Human Immunodeficiency Virus Positive Women Research Articles

Trichomonas vaginalis AND HIV INFECTION: RELATION AND PREVALENCE AMONG WOMEN IN SOUTHERN BRAZIL

Trichomoniasis is a curable sexually transmitted infection (STI) that has been reported to be linked to exposure to human immunodeficiency virus (HIV), although few studies have described this association. The purpose of this study was to focus on the incidence of trichomoniasis in low-income women, its relation to HIV status, viral load levels and TCD4+ cell counts, among other risk factors, using an in vitro culture as a diagnostic test. A crosssectional study among 267 women (103 HIV-positive and 164 HIV-negative) was conducted in 2015. The overall prevalence of Trichomonas vaginalis (TV) infection was 6.4%. Among HIVpositive and HIV-negative women, the prevalence was 3.9% and 7.9%, respectively, yet these results were not statistically different (p=0.1878). The factors associated with TV infection were cigarette smoking (OR= 3.52), vaginal itching (OR=4.43) and bacterial vaginosis (BV) (OR= 5.29). HIV status, TCD4+ cell count and viral load were not associated with TV infection in this group. The prevalence rates found, lower than those observed in other studies, may be due to the fact that the women evaluated in the present study are part of a low-risk populationas well as the limited sample size of HIV positive women.

J-107 Interrogating the immunologic and microbial cervical microenvironment in HPV infection

Infection with high-risk human papillomavirus (hrHPV) infection in the oral and anogenital mucosa has been confirmed to be a necessary but insufficient cause of invasive cervical cancer (ICC), which is a leading cause of cancer incidence and mortality worldwide. Over the past 2 decades, our understanding of the natural history of cervical hrHPV infection has evolved, especially with regard to the influence of co-infections and the dynamics of the cervical microenvironment. For example, it is now recognized that at least a proportion of hrHPV infections are immunologically controlled for long periods of time in an undetectable (latent) state, at risk of recurrent detection (reactivation) upon immune suppression.1 This phenomenon is most clearly illustrated when comparing the HPV natural history in HIV-infected and HIV-uninfected individuals, where both incident and persistent detection of HPV is proportionally increased with increasing immune suppression.2 Multiple new type cervical HPV detection increases nearly 4-fold within weeks of acute HIV infection, suggesting a key role for tissue resident T-cell memory in control of latent HPV infection.3 In HIV-uninfected women, we have observed polarization toward T-helper type 2 immune profiles of the lower genital tract immune microenvironment. In an older, well-screened US population, HPV positive women exhibited immune profiles similar to those described in allergic inflammation.4 In the developing world, we have reported an increased prevalence of HPV infection at older ages in Amazonian women with soil-transmitted helminth (STH) infection, who showed evidence of Th2-skewed immunity in lower genital tract secretions compared with STH-uninfected women.5 This epidemiologic evidence, combined with experimental animal models of papillomavirus infection, collectively implicate a key role of host immunity in the control of cervical HPV infection and, by extension, risk of cervical cancer. This presentation will make a case that the time has come to move human HPV natural history studies away from traditional designs with large sample sizes and long interval censored sampling (eg, every 6 months) to designs with smaller sample sizes and more frequent sampling density (eg, every week) to allow interrogation of the dynamic interplay between the shifting microenvironment and HPV detection. Prioritizing a focus on understanding the dynamics and immune mediators involved in healthy control of HPV infection may be an overlooked fundamental system component required to fully understand the causes of dysregulation of HPV infection and persistent detection. This represents a paradigm shift in studying the molecular epidemiology of human viral infections, reflects more fully a systems approach to understanding biological complexity, and may lead to development of less invasive interventions at earlier stages in viral natural history to prevent severe pathological outcomes. REFERENCES 1. Gravitt PE. The known unknowns of HPV natural history. J Clin Invest. 2011;121:4593–4599. 2. Strickler HD, Burk RD, Fazzari M, et al. Natural history and possible reactivation of human papillomavirus in human immunodeficiency virus-positive women. J Natl Cancer Inst. 2005;97:577–586. 3. Nowak RG, Gravitt PE, Morrison CS, et al. Increases in human papillomavirus detection during early HIV infection among women in Zimbabwe. J Infect Dis. 2011;203:1182–1191. 4. Marks MA, Viscidi RP, Chang K, et al. Differences in the concentration and correlation of cervical immune markers among HPV positive and negative perimenopausal women. Cytokine. 2011;56:798–803. 5. Gravitt PE, Marks M, Kosek M, et al. Soil-transmitted helminth infections are associated with an increase in human papillomavirus prevalence and a T-helper type 2 cytokine signature in cervical fluids. J Infect Dis. 2016;213:723–730.

Prenatal screening of HIV positive pregnant women under HAART (highly active antiretroviral therapy)

Introduction: HIV (human immunodeficiency virus) infection is the typical example of an emergent disease with an explosive pandemic evolution. HAART therapy (highly active antiretroviral therapy) dramatically influenced AIDS evolution, reducing the incidence of associated diseases and also its mortality.

Mid-arm muscle area and anthropometry predict low birth weight and poor pregnancy outcomes in Tanzanian women with HIV

BackgroundAn observational study was conducted to examine the role of maternal anthropometry, including mid-arm muscle area (MAMA) and others, as risk factors for low birth weight (LBW), small for gestational age (SGA) and preterm births in human immunodeficiency virus (HIV) infected pregnant women. HIV-positive women (N = 2369), between 12 and 32 weeks gestation were followed through delivery in Tanzania, from 2003 to 2008. Participants were women enrolled in a randomized, double-blind, placebo-controlled, clinical trial who delivered live births.MethodsBinomial regression analysis was used to evaluate the association of maternal nutritional indicators of MAMA, mid-upper arm circumference (MUAC), body mass index (BMI) and maternal weight with LBW, SGA and preterm in multivariate analysis.ResultsHigher MAMA was associated with a 32% lower risk of LBW compared to lower measurements (RR = 0.68, 95% CI = 0.50–0.94). Similar protective associations were noted for higher BMI (RR = 0.58, 95% CI = 0.42–0.79); maternal weight (RR = 0.50, 95% CI = 0.36–0.69) and MUAC (RR = 0.62, 95% CI = 0.45–0.86). Higher MAMA was also associated with lower risk of SGA (RR = 0.78, 95% CI = 0.68–0.90) and marginally associated with preterm (RR = 0.85, 95% CI = 0.69–1.04). Beneficial associations of MUAC, BMI and maternal weight with SGA and preterm were also observed.ConclusionMAMA performs comparably to MUAC, maternal weight and BMI, as a predictor of LBW and SGA in HIV-infected women. The possible role of MAMA and other indicators in screening HIV positive women at risk of adverse pregnancy outcomes should be investigated.

English

Dual voices of women with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) show the experiences of the HIV positive women who are ignored by the society at large. The study aims to showcase the voices of women living with HIV and AIDS at a micro-level to approach the disease in a more holistic way. Qualitative study was employed to explore and describe the experiences of women living with HIV and AIDS. The study area is a clinic in Gauteng Province of South Africa. A non-probability purposive sampling technique was used to select the study participants (n=12). In-depth, individual semi-structured interviews were conducted and thematic content approach was used for data analysis. Five themes were used to describe the women’s five experiences from being diagnosed with HIV: disclosing HIV positive status, signs and symptoms of HIV and AIDS, stigmatization, emotions and services being rendered. HIV and AIDS have negative effects on the women. They are looking for ways to cope with the disease. Women should be given enough support and health care. This can be done by providing enough consultation rooms, adequate waiting time, pre-counseling before given antiretroviral treatment (ART), engagement of male partners and relatives and addressing peer support and confidentiality. Key words: Acquired immune deficiency syndrome (AIDS), experiences, human immunodeficiency virus (HIV), women.

The Correlation between HIV/AIDS Positive Pregnant Mother with Infant APGAR Score in RSD dr. Soebandi Jember

Human Immunodeficiency Virus (HIV) is a virus that decreased immunity and a set symptoms of diseases called Acquired Immune Deficiency Syndrome (AIDS). One of the major risk factors for HIV transmission is perinatal transmission about 2.8% during pregnancy, delivery, and postpartum. HIV positive mothers have a potential to give birth infants with low APGAR. APGAR Score was used as a reference to determine asphyxia in the first and fifth minutes of life. The purpose of this research were to determine the correlation between HIV/AIDS positive pregnant mother with infant APGAR Score and to determine the other factors that affect the infant APGAR Score in RSD dr. Soebandi Jember. This research used observational analytic survey method with cross sectional design using medical record of HIV positive and negative pregnant women from August 2014-July 2017 in RSD dr. Soebandi Jember as a subject that qualify the inclusion and exclusion criteria. This research used case group sampling technique by total sampling and control group by simple random sampling each 52 samples. Test result of the correlation between HIV/AIDS positive pregnant mother with infant APGAR Score using Chi-Square test obtained p value=1.000 (OR=1.13) that means there was no significant correlation. Test result of the correlation between the other factors that affect infant APGAR Score concluded that there were no significant correlation.
 Keywords: pregnant mother, HIV/AIDS, APGAR Score, infant

Factors affecting long acting and permanent contraceptive methods utilization among HIV positive married women attending care at ART clinics in Northwest Ethiopia

BackgroundGlobally, unintended pregnancy has been very high accounting for 27% of maternal deaths. Different studies noted that nearly half of HIV positive women who gave unintended birth were using contraceptive methods prior to their unintended pregnancy. This implies that contraceptive failure contributes to unintended pregnancy. Long-term and permanent contraceptive methods are safe and effective contraceptive options. In women who are using long acting and permanent methods, the unintended pregnancy rate is very low and it is almost the same both in typical and perfect users. However, there is limited information on factors that affect long acting and permanent contraceptive methods utilization among Human Immuno-deficiency Virus (HIV) positive women in Ethiopia. Therefore, the purpose of this study was to assess long acting and permanent contraceptive utilization and its associated factors.MethodsAn institution-based cross-sectional study was conducted among 505 married women attending care at Anti Retroviral Therapy (ART) clinics in Bahir Dar from March 16, 2014 to April 15, 2014. The data were collected using a structured and interviewer administered questionnaire. Both bivariate and multivariate logistic regressions were used to identify associated factors.ResultsA total of 505 married women participated in the study with a response rate of 99.6%. The utilization of long acting and permanent contraceptive methods (LAPMs) was 27.5% [95% CI, 23.8–31.5]. The multivariate analyses showed that women who were getting pre- anti retroviral therapy (Pre-ART) services [Adjusted Odds Ratio = 2.65, 95% confidence interval: 1.44, 4.86], had spousal discussion on family planning sometimes [Adjusted Odds Ratio = 6.03, 95% CI:2.42–15.01] and frequently [Adjusted Odds Ratio = 6.61, 95% confidence interval: 2.49–17.47], had previous experience on long acting contraceptive methods [Adjusted Odds Ratio = 9.06, 95% confidence interval: 5.38–15.26], no exposure to myths about LAPMs [Adjusted Odds Ratio = 2.07, 95% confidence interval: 1.24–3.45], had birth intention after 2 years [Adjusted Odds Ratio = 6.95, 95% confidence interval: 3.35–14.42], and no such intention [Adjusted Odds Ratio = 7.60, 95% confidence interval: 3.77–15.34] were factors significantly associated with utilization of long acting and permanent contraceptive methods.ConclusionThe utilization of long acting and permanent contraceptive methods was relatively high. Discussion with partners on family planning, previous experiences of LAPMs, not hearing myths about LAPMs, women not started ART, and no birth intention were positively associated with LAPMs utilization. It is therefore recommended that health service providers need to make couples counseling on FP, undergo behavioral change communication (BCC) to avoid misconceptions/myths regarding LAPMs. Further research is also recommended to address the gaps mentioned in the limitation section and to explore the reason/s for not using LAPMs (qualitative study).

Burden of tuberculosis in HIV-positive pregnant women in Cape Town, South Africa

The burden of active tuberculosis (TB) in pregnancy compared with preconception and postpartum is unclear, particularly with universal antiretroviral therapy (ART) initiation in pregnancy. We retrospectively compared active TB incidence in the 18 months preconception, during pregnancy and up to 6 months postpartum in human immunodeficiency virus (HIV) positive women attending antenatal care at a primary health care facility in Cape Town from 2013 to 2014. Among 1513 women (4116 person-years [py]), 1489 (98.4%) received lifelong ART in pregnancy, and 79 TB episodes were identified. Unadjusted TB incidence rates (IR) preconception, during pregnancy and postpartum were 2466 (95%CI 1863-3202), 1127 (95% CI 600-1928) and 1447 (95% CI 694-2661) per 100 000 py, respectively. Adjusting for age and CD4 count at first antenatal visit and ART status, TB risk was lower during pregnancy (incidence rate ratio [IRR] 0.17 vs. preconception, 95%CI 0.09-0.31) and increased slightly postpartum (IRR 1.31 vs. pregnancy, 95%CI 0.56-3.07). Among HIV-positive women in South Africa, the TB burden preconception, during pregnancy and postpartum was substantial. The risk of TB during pregnancy was lower than preconception, but increased slightly postpartum; this represents missed opportunities for diagnosis, prevention and control. Improved TB prevention strategies and integrated care for HIV-positive women and their children are needed.

Epidemiology of HIV and Tuberculosis in pregnant women, South West Nigeria

Pregnant women remain the most vulnerable high-risk population to the devastating impact of the on-going human immunodeficiency virus (HIV) generalized epidemic and co-infection with Tuberculosis in Nigeria. By the end of 2017, the country ranked the second highest in adult HIV-infected individuals and the highest population of orphans due to AIDS in sub-Saharan Africa. We assessed the epidemiology of HIV among pregnant women across ten facilities in south-west Nigeria. This is a cross-sectional study design in which 353 pregnant women randomly selected across ten health care facilities in two states in south west Nigeria. This study was conducted between January and May 2015. HIV testing was conducted and active tuberculosis screening was implemented using the fluorescence microscopy. In addition, a structured questionnaire was administered to elicit risk factors of HIV infection and syndromic Tuberculosis in the study population. We found a 5.1% (18/353:95% CI:3.0%-8.0%) rate of HIV and 0% active tuberculosis in the study population. HIV positive pregnant women were 6 times more likely to have blood transfusion with greater odds of infection found in pregnant women with history of blood transfusion in the previous three months (OR:3.27, 95% CI:0.44-24.36). Pregnant women who tested HIV negative had 70% reduction in odds of infection (OR:0.21:95% CI:0.06-0.77). This study suggests a possible strong epidemiological link between HIV infection and recent blood transfusion among pregnant women attending ante-natal clinics in south west Nigeria. We therefore recommend further study to develop a more robust estimate of blood transfusion and the risk of HIV in pregnant women in Nigeria.

Low uptake of cervical cancer screening among HIV positive women in Gondar University referral hospital, Northwest Ethiopia: cross-sectional study design

BackgroundCervical cancer is one of the leading causes of death in women worldwide. Majority of the cases are found in developing countries. The increasing risk of cervical cancer death and the high prevalence of human papilloma virus (HPV) infection in Human immuno-deficiency virus(HIV) positive women calls for determining the level of premalignant cervical cancer (Ca) screening uptake. So, this study aimed to assess the uptake of cervical cancer screening and its associated factors.MethodsAn institution based cross sectional study was conducted from April to May, 2016, among adult HIV positive women attending care and treatment at Gondar University Referral Hospital. The data were collected using an interviewer administered questionnaire.Bivariate and multivariable logistic regression analyses were used to determine the presence and the degree of association between dependent and independent variables. In the multivariable logistic analysis, a P-value of < 0.05 and odds ratio with a 95% confidence interval were considered to determine independent predictors for the uptake of cervical cancer(Ca) screening.ResultsThe life-time uptake of cervical cancer screening among HIV positive women was 10% (95% Confidence Interval(CI): 7.3–12.8). In multivariable the analysis, women with primary education (Adjusted Odds Ratio(AOR) = 3.92, 95%CI:1.70–8.99), secondary education (AOR = 3.84, 95%CI: 1.50–9.83), and tertiary level education (AOR = 4.16, 95%CI: 1.24–13.98), having a child (AOR = 3.02, 95%CI: 1.23–7.46), diagnosed as HIV positive ten years back or more (AOR = 2.71, 95% CI: 1.06–6.97), and Cell Differentiation 4(CD4) count of less than or equal to 200cell/mm3 (AOR = 5.29, 95% CI: 2.58–10.83) were significantly associated with the uptake of cervical cancer screening.ConclusionIn this study, the uptake of cervical cancer screening was very low. Educational status, parity, length of time after diagnosis as HIV positive, and CD4 count are important predictors of cervical cancer screening. Health care workers and cervical cancer prevention and control program coordinators and implementers need to provide counseling services for all Anti-retroviral Therapy(ART) care attendants. So as to explore the root causes for the low utilization of precancerous stage of cervical Ca screening service, conducting a study on the supply side with a qualitative component is mandatory.

Effect of Gestational Age at Tenofovir-Emtricitabine-Efavirenz Initiation on Adverse Birth Outcomes in Botswana.

Among human immunodeficiency virus-positive women in Botswana on the recommended first-line antiretroviral therapy regimen, tenofovir-emtricitabine-efavirenz, initiated within the first or early second trimester, we found no increased risk of stillbirth, neonatal death, preterm/very preterm delivery, or the infant being born small or very small for gestational age. Treatment with tenofovir-emtricitabine-efavirenz <1 year before conception increased the risk of preterm delivery slightly over late-second-trimester treatment initiation (adjusted risk ratio, 1.33 [95% confidence interval, 1.04-1.70]).

Facing HIV infection and unintended pregnancy: Rakai, Uganda, 2001\u20132013

BackgroundUnintended pregnancy is a persistent and global issue with consequences for the health and well-being of mothers and babies. The aim of this paper is to examine unintended pregnancy over time in the context of substantial human immunodeficiency virus (HIV) prevalence and increasing access to anti-retro viral therapy (ART).MethodData are from the Rakai Community Cohort Study (RCCS) – a cohort of communities with 10,000–12,000 adults, ages 15–49, in Rakai District, Uganda. We examined prevalence of current pregnancies over time, intended pregnancy, and unintended pregnancies (unwanted, mistimed, ambivalent). We then examined risk factors for the different categories of unintended pregnancy among women who were currently pregnant. The full sample included 32,205 observations over 13 years.ResultsThe prevalence of mistimed pregnancy and unwanted pregnancy both decreased significantly over time (p < .001). The prevalence of current pregnancies and intended pregnancy showed no significant changes over the thirteen year period. The same overall pattern was found when only examining HIV positive women in the sample; however, the trends were not significant. Out of the 2820 current pregnancies reported, 54.4% were intended, 29.8% were mistimed, 13.2% were unwanted, and 2.5% were ambivalent. After controlling for other predictors, HIV status had no independent effect on mistimed pregnancy but had a significant effect on unwanted pregnancy (RRR = 2.44, 95% CI = 1.65–3.61, p < .001] and ambivalent pregnancy [RRR = 2.07; CI: 1.03 to 4.18, p = 0.041]. In 2004, after the introduction of ART, there was a decreased risk in unintended pregnancy [RR = 0.75; CI: 0.66 to 0.84, p < .001]. Women with a secondary education or higher also had a decreased risk in unintended pregnancy [RR = 0.70; CI: 0.70 to 0.92, p = 0.002].DiscussionHIV was an important predictor of unwanted pregnancy. Unintended pregnancy decreased in the sample over time which may be due to an increase in ART availability and rising levels of education.

Effectiveness and associated factors of prevention for mother-to-child human immunodeficiency virus transmission in 536 human immunodeficiency virus-positive pregnant women in Hubei Province

Objective To evaluate the effectiveness and associated factors of prevention of mother-to-child human immunodeficiency virus (HIV) transmission in Hubei Province, and to provide a reference for prevention of mother-to-child transmission of HIV. Methods In this prospective cohort study, HIV-positive pregnant women who were in some counties and cities of Hubei Province from January 2004 to December 2016 were enrolled. Prevention of mother-to-child transmission of HIV was conducted for these HIV-positive pregnant women and their infants, and their clinical data were collected. Descriptive analysis and χ2 test were used to analyze the general characteristics of HIV-positive pregnant women and their infants. Logistic regression analysis was adopted to explore the associated factors of mother-to-child HIV transmission. Results In total, 536 HIV-positive pregnant women (628 pregnancies) were found, among which, 334 pregnant women and 345 infants were enrolled in this study. Twenty-four infants were HIV-positive, which was 6.96% in all infants (95%CI: 4.27%-9.64%). The rates of mother-to-child HIV transmission without prevention, formula feeding only, infant medication plus formula feeding, mother and infant medication plus formula feeding were 35.71% (95%CI: 21.61%-51.93%), 8.82% (95%CI: 2.08%-15.57%), 7.41% (95%CI: 0.92%-24.22%), and 0.48% (95%CI: 0.01%-2.64%), respectively. No antiretroviral medications during delivery (OR=14.484, 95%CI: 1.740-120.577, P=0.013), breastfeeding (OR=6.542, 95%CI: 2.416-17.713, P=0.000), and CD4+ T lymphocyte count<200 cells/μL during delivery (OR=3.060, 95%CI: 1.076-8.703, P=0.036) were independent risk factors of mother-to-child HIV transmission. Conclusions The rate of mother-to-child HIV transmission without prevention is high in Hubei Province, which can be significantly reduced by comprehensive interventions (mother and infant medication plus formula feeding). Thus, we should diagnose HIV-positive pregnant women as early as possible, and should give pregnant woman antiretroviral therapy plus infant medication and formula feeding to further reduce the rate of mother-to-child HIV transmission. Key words: HIV; Pregnant women; Prevention of mother to child transmission; Associated factors

Adherence to Anti-retroviral Therapy among HIV Positive Pregnant Women in Ayder Refferal Hospital, Northern Ethiopia

Background: Human Immunodeficiency Virus (HIV) is one of the major global public health problems. Antiretroviral therapy (ART) helps to prevent transmission of HIV from infected pregnant women to the un-born babies. ART adherence rate, as high as 95% is crucial to effectively decrease maternal viral load and risk of vertical transmission of HIV. The aim of this study was to evaluate ART adherence level among HIV positive pregnant women in Ayder referral hospital.Methods: A cross-sectional study was conducted from March to May 2016 at Ayder referral hospital. All HIV positive pregnant women who were on ART follow up during the study period were included. Data were collected through direct interview of participants and review of their medical records. Data were entered and analyzed using SPSS version 20 software.Results: A total of 41 HIV-positive pregnant women were interviewed. The mean age was 30.1 ± 2.3 years. Thirty eight (92.7%) participants were within the age group of 20-34 years. Forty participants (97.6%) were disclosed their HIV status to their husband and/or families. Nineteen (46.3%) participants were taking ART medication for less than 2 years. Thirty nine participants had good adherence rate (≥ 95%). Illiterate participants had lower adherence rate (71.4%) as compared to literates. The common reasons for missing a dose in the last one month were forgetfulness and side effect of the drug.Conclusions: This study showed a good ART adherence among HIV positive pregnant women. The main reasons for missing a dose in the last one month were forgetfulness and side effect of the drug.

Hematological parameters of human immunodeficiency virus positive pregnant women on antiretroviral therapy in Aminu Kano Teaching Hospital Kano, North Western Nigeria.

CONTEXT:Human immunodeficiency virus (HIV) scourge continues to affect young women within the reproductive age group and pregnancy is a recognized indication for the use antiretroviral (ARV) drugs among HIV-positive women.AIMS:The aim is to determine the combined effect of pregnancy, HIV and ARV drugs on the hematological parameters of the pregnant women.SETTINGS AND DESIGN:This was a comparative cross-sectional study conducted among 70 each of HIV-positive and negative pregnant women.SUBJECTS AND METHODS:Bio-demographic and clinical data were extracted from the client folder and 4 ml of blood sample was obtained from each participant. Full blood count was generated using Swelab automatic hematology analyzer while reticulocyte count and erythrocyte sedimentation rate (ESR) were conducted manually.STATISTICAL ANALYSIS USED:Data analysis was performed using SPSS version software 16 while P < 0.05 was considered statistically significant.RESULTS:Pregnant women with HIV had statistically significant lower hematocrit and white blood cell (WBC) and higher ESR than pregnant women without HIV (P < 0.000). There was no statistically significant difference between the two groups in terms of platelet and reticulocyte (P > 0.05). However, among HIV positive pregnant women, those with CD4 count <350/μL had statistically significant lower WBC and lymphocyte count than those with CD4 count ≥350/μL (P < 0.05), whereas, those on zidovudine (AZT)-containing treatment had statistically significant lower hematocrit and higher mean cell volume than those on non-AZT-containing treatment (P < 0.05), but there was no statistically significant difference in any of the hematological parameters (P > 0.050) between women on first- and second-line ARV regimens.CONCLUSIONS:There is a significant difference in terms of hematological parameters between HIV-positive and HIV-negative pregnant women in this environment.

Comparison of Candidal Species in Oral and Cervical Smears in Human Immunodeficiency Virus Positive Women- A Prospective Study

Comparison of Candidal Species in Oral and Cervical Smears in Human Immunodeficiency Virus Positive Women- A Prospective Study

English

Women living with human immunodeficiency virus (HIV) infection have a higher burden of premalignant lesion of the cervix. This may be influenced by their sociodemographic profile. To study the sociodemographic determinants of abnormal cervical cytology among HIV-positive women attending the adult HIV clinic in Nnamdi Azikiwe University Teaching Hospital Nnewi (NAUTH), Nnewi, Nigeria, the Pap smears of 110 HIV-positive women attending the adult HIV clinic at the hospital were evaluated for cytological abnormalities using the Bethesda system of classification. Data on sociodemographic factors were obtained with the aid of semi structured questionnaires. Epi info statistical package was used to analyze the data. Majority of the women were married (61.8%; n=68), traders (67.3%; n=74) and who had attained at least secondary education (85.5%; n=94). All of them were Christians. The mean age and parity were 37.7±9.5 years and 2.8±2.3, respectively. The mean CD4 count was 557.1± 26 cells/ml and 89.1% (n= 98) of the women were on highly active antiretroviral therapy (HAART). The prevalence of cervical cytological abnormalities among the studied women was 28.2% (n=31). The mean age (35.4 vs. 38.9 years; p<0.05) was significantly lower among women with positive cervical cytological abnormalities and the prevalence of cytological abnormalities was significantly high among women aged 25 to 29 years (c2=9.30, p=0.05), traders (c2=10.7, p=0.03) and the Anglicans (c2=6.7, p=0.04). The prevalence rate was also the highest among women who were para 0-1 (36.6%), unemployed (100.0%), with no formal education (33.3%), and those who were separated from their husbands (100.0%), but these were not statistically significant. The prevalence of cervical cytological abnormalities among the HIV positive women attending the HIV clinic in NAUTH was high. Younger age, being a trader and Anglican Christian denomination were significantly associated with increased risk of premalignant lesions of the cervix. Key words: Cervical, cytological, premalignant lesions, human immunodeficiency virus (HIV) positive.

Cesarean delivery technique among HIV positive women with sub-optimal antenatal care uptake at the Douala General Hospital, Cameroon: case series report

BackgroundThe human immunodeficiency virus (HIV) pandemic is a serious public health problem worldwide, especially in low-income countries of sub-Saharan Africa (SSA). The prevention of mother to child transmission of HIV (PMTCT) is a major concern to those countries. Cesarean section has been described in the literature to be effective in the prevention of mother to child transmission (MTCT).Case series presentationWe present a series of seven cases of HIV positive pregnant women with sub-optimal antenatal care up-take who delivered by cesarean section at the Department of Obstetrics and Gynecology of the Douala General Hospital. During the cesarean section the fetal head was delivered through the uterine incision without rupture of amniotic membranes. The amniotic membranes were ruptured after delivery of the fetal head, and then the rest of the body was delivered.ConclusionsMost of the study participants had multiple risk factors for preterm labour. When a good cesarean section technique is used in women with high viral load and low CD4 counts, risk of MTCT HIV are greatly reduced even in low-income countries.

Effect of antiretroviral therapy on changes in the fertility intentions of human immunodeficiency virus-positive women in Addis Ababa, Ethiopia: a prospective follow-up study.

OBJECTIVESWith access to antiretroviral therapy (ART), people living with human immunodeficiency virus (HIV) are able to consider childbearing to a greater extent than previously. In many cases, ART has transformed their intentions to have children. The present study aimed to assess changes in fertility intentions 12 months after ART initiation among HIV-positive women in Addis Ababa, Ethiopia.METHODSAn institution-based follow-up study was conducted among 360 HIV-positive women in Addis Ababa. A logistic regression model was used to assess the influence of socio-demographic, reproductive health, and clinical characteristics on changes in the fertility intentions of women.RESULTSOverall, 40.8% (147 of 360) of the women reported that they desired to have a child in the future at the baseline visit, while 48.3% (174 of 360) did so at the 12-month follow-up. The proportion of women who reported that they desired to have a child 12 months after ART initiation was higher among ART-initiated women (55.8%, 106 of 190) than ART-naïve women (40.0%, 68 of 170). The adjusted analysis indicated that a change in fertility intentions between baseline and the follow-up visit was significantly associated with ART use (adjusted odds ratio [aOR], 2.47; 95% confidence interval [CI], 1.20 to 5.20) and marital status, with single (aOR, 5.33; 95% CI, 1.10 to 25.92) and married (aOR, 6.35; 95% CI, 1.44 to 27.99) women being more likely to report fertility intentions than divorced/widowed women.CONCLUSIONSART use was a significant predictor of change in fertility intentions between the baseline and follow-up visit, which suggests that additional efforts are necessary to integrate family planning and HIV services to address the safe fertility goals of women in the study area.

Randomized trial of stopping or continuing ART among postpartum women with pre-ART CD4 ≥ 400 cells/mm3.

BackgroundHealth benefits of postpartum antiretroviral therapy (ART) for human immunodeficiency virus (HIV) positive women with high CD4+ T-counts have not been assessed in randomized trials.MethodsAsymptomatic, HIV-positive, non-breastfeeding women with pre-ART CD4+ T-cell counts ≥ 400 cells/mm3 started on ART during pregnancy were randomized up to 42 days after delivery to continue or discontinue ART. Lopinavir/ritonavir plus tenofovir/emtricitabine was the preferred ART regimen. The sample size was selected to provide 88% power to detect a 50% reduction from an annualized primary event rate of 2.07%. A post-hoc analysis evaluated HIV/AIDS-related and World Health Organization (WHO) Stage 2 and 3 events. All analyses were intent to treat.Results1652 women from 52 sites in Argentina, Botswana, Brazil, China, Haiti, Peru, Thailand and the US were enrolled (1/2010-11/2014). Median age was 28 years and major racial categories were Black African (28%), Asian (25%) White (15%). Median entry CD4 count was 696 cells/mm3 (IQR 575–869), median ART exposure prior to delivery was 19 weeks (IQR 13–24) and 94% had entry HIV-1 RNA < 1000 copies/ml. After a median follow-up of 2.3 years, the primary composite endpoint rate was significantly lower than expected, and not significantly different between arms (continue arm 0.21 /100 person years(py); discontinue 0.31/100 py, Hazard ratio (HR) 0.68, 95% CI: 0.19, 2.40). WHO Stage 2 and 3 events were significantly reduced with continued ART (2.08/100 py vs. 4.36/100 py in the discontinue arm; HR 0.48, 95%CI: 0.33, 0.70). Toxicity rates did not differ significantly between arms. Among women randomized to continue ART, 189/827 (23%) had virologic failure; of the 155 with resistance testing, 103 (66%) failed without resistance to their current regimen, suggesting non-adherence.ConclusionsOverall, serious clinical events were rare among young HIV-positive post-partum women with high CD4 cell counts. Continued ART was safe and was associated with a halving of the rate of WHO 2/3 conditions. Virologic failure rates were high, underscoring the urgent need to improve adherence in this population.Trial registrationClinicalTrials.gov NCT00955968