Infants Of HIV-positive Mothers Research Articles

Prevalência de sífilis congênita em recém-nascidos expostos ao HIV

INTRODUCTION: The current epidemiological situation in Porto Alegre is worrying due to the high rates of vertical transmission of HIV, syphilis in pregnant women and congenital syphilis, making the evaluation of the prevalence of congenital syphilis in newborns exposed to HIV relevant. It is estimated that an analysis of the data found may lead to measures capable of assisting in the prevention of both infections. OBJECTIVES: To describe pregnancy coinfection HIV/syphilis data and the consequences to their newborns. METHODS: A retrospective cohort study of live births of HIV-positive mothers with and without gestational syphilis, born at Hospital de Clínicas of Porto Alegre from January 1st, 2013 to December 31th, 2017. RESULTS: A total of 440 newborns from HIV-positive mothers were divided into two groups: the first, with 392 infants of HIV-positive mothers without gestational syphilis, resulting in 3 HIV-infected infants (vertical transmission 0,7%); the second group, with 48 infants born from mothers with HIV/syphilis coinfection (prevalence of gestational syphilis 10,9%), with 64,6% needing hospitalization for congenital syphilis treatment, and 4 HIV-infected newborns (vertical transmission 8,3%). When compared the two groups, it was verified that this difference was statistically significant. CONCLUSIONS: The gestational and congenital syphilis prevalence in our hospital is alarming, and coinfection HIV/syphilis seems to be an independent risk factor to the vertical transmission of HIV.

Early Extended Neonatal Screening for Congenital Cytomegalovirus Infection: A Quality Improvement Initiative

Identification of congenital cytomegalovirus (cCMV) infection in neonates is important for early diagnosis of sensorineural hearing loss. Therefore, a quality improvement project was designed with an aim to improve newborn CMV screening by 25% from a baseline rate of 22%. This project was conducted across two hospital sites at one medical center with two tertiary care newborn nurseries and neonatal intensive care units. Symptomatic neonates with suggestive findings of cCMV, who had failed the newborn hearing screen, who had not had a hearing screen performed by 10 days of age, or who were infants of HIV-positive mothers were screened for cCMV. Serial interventions (formalized teaching sessions using an algorithm and involving a nurse educator, creation of electronic medical record order sets, huddle board reminders, and regular audits) were conducted, and statistical process control p-charts were used to identify any signals and to determine if there was any special cause variation. Of 5,817 infants born in 2018, 903 were eligible for screening. Small for gestational age (46%) was the most common indication for screening. After multiple interventions, the median screening rate increased from a baseline of 22% in 2016 to 74% during the one-year study period. Four infants had positive CMV screen and received appropriate treatment as a result of these interventions. Multidisciplinary quality improvement initiatives can improve newborn screening for cCMV infection in a tertiary care environment.

Outcome of infants of HIV positive mothers following administration of nevirapine drops at secondary level referral centre

Introduction: Prevention of transmission of HIV to new born and infants through the integration of preventive and care measures. Objective: To assess HIV transmission, adverse reactions and morbidity among neonates and infants born to HIV positive mothers till 18months of age over a period of 10 years by prevention of mother to child transmission of HIV. Methods: The study was conducted atDepartment of Obstetrics and Gynecology and Department of Paediatrics, secondary level referral centre, MCH block, District hospital, Vizianagaram, Andhra Pradesh, India. The data was collected during May2009 to May 2018 from records of maternal details registered at PPTCT clinic as well as list of infants undergoing Early Infant Diagnosis (EID) recorded in the standard format as per instructions from National AIDS Control Organization (NACO) of India.The study was based on administration of Nevirapine drops and Cotrimoxazole syrup as per the guidelines of National AIDS Control Organization (NACO). Results: A total of 68,000 babies were born during 2009 to 2018, of which 63320 were live born, among them 152 were born to HIV positive mothers. All the 152 babies were given Nevirapine drops immediately after delivery followed by cotrimoxazole syrup and tested for HIV antibodies at 6 months, 12 months and 18months of age. Amongst all the babies born to HIV positive mothers, only one baby was HIV reactive, and moreover no baby developed any life threatening adverse reaction in this study. Conclusion:The follow up study of new born babies of HIV positive mothers on Nevirapine drops is found to be effective and may be continued as per the guidelines of NACO.

Evaluation of Adherence to Nevirapine for Prevention of Mother-to-Child Transmission amongst Infants of HIV Positive Mothers in the First 6 Weeks of Life in Lagos Nigeria

Background: Over 90% of infection in children is acquired through mother to child transmission (MTCT). Nevirapine’s efficacy, safety and affordable cost make it the most preferred non-nucleoside reverse transcriptase inhibitor (NNRTI) for paediatric prophylactic use in resource limited settings. There are very few studies on pediatric adherence to antiretroviral prophylaxis, especially in very young infants. The objective of the study was to evaluate the adherence to nevirapine for prevention of mother to child transmission (PMTCT) amongst infants of HIV positive mothers in the first 6 weeks of life. Methods: This was a questionnaire based prospective cross-sectional multicenter study initiated in July 2015 and concluded in December 2017. The study was carried out at the Aids Prevention in Nigeria (APIN/HIV) human immunodeficiency paediatric clinics of the Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos State, 68 Nigerian Army Reference Hospital Yaba (68NARHY) Lagos, Nigeria and the Holy Family Catholic Hospital, Festac Town, Amuwo Odofin, Lagos State. Nevirapine adherence, in infants of 0 - 6 weeks was measured by maternal verbal reports. Results: Eighty-one (81) infants receiving nevirapine within the age of 0 - 6 weeks completed the study. Majority of the infants started treatment at birth (32%) and after 4 weeks (31%). 54% of the 81 respondents do not miss or skip their doses while 46% of respondents skip doses. Majority of the respondents 18 (49%) missed their doses for 24 - 48 hours while 25% missed their doses because they were away from home and 23% ran out of pills. 85.2% took ≥95% of the prescribed medications (good or high adherence ), 8.2% took 80% - 95% of doses (moderate adherence) while 6.2% took 0.05). Conclusions: The adherence rates found in this study are comparable to other studies in developing countries. But these rates are still low for good clinical outcomes. Different levels of adherence were documented with the majority having good or high adherence. Not all of the infants started treatment at birth and Institutional delivery should be encouraged to improve early initiation of prophylaxis. The finding of patients with low adherence rates among the study population calls for intensification of counselling on adherence and should continue to be an integral part of prevention of mother to child transmission. Improved access to antiretroviral agents and improved care delivery systems are important.

Has Knowledge Influenced Right Choice? Assessing the Feeding Practices for Infants of HIV Positive Mothers in a Rural Northern Nigeria

Has Knowledge Influenced Right Choice? Assessing the Feeding Practices for Infants of HIV Positive Mothers in a Rural Northern Nigeria

Effectiveness of Early Infant Diagnosis (EID) in Detecting the Serostatus of HIV-Exposed Infants and Children.

Although interventions to prevent mother-to-child transmission of HIV infection are being increasingly implemented as a part of national guideline, the prevalence of pediatric HIV remains high. There is remarkable increase in survival if HIV-infected children have access to early infant diagnosis (EID) and treatment. The study was conducted in the Department of Obstetrics and Gynecology Medical College, Kolkata from July 2011 to February 2014 after obtaining approval from the institutional ethics committee. All the infants of HIV-positive mothers who came for EID between 6weeks to 18months of age during the study period were included in the study. A total number of 151 infants were included in the study and divided into Group A and B according to the time of first testing. It was a prospective observational longitudinal study. Data were collected from the EID register of PPTCT unit Medical College Kolkata. EID was done as laid out in the pediatric ART (anti-retroviral therapy) guidelines of the National AIDS Control Organization. Effectiveness of EID is judged by the corroboration of results at 6week, 6 and 18 months. Comparing the results in group A, we found that 10.26, 8.41, and 7.29% were positive at 6weeks, 6 and 18months, respectively, and with p value of 0.5828 the differences were not statistically significant. In group B, we observed that 47.06 and 45.45% were positive at 6 and 18months, respectively. Analysis revealed a p value of 0.9072 indicating no significant statistical difference between the results of testing in different periods. This reflects a good correlation between the 6weeks, 6 and 18 months value, thus establishing the integrity of the EID. Ultimate integrity of the PPTCT is judged by testing the child. EID is a novel procedure which aims at earlier diagnosis and initiation of treatment in the children.

Evaluation of spaced education as a learning methodology for in-service training of health workers in Ethiopia

Participation in in-service training can be a challenge for health workers, especially those stationed in remote areas. Spaced education is an innovative learning methodology that can be delivered electronically by Internet or mobile smartphone. This pilot study, which followed a convenience sample of 37 Ethiopian nationals enrolled in a spaced education course over a six-month period, attempted to determine the acceptability and effectiveness of the methodology in a low-resource context. The course content was co-developed by Ethiopian and international nutrition experts and focused on the recently revised Ethiopian Federal Ministry of Health (FMOH) guidelines on the feeding of infants of HIV-positive mothers. Conducted by the US Agency for International Development (USAID)-funded CapacityPlus project, led by IntraHealth International, the study suggests that the Internet-based spaced education methodology is acceptable and effective for the acquisition of knowledge in a low-resource context for course participants with a clinical or public health background and moderately reliable Internet access. More research is needed to test the feasibility, acceptability, and effectiveness of the methodology among a wider population of health workers in developing countries, and particularly among government and volunteer health workers in rural and remote settings.

Paternal Involvement and Fetal Morbidity Outcomes in HIV/AIDS

Prior research indicates that infants with absent fathers are vulnerable to unfavorable fetal birth outcomes. HIV is a recognized risk factor for adverse birth outcomes. However, the influence of paternal involvement on fetal morbidity outcomes in women with HIV remains poorly understood. Using linked hospital discharge data and vital statistics records for the state of Florida (1998-2007), the authors assessed the association between paternal involvement and fetal growth outcomes (i.e., low birth weight [LBW], very low birth weight [VLBW], preterm birth [PTB], very preterm birth [VPTB], and small for gestational age [SGA]) among HIV-positive mothers (N=4,719). Propensity score matching was used to match cases (absent fathers) to controls (fathers involved). Conditional logistic regression was employed to generate adjusted odds ratios (OR). Mothers of infants with absent fathers were more likely to be Black, younger (<35 years old), and unmarried with at least a high school education (p<.01). They were also more likely to have a history of drug (p<.01) and alcohol (p=.02) abuse. These differences disappeared after propensity score matching. Infants of HIV-positive mothers with absent paternal involvement during pregnancy had elevated risks for adverse fetal outcomes (LBW: OR=1.30, 95% confidence interval [CI]=1.05-1.60; VLBW: OR=1.72, 95% CI=1.05-2.82; PTB: OR=1.38, 95% CI=1.13-1.69; VPTB: OR=1.81, 95% CI=1.13-2.90). Absence of fathers increases the likelihood of adverse fetal morbidity outcomes in women with HIV infection. These findings underscore the importance of paternal involvement during pregnancy, especially as an important component of programs for prevention of mother-to-child transmission of HIV.

143 HIV Transmission: The Role of Neutralizing Antibodies

At present, it is unknown whether the presence of HIV-specific neutralizing antibodies (NAbs) provides any protection from infection in individuals naturally exposed to HIV. Although here is evidence that select NAbs can protect in the SHIV/macaque model, these studies were limited to analysis of a few select neutralization sensitive challenge strains that are not representative of circulating HIV. We have examined whether NAbs, when present at the levels found in natural HIV-infection, can reduce the risk of HIV acquisition using two cohorts: 1) HIV positive high-risk women who continue to be exposed to new source partners and 2) breastfeeding infants of HIV positive mothers, who may have HIV NAbs through passive transfer. Both of these settings provide a situation in which the individual has pre-existing HIV-specific antibodies at the time of exposure to HIV. Among high-risk women, those who became superinfected by a second partner did not show evidence of notably weak or narrow NAb responses at the time of superinfection compared to women who did not become superinfected. In infants, the presence of broad potent neutralizing antibodies did not impact of their risk of HIV acquisition after birth. Together, these studies suggest that neutralizing antibodies that are elicited by a natural HIV infection are not of sufficient breadth or potency to protect against diverse circulating strains of HIV-1.

Breastfeeding in mothers with HIV

As paediatricians, we advocate for breastfeeding as the most beneficial form of infant nutrition. However, when the mother has human immunodeficiency virus (HIV), infection breastfeeding can potentially harm the infant because of mother-to-child transmission (MTCT) of the virus. The first documented case of MTCT of HIV through breastfeeding occurred in Australia in 1983. The World Health Organisation (WHO) estimates that more than 200 000 of the 500 000 new HIV infections that occur each year in children are the result of transmission of the virus through the mother’s breast milk. For many HIV-infected women in resource-poor countries, there is no safe alternative to breastfeeding available. The WHO currently recommends that where there are no affordable, safe, acceptable alternatives, HIV-infected women should exclusively breastfeed their children up to the age of six months and then wean rapidly. In resource-poor countries, this reduces infant mortality irrespective of the mother’s HIV status. This is in contrast to the developed world where interventions to prevent MTCT generally include maternal highly active antiretroviral therapy (HAART) during pregnancy, elective caesarean section and avoidance of breastfeeding, reducing transmission to 1–2%. We recently were involved in the antenatal care of a woman with HIV infection who was clinically well (CD4+ count of greater than 500 ¥ 10/mL), who had commenced HAART during pregnancy as part of a MTCT risk reduction strategy and who had an undetectable viral load. When discussing with her our recommendations for infant feeding (i.e. that all infants of HIV-positive mothers should be formula-fed), it became apparent that she intended to breastfeed her infant. We took the view that we had a duty of care to protect the infant from potential exposure to HIV and strongly recommended that the infant should not receive breast milk. What is the evidence to support our recommendations? Is the risk to the infant sufficient to justify taking action to protect the child from exposure to HIV in breast milk?

The Effect of Bifidobacterium lactis on the Growth of Infants: A Pooled Analysis of Randomized Controlled Studies

Background/Aims: Breast milk is the best source of nutrition for the growth of the newborn infant. It is therefore essential that mothers who cannot breastfeed or choose not to are provided with alternatives that closely match the composition and functionality of breast milk. This study aimed to investigate the growth effects of probiotic-supplemented formulas on both healthy and vulnerable populations of infants. Methods: A meta-analysis of data from 5 randomized controlled clinical trials that included infants fed formulas containing a probiotic Bifidobacterium lactis CNCM I-3446 was performed (n = 525). A sub-analysis was performed among infants of HIV-positive mothers (n = 120). Growth measurements (gain in weight and body mass index, BMI, from enrollment to 120 days) were compared between infants fed a formula containing B. lactis and those fed a control formula. Changes in length and Z-scores were also compared. Results: Formula with B.lactis was demonstrated to be at least as good as formula without B. lactis in the meta-analysis of 5 studies. The lower boundary of the 95% confidence interval (CI) of the differences in mean weight gain (95% CI 0.09–2.93 g/day) was above the predefined non-inferiority margin of –3.0 g/day. Moreover, among infants with HIV-positive mothers, weight gain of those taking B. lactis was significantly higher than of those not taking B. lactis, by 3.1 g/day (95% CI 0.4–5.8 g/day, p = 0.0226) and the BMI gains were significantly higher, by 6.4 g/m²/day (95% CI 0.0.3–12.5 g/m²/day, p = 0.0400). The corresponding weight for age and BMI Z-scores were also significantly higher, by 0.37 (95% CI 0.03–0.71, p = 0.0308) and by 0.42 (95% CI 0.02–0.83, p = 0.0377), respectively, whereas differences in length gain or length-for-age Z-score were not significant. Among infants in the non-HIV mothers group, there were no significant differences between infants fed formulas with or without B. lactis, for any of the growth parameters. Conclusions: The analysis suggests that B. lactis may have a positive effect on growth in vulnerable populations, specifically in infants born to mothers with HIV.

Simultaneous determination of HIV antibodies, hepatitis C antibodies, and hepatitis B antigens in dried blood spots –a feasibility study using a multi-analyte immunoassay

HIV in particular, as well as hepatitis B and C, present a burden on healthcare systems worldwide. Early detection of these diseases may prevent further infections and improve the outcome for patients. In particular, transmission of HIV from mother to child can be significantly reduced when preventive measures are taken before birth. We have developed and optimized a method for the simultaneous detection of HIV 1 and hepatitis B and C from dried blood specimens using the Luminex multi-analyte profiling technology (LabMap). Dried blood spots provide a convenient method for mailing, analysis and storage of samples. Specimens from known HIV-positive children (n=46) as well as hepatitis B- (n=8) and hepatitis C-positive patients (n=7) tested positive in our assay. Storage for up to 10 years did not interfere with the test in the case of HIV-positive patients. Results for five different antibodies and one antigen were obtained in approximately 80 seconds. Furthermore, antibody levels in infants of HIV-positive mothers were monitored over a period of 1 year. Antibodies were no longer detectable after 260-360 days, which compared well with results independently obtained by ELISA and Western blot analysis. We demonstrated the feasibility of the simultaneous detection of infectious diseases from dried blood. Our novel method also provides a convenient tool for monitoring children from HIV-positive mothers and for possible screening efforts.

The relationship of maternal and child HIV infection to security of attachment among Ugandan infants.

This study was designed to examine the relationship of maternal and child human immunodeficiency virus (HIV) infection to the security of attachment of Ugandan infants. The attachment patterns of two groups of Ugandan mother-infant pairs: 35 HIV-positive mothers and their infants and 25 HIV-negative mothers and their infants were compared. We tested the hypothesis that infants of HIV-positive mothers would demonstrate less secure attachment as measured by the Waters Attachment Q-set than infants of HIV-negative mothers. No differences were found in the security of attachment of infants of HIV-positive versus HIV-negative mothers. Infants of HIV-positive mothers with Acquired Immunodeficiency Syndrome (AIDS) were less securely attached than infants of mothers without AIDS. These findings underscore the relationship of infant security of attachment to maternal HIV infection in the presence of AIDS-related symptoms but not to asymptomatic maternal HIV infection.

Incidence of premature birth and neonatal respiratory disease in infants of HIV-positive mothers

Objective: We sought to determine the prematurity rate in infants of HIV-positive mothers and to characterize the incidence and severity of neonatal respiratory disease in this population. Study design: From 1990 to 1994, 600 live-born infants of HIV-infected mothers were enrolled prenatally (73%) or postnatally (27%) from five U.S. centers. Logistic regression was used to determine the association of HIV status in the infant with prematurity (≤37 weeks), low birth weight (≤2.5 kg), and very low birth weight (≤1.5 kg) rates. The incidence of respiratory distress syndrome (RDS), bronchopulmonary dysplasia, meconium aspiration syndrome, and neonatal pneumonia was compared with anticipated rates for gestational age and birth weight. Results: Very high rates of prematurity (19%), low birth weight (18.3%), and very low birth weight (3.3%) were found in the infants of HIV-positive mothers; and HIV infection in the infant was associated with younger gestational age. The overall incidence of RDS was 3% (17/600), which coincided with the anticipated rate, after adjusting for prematurity and birth weight. Only five infants (all ≤ 1.5 kg) had bronchopulmonary dysplasia, and none required assisted ventilation beyond 14 days. Three term infants had mild meconium aspiration syndrome, and there were no cases of documented neonatal pneumonia. Conclusion: Infants born to HIV-positive mothers exhibited high prematurity and low birth weight rates, and the odds of prematurity were higher in infants who were infected with HIV. Despite the high incidence of prematurity and perinatal risk of this population, incidence and severity of neonatal respiratory disease were not higher than would be expected from available neonatal data in populations not exposed to HIV. (J Pediatr 1997;131:851-6)

RISK OF PREMATURITY AND NEONATAL RESPIRATORY DISEASE ASSOCIATED WITH MATERNAL HIV INFECTION. † 1354

We sought to determine the impact of HIV in pregnancy on rates of prematurity, low birth weight (LBW), and neonatal respiratory morbidity in the offspring of HIV positive mothers. From 1990 to 1994, 599 neonates born to HIV positive mothers (51% black, 12% white, 31% Hispanic, 6% others) were enrolled at five centers in the U.S. Of the 599, 92 were HIV positive, 454 were HIV negative, and 53 died or were lost to followup. Incidence of respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), meconium aspiration syndrome (MAS), and neonatal pneumonia was compared to anticipated rates for HIV unexposed neonates of comparable gestation and birth weight. Rates of prematurity (<37 weeks), LBW (<2.5 kg), and VLBW (<1.5 kg) were 19, 17.7, and 3.3%, respectively in the infants of HIV positive mothers, greatly exceeding comparable rates for the U.S. population, corrected for race. The incidence of RDS was 3% (17/599) which coincided with the anticipated rate after adjusting for prematurity and birth weight. Of 16 infants <1.5 kg, 31% (5/16) developed BPD. Only 3/599 infants developed mild MAS and none had documented neonatal pneumonia. Lower gestational age (weeks) was associated with increased odds of HIV infection (p=0.01) in the infants after adjusting for race. We conclude that 1) infants born to HIV positive mothers exhibit very high prematurity and LBW rates; 2) the odds of prematurity are higher in infected (vs uninfected) infants; and 3) the incidence and severity of neonatal respiratory morbidity are no higher than available data from HIV unexposed neonates. We speculate that good prenatal and neonatal care can minimize respiratory morbidity in this high risk population.

Perinatal transmission of HIV-1

We present the baseline results of a prospective cohort study on the perinatal transmission of HIV-1 in Kigali, Rwanda. HIV-1-antibody testing was offered to all women of urban origin delivering a live newborn at the maternity ward of the Centre Hospitalier de Kigali from November 1988 to June 1989; 218 newborns of 215 HIV-positive mothers were matched to 218 newborns of 216 HIV-negative mothers. The matching criteria were maternal age and parity. No differences in socioeconomic characteristics were observed between HIV-positive and HIV-negative women. HIV-positive mothers more frequently reported a history of at least one death of a previously born child (P less than 0.01) and a history of abortion (P less than 0.001). Most of the HIV-positive women were asymptomatic, but 72.4% of them had a CD4; CD8 ratio less than 1 versus 10.1% in the HIV-negative group (P less than 0.001). The frequency of signs and symptoms was not statistically different in the two groups, except for a history of herpes zoster or chronic cough, which was more frequent among HIV-positive women. The rates of prematurity, low birth weight, congenital malformations and neonatal mortality were comparable in the two groups. However, infants of HIV-positive mothers had a mean birth weight 130 g lower than the infants of HIV-negative mothers (P less than 0.01). The impact of maternal HIV-1 infection on the infant seems limited during the neonatal period.