Human Immunodeficiency Virus Infection In Pregnancy Research Articles

Universal Repeat Screening for Human Immunodeficiency Virus in the Third Trimester of Pregnancy

To assess the cost effectiveness of universal repeat screening for human immunodeficiency virus (HIV) infection in the third trimester of pregnancy. A decision-analytic model was constructed to compare two strategies: screening for HIV infection in the first trimester alone compared with the addition of repeat screening in the third trimester. Probabilities, costs, and utilities were derived from the literature and varied in sensitivity analyses. The assumed incidence of HIV infection in pregnancy was 0.0145% or 14.5 per 100,000. Outcomes included costs (in 2022 U.S. dollars), maternal and neonatal quality-adjusted life-years (QALYs), and cases of neonatal HIV infection. Our theoretical cohort contained 3.8 million pregnant individuals, the approximate number of births per year in the United States. The willingness-to-pay threshold was set at $100,000/QALY. We performed univariable and multivariable sensitivity analyses to determine inputs that most influenced the model. Universal third-trimester screening prevented 133 cases of neonatal HIV infection in this theoretical cohort. Universal third-trimester screening led to an increased cost of $17.54 million and 2,732 increased QALYs, with an incremental cost-effectiveness ratio of $6,418.56 per QALY, less than the willingness-to-pay threshold. In a univariate sensitivity analysis, third-trimester screening remained cost effective with variation of HIV incidence in pregnancy to as low as 0.0052%. In a theoretical U.S.-based cohort of pregnant individuals, universal repeat screening for HIV infection in the third trimester was found to be cost effective and to reduce vertical transmission of HIV. These results merit consideration of a broader HIV-screening program in the third trimester.

Follow up of HIV perinatal exposure and accomplishment of strategies to reduce the risk of viral transmission, experience in a reference hospital in Medellín

Introduction: Prevention of mother-to-child transmission of the human immunodeficiency virus (HIV) is essential to limit the spread of the disease. Colombian data about HIV infection in pregnancy are scarce, as well as on the results of the strategies used worldwide to reduce perinatal transmission. Objective: To describe the characteristics and outcomes of pregnant women infected with HIV and their children in a reference center in Medellín. Materials and methods: We conducted a retrospective observational study for the 2012-2015 period by studying the clinical records of newborns exposed to HIV and their mothers. We evaluated the characteristics of prenatal care, deliveries, and infant postnatal care, as well as the follow-up data to confirm or exclude HIV transmission. Results: We included 106 infants and their mothers. We found that 39,6% of mothers knew about the HIV diagnosis before pregnancy and 58,5% were diagnosed during pregnancy; 95.3% of them attended prenatal controls, but only 46.5% as of the first trimester; 95% of them received antiretrovirals, but 23.9% started therapy just during the third trimester. Only 63% of women had a viral load for HIV after 34 weeks of gestation. None of the 103 children with follow up had confirmed presence for HIV and in 88% of them, it was discarded. Conclusions: No cases of perinatal HIV transmission were found in the study. However, difficulties and delays persist in prenatal care, in timely maternal follow-up to confirm or discard HIV, and for early detection of maternal co-infections and their effects on newborns.

Changing Patterns and Factors Associated With Mode of Delivery Among Pregnant Women With Human Immunodeficiency Virus Infection in the United States.

To describe patterns and factors associated with mode of delivery among pregnant women with human immunodeficiency virus (HIV) infection in the United States in relation to evolving HIV-in-pregnancy guidelines. We conducted an analysis of two observational studies, Pediatric AIDS Clinical Trials Group and International Maternal Pediatric Adolescent AIDS Clinical Trials Network Protocol P1025, which enrolled pregnant women with HIV infection from 1998 to 2013 at more than 60 U.S. acquired immunodeficiency syndrome clinical research sites. Multivariable analyses of factors associated with an HIV-indicated cesarean delivery (ie, for prevention of mother-to-child transmission) compared with other indications were conducted and compared according to prespecified time periods of evolving HIV-in-pregnancy guidelines: 1998-1999, 2000-2008, and 2009-2013. Among 6,444 pregnant women with HIV infection, 21% delivered in 1998-1999, 58% in 2000-2008, and 21% in 2009-2013; 3,025 (47%) delivered by cesarean. Cesarean delivery increased from 30% in 1998 to 48% in 2013. Of all cesarean deliveries, repeat cesarean deliveries increased from 16% in 1998 to 42% in 2013; HIV-indicated cesarean deliveries peaked at 48% in 2004 and then dropped to 12% by 2013. In multivariable analyses, an HIV diagnosis during pregnancy, initiation of antiretroviral therapy in the third trimester, a plasma viral load 500 copies/mL or greater, and delivery between 37 and 40 weeks of gestation increased the likelihood of an HIV-indicated cesarean delivery. In analyses by time period, an HIV diagnosis during pregnancy, initiation of antiretroviral therapy in the third trimester, and a plasma viral load of 500 copies/mL or greater were progressively more likely to be associated with an HIV-indicated cesarean delivery over time. Almost 50% of pregnant women with HIV infection underwent cesarean delivery. Over time, the rate of repeat cesarean deliveries increased, whereas the rate of HIV-indicated cesarean deliveries decreased; cesarean deliveries were more likely to be performed in women at high risk of mother-to-child transmission. These findings reinforce the need for both early diagnosis and treatment of HIV infection in pregnancy and the option of vaginal delivery after cesarean among pregnant women with HIV infection.

HIV Antibody Seroprevalence and Determinants Amongst Antenatal Clients in a Tertiary Hospital in the Niger Delta

Background: The pandemicity of the human immunodeficiency virus (HIV) has continued to be a ‘medical quagmire,’ one of the most serious global catastrophe and public health problem that plagues the world today. Objectives: To determine the seroprevalence and clinico-epidemiological correlates of HIV infection in pregnancy. Methodology: This is a descriptive cross sectional study. Two hundred and twenty (220) consecutive healthy pregnant women attending the antenatal booking clinic of the hospital who met the inclusion criteria were recruited. Data was collected via a questionnaire. Data entry and analysis was done using SPSS (statistical package forsocial sciences) 22 statistical package (SPSS Inc., Illinois, U.S.A). P value less than 0.05 was taken as being significant. Results: Of the 220 women, 4.6% (n=10) were seropositive for HIV antibodies. Multiple sexual partners was the significant risk factors for HIV seropositivity (p<0.05). There was no significant association with respect to tattoo/scarification marks, female circumcision, previous blood transfusion, intravenous drug abuse or sharing of sharps, previous surgery, episiotomies or dilatation and curettage (p>0.05). Conclusion: The high endemicity of HIV infection in this study justifies the need for routine screening in pregnancy to identify and institute treatment of the infection promptly as this will reduce the mother to child transmission of the virus. Sex education on the dangers of multiple sexual partners or sexual promiscuity, availability of barrier methods of contraception and patronage, more efforts/interventions by relevant agencies, high sense of vigilance amongst others are very vital to curtailing this global pandemic in our society.

Mother-to-child transmisson of HIV: an eight-year experience

Mother-to-child transmission of human immunodeficiency virus (HIV) can be prevented by prenatal, perinatal and postnatal interventions. Although the incidence of HIV infection in Turkey is low, the number of cases are increasing in years. The aim of this study was to evaluate the characteristics of infants with HIV-positive mothers followed in a pediatric HIV center in Istanbul, Turkey and to describe the vertical transmission of HIV infection among the cases. Clinical and laboratory features of HIV-infected mothers and their exposed infants, followed in our department between June 2007 and February 2015 were retrieved from medical records retrospectively. The data about HIV infection and pregnancy course were confirmed with medical records when possible otherwise based on mothers' self-reports. Clinical and laboratory data about the birth and after birth of the babies in the other centers were obtained from the related centers. A total of 32 HIV-exposed infants (18 female, 14 male) were followed in eight years. HIV infection could be diagnosed in 15 (46.9%) mothers before pregnancy, in 10 (31.3%) during pregnancy and in seven (21.8%) during delivery. Nine of the mothers (28.1%) did not receive antiretroviral therapy during pregnancy. The median age for the patients at the admission were 13.5 days in which the earliest was a day and the latest was 420 (14 months) days. Three of the infants were fed with breast milk. Four infants (12.5%) did not receive antiretroviral prophylaxis. Cotrimoxazol prophylaxis were given approximately to 60% (n= 19) of the infants starting from 4-6 weeks. HIV viral load could be tested within the first 48 hours among 20 infants and except one, all was found as negative. A total of two infants (6.2%) were infected with HIV and their initial viral loads were 89.500 and 87.500 copies/ml, respectively. One of the infant was delivered vaginally and his mother's HIV status was detected during delivery. The mother of other infected infant was diagnosed only three weeks before birth and delivered with cesarean section. Both mothers had high viral loads just before delivery (> 102.000 and 67.000 copies/ml, respectively). One of the infants infected with HIV died in the 4(th) month due to pulmonary infection and sepsis. This study reveals a high rate of perinatally transmitted HIV infection and mortality. The limited number of cases involved in this one-center study should be taken into account while interpreting this result. All pediatric HIV centers in Turkey should work as partners for more precise national results. Nevertheless, our results draw attention to the lack of prenatal follow-up evaluation in women. In particular, the prompt diagnosis of HIV infection in pregnancy should be provided or not to be missed and follow-up of pregnant women with HIV should be carried out by specialist centers.

HIV infection in pregnancy: maternal and perinatal outcomes in a tertiary care hospital in Calabar, Nigeria.

Human immunodeficiency virus (HIV) infection is likely to have untoward effects on pregnancy and its outcome. This study assessed the impact of maternal HIV infection on pregnancy outcomes in a tertiary centre in Calabar, Nigeria. This retrospective study analysed delivery records of 258 HIV-positive and 257 HIV-negative women for pregnancy and delivery complications. Maternal and fetal outcomes of HIV-positive pregnancies were compared with those of HIV-negative controls. Adverse pregnancy outcomes significantly associated with HIV status were: anaemia: 33 (8.1%) vs. 8 (3.1%) in controls; puerperal sepsis: 18 (7%) vs. 2 (0.8%); and low birth weight: 56 (21.7%) vs. 37 (14.4%). Caesarean delivery was higher among HIV-positive women than controls: 96 (37.2%) vs. 58 (22.6%). Preterm births were higher in those HIV cohorts who did not receive antiretroviral therapy (ART): 13 (16.9%) vs. 7 (3.9%). HIV-positive status increased adverse birth outcome of pregnancy. ART appeared to reduce the risk of preterm births in HIV-positive cohorts.

Management of HIV infection in pregnancy

Human immunodeficiency virus (HIV) remains an important global infection and cause of significant morbidity and mortality. The majority of new HIV infection occurs in the developing world, where women and their children are greatly affected by the consequences of HIV associated disease. By comparison, in the developed world, women represent a minority of those with new HIV infection. The problems associated with the management of pregnancy and childbirth require specialist care across multidisciplinary teams to ensure the best clinical outcome for mothers and their babies, as well as assuring the confidentiality and safety of patient care and public health. Preventing mother-to-child-transmission (MTCT) has been the goal of research and collaborative guidelines in the UK for much of the past decade and has contributed to reducing MTCT, which is now a rare occurrence in the UK. The global target of eliminating MTCT requires a major and sustained effort to improve access to testing, antiretroviral therapy and expert multidisciplinary care.

British HIV Association guidelines for the management ofHIVinfection in pregnant women 2012

British HIV Association guidelines for the management of<scp>HIV</scp>infection in pregnant women 2012

Psychosocial Dimensions of HIV Infection in Pregnancy

As more experience has accrued regarding human immunodeficiency virus (HIV) infection in women and HIV infection in pregnancy, there has remained a gap in our understanding of the psychosocial effects of HIV infection upon the pregnant women. There is limited information regarding psychologic and sociologic effects of HIV infection upon pregnancy and vice versa; there is sufficient indication of a relationship between stressors related to each of these and the potential for a deleterious affect upon the pregnancy. These stresses often include the determination whether to disclose or not disclose their serostatus.

Seroprevalence of human immunodeficiency virus infection in pregnancy in a tertiary care hospital

Human Immunodeficiency Virus (HIV) /Acquired Immunodeficiency Syndrome (AIDS) is increasing at an alarming rate globally. It has now become a major challenge & threat to public health. HIV infection in women occur primarily during their reproductive years, hence pregnancy provides a unique opportunity for implementing prevention strategies against HIV infection. If we estimate seroprevalence in pregnancy, the effective & timely intervention will reduce the transmission of infection to newborns. To study the seroprevalence of HIV infection in pregnancy in a tertiary care hospital. Antenatal Care Clinic of a Tertiary Care Hospital. A cross-sectional study. Blood samples of all the pregnant women with written consent were collected and tested for HIV antibodies as per National AIDS Control Organization (NACO) guidelines over a period from September 2002 to August 2004. However only those who were HIV sero-reactive were included in this study. Spouses of sero-reactive pregnant women were also counselled and tested. Statistical analysis was done using Chi-square test. Out of the total 10683 blood samples from pregnant women tested, 147 (1.38%) were found to be HIV sero-reactive. Sero-reactive cases when compiled year-wise, showed increase in the seroprevalence from 1.24% in September 2002 -- August 2003 to 1.45% in September 2003 -- August 2004. Majority 69 (46.94%) sero-reactive pregnant women were in the age group of 19--24 years followed by 25--29 years age group (31.29%). Out of 88 spouses of HIV sero-reactive pregnant women, 85 (96.59%) were found to be HIV sero-reactive. In the present study, seroprevalence of HIV infection was found to be 1.38% amongst pregnant women.

Preeclampsia and HIV infection

Preeclampsia is a common complication of pregnancy and a major cause of maternal morbidity. It is associated with placental disorder endothelial cell dysfunction and systemic vasospasm. The events leading these alterations remains unclear but it seems that abnormal activation of the immune system play a relevant role in the etiology of preeclampsia. Some reports suggest a trend toward an increasing prevalence of human immunodeficiency virus (HIV) infection in pregnancy. Different studies have evaluated maternal immune response to HIV infection in pregnancy and investigated whether its represents a risk factor for adverse perinatal outcome however controversial results have been obtained. Our purpose was to investigate the rate of preeclampsia in HIV seropositive pregnant women that were referred to Obstetric Outpatient Clinic of UNIFESP-EPM between 2000 and 2002. (excerpt)

HIV in Pregnancy: Experience at Abeokuta, Nigeria

Background: The human immunodeficiency virus (HIV) pandemic remains a major threat to public health. Measures to minimize mother to child transfusion remain a major focus of research. Objectives: To determine the prevalence of HIV in pregnancy in our obstetric clinic population and evaluate the effects of HIV infection on the course and outcome of pregnancy. Materials & Methods: A case-control study of all HIV-positive pregnant women who delivered at the Federal Medical Centre, Abeokuta between January, 1997 and June, 2000. Selected characteristics including age, parity, gestational age at booking, weight gain in pregnancy, duration of pregnancy and the infants’ characteristics were compared between seropositive and negative women. Results: Sixteen women had HIV infection among a total of 2,442 women booked during the study period. The prevalence of HIV infection in pregnancy was 0.7%. Following diagnosis, eight of the HIV positive women defaulted from ante-natal care None opted for anti-retroviral therapy. There were no statistically significant differences in the haematocrit at booking (p=0.9), the weight gain in pregnancy (p=0.2), birth-weights between the two groups. All the women had vaginal deliveries. There were significant differences in the infants’ Apgar scores and perinatal mortality rates were higher in the HIV positive group. All the mothers chose to breastfeed their infants. Conclusion: HIV infection in this population is associated with birth asphyxia and a high perinatal mortality rate. The survivors are also at great risk of vertical transmission during breast-feeding. Key Words: HIV, Pregnancy, Vertical Transmission, Birth Asphyxia. [Trop J Obstet Gynaecol, 2002, 19: 21-24].

Prevention of perinatal HIV transmission during pregnancy.

Transmission of the human immunodeficiency virus (HIV) from mother to child can occur in utero, during labour or after delivery from breastfeeding. The majority of infants are infected during delivery. Maternal HIV-1 plasma viral load at delivery is the most important predictor of vertical transmission. For this reason, efforts to interrupt transmission have focused on the use of antiretroviral therapy. Zidovudine has been shown to reduce significantly vertical HIV transmission when used antepartum and intrapartum by the mother and postpartum by the newborn for 6 weeks. However, zidovudine monotherapy increases the risk of developing zidovudine resistance and may jeopardize the goal of durable viral suppression and allow HIV disease progression in the mother and transmission to the infant. Potent antiretroviral therapy is now recommended for all HIV-infected pregnant women using the same criteria for non-pregnant individuals. If possible, combination antiretroviral regimens should include the use of zidovudine but not at the expense of long-term viral suppression. The use of elective Caesarean section should probably be reserved for women who fail to achieve viral suppression at the time of delivery or if indicated for obstetrical reasons. The practice of breastfeeding has been shown to diminish the long-term efficacy of perinatal antiretroviral therapy. All HIV-infected mothers should avoid breastfeeding the newborn if possible. This review summarizes major prospective and retrospective antiretroviral treatment studies in HIV-infected pregnant women. Pharmacokinetic information as it relates to pregnancy and adverse event profiles of antiretroviral agents are also discussed. The impact of recent advances in the management of HIV infection in pregnancy is discussed with regard to their feasibility in resource-poor countries.

Identification of HIV infection in pregnancy: another era.

In order to be successfully implemented, some interventions to prevent vertical transmission of human immunodeficiency virus (HIV) will require prior identification of HIV-infected women. The testing and counselling of pregnant women should therefore be promoted. Promoting testing and counselling within prenatal clinics would be a good strategy; however, additional data on the social and economic implications of HIV testing are needed to demonstrate the relevance of such a strategy. Promotion of testing and counselling should be developed in collaboration with community-based organizations, non-governmental organizations and people living with HIV, in order to increase the involvement and understanding of the community at large.

Serological screening for sexually transmitted infections in pregnancy: is there any value in re-screening for HIV and syphilis at the time of delivery?

The aim of this study was to assess the prevalence of syphilis, human immunodeficiency virus (HIV), and hepatitis B virus (HBV) infections in women at the time of delivery, and to determine the seroconversion rates for syphilis and HIV infections from initial booking visit to delivery. The labour ward of a typical tertiary hospital in a developing country and serving an indigent African population. Four hundred and eighteen women presenting in labour were randomly selected and informed consent obtained for serological testing for syphilis and HBV infections in umbilical cord blood samples. The specimens were then given a study number, the gestational ages recorded and anonymously tested for HIV infection. Of the 191 women who had antenatal care, 13 (6.8%) were HIV antibody positive at the initial "booking" visit. An additional 4 were found to be HIV antibody positive at the time of delivery resulting in a seroconversion rate of 2.2%. The seroconversion rate for syphilis at the time of delivery was 2.7%. Hepatitis B surface antigens were detected in only 2 women, one of whom was antigen positive. The high seroconversion rates for both syphilis and HIV infection in pregnancy justifies re-screening for these conditions in endemic areas such as ours.

Antenatal testing for human immunodeficiency virus. Results from the Royal College of Obstetricians and Gynaecologists' national study of HIV infection in pregnancy

Current policies on antenatal testing for human immunodeficiency virus (HIV) in the main obstetric units of the United Kingdom and the Republic of Ireland were surveyed by postal questionnaire; 294 of 299 units responded. HIV testing was available at 192 (65%) of the 294 units that responded. 414 HIV-positive pregnancies in 386 women were reported from 74 (25%) units. Most were from Scotland, the four Thames Regions, and Ireland. In 46% of the HIV-positive women the infection was identified by antenatal testing; the remainder had been tested previously and knew that they were infected. The findings support the view that selective antenatal testing should be established in areas where no testing is offered at present and possibly that testing should be offered to all pregnant women in high-prevalence areas.

ANTENATAL TESTING FOR HUMAN IMMUNODEFICIENCY VIRUS: Results from the Royal College of Obstetricians and Gynaecologists' National Study of HIV Infection in Pregnancy

Current policies on antenatal testing for human immunodeficiency virus (HIV) in the main obstetric units of the United Kingdom and the Republic of Ireland were surveyed by postal questionnaire; 294 of 299 units responded. HIV testing was available at 192 (65%) of the 294 units that responded. 414 HIV-positive pregnancies in 386 women were reported from 74 (25%) units. Most were from Scotland, the four Thames Regions, and Ireland. In 46% of the HIV-positive women the infection was identified by antenatal testing; the remainder had been tested previously and knew that they were infected. The findings support the view that selective antenatal testing should be established in areas where no testing is offered at present and possibly that testing should be offered to all pregnant women in high-prevalence areas.