). Additionally, a statistically significant difference was observed between EBV viral load in saliva samples and HIV status where HIV+ mothers had a higher EBV viral load in saliva at 6-weeks post-partum compared to HIV- mothers (p-value < 0.01). The difference in EBV shedding in breast milk was not found to be statistically significant. Furthermore, no difference in frequency of EBV strain was attributable to HIV- or HIV+ mothers. Interestingly, we found that infants born to HIV+ mothers had a higher EBV viral load at the time of their first EBV detection in blood than infants born to HIV- mothers and this was independent of age at detection. Overall, our study suggests that HIV infected mothers shed more virus in saliva than HIV-negative mothers and infants born to HIV+ mothers were at risk for loss of control of primary EBV infection as evidenced by higher EBV viral load following primary infection.

Dynamic analysis of mother-to-child transmission of HIV and antiretroviral treatment as optimal control

Human immunodeficiency virus (HIV) is still an extremely dangerous pandemic and without a prominent cure. And one of the most vulnerable population prone to acquiring the virus can be newborn babies from their HIV positive mothers. It can even turn fatal when an individual gets acquired immunodeficiency syndrome (AIDS) and the disease is left untreated and uncontrolled. One such treatment for suppressing the infections is antiretroviral therapy (ART) treatment. To gain insight of the Indian scenario of the mother to child transmission (MTCT) and the present work of the ARTs strategy in India we shall study a model for HIV infected newborns. Hence, we have formulated a model consisting of newborns born to HIV infected mothers, infected newborns and newborns acquiring AIDS. We have found the equilibrium points and established the local stability of the system. We then considered ARTS as optimal control for the HIV infected newborns and thus, extended our model with the class of newborns going for ARTS. With the help of Pontryagin’s Maximum Principle, we then obtain the optimal ART intensity as part of intervention to control infection among newborns for our optimal control problem. For the numerical simulations we took real time data of India for all parameters along with MTCT rate for the state of Maharashtra. One of our numerical results shows that ART’s as strategy among newborns born to HIV infected mothers decreases the number of HIV infected babies. Thus, the paper highlights the necessary and crucial role of ART programs for babies born to HIV positive mothers in order to suppress the infection for their brighter futures in the epidemic dynamics of India.

Discordant retention of HIV-infected mothers and children: Evidence for a family-based approach from Southern Mozambique.

It is often assumed that children and their caregivers either stay in care together or discontinue together, but data is lacking on caregiver–child retention concordance. We sought to describe the pattern of care among a cohort of human immunodeficiency virus (HIV) infected children and mothers enrolled in care at the Manhiça District Hospital (MDH).This was a retrospective review of routine HIV clinical data collected under a larger prospective HIV cohort study at MDH. Children enrolling HIV care from January 2013 to November 2016 were identified and matched to their mother's HIV clinical data. Retention in care for mothers and children was assessed at 24 months after the child's enrolment. Multinomial logistic regression was performed to evaluate variables associated with retention discordance.For the 351 mother–child pairs included in the study, only 39% of mothers had concordant care status at baseline (23% already active in care, 16% initiated care concurrently with their children). At 24-months follow up, a total of 108 (31%) mother–child pairs were concordantly retained in care, 88 (26%) pairs were concordantly lost to follow up (LTFU), and 149 (43%) had discordant retention. Pairs with concurrent registration had a higher probability of being concordantly retained in care. Children who presented with advanced clinical or immunological stage had increased probability of being concordantly LTFU.High rates of LTFU as well as high proportions of discordant retention among mother–child pairs were found. Prioritization of a family-based care model that has the potential to improve retention for children and caregivers is recommended.

Brain microstructural changes support cognitive deficits in HIV uninfected children born to HIV infected mothers

IntroductionAntiretroviral therapy (ART) is considered the most effective way to prevent perinatal transmission of human immunodeficiency virus (HIV). However, there is little knowledge about the effect of ART on the brain of HIV uninfected children born to HIV infected mothers (HUC). The current study evaluated the brain’s microstructural integrity, and cognitive function in HUC compared to healthy children born to normal mothers (CHNM) and HIV infected children born to HIV infected mothers (HIC) to investigate the effect of in-utero exposure of ART on cerebral gray and white matter. Materials and methodsForty nine HIC, 12 HUC and 18 CHNM underwent neuropsychological (NP) assessment and a brain MRI. Diffusion tensor imaging (DTI) data was used to generate fractional anisotropy (FA) and mean diffusivity (MD) maps. Voxel wise comparison for FA and MD was performed between three groups using an analysis of covariance (ANCOVA) including age and sex as covariates, and correction for multiple comparisons (false discovery rate (FDR), p ​< ​0.05 with minimum extended cluster size, 150 voxels). NP test scores were also compared between three groups using ANOVA with Post Hoc Bonferroni multiple comparison corrections (p ​< ​0.05). Significantly changed FA and MD values in different brain regions in HIC and HUC compared to CHNM were used for correlation analysis with NP test scores using Pearson’s correlation. ResultsHIC and HUC groups showed significantly decreased NP test scores in various domain compared to CHNM. Significantly lower NP test scores was observed in HIC than those of HUC. HIC showed decreased FA and increased MD in multiple brain sites as compared to both CHNM and HUC. Decreased FA along with both increased and decreased MD in different brain regions was present in HUC compared to CHNM. Both positive and negative correlation of altered FA and MD values from different brain regions in HIC and HUC with NP test scores was observed. ConclusionThe presence of brain tissue changes and neurocognitive function deficit in absence of HIV infection in HUC indicates that ART may have a detrimental impact on the developing brain. The findings of the current study underscore the need for screening of ART exposed children for neurodevelopment and cognitive abnormalities at an early stage and call for access to early interventions, and nutritional and care programs.

Influences of Mobile Phones-Based Short-Message-Services Communications on the HIV Sexual Risk Behaviors among Pregnant Women’s Male Partners, Case Control Study Tanzania

Introduction: In the twenty-first century, Human Immunodeficiency Virus (HIV) continues to be among the major public health problem globally. The disease is implicated to the result of the over 32 million deaths, and in 2018 the disease caused over 770,000 deaths globally. The disease can be transmitted from an HIV-positive pregnant woman to her child during pregnancy and childbirth about 15% - 20%, and 5% - 15% in breastfeeding. Awareness of HIV infection sexual risk behaviors and practices among male partners of pregnant mothers, therefore, plays a greater role in reducing new infection to them and the prevention of mother-to-child transmission of HIV. Methods: We conducted a retrospective case-control study involving randomly selected 314 pregnant women’s male partners attending PMTCT services in the Tabora Municipality for from September 2018 to August 2019. The enrolled study participants were randomly allocated to cases and controls and, SMS communication was sent twice weekly with 5 standard key messages from the PMTCT community guide and followed up. Results: The awareness that HIV infected mothers can transmit HIV infection in labor and during breastfeeding among their male partners was raised to 73.3% and 61.8% from 55.4% and 47.5% to study and control groups respectively following intervention. Similarly, men aged below 35 years from the study group showed an 18.3% change and a 35.4% change for those who were over 35 years old compared to the control. The difference was tested and found to be statistically significant with a p-value of 0.001 (relative risk of 0.11) and less than 0.001 (relative risk of 0.07) respectively at a 95% confidence interval. This indicates that following SMS communication intervention men from the study group were less likely to practice HIV infection sexual risk behavior compared to the control group.

Factors Associated with Mother-to-child Transmission of HIV in Eswatini

ABSTRACT Background: Mother-to-child-transmission of the human immunodeficiency virus (HIV) continues to cause increased child morbidity and mortality despite the constantly improved prevention of mother to child transmission (PMTCT) programme interventions. The programme interventions continue to be surrounded by barriers hindering eradication of HIV in newborns. Objective: To identify factors associated with HIV seropositivity in infants aged 6–8 weeks in Eswatini. Method: A secondary analysis of 1415 HIV infected mothers and their HIV exposed infants who attended child immunisation clinics between 2011 and 2012 was performed. Factors associated with HIV seropositivity were analysed through univariate and multivariable logistic regression methods. Results: Of the 1415 HIV exposed infants, 31 were HIV positive reflecting a mother-to-child-transmission rate of 2.2%. Maternal age, number of antenatal clinic (ANC) visits, maternal antiretroviral regimen, place of delivery and birth-weight were associated with HIV seropositivity on univariate analysis. On multivariate analysis, the only factor which remained significantly protective (OR = 0.83; P value = 0.004) for HIV transmission to infants were the number of ANC visits. Those infants whose mothers had more than 4 visits were less likely to be HIV positive when compared with fewer visits. Conclusion: Increased number of antenatal care visits attended by pregnant women is beneficial as it increases access to PMTCT services thereby decreasing the prospect of mother-to-child HIV transmission.

Knowledge, attitude and practice among private medical professionals enrolled in public private partnership program for prevention of mother to child transmission of human immunodeficiency virus in three districts of Karnataka

Background: Human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS), is one of the world’s most serious public health challenges. Nearly all young children newly infected with HIV are infected through mother-to-child transmission. Only about half of the HIV infected mothers received ART and quarter of the babies born through HIV infected mothers receive ARV prophylaxis. This low coverage due to a high proportion of women delivering in private health facilities. Lack of policy for the private sector, inadequate knowledge and fear of occupational exposure are some barriers.Methods: A cross sectional study conducted among private practitioners enrolled in parent to child transmission (PPTCT) program in three districts of Karnataka. 175 obstetricians and pediatricians engaged in giving care to HIV infected mother and children were selected randomly and were interviewed using a pre tested semi structured questionnaire and the scores were graded.Results: Mean age of the participants was 38.95 years with SD of 9.12 years. The mean years of experience was found to be 14.36 years with SD of 6.45 years. The knowledge was average scoring 66.56%. The attitude and practice were 69.21% and 64.21% respectively. The mean score for KAP was 28.89 (9.56) out of 43 questions. There was significant association between age of the participants, specialization and years of experience with scoring.Conclusions: The knowledge, attitude and practice among private practitioners were average. To enhance the coverage of PMTCT, there is a need for strengthening private sector with strong political will thus reducing morbidity and mortality of the disease.

Antibody Responses Specific to Hepatitis B Virus Vaccine in Children Exposed InUtero to Antiretroviral Therapy

The use of antiretroviral (ARV) has been one of the most effective means of preventing vertical transmission of the human immunodeficiency virus (HIV) to exposed children born of HIV infected mothers. Nevertheless, responses to childhood vaccination against Hepatitis B virus (HBV) infections remain suboptimal in HIV exposed uninfected children irrespective of maternal ARV prophylaxis. In a cross-sectional study we have assessed the impact of in-utero exposure to ARV on paediatric HBV vaccination. Anti-HBV surface antigen specific antibodies (anti-HBs abs) were measured in plasma specimens from 44 healthy children unexposed to both HIV and ARV (HU), 25 HIV-exposed uninfected children naïve to intrauterine exposure to ARV (HEU.AR - ), 29 ARV and HIV-exposed uninfected children during pregnancy (HEU.ARV +), 50 children vertically infected with HIV but naïve to intrauterine exposure to ARV (HEI.ARV - ) and 22 children vertically infected with HIV with in utero exposure to ARV (HEI.ARV +). The protective seroconversion rate after childhood HBV vaccination (anti-HBs ≥10 mUI/ml) among HEU.ARV + children (58%) was significantly lower relative to both HEU.ARVc - (100%, P=0.0010) and the healthy unexposed children (92 %, P=0.0069). Similarly, HEI.ARV + children also had significantly lower anti-HBs IgM antibody responses when compared to both HU (p=0.0003) and HEI.ARV - (0.0001) children respectively. Thus in-utero exposure to ARV probably contributes in reducing HBV vaccine antibody response rate in both HIV exposed uninfected and vertically infected children after childhood vaccination. Nevertheless, the overall impact of ARV was to improve anti-HBs IgG responses in HIV infected children suggesting a possible role in immune reconstitution leading to improved IgG antibody responses.

Assessment of Knowledge, Attitude, and Practice of HIV Positive Mothers on Antiretroviral Treatment towards Infant Feeding in Gondar Town Health Institutions, North West Ethiopia, 2017.

Introduction The world health organization recommends feeding practices for infants born from Human Immunodeficiency Virus infected mothers to be safe to both the infant and the mother. This includes prevention of mother to child transmission of the virus and at the same time meeting nutritional requirements of the child. This requires prioritizing prevention of HIV transmission through breastfeeding against non-HIV morbidity and mortality especially from malnutrition and serious illnesses such as diarrhea, among nonbreastfed infants. Objective This study was aimed at assessing knowledge, attitude, and practice of HIV positive mothers on antiretroviral therapy towards infant feeding. Method Institution based cross-sectional study was conducted among 402 HIV positive mothers at ART clinics of Gondar town from March 1 to April 18, 2017. Systematic random sampling technique was used to select study participants. Data was collected using a structured, pretested, interviewer-administered questionnaire. The collected data was entered into Epi Info version 7 and analyzed using SPSS version 20 software. Result A total of 402 participants were interviewed with a 100% response rate. The mean age of participants was 29.24 (SD±10.06) years. The overall level of participant good knowledge and favorable attitude was 68.91% and 75.87%, respectively. Only 23.7% of mothers were practicing infant feeding according to WHO recommendation.

Expression Level of Plasma Soluble Toll like Receptor 2 and 6 in the Mother to Child Transmission of Human Immunodeficiency Virus Type 1

Background and context: Dysregulation of the immune system by the Human immunodeficiency virus (HIV) has an impact on innate immune components such as Toll-like receptors (TLRs). Objective: We looked at the plasma concentration of soluble TLR2 and sTLR6 in mother-to-child transmission. Methods: Two hundred and eighty three mothers with their newborn were recruited. Mothers were classified into five groups: transmitter with prevention (TWP), transmitter without prevention (TWDP), non-transmitter with prevention (NTWP), non-transmitter without prevention (NTWDP) and controls. Mothers’ blood samples were collected in EDTA tubes. Levels of sTLR2/6 were determined using sandwich enzyme-linked immunosorbent assays. HIV status of new-born was determined using PCR-DNA on dried blood spots. Results: HIV infected mothers have a statistically higher level of sTLR2 than HIV non-infected mothers (p=0.001). The highest concentration was found in the NTWDP >TWP >NTWP >TWDP. There was a significant difference between all the medians comparing groups two by two. For sTLR6 there was neither a significant difference (p=0.156) between HIV infected and non-infected mothers, nor between groups. The median concentration was higher in NTWDP > NTWP > TWP > TWDP. Conclusion: sTLR2 and sTLR6 plasma concentration may be associated to the prevention of mother-to-child transmission. But antiretroviral treatment could also dim down this protective effect.

A Cluster Randomised Trial to Determine the Efficacy of the "Feeding Buddies" Programme in Improving Exclusive Breastfeeding Rates Among HIV-Infected Women in Rural KwaZulu-Natal, South Africa.

This cluster randomised trial in KwaZulu-Natal South Africa, evaluated the implementation of a Feeding Buddies (FB) programme to improve exclusive breastfeeding (EBF) amongst human immunodeficiency virus infected mothers. Eight clinics were randomly allocated to intervention and control arms respectively. Pregnant women attending the prevention of mother-to-child transmission program and intending to EBF were enrolled: control (n=326), intervention (n=299). Intervention mothers selected FBs to support them and they were trained together (four sessions). Interviews of mothers occurred prenatally and at post-natal visits (day 3, weeks 6, 14 and 22). Breastfeeding results were analysed (Stata) as interval-censored time-to-event data, with up to four time intervals per mother. EBF rates at the final interview were similar for control and intervention groups: 44.68% (105/235) and 42.75% (109/255) respectively (p=0.67). In Cox regression analysis better EBF rates were observed in mothers who received the appropriate training (p=0.036), had a community care giver visit (p=0.044), while controlling for other factors. Implementation realities reduced the potential effectiveness of the FBs.

Knowledge and Awareness of MTCT and PMTCT Post-Natal Follow-up Services Among HIV Infected Mothers in the Mankweng Region, South Africa.

Background:The pandemic of Human Immunodeficiency Virus (HIV) is the most severe health challenge affecting children across the world. It is estimated that more than 90% of all HIV infections in children result from Mother-to-Child Transmission (MTCT). Poor knowledge and awareness of MTCT and Prevention of Mother-to-Child Transmission (PMTCT) among HIV positive mothers and their babies is a major setback to the success of the PMTCT programmes.Methods:A qualitative approach and a cross-sectional design were applied in this study. The sample size of the study was 26 participants. Purposive sampling was used to select HIV infected mothers enrolled for PMTCT follow-up services and health care providers responsible for the implementation of the PMTCT programmes. In-depth interviews were conducted with fifteen HIV infected mothers at two health facilities. Two Focus Group Discussions (FGDs) were conducted with eleven health workers at the two health facilities. Focus groups comprised of six participants from Mankweng Clinic and five participants from Mankweng Gateway Clinic.Results:The findings from the study reveal that the majority of the respondents were aware of MTCT, but lacked knowledge and understanding about how a mother can transmit HIV to her child during pregnancy, labour and breastfeeding. The majority of the participants did not understand the risk of MTCT after birth and failed to mention breastfeeding as a mode of transmission. However, most of the participants were aware that MTCT can be prevented. The respondents were aware of the importance of treatment adherence as a prevention measure to avoid MTCT.Conclusion:Based on these findings, a number of recommendations were made. The first is that educational and awareness programmes need to be developed or strengthened on health risks. Mass campaign media should provide information on the importance of PMTCT activities through the use of community radio stations, Television, newsletters, bill boards etc. People need to know more about PMTCT activities, health personnel need continuous training to provide clear information on PMTCT activities.

Implementation of the Prevention of Mother-to-Child Transmission (PMTCT) Program in the Northern Cape, South Africa.

South Africa's Prevention of Mother-to-Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) program has been implemented for over ten years. This has led to a considerable reduction in mother-to-child transmissions. In 2010, the Northern Cape Province had a 1.4% transmission rate, being the lowest in the country. To describe the implementation of the PMTCT program in the Frances Baard district, Northern Cape Province; South Africa and identify factors that may influence the effectiveness of this program. 100 Mother-child pairs from four clinics participated in this cross-sectional study. Information was collected on socio demographics, antenatal clinic attendance, feeding counseling, knowledge and practices, CD4 cell count and HIV stage, antiretroviral treatment (ART) initiation/adherence and partner involvement. Almost 25% of mothers first attended an antenatal clinic during their third trimester, out of them, 52.2% were tested for HIV infection for the first time. Most of the mothers received counseling on feeding practices during antenatal visits (97%), after labor (64%) and during post natal visits (84%). Most mothers knew the definition (77%) and recommended duration (76%) of exclusive breastfeeding and the dangers of defaulting ART when breastfeeding (75%), but only two mothers knew the risk of mixed feeding. Fifteen mothers were pressured to stop breastfeeding by healthcare professionals before 12 months. More than half (52%) of the mothers started ART during their last pregnancy, among them, 50% only started treatment after 14 weeks of gestation. The children who received ART, 13.7% defaulted their treatment for one day or more. All three HIV infected children's mothers defaulted their own ART while breastfeeding. The PMTCT program is implemented according to the national policy in this district. Earlier ART initiation and improved compliance, education of healthcare workers, more focused counseling sessions and improving community awareness of early antenatal visits may improve effectiveness of this program.

Prevalence of hepatitis C Antibody in Human Immunodeficiency Virus infected children

Background: Hepatitis C virus (HCV) is a major public health problem for Human Immunodeficiency virus (HIV) infected population. Both infections share same routes of transmission, and quite often co-exist, with dual infections associated with reciprocal and mutually more rapid progression than either infection alone. Co-infection also adversely impacts on the course and management of both infections. This study was carried out to document the prevalence and determinants of HCV sero-positivity in HIVinfected children.Methodology: A total of 132 HIVinfected children attending the Paediatric Antiretroviral Clinic were recruited as subjects. Another 132 HIV negative children matched for age and sex were recruited as controls. Relevant demographic data was taken from each child. Blood samples were also obtained from each child and from their mothers when available, and assayed for the presence of anti-HCV using a membranebased immune-assay kit.Results: The sero-prevalence of HCV antibodies was 9.8% among HIV-infected children and 3.0% among the controls. This was a statistically significant difference (p = 0.042, Fisher exact). HCV sero-postivity was more frequent in children after 5 years of age in both subjects (92.3%) and controls (100.0%). Injection at patent medicine vendor (PMV) was noted to be the most risky practice leading to HCV in children, with more than thrice the chances of HCV sero-positivity than in those who didn’t receive injections at PMV. Four mothers of the HIV-infected children were co-infected with HCV and none in the control group. All 4 children of these dually infected mothers were also co-infected. Controlling for other factors, children of HIV infected mothers were more than twice as likely to have HCV antibody as children whose mothers were HIV negative (RR = 2.67). Similarly, HCV infected mothers have 12% greater chance of transmitting HCV to their children than noninfected mothers and children delivered vaginally were 1.6 times more likely to have HCV antibody than those delivered via caesarean section.Conclusions: The prevalence of anti-HCV in HIV-infected children is significantly higher than that of HIV uninfected peers. Factors strongly associated with HCV sero -positivity identified are maternal HIV and HCV infections, vaginal delivery and injections at patent medicine vendor.Keywords: HCV; HIV; children

Epidemiology of children with acquired immune deficiency syndrome (stage 3): A referral hospital-based study in Iran.

Lack of recognition of human immunodeficiency virus (HIV) infection especially in children and delayed implementation of effective control programs makes HIV infection as a major cause for concern. Information on HIV epidemiology in Iran as well as other Islamic countries is limited. The aim of our study was to describe the clinical manifestation and laboratory finding of HIV infected children who were admitted to a referral Children Medical Center (CMC) in Tehran, Iran, during 11 years from January 2002 to January 2013. This was a retrospective study carried out over a period of 11 years. The records of all patients attending to the CMC with confirmed acquired immunodeficiency syndrome (AIDS) were screened. The patients were evaluated for social circumstance, family history, age, gender, clinical, and laboratory features. Clinical data including fever, respiratory distress, diarrhea, rash, etc. as well as laboratory tests including complete blood count, serum glucose level, electrolytes, liver function test, cultures, CD4 lymphocyte count were evaluated. During the study period, 32 HIV positive children were enrolled. The majority of patients were presented with weight loss, prolonged fever, respiratory infection and chronic diarrhea. In this study, salmonella infections as well as streptococcal pneumonia and candida infections followed by, tuberculosis and Pseudomonas aeruginosa infections were the predominant opportunistic infections. Since the number of HIV-positive children has been alarmingly increasing in recent years and perinatal transmission is the most common route of HIV infection in children, essential recommendations for prenatal HIV testing as well as appropriate antiretroviral therapy by HIV infected mothers are needed.

Comparison of anti-retroviral therapy treatment strategies in prevention of mother-to-child transmission in a teaching hospital in Ethiopia.

More than 90% of Human immunodeficiency virus (HIV) infection in children is acquired due to mother-to-child transmission, which is spreading during pregnancy, delivery or breastfeeding. To determine the effectiveness of highly active antiretroviral and short course antiretroviral regimens in prevention of mother-to-child transmission of HIV and associated factors Jimma University Specialized Hospital (JUSH). A hospital based retrospective cohort study was conducted on HIV infected pregnant mothers who gave birth and had follow up at anti-retroviral therapy (ART) clinic for at least 6 months during a time period paired with their infants. The primary and secondary outcomes were rate of infant infection by HIV at 6 weeks and 6 months respectively. The Chi-square was used for the comparison of categorical data multivariate logistic regression model was used to identify the determinants of early mother-to-child transmission of HIV at 6 weeks. Cox proportional hazard model was used to analyze factors that affect the 6 month HIV free survival of infants born to HIV infected mothers. A total of 180 mother infant pairs were considered for the final analysis, 90(50%) mothers received single dose nevirapine (sdNVP) designated as regimen-3, 67 (37.2%) mothers were on different types of ARV regimens commonly AZT + 3TC + NVP (regimen-1), while the rest 23 (12.8%) mothers were on short course dual regimen AZT + 3TC + sdNVP (regimen-2). Early mother-to-child transmission rate at 6 weeks for regimens 1, 2 and 3 were 5.9% (4/67), 8.6% (2/23), and 15.5% (14/90) respectively. The late cumulative mother-to-child transmission rate of HIV at 6 months regardless of regimen type was 15.5% (28/180). Postnatal transmission at 6 months was 28.5% (8/28) of infected children. Factors that were found to be associated with high risk of early mother-to-child transmission of HIV include duration of ARV regimen shorter than 2 months during pregnancy (OR=4.3, 95%CI =1.38-13.46), base line CD4 less than 350 cells/cubic mm (OR=6.98, 95%CI=0.91-53.76), early infant infection (OR=5.4, 95%CI=2.04-14.4), infants delivered home (OR=13.1, 95%CI=2.69-63.7), infant with birth weight less than 2500 g (OR=6.41, 95%CI=2.21-18.61), and mixed infant feeding (OR=6.7, 95%CI=2.2-20.4). Antiretroviral regimen duration less than 2 months, maternal base line CD4 less than 350 cells/cubic mm and mixed infant feeding were also important risk factors for late infant infection or death. The effectiveness of multiple antiretroviral drugs in prevention of early mother-to-child transmission of HIV was found to be more effective than that of single dose nevirapine, although, the difference was not statistically significant. But in late transmission, a significant difference was observed in which infants born to mother who received multiple antiretroviral drugs were less likely to progress to infection or death than infants born to mothers who received single dose nevirapine.

Vitamin D deficiency and risk of postpartum tuberculosis among HIV-infected breastfeeding mothers in India.

Some studies have associated low vitamin D levels with the risk of tuberculosis (TB), but its association in human immunodeficiency virus (HIV) infected mothers in a TB-endemic region has not been well studied. We conducted a nested 1:2 case-control study among HIV-infected mothers in western India to evaluate the association between maternal vitamin D levels and the risk of postpartum TB. Vitamin D insufficiency, moderate deficiency and severe deficiency were observed in a high proportion of HIV-infected mothers, but were not associated with the risk of postpartum TB.

Tuberculosis interferon-gamma responses in the breast milk of human immunodeficiency virus infected mothers.

Tuberculosis (TB) cellular immune responses were examined in the breast milk of human immunodeficiency virus infected mothers using the T-SPOT. TB interferon-gamma release assay (IGRA). Positive TB interferon-gamma (IFN-γ) responses were detected in 6 of 8 (75%) valid breast milk assays. Among 7 mothers with paired breast milk and blood assays, TB IFN-γ responses were higher in breast milk than in blood (P = 0.02). The magnitude of TB IFN-γ responses in maternal breast milk and blood were correlated. Elucidating the influence of TB immune responses in breast milk on infant TB susceptibility and immunity may inform future maternal TB vaccine strategies.

English

BACKGROUND: Parent to child transmission is the most important source of HIV infection in pediatric age group. Ante-natal, natal and post natal periods are crucial time for transmission of Human Immune-deficiency Virus infection from mother to child. OBJECTIVE: There are about 1.9 million expected pregnancies in a year in Rajasthan. With HIV prevalence rate amongst women attending ANC services is 0.19% (HIV sentinel surveillance report of 2008) a large number of pregnant women are expected to be HIV positive. There is about 30% a high rate of risk of HIV transmission from HIV infected mothers to their children. By ensuring safe delivery with mandatory services and preventive measures this transmission can be stopped. Therefore testing and counseling of every pregnant women for Human Immuno-deficiency Virus (HIV) / Acquired Immuno Deficiency Syndrome (AIDS) is of vital importance to forestall spread of HIV infection by this route. MATERIAL AND METHODS: Present study is carried out to evaluate status of HIV Testing and counseling of pregnant women in year 2011-2012 in Rajasthan state and to assess measures taken to reduce transmission from mother to child to achieve zero transmission status in new born. RESULTS: The study reveals that only 4, 16, 343 pregnant women i.e. only 21.91 % were tested in the year 2011-12 out of estimated 1.9 million pregnancies every year in Rajasthan state and 454 pregnant women i.e. only 12.39% were detected HIV positive out of about 3600 expected to be positive during that period. CONCLUSION: It is observed that around 1000 new born children in Rajasthan are likely to get transmission of HIV infection from unidentified positive pregnant women every year. This can be prevented by ensuring and HIV testing and by enhancing facilities for safe delivery of every pregnant