Management Of HIV In Pregnancy Research Articles

National trends in mode of delivery among patients with HIV, 2000-2018

Management of HIV in pregnancy has changed considerably in the past 20 years. Since 2000, ACOG has recommended scheduled cesarean delivery (CD) for women with HIV with viral load >1000 copies/ml. We sought to describe trends in cesarean and operative vaginal delivery (OVD) among women with HIV in the United States.

HIV infections and HIV testing during pregnancy, Germany, 1993 to 2016.

BackgroundElimination of mother-to-child transmission (MTCT) of HIV by 2020 is a goal of the World Health Organization (WHO) action plan for the European Region. However, data to monitor progress towards MTCT elimination are not readily available in Germany.AimWe aimed to estimate the number of pregnant women with HIV and MTCT rates in Germany.MethodsWe triangulated retrospectively obtained data from: (i) healthcare reimbursement for HIV screening tests, (ii) a statutory health insurance subsample of prevalent and incident HIV diagnoses among pregnant women, (iii) a mathematical model of the German HIV epidemic with number, region of origin and risk factors for women of childbearing age, and (iv) the statutory anonymous HIV registry on children infected through HIV MTCT.ResultsThe number of women aged 15–49 years with HIV increased from ca 6,000 in 1993 to ca 11,000 in 2016. Risk of injecting drug use (IDU) declined from 65% in 1993 to 16% in 2016. The annual proportion of women living with HIV giving live birth increased from a mean of 1.9% during 1993 to 1998 to 4.9% in 2011 to 2015. HIV screening rates during pregnancy increased from ca 50% in 2001 to ca 90% in 2016. The HIV MTCT rate dropped from 6.8% in 2001 to 1.1% in 2016.ConclusionsThe population of women living with HIV in Germany shifted from predominantly IDU-associated infections to predominantly sexually acquired infections, while fertility rates more than doubled. MTCT rates dropped, mainly because of improved detection and management of HIV in pregnancy.

Comparison of two combined antiretroviral treatment regimens in the management of HIV in pregnancy: an observational study

Objective Combined antiretroviral therapy (cART) in pregnancy traditionally included two nucleoside reverse transcriptase inhibitors plus 1 protease inhibitor (PI). Recently, integrase strand transfer inhibitors (INSTI) have been approved for use in pregnancy. We sought to compare the rate of undetectable VL near delivery in pregnant HIV-infected women receiving INSTI-based versus PI-based cART. Material and methods Prospective cohort study (January 2010–March 2017) of pregnant HIV-infected pregnancies receiving care in a single obstetric infectious disease clinic. Included pregnancies (total = 171; INSTI − group = 111, PI − group = 60) had at least 2 VL (before and after intervention) during pregnancy. The primary outcome was the rate of undetectable VL near delivery. Results We found comparable rates of undetectable HIV VL near delivery in pregnancies treated with INSTI-cART (74/111, 66.7%) compared to PI-cART (34/60, 56.7%; [adjusted p = .116, RR 1.26, 95% CI 0.92–2.59]). Compared to the PI-group, pregnancies in the INSTI-group showed lower median HIV VL near delivery (20 versus 50 copies/mL; adjusted p = .0454) and greater VL reduction (adjusted p = .0185). There were 3/171 (1.75%) infants diagnosed with HIV, 1 in the INSTI-group and 2 in the PI-group (p = .5635, RR 0.51, 95% CI 0.10–2.53). Conclusion Pregnant HIV-infected women receiving either INSTI- or PI-based cART achieved comparable rates of undetectable HIV VL near delivery with similar perinatal transmission.

British HIV Association guidelines for the management of HIV in pregnancy and postpartum 2018.

British HIV Association guidelines for the management of HIV in pregnancy and postpartum 2018.

Selenium deficiency and pregnancy outcome in pregnant women with HIV in Lagos, Nigeria.

To investigate the prevalence of maternal selenium deficiency and its effects on pregnancy outcomes in pregnant women with HIV in Lagos, Nigeria. The present descriptive cross-sectional study enrolled women aged 15-49years with HIV who were at 14-26weeks of a singleton pregnancy and were attending Lagos University Teaching Hospital, Lagos, Nigeria, between August 1, 2016, and April 30, 2017. Participants were selected by consecutive sampling and baseline data were collected through interviews. Venous blood samples were obtained to measure selenium concentrations, and associations between low maternal selenium concentrations (defined as <0.89μmol/L) and pregnancy outcomes were examined using bivariate and multivariate analysis. The final analysis included 113 patients; selenium deficiency was recorded in 23 (20.4%) patients. Women with selenium deficiency had an approximately eight-fold higher risk of preterm delivery (adjusted odds ratio 7.61, 95% confidence interval 4.37-18.89; P=0.031) and of delivering a term neonate with a low delivery weight (adjusted odds ratio 8.11, 95% confidence interval 3.27-17.22; P=0.012), compared with women with a normal selenium concentration. The prevalence of selenium deficiency among pregnant women with HIV in Lagos was relatively high. The significant associations observed between maternal selenium deficiency and adverse pregnancy outcomes could have implications for the future management of HIV in pregnancy.

UK national clinical audit: management of pregnancies in women with HIV

BackgroundThe potential for HIV transmission between a pregnant woman and her unborn child was first recognized in 1982. Since then a complex package of measures to reduce risk has been developed. This project aims to review UK management of HIV in pregnancy as part of the British HIV Association (BHIVA) audit programme.MethodsThe National Study of HIV in Pregnancy and Childhood (NSHPC), a population-based surveillance study, provided data for pregnancies with an expected delivery date from 1/1/13 - 30/6/14. Services also completed a survey on local management policies. Data were audited against the 2012 BHIVA pregnancy guidelines.ResultsDuring the audit period 1483 pregnancies were reported and 112 services completed the survey. Use of dedicated multidisciplinary teams was reported by 99% although 26% included neither a specialist midwife nor nurse. 17% of services reported delays >1 week for HIV specialist review of women diagnosed antenatally. Problematic urgent HIV testing had been experienced by 9% of services although in a further 49% the need for urgent testing had not arisen. Delays of >2 h in obtaining urgent results were common.Antiretroviral therapy (ART) was started during pregnancy in 37% women with >94% regimens in accordance with guidelines. Late ART initiation was common, particularly in those with a low CD4 count or high viral load.Eleven percent of services reported local policy contrary to guidelines regarding delivery mode for women with a VL <50 copies/mL at ≥36 weeks. According to NSHPC reports 27% of women virologically eligible for vaginal delivery planned to deliver by CS.ConclusionsPregnant women in the UK are managed largely in accordance with BHIVA guidelines. Improvements are needed to ensure timely referral and ART initiation to ensure the best possible outcomes.

The management of HIV in pregnancy: A 10-year experience

ObjectiveThe package of care to reduce HIV mother to child transmission (MTCT) has evolved significantly since trials of ante and intrapartum antiretroviral therapy (ART) in 1994. In the UK MTCT rate has fallen from 25.6% in the 1990s to 0.46%. We review the management of HIV in pregnancy in Brighton in the context of evolving guidelines. Study designHIV, obstetric and neonatal notes of all HIV positive women, pregnant between 2003 and 2014, were reviewed. Results97 pregnancies in 75 women were identified, resulting in 79 live births. Antenatal HIV diagnosis was made in 22 (28%). The proportion of pregnancies in those with known HIV at conception increased over the time period. At conception 58 (60%) were on ART, 33 (57%) of who continued on their original regimen. 34 (35%) initiated ART following conception: 14 known to be HIV positive, 20 diagnosed during pregnancy. Two did not start ART (1 due to miscarriage, 1 as diagnosed post-delivery) and in three cases ART history was unavailable due to transfer to alternative centres. ART was initiated on average at 22 weeks gestation (range 6–34). 4(5%) received Zidovudine (AZT) monotherapy, all before 2006. Choice of combination ART (cART) varied with time reflecting changing guidelines. Prior to 2008 an AZT containing regimen was used in 83% versus 8% after. Planned mode of delivery was documented in 73: 30(41%) planned a normal vaginal delivery (NVD), 43(59%) a caesarean section (CS).The viral load (VL) was <50copies/mL in 58(76%) at 36 weeks and 64(84%) at delivery. 90% with a detectable VL at 36 weeks delivered via CS. 100% received neonatal post-exposure prophylaxis (PEP): 68(88%) AZT monotherapy, 9(12%) cART. 84% initiated PEP within four hours. 90% completed 28days. 8(10%) babies experienced side effects. In the 10-year review period, one infant (1.3%) was diagnosed HIV positive. Both mother and infant received care in accordance with guidelines, including neonatal PEP within 4hours. ConclusionCare of the HIV positive pregnant woman in Brighton has been successful with overall transmission consistent with that seen nationally. Despite effective preventative strategies MTCT remains a risk and women should be counselled accordingly.

Female perspectives of male partners' inclusion in the prevention of mother-to-child HIV transmission programme in KwaZulu-Natal.

BackgroundThe South African government intervened by implementing the prevention of mother–to-child transmission programme (PMTCT) to curb the HIV transmission from mother to child during and after pregnancy. The PMTCT programme has been at the forefront of global prevention efforts since 1998. Without treatment, the risk of transmission ranges from one in five to one in two newborns; however, the risk of mother-to-child transmission can be reduced to as low as 2%–5% with evidenced interventions. Sub-Saharan Africa, and most particularly South Africa, is the most affected by the pandemic despite having the largest financial investment in PMTCT services across the continent.ObjectivesThe objectives of the study were to describe and explore the female perspectives of male inclusion in the prevention of mother-to-child HIV transmission programme in KwaZulu-Natal.MethodologyA qualitative, descriptive, explorative study was conducted through in-depth individual interview of pregnant women until data saturation.ResultsThe findings of the study revealed that the existing design of public hospitals was not wholly conducive to facilitating male inclusion in maternal and child health services. Resources were largely insufficient to support the participation of pregnant mothers and any attempts to support the inclusion of males needed to be based on a clear increase in service provision.ConclusionThe study recommended male partners’ inclusion in the prevention of mother-to-child HIV transmission to support effective management of HIV in pregnancy and PMTCT programmes. The inclusion of men will provide the holistic support needed by pregnant women on PMTCT programmes.

Gender Inclusiveness in Prevention of Mother to Child Transmission Programme in KwaZulu-Natal: Male Perspectives

Background: Most developing and developed countries require PMTCT to preserve humanity and children’s survival. All dynamics around PMTCT implementation seek commitment from all stakeholders at different levels to ensure elimination of new HIV infections in children. In 2010, 48% of pregnant women living with HIV in low and middle income countries (716 500 of 1.49 million) received effective antiretroviral regimens excluding single dose nevarapine. An estimated 35% of pregnant women living with HIV in low and middle countries received an HIV test in 2010, up from 7% in 2005. HAART coverage has increased from 1.48 million infants born to mothers living with HIV to 32% to 42%. Objectives: The purpose of the study was to explore and describe the range of barriers and motivational factors for gender inclusiveness within the (Prevention of mother to child transmission) PMTCT programme in public hospitals in KwaZulu-Natal as perceived by males. Methodology: A qualitative, descriptive, explorative study was conducted through individual interview of males until data saturation. Results: The findings of the study reveal that; males were not aware of their role in the prevention of mother to child transmission and did not feel comfortable to be in the mist of pregnant women. Conclusion: The study recommends intense male recruitment into PMTCT to ensure effective management of HIV in pregnancy and to prevent MTCT. This will ensure a holistic support needed by pregnant women on PMTCT.

Adverse outcomes of pregnancy in HIV-positive women in the era of HAART: a perspective from an outer London centre in the UK

Background : Increasing number of women with HIV are choosing to become pregnant as there is dramatic reduction in the risk of vertical transmission. However, management of HIV in pregnancy still poses a variety of challenges and adverse pregnancy outcomes are still common. We aimed to explore the factors associated with adverse outcomes of pregnancy in our HIV cohort. Methods : It is a retrospective case note review of all the women attended our unit and had HIV care from 2008-2011. A total of 87 women were followed up. Three women had two pregnancies during the study period. Data collected from Genitourinary Medicine and maternity records were analysed using SPSS program. Results : Mean age was 34 yrs ranging from 20-43 yrs. Majority (91%) were of African origin; 67% had HIV subtype C; 26% resistant to one or more class of HIV drugs; 55% had a nadir CD4 fewer than 350; 44% diagnosed at an antenatal setting and 62% were planned pregnancies. Prior to the current pregnancy, these women had 121 children: 5% of the children have HIV and 33% not tested for HIV. Of the partners, 38% have HIV and 73% were aware of their partner's HIV status. None of the children born during the study period were infected with HIV; mean birth weight was 2789 g; there were 3 sets of twins; one still birth and one child died soon after birth. Around 46% were on anti-retroviral therapy (ART) during conception, 6% had miscarriages and 16% had emergency caesarean sections. At delivery, viral load was detectable in 23%, mainly due to poor adherence (11%) and late presentation (9%). 38% of the women experienced an obstetric complication, premature labour 9%; premature rupture of membranes and gestational diabetes both accounted to 4% whilst 3% had post-partum haemorrhage. On ART during conception and late HIV diagnosis that is nadir CD4, less than 350 cells were significantly associated (P< 0.05) with having a foetal complication such as prematurity 8%, low birth weight 7% or having a foetal abnormality 2.3%. There was no significant association between 1st and 2nd trimester ART exposure and adverse pregnancy outcomes such as prematurity, low birth weight or foetal abnormality. Conclusion : Late diagnosis of HIV and ART during conception is significantly associated with adverse outcomes of pregnancy. Widespread HIV testing is essential and has to be extended to non-traditional settings. In addition, more studies are needed on ART exposure and adverse pregnancy outcomes. (Published: 11 November 2012) Citation: Abstracts of the Eleventh International Congress on Drug Therapy in HIV Infection Thayaparan P et al. Journal of the International AIDS Society 2012, 15 (Suppl 4):18238 http://www.jiasociety.org/index.php/jias/article/view/18238 | http://dx.doi.org/10.7448/IAS.15.6.18238

Managing HIV in pregnancy in a community-based sexual health clinic: a decade in review

The management of HIV in pregnancy has evolved significantly over the past 10 years as our experience of combination antiretroviral therapy (ART) has grown. We reviewed 109 pregnancies which were managed at our community-based integrated HIV and sexual health clinic to investigate preconception and antenatal care, and trends in ART over time. We document an increasing proportion of pregnancies in which the mother was aware of her HIV status pre-conception and conception on ART. Pre-conception care was sought in a minority of cases, and many women did not present for first antenatal review until the end of the second trimester. Of 108 live births, there was one case of vertical transmission (0.93%). While our study demonstrates the efficacy of current strategies to prevent mother to child transmission of HIV infection, more could be done to encourage HIV-positive women to seek preconception advice and to attend for early review in the first trimester.

Audit of the Perinatal Recommendations from the 'Perinatal Transmission of HIV in England, 2002-2005' Report: Category: Scientific free paper

In 2007, a report was published documenting the findings of an audit regarding perinatal transmission of HIV undertaken by the Audit, Information and Analysis Unit (AIAU), the National Study of HIV in Pregnancy and Childhood (NSHPC), and the Children's HIV Association (CHIVA). This report set out perinatal recommendations aimed to improve diagnosis and management of HIV in pregnancy to further reduce mother-to-child transmission rates, and ultimately reduce childhood incidence of HIV infection.

Changing management of HIV in pregnancy: service development following the introduction of universal antenatal screening

Universal antenatal screening for HIV was introduced in 2000 with the aim of screening 90% of the population and offering interventions to those infected; aiming to reduce the incidence of...

Zidovudine monotherapy in pregnancy: is it state of the art?

Sir, In their editorial ‘Zidovudine monotherapy in pregnancy: is it state of the art?’ Katzenstein and Gerstoft [1] suggest that the inclusion of zidovudine monotherapy (ZDVm) in the latest version of the British HIV Association (BHIVA) guidelines [2] for the management of HIV in pregnancy might be ‘a remnant from an earlier recommendation that has not been formally disqualified by clinical studies’. We would suggest that there is a more positive case and here consider their four aims of antiretroviral (ARV) therapy in pregnancy in this light.

HIV and Pregnancy

HIV is becoming more prevalent in the UK, and is being increasingly detected in asymptomatic women during antenatal screening. Taunton &amp; Somerset Hospital wrote an ICP document for the management of HIV in pregnancy according to their Trust policy, and it is presented here.

Management of HIV in pregnancy: a clinical review

Context: The prevalence rate of HIV infection in pregnant women in some African countries is over 30 percent. HIV may adversely affect pregnancy outcome leading to spontaneous abortion, premature delivery, intrauterine growth restriction and low birth weight infants. The natural perinatal transmission risk varies from 15-45%. With improved scientific knowledge in antiretroviral therapy, obstetric care and infant feeding practices, it is now possible to achieve and sustain satisfactory maternal health and prevent perinatal transmission. The application of these strategies has resulted in substantial reduction in perinatal transmission risks (less than 2%) in developed countries. Objective: This article reviews the specific strategies in the management of HIV positive pregnant woman. It is also meant to serve as guide to health workers who provide care for HIV positive pregnant women.Methodology: Extensive literature search and review of journal/internet articles, WHO publications, international and local guidelines on management of HIV in pregnancy. Conclusion: Within the setting of maternity services, HIV positive women can be diagnosed and managed appropriately. The care should be multidisciplinary, sensitive, non-stigmatizing, non-discriminatory and supportive. The capacity to achieve this can be developed through training and retraining of health care workers. Keywords: human immunodeficiency virus, HIV, pregnancy, perinatal transmissionTropical Journal of Obstetrics and Gynaecology Vol. 22(1) 2005: 65-73

Management of HIV in Pregnancy

Management of HIV in Pregnancy

Management of HIV in Pregnancy

Dr. Davies is Co-Director, High Risk Obstetric Pregnancy Practice; Obstetric Liaison, Children's Hospital Immunodeficiency Program; and Assistant Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Box B198, University of Colorado School of Medicine, 4200 East Ninth Avenue, Denver, CO 80262; E-mail: [email protected]. The author has disclosed that she has no significant relationships with or financial interests in any commercial organizations pertaining to this educational activity. Wolters Kluwer Health has identified and resolved all faculty conflicts of interest regarding this educational activity.

Management of HIV in Pregnancy: Part I

Management of HIV in Pregnancy: Part I

Management of HIV in Pregnancy: Part I: CME QUIZ: Volume 26, Number 2

Management of HIV in Pregnancy: Part I: CME QUIZ: Volume 26, Number 2