Morbidity In HIV-infected Women Research Articles

Severe morbidity according to sex in the era of combined antiretroviral therapy: the ANRS CO3 Aquitaine Cohort.

ObjectiveTo describe trends and determinants of severe morbidity in HIV-infected women and men.DesignA French prospective cohort of HIV-infected patients of both sexes and all transmission categories.MethodsWe used hospital admission data from January 2000 to December 2008. A severe morbid event (SME) was defined as a clinical event requiring hospitalization for ≥48 h, several events could be reported during hospitalization. Yearly incidence rates of SME were estimated and compared using Generalized Estimating Equations.ResultsAmong 4,987 patients (27% women), followed for a median of 8.7 years, 1,473 (30%) were hospitalized (3,049 hospitalizations for 5,963 SME). The yearly incidence rate of hospitalization decreased in men, from 155 in 2000 to 80/1,000 person-years (PY) in 2008 and in women, from 125 to 71/1,000 PY, (p<0.001). This trend was observed for all SME except for hepatic events, stable in men (15 to 13/1,000 PY) and increasing in women (2.5 to 11.5), cardiovascular events increasing in men (6 to 10/1,000 PY) and in women (6 to 14) and non-AIDS non-hepatic malignancies increasing in men (4 to 7/1,000 PY) and stable in women (2.5). Intraveneous drug users, age >50 years, HIV RNA >10,000 copies, CD4 <500/mm3, AIDS stage, hepatitis C co-infection and cardiovascular risk factors (diabetes, high blood pressure, and tobacco use) were associated with SME.ConclusionsHIV-infected individuals in care in France require less and less frequently hospitalization. Women are now presenting with severe hepatic and cardio-vascular events. Disparities in SME between men and women are primarily explained by different exposure patterns to risk factors. Women should be targeted to benefit cardiovascular prevention policies as well as men.

SOCIO-DEMOGRAPHIC DETERMINANTS OF FAMILIAL AND PARTNER PRESSURES TO CONCEIVE IN HIV-POSITIVE WOMEN IN ONTARIO, CANADA

IntroductionAccess to antiretroviral therapy has improved quality of life, minimized vertical transmission, and reduced mortality and morbidity in HIV-infected women. With these advances, many HIV-infected women and their partners are...

Is there still a role for Caesarean section in preventing vertical HIV transmission in the era of highly active antiretroviral therapy?

AbstractHuman immunodeficiency virus (HIV) may be transmitted from an infected mother to her child during pregnancy, delivery or breastfeeding. Without any intervention, transmission rates may range from 15–45%. However, this can be reduced to < 5% with effective drug therapy. A scheduled Caesarean section that is performed before the onset of labour or the rupture of membranes has been shown to reduce the intrapartum risk in a meta-analysis of earlier studies. The review further concluded that the benefit of performing an elective Caesarean section outweighed the risk of postpartum morbidity in HIV-infected women. However, balancing the risk to benefit ratio is influenced by the underlying rate of mother-to-child transmission (MTCT) in an individual patient.Caesarean section, while initially shown to reduce the MTCT risk, is itself associated with significant morbidity to the mother. Pregnancy-related sepsis is among the leading causes of maternal deaths, particularly in women who deliver by Caesarean se...