Mother-to-child Transmission Of HIV Research Articles

Prevention of Mother-to-child Transmission of HIV

Introduction Over the past several years, major successes have been achieved in prevention of mother-to-child transmission (MTCT) of human immunodeficiency virus type 1 (HIV). However, these successes have occurred primarily in those countries with the greatest resources and the lowest burden of HIV infection among women and children. Significant challenges remain, particularly in those countries with more limited resources and a greater population burden of HIV infection. Each day an estimated 2000 infants become infected with HIV, virtually all residing in resource-poor settings [1]. MTCT of HIV can occur during pregnancy, at the time of labor and delivery, and postnatally (through breastfeeding) [2]. Rates of MTCT of HIV have been calculated in studies conducted around the world in the absence of interventions to decrease transmission [3]. Overall, most studies reported a transmission rate in the range of 25%–30% and higher transmission rates were observed in resource-poor settings (13%–42%) than in resource-rich settings (14%–25%). In this chapter, risk factors for MTCT of HIV will be reviewed briefly. In addition, interventions for the prevention of MTCT of HIV will be discussed, both those already shown to be efficacious and those under study. Finally, strategies to prevent MTCT of HIV will be addressed. Risk factors for, and interventions to prevent, mother-to-child transmission of HIV Numerous risk factors for MTCT of HIV have been identified or are under investigation [4].

Aids Epidemic in Thailand: Good News, Bad News, and a Warning

Thailand. Between 1985 and 2006, an estimated 1,102,628 people (adults and children) were infected with HIV and 558,578 died of AIDS related complications (data from the Thailand A2 Team cited in AIDS Thailand, 2007). These numbers are large (one is too many). They represent a level of human tragedy and misery beyond measure. Nevertheless, Thailand’s response to the AIDS epidemic has been one of the most successful in the world. Its no-nonsense, pragmatic approach to combating the disease prevented millions of new infections (Brown, 2003; UNDP, 2004). Because of past actions, reductions are now being seen in the number of people (adults and children) living with HIV, the number of adults (15+) living with HIV, the number of children (0-14) living with HIV, and the number of deaths of adults and children from AIDS (UNAIDS/WHO, 2006). In addition, the number of new annual HIV infections in the general population continues to drop from its early 90s high (UNDP, 2004: 2; UNAIDS/WHO, 2006: 32). Moreover, rates of HIV infection among pregnant women have declined significantly from their highs in the mid90s (UNAIDS/WHO, 2006a:6; UNAIDS/WHO, 2004:2). There has been a reduction in motherto-child transmission of HIV (WHO, 2006). More good news: 75% of all HIV-infected pregnant women now receive AZT to prevent MTCT, virtually all children born to HIV-infected mothers receive drug treatment, and just over half of the 12,000 children needing antiretroviral therapy are currently receiving it (WHO, 2006). Make no mistake, problems remain. Without © Kamla-Raj 2008 J. Soc. Sci., 16(1): 79-80 (2008)

Primiparous mothers’ knowledge about mother-to-Child transmission of HIV in Lusaka, Zambia

Objective to learn what primiparous mothers in Lusaka, Zambia know about human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), mother-to-child transmission (MTCT) of HIV, and breast feeding. Design qualitative interviews analysed by thematic manifest content analysis. Setting postnatal wards at Lusaka University Teaching Hospital. Participants 14 primiparous mothers were interviewed. Findings 1 year after implementation of the prevention of MTCT programme in Zambia, the majority of the women interviewed lacked basic knowledge about MTCT. They did not know that HIV is present in breast milk and that it is a source of transmission. Few mothers had been informed about breast feeding, correct attachment and ways of avoiding breast infection. The mothers seemed to be uncertain about what HIV actually is, and they preferred to talk about MTCT and safe breast feeding rather than HIV/AIDS in general, which was the main reason for their participation in the study. According to the mothers, the most effective way of preventing transmission of HIV to the unborn baby was a single dose of nevirapine. Many believed that treatment is equal to cure and gives the baby full protection. The overall feeling of mothers was that they had not received information and support from the antenatal clinics and postnatal wards. The more traditional women preferred not to discuss these issues with their friends, their husbands or their families, which may make it more difficult to spread information and encourage couples to make decisions about their and their baby's future. Conclusion these findings suggest that primiparous mothers and their families need more education about MTCT of HIV. The mothers also need basic education about breast feeding and how to avoid breast injuries. The main reason for mothers’ poor knowledge may be that health workers do not have the necessary information. There seems to be a need for training in breast-feeding and baby-feeding counselling in the context of HIV in order to promote exclusive and safe breast feeding. As such, further research about health workers’ knowledge and methods of teaching is required.

Knowledge and behaviour of nurse/midwives in the prevention of vertical transmission of HIV in Owerri, Imo State, Nigeria: a cross-sectional study

BackgroundMother-to-Child Transmission (MTCT) of HIV remains the main mode of acquisition of HIV in children. Transmission of HIV may occur during pregnancy, delivery or breastfeeding. Studies have shown that some specific interventions help to reduce the transmission of the virus to the baby. In order to target safe, rational and effective intervention to reduce MTCT of HIV, it is necessary to ensure that the nurse/midwife has knowledge of the strategies for the prevention of vertical transmission of HIV.MethodThe cross-sectional design was utilized to determine the knowledge and behaviour of nurse/midwives in the prevention of vertical transmission of HIV in Owerri, Imo State, Nigeria. The study sample consisted of 155 nurse/midwives drawn from three selected hospitals through stratified random sampling method. Official permission was obtained from the institutions and consent from participants. Data was collected through the use of a self administered questionnaire. Information sought included respondents' demographic characteristics, knowledge about and behaviour of prevention of vertical transmission as well as factors influencing behaviour.ResultsFindings revealed that nurse/midwives had moderate level of knowledge with mean score of 51.4%. The mean score on behaviour was 52.5%, major factors that influence behaviour in these settings were mainly fear of getting infected, irregular supply of resources like gloves, goggles, sharp boxes, and water supply was not regular also. Hypotheses tested revealed that there is a positive relationship between knowledge and behaviour (r = 0.583, p = 0.00). Knowledge level of nurse/midwives who had educational exposure was not different from those who did not (t = 1.439, p = 0.152). There was a significant difference in the knowledge of nurse/midwives who had experience in managing pregnant women living with HIV/AIDS and those who did not (t = 2.142, p = 0.03). Also, there was a significant relationship between behaviour and availability of resources (r = 0.318, p = 0.000).ConclusionThe study revealed that the nurse/midwives though moderately knowledgeable still had gaps in certain areas. Their behaviours were fairly appropriate. There is need for improved knowledge through structured educational intervention. Resources needed for practice should always be made available and the environment should be much more conducive for practice.

CCR5 Haplotypes and Mother-to-Child HIV Transmission in Malawi

BackgroundCCR5 and CCR2 gene polymorphisms (SNPs) have been associated with protection against HIV transmission in adults and with delayed progression to AIDS. The CCR5 Δ32 deletion and SNP -2459G are associated with reduced expression of the CCR5 protein.Methodology/Principal FindingsWe investigated the association between infant CCR2/CCR5 diplotype and HIV mother to child transmission (MTCT) in Malawi. Blood samples from infants (n = 552) of HIV positive women who received nevirapine were genotyped using a post-PCR multiplex ligase detection reaction and haplotypes were identified based on 8 CCR2/CCR5 SNPs and the open reading frame 32 base pair deletion. Following verification of Hardy-Weinberg equilibrium, log linear regression was performed to examine the association between mutations and MTCT. Overall, protection against MTCT was weakly associated with two CCR5 SNPs, -2459G (Risk ratio [RR], 0.78; confidence interval [CI], 0.54–1.12), and the linked CCR5 -2135T (RR, 0.78; CI, 0.54–1.13). No child carried the CCR5 Δ32 SNP. Maternal Viral Load (MVL) was found to be an effect measure modifier. Among mothers with low MVL, statistically significant protection against MTCT was observed for -2459G (RR, 0.50; CI, 0.27–0.91), and -2135T (RR, 0.51; CI, 0.28–0.92). Statistically significant protection was not found at high MVL.Conclusions/SignificanceResults from this study suggest that CCR5 SNPs -2459G and -2135T associated with reduced receptor expression protect against MTCT of HIV at low MVLs, whereas high MVLs may over-ride differences in coreceptor availability.

Maternal HIV-1 DNA Load and Mother-to-Child Transmission

While many factors contribute to mother-to-child transmission (MTCT) of HIV-1, maternal plasma HIV-1 RNA viral load (RNA-VL) has been consistently found as the main risk factor, including when antiretroviral prophylaxis was used to prevent MTCT. However the predictive value of RNA-VL is poor. A recent study of HIV-1-positive pregnant women who did not receive antiretroviral prophylaxis reported an association between HIV-1 DNA viral load (DNA-VL) and MTCT that was stronger than the association between RNA-VL and MTCT. We sought to determine if HIV-1 DNA-VL was independently associated with MTCT of HIV in a population of women who received zidovudine prophylaxis during pregnancy and whose infants received zidovudine after birth. Patients were 33 non-breastfeeding transmitting (TR) and 33 nontransmitting mothers (NTR) from Perinatal HIV Prevention Trial (PHPT-1), a multicenter clinical trial conducted in Thailand comparing zidovudine prophylaxis durations to prevent MTCT. TR and NTR mothers were matched according to baseline RNA-VL. Maternal peripheral blood mononuclear cell (PBMC)-associated HIV-1 DNA was extracted from whole blood, and DNA-VL was established by quantitative real-time polymerase chain reaction. We found that TR had a significantly higher cell-associated HIV-1 DNA viral load than did NTR. Median TR DNA-VL was 2.54 log(10) copies per microgram PBMC DNA, while it was 2.28 log(10) copies per microgram PBMC DNA in NTR (Wilcoxon p = 0.02). In summary, HIV-1 DNA viral load was associated with MTCT in a population of women who received antiretroviral prophylaxis during pregnancy, independently from RNA viral load.

Maternal knowledge on mother-to-child transmission of HIV and breastmilk alternatives for HIV postive mothers in Homa Bay District Hospital, Kenya

Mother- to- Child Transmission (MTCT) of HIV is a relatively new concept in rural populations and despite the huge amount of work that has been done on the HIV/AIDS, there still remains a dearth of information in knowledge of mothers on this concept especially in areas related to appropriate feeding methods for infants born to mothers infected with the virus. To determine maternal knowledge on MTCT of HIV in the rural setting and to examine viable breastmilk alternatives for mothers who would be HIV positive. A cross- sectional study, supported by an observational study. A rural district community and Homa-Bay District Hospital in South Western Kenya. One hundred and twelve non-tested mothers having infants aged 0-12 months in the community and a sub-group (10%) of HIV positive mothers from the District Hospital. Maternal knowledge on MTCT of HIV was as low as 8.9% in the study area. The MTCT knowledge was found to influence the alternative feeding choice as mentioned by the non-tested mothers (p = 0.001; OR = 1.41; 95%CI, 1.04-3.86). Those with high MTCT knowledge tended to be more receptive and considered feeding alternatives other than cowmilk like expressed breastmilk (p = 0.1 5), formula (p = 0.036; OR = 2.44; 95%CI, 1.66-6.04) and milk from milk bank (p = 0.015; OR = 1.34; 95%CI, 1.13-5.50) than their counterparts with low MTCT knowledge. Cowmilk, formula and wet-nursing were the three feeding alternatives that were viable with varying socio-cultural, economic and/or nutritional constraints. Maternal MTCT knowledge influences the choice of alternative infant feeding option but not breastfeeding practices. Cowmilk is the most common, socio-culturally acceptable and accessible breastmilk alternative in this community. It is recommended that in order to improve MTCT knowledge, health education and nutrition counselling be intensified in PMTCT programmes, VCT centers and ANC clinics. Concurrently, effort should be made to increase the supply of cowmilk within the community so as to make it more readily available and affordable.

Twin pregnancy as a risk factor for mother-to-child transmission of HIV-1: trends over 20 years

We investigated whether twin pregnancies were at increased risk of mother-to-child HIV-1 transmission (MTCT), in comparison with singletons. Among HIV-1 infected women enrolled in the French Perinatal HIV Cohort (n = 9262), we studied the association between twin deliveries and MTCT rate according to three time periods (pre-1994, 1994-1996, 1997-2004) and the effect of birth order. The mother was considered to have transmitted if at least one of the twins was infected. Univariate and multivariate analyses of risk factors for MTCT were performed for deliveries in the periods up to 1996. Overall, 2.1% (192/9262) of all the deliveries were twins. The rate of prematurity was greater in twins than in singletons (54% and 13%, respectively). Up to 1996 the rate of MTCT of HIV-1 was 28.3% (15/53) in twin pregnancies, versus 13.5% (414/3077) in singletons [odds ratio (OR), 2.5; 95% confidence interval (CI), 1.4-4.7; P = 0.002; adjusted OR, 2.3: 95% CI, 1.1-2.3; P = 0.03). In the period from 1997 to 2003, MTCT was low and did not differ between twins (1.0%) and singletons (1.8%; P = 1.0). Overall, the transmission rate for the first-born child was threefold that for the second-born child (14/164, 8.5% versus 4/164, 2.4%; P = 0.008). Twin pregnancies were at increased risk of transmission, but in the era of HAART this risk was reduced for twins, as well as singletons. Management of multiple pregnancies should take into account the risks of premature rupture of the membranes and preterm delivery.

Resistance to Antiretroviral Drugs: A Threat to the Prevention and Treatment of Pediatric HIV Infection

Mother-to-child transmission (MTCT) of HIV was recognized early in the worldwide AIDS pandemic and by the late 1980s abnormal psychomotor development candida esophagitis and recurrent invasive bacterial infections were recognized as signatures of HIV infection in infants. Pneumocystis pneumonia occurred in many infants within the first 3-6 months of life often preceding death by as little as 1 month. Although symptoms of HIV infection generally appeared much later children who developed symptoms in the first year of life generally died by 2-3 years of age and AIDS became the seventh leading cause of mortality in young children in the United States by 1996. Nucleoside analogue reverse-transcriptase inhibitor (NRTI) antiretroviral therapy delayed the progression of disease and zidovudine sometimes caused dramatic improvements in cognitive function but these salutary effects were usually modest and transient in nature. Fortunately striking progress in both the prevention and treatment of HIV infection of children was made in early to mid-1990s. Administration of zidovudine during pregnancy labor and delivery accompanied by 6 weeks of postnatal therapy for the infant was shown to reduce MTCT of HIV by 70%. A series of studies in the 1990s identified virological immunological and obstetrical variables linked with perinatal infection of infants. (excerpt)

Prevention of mother to child transmission of HIV infection in Pacific countries

A generalized epidemic of HIV infection has been evolving in Papua New Guinea over the last decade, whereas in other Pacific Island countries and territories (PICT) HIV transmission has generally been less widespread. Programmes to detect HIV infection in pregnant women and to prevent mother to child transmission (MTCT) during either delivery or breast-feeding can decrease the incidence of infection in infants. The limited health infrastructure present in some PICT may delay the implementation of effective programmes to decrease MTCT of HIV. We used a standardized questionnaire to survey health-care providers in 22 PICT for information on the epidemiology of HIV infection and strategies used during 2004 to prevent MTCT of HIV infection in their country. We supplemented these survey responses with data obtained from regional organizations supporting national responses to HIV. We obtained responses from 21 PICT. The reported prevalence of known HIV infection was >150 per 100 000 persons in Papua New Guinea, approximately 100 per 100 000 persons in French Polynesia, Guam, New Caledonia and Tuvalu and <50 per 100 000 persons in the remaining 14 PICT. Other than in Papua New Guinea, where an estimated 500 pregnant women had HIV infection diagnosed in 2004, reported HIV infection among pregnant women was rare. Ten PICT reported that an HIV antibody test was offered as a routine component of antenatal care and 11 reported that antiretroviral medications were available for the prevention of MTCT of HIV infection. The prevalence of HIV infection differs greatly between PICT with a varying risk of MTCT of HIV infection. Successful prevention of MTCT of HIV infection throughout the PICT will require improved uptake of antenatal HIV antibody testing and better access to antiretroviral medications.

The Cochrane Library and mother‐to‐child transmission of HIV: an umbrella review

AbstractBackgroundThe majority of HIV‐infected children acquire the infection from their mothers. Preventing mother‐to‐child transmission (MTCT) of HIV is a key step in reducing the number of paediatric HIV infections.ObjectiveTo summarize the Cochrane reviews which have assessed the efficacy of interventions to prevent MTCT of HIV.MethodsThe Cochrane Database of Systematic Reviews was searched for any intervention to prevent MTCT of HIV. Data were extracted in duplicate and the GRADE assessment tool used to analyze the quality of extracted data.Main ResultsFive reviews met our inclusion criteria, and were of medium to high quality. One review examined the efficacy of antiretroviral prophylaxis for preventing MTCT of HIV. Each regimen used, ranging from the two‐dose nevirapine regimen to combination regimens, such as zidovudine and lamivudine, reduced the risk of MTCT of HIV. A meta‐analysis was not conducted as different regimens were used in the different trials. Caesarean section before labour and before ruptured membranes reduces the risk of MTCT of HIV (risk ratio [RR] 0.34, 95% confidence interval [CI] 0.14 to 0.8) compared to vaginal delivery. There was no evidence that vaginal disinfection (RR 0.94; 95%CI: 0.71 to 1.25), vitamin A supplementation (RR 1.10; 95%CI: 0.95 to 1.26), or hyperimmune HIV immunoglobulin (RR 0.67; 95%CI: 0.29 to 1.55) are efficacious interventions for the prevention of MTCT of HIV. There was no review on alternatives to breastfeeding.Authors' ConclusionsAntiretroviral prophylaxis and caesarean section before labour and before ruptured membranes are efficacious in reducing the risk of MTCT of HIV. However, there is a need for research directed at (1) simplifying antiretroviral regimens to facilitate adherence and to minimize toxicity for both mothers and infants, (2) assessing the long‐term impact of drug resistance on future treatment of HIV‐infected mothers and infants, and identifying regimens that are less likely to induce resistance, and (3) assessing the efficacy of caesarean section among HIV‐infected women with undetectable viral loads or who are receiving combination antiretroviral regimens. Copyright © 2007 John Wiley &amp; Sons, Ltd.

Using formative research to develop a context-specific approach to informed consent for clinical trials.

PARTICIPANT UNDERSTANDING is of particular concern when obtaining informed consent. Recommendations for improving understanding include disclosing information using culturallyappropriate and innovative approaches. To increase the effectiveness of the consent process for a clinical trial in Malawi on interventions to prevent mother-tochild transmission of HIV during breastfeeding, formative research was conducted to explore the community's understanding of medical research as well as how to explain research through local terms and meanings. Contextual analogies and other approaches were identified to explain consent information. Guided by theory, strategies for developing culturally appropriate interventions, and recommendations from the literature, we demonstrate how the formative data were used to develop culturally appropriate counseling cards specifically for the trial in Malawi. With appropriate contextual modifications, the steps outlined here could be applied in other clinical trials conducted elsewhere, as well as in other types of research.

Educating African Pastors on Mother‐to‐Child Transmission of HIV/AIDS

To educate pastors of the Assemblies of God in Burkina Faso concerning HIV/AIDS and mother-to-child transmission (MTCT). A pretest-posttest design was used with a convenience sample of 102 pastors attending the educational program on HIV/AIDS and MTCT in January, February, and March of 2005. The educational program was implemented in local Bible colleges in Ouagadougou, Burkina Faso. Participants attended an 18-hour program on HIV/AIDS and MTCT. A picture booklet was designed and used to help explain the prevention of MTCT of HIV The pretest-posttest examination and follow-up evaluation were designed for this project. Results of the pretest showed minimal knowledge of pastors regarding HIV/AIDS. The median composite scores on the knowledge questions increased from 16% on the pretest to 92% on the posttest. Within the 3-month follow-up period, 34 follow-up evaluations were received. Although all the responding pastors had recommended testing for expectant mothers, only 13 had discussed MTCT in their churches or communities. The educational program was effective in increasing the pastors' knowledge of HIV/AIDS and MTCT. Further research is needed to identify barriers to full utilization of that knowledge.

Maternal syphilis infection is associated with increased risk of mother-to-child transmission of HIV in Malawi

To determine the association between maternal syphilis and HIV mother-to-child transmission (MTCT). Prospective cohort study. Pregnant women admitted at Queen Elizabeth Central Hospital (Malawi) in late third trimester were screened for HIV (by HIV rapid tests) and syphilis (by rapid plasma regain test and Treponema pallidum hemagglutination assay). HIV-infected women and their infants received nevirapine, according to the HIVNET 012 protocol. They were followed up at 6 and 12 weeks postpartum. Infant HIV infection was diagnosed by DNA PCR. Of the 1155 HIV-infected women enrolled, 1147 had syphilis test results, of whom 92 (8.0%) were infected. Only 751 HIV-positive women delivered live singleton infants who were tested for HIV at birth. Of these, 65 (8.7%) were HIV-infected, suggesting in utero (IU) HIV MTCT. Of the 686 infants who were HIV-negative at birth, 507 were successfully followed up. Of these, 89 (17.6%) became HIV-infected, suggesting intrapartum/postpartum (IP/PP) HIV MTCT. Maternal syphilis was associated with IU HIV MTCT, after adjusting for maternal log10 HIV-1 viral load and low birth weight (LBW) [adjusted relative risk (ARR), 2.77; 95% CI, 1.40-5.46]. Furthermore, maternal syphilis was associated with IP/PP HIV MTCT (ARR, 2.74; 95% CI, 1.58-4.74), after adjusting for recent fever, breast infection, LBW and maternal log10 HIV-1 viral load. Maternal syphilis is associated with IU and IP/PP HIV MTCT. Screening and early treatment of maternal syphilis during pregnancy may reduce pediatric HIV infections.

Comparison of HIV-1 Mother-to-Child Transmission After Single-Dose Nevirapine Prophylaxis Among African Women With Subtypes A, C, and D

The HIVNET 012 trial in Uganda showed that mother-to-child transmission (MTCT) of HIV-1 can be prevented by providing pregnant women and their infants with a single dose (SD) of the antiretroviral drug nevirapine (NVP). Safety and efficacy of 1- or 2-dose NVP prophylaxis for prevention of MTCT have been documented in other studies. We have shown that NVP resistance emerges in some women after SD NVP prophylaxis and that the portion of women with NVP resistance is influenced by HIV-1 subtype. At 6 to 8 weeks after SD NVP NVP resistance was more common in women with subtype C (69.2%) than in women with subtype D (36.1% P < 0.0001) or subtype A (19.4% P < 0.0001).4 Selection of NVP-resistant HIV-1 variants in women after NVP dosing could theoretically lower the efficacy of NVP prophylaxis for prevention of HIV transmission by breast-feeding in the first few weeks after birth. In the HIVNET 012 trial most women were infected with HIV-1 subtype A or D. Risk of MTCT was slightly (but not statistically) higher in women with subtype D. In this report we combined data from the HIVNET 012 and NVAZ trials to compare the risk of MTCT in women with subtype C to the risk of MTCT in women with subtypes A and D in the setting of SD NVP prophylaxis. (excerpt)

Children Born to HIV-1-Infected Women in Sweden in 1982-2003

To describe the HIV-1 epidemic among childbearing women and their children in Sweden, a population-based analysis of data on all known mother-child pairs in Sweden with perinatal exposure to HIV-1 1982-2003 was conducted. The mother-to-child transmission (MTCT) rate in children prospectively followed from birth decreased from 24.7% in 1985-1993 to 5.7% in 1994-1998 and 0.6% in 1999-2003. The use of antiretroviral treatment of the mother during pregnancy and/or prophylactic antiretroviral intervention increased from 2.3% to 91.6% during the same period, and the elective cesarean delivery rate increased from 8.0% to 80.3%. No MTCT of HIV-1 occurred in Sweden after 1999.Fifty-one vertically HIV-1-infected children aged 2.7 to 17.6 years were living in Sweden by 31 December 2003, 71% being treated with antiretroviral agents. No HIV-1-related child death has been reported in Sweden after 1996. The conclusion is that MTCT of HIV-1 can be almost eliminated when appropriate resources are available. A national pregnancy screening program for HIV-1 running since 1987 with a high acceptance rate and the implementation of measures to prevent MTCT since 1994 have resulted in a significant decrease in the number of infected children. Inasmuch as knowledge of the infection status of the mother is crucial for reduction in MTCT of HIV-1, continued antenatal screening is important even in a low-prevalence country such as Sweden.

Tumour necrosis factor-α stimulates HIV-1 replication in single-cycle infection of human term placental villi fragments in a time, viral dose and envelope dependent manner

BackgroundThe placenta plays an important role in the control of in utero HIV-1 mother-to-child transmission (MTCT). Proinflammatory cytokines in the placental environment are particularly implicated in this control. We thus investigated the effect of TNF-α on HIV-1 expression in human placental tissues in vitro.ResultsHuman placental chorionic villi fragments were infected with varying doses of luciferase reporter HIV-1 pseudotypes with the R5, X4-Env or the vesicular stomatitis virus protein G (VSV-G). Histocultures were then performed in the presence or absence of recombinant human TNF-α. Luciferase activity was measured at different time points in cell lysates or on whole fragments using ex vivo imaging systems.A significant increase in viral expression was detected in placental fragments infected with 0.2 ng of p24 antigen/fragment (P = 0.002) of VSV-G pseudotyped HIV-1 in the presence of TNF-α seen after 120 hours of culture. A time independent significant increase of viral expression by TNF-α was observed with higher doses of VSV-G pseudotyped HIV-1. When placental fragments were infected with R5-Env pseudotyped HIV-1, a low level of HIV expression at 168 hours of culture was detected for 3 of the 5 placentas tested, with no statistically significant enhancement by TNF-α. Infection with X4-Env pseudotyped HIV-1 did not lead to any detectable luciferase activity at any time point in the absence or in the presence of TNF-α.ConclusionTNF-α in the placental environment increases HIV-1 expression and could facilitate MTCT of HIV-1, particularly in an inflammatory context.

A phase III clinical trial of antibiotics to reduce chorioamnionitis-related perinatal HIV-1 transmission

A multisite study was conducted in Africa to assess the efficacy of antibiotics to reduce mother-to-child transmission (MTCT) of HIV-1. A randomized, double-blinded, placebo-controlled, phase III clinical trial. HIV-1-infected women were randomly assigned at 20-24 weeks' gestation to receive either antibiotics (metronidazole plus erythromycin antenatally and metronidazole plus ampicillin intrapartum) or placebo. Maternal study procedures were performed at 20-24, 26-30, and 36 weeks antenatally, and at labor/delivery. Infants were seen at birth, 4-6 weeks, and 3, 6, 9 and 12 months. The primary efficacy endpoints were overall infant HIV-1 infection and HIV-1-free survival at 4-6 weeks. All women and infants received single-dose nevirapine prophylaxis in this study. A total of 1510 live-born infants were included in the primary analysis. The proportions of HIV-1-infected infants at birth were similar (antibiotics 7.1%; placebo 8.3%; P = 0.41). Likewise, there were no statistically significant differences at 4-6 weeks in the overall risk of MTCT of HIV-1 (antibiotics 16.2%; placebo 15.8%; P = 0.89) or HIV-1-free survival (79.4% in each study arm). Post-randomization, the proportion of women with bacterial vaginosis at the second antenatal visit was significantly lower in the antibiotics arm compared with the placebo arm (23.8 versus 39.7%; P < 0.001), but the frequency of histological chorioamnionitis was not different (antibiotics 36.9%; placebo 39.7%; P = 0.30). Adverse events in mothers and their infants did not differ by randomization arm. This simple antepartum and peripartum antibiotic regimen did not reduce the risk of MTCT of HIV-1.

Assessing the Impact of Federal HIV Prevention Spending on HIV Testing and Awareness

The United States allocates more than $900 million annually for the prevention of HIV infection. We assessed the impact of this funding on HIV testing and knowledge. We linked data from the Behavioral Risk Factor Surveillance System with tracking of Centers for Disease Control and Prevention (CDC) HIV prevention funding. We developed and validated regression models of the relation between HIV prevention funding to a respondent's state and the odds that the respondent (1) had been tested for HIV, and (2) was aware of methods to prevent mother-to-child HIV transmission (MTCT). The odds of having been tested for HIV increased with increased CDC funding to states (P=.009), as did awareness of prevention of MTCT (P=.002). We estimate that CDC HIV prevention funds led to 12.8 million more people being tested for HIV between 1998 and 2003 than would have been tested had all states received funds equal to the lowest quintile of funding. Federal HIV prevention funds independently correlate with increased HIV testing and knowledge of prevention of MTCT. Proposed reductions in HIV prevention spending would likely have adverse public health consequences.

Knowledge and attitude towards mother to child transmission of HIV and it's prevention among post natal mothers in Tikur Anbessa and Zewditu Memorial Hospitals, Addis Ababa

Background: HIV/AIDS is currently a major public health problem in Ethiopia and mother to child transmission (MTCT) is responsible for 90% of childhood HIV infections. The transmission of HIV from infected mothers to babies could occur during antenatal period, as well as during delivery and breastfeeding (postnatal period). Since breastfeeding is essential for child survival, it is also necessary to assess mothers' knowledge and attitude towards HIV transmission and its prevention during breastfeeding. Objectives: This study attempts to assess mothers' knowledge of MTCT of HIV including breastfeeding, in two government hospitals in Addis Ababa. It also describes mothers' attitudes towards voluntary counseling and testing (VCT) services. Methods: A cross sectional, descriptive study was conducted to assess knowledge and attitude towards MTCT and its' preventive methods on postnatal mothers who delivered at Tikur Anbessa and Zewditu Memorial Hospitals, Addis Ababa, from January to March 2004. A structured, pre-tested questionnaire was used for data collection. Results: A total of 384 mothers were interviewed 78.4% of whom were from Addis Ababa. 87.0% were aged between 16-30 years. Of these mothers 54.9% were primipara, 89.9% were married, and 84.6% were Christians. Amhara (44.5%), Oromo (26.3%), Gurage (17.2%), and Tigre (7.0%) were the major ethnic groups in the study population. All the 384 respondents had heard about HIV/AIDS of which, 82.3 % mentioned the major routes of transmission and 89.8% knew that that HIV could be transmitted from an infected mother to her baby. Most of the respondents (76.8%) knew that MTCT of HIV is preventable, 64.6% knew the protective effect of prophylactic anti-retroviral drugs, 37.1% knew that abstinence from breastfeeding can prevent MTCT, 10.4% knew elective caesarean section (C/S) as a preventive method and 6.9% stated that protection of the mother from HIV is the same as protecting her baby. Those mothers who were from Addis Ababa, and whose educational level was secondary and above were found to be more knowledgeable about MTCT and PMTCT. Three hundred seventeen (82.6%) of the mothers knew what VCT meant and 76.8% of them have positive attitudes to wards VCT. 69.3% of the mother indicated that mothers should be tested before breastfeeding and 67.4% agreed to have VCT before breastfeeding their new babies. 60.2% planned to have VCT before their next pregnancy.Conclusion: This study showed that most mothers in this study knew that HIV could be transmitted from mother to child and that it can be prevented. A majority are of the opinion that VCT can be a preventive strategy and most of them have the intention to have counseling and testing before the next pregnancy. Hence well-organized VCT centers and PMTCT programs should be established to halt the epidemic from affecting the next generation. Ethiopian Journal of Health Development Vol. 19(3) 2005: 211-218