Mother-to-child Transmission Of HIV Research Articles

Reducing Mother-to-Child Transmission of HIV Using Quality Improvement Approaches.

Over half of mother-to-child HIV transmission (MTCT) occurs postdelivery. Keeping mother–infant pairs in care remains challenging. Health workers in 3 countries used quality improvement (QI) approaches to improve data systems, mother–infant retention, and facility-based care delivery. The number and proportion of infants with known HIV status at time of discharge from early infant diagnosis programs increased in Tanzania and Uganda. We analyzed data using statistical process control charts. Mother-to-child HIV transmission did not decrease in 15 Kenyan sites, decreased from 12.7% to 3.8% in 28 Tanzanian sites, and decreased from 17.2% to 1.5% in 10 Ugandan sites with baseline data. This improvement is likely due to the combination of option B+, service delivery improvements, and retention through QI approaches. Reaching the global MTCT elimination target and maximizing infant survival will require health systems to support mother–infant pairs to remain in care and support health workers to deliver care. Quality improvement approaches can support these changes.

Knowledge of Transmission of HIV/AIDS from Mother to Child Among Pregnant Women

Mother-to-child transmission (MTCT) of HIV is the spread of HIV infection from women with HIV to her child either during pregnancy, childbirth or breastfeeding. Pregnant women with HIV who have knowledge and awareness, receive anti-retroviral therapy (ART) during pregnancy and childbirth to prevent occurrence of MTCT of HIV during delivery, to reduce the risk of infection. The present study sought to assess the knowledge of transmission of HIV from mother to child among 200 selected mothers attending the Gynae OPD of RIMS Hospital, Imphal (Manipur). Data was collected from 24 May to 2 June 2018 (10 days). The study brought out that educational status of mother is associated with knowledge of MTCT of HIV/AIDS, so that nurses and other health care functionaries should be actively engaged in imparting relevant health education.

The Role of Prenatal Care and Systematic HIV Testing in Preventing Perinatal Transmission in Tanzania, 2011-2012

In 2012, the prevalence of HIV infection among Tanzanian women was 6.3%, and 18% of Tanzanian children were born infected with HIV. The purpose of this study was to determine the importance of prenatal care attendance on comprehensive knowledge of HIV mother-to-child transmission (MTCT), HIV testing and counseling, and awareness of HIV testing coverage services in Tanzania. The study population was Tanzanian women of childbearing. Guided by the health belief model, this cross-sectional survey design used secondary data from the 2011–2012 Tanzania Demographic Health Survey. Factors of interest were comprehensive knowledge of HIV MTCT, HIV testing and counseling, and awareness of HIV testing coverage services; the outcome was prenatal care visit (PNCV) attendance. Findings showed that 69% of women had their first PNCV in the second trimester, meaning fewer than four visits. Multinomial logistic regression modeling assessed the association between factors of interest and outcome. Findings denoted that the factors of interest after controlling for married versus never married, maternal age, and wealth were associated with PNCV. These findings have positive social change implications by informing efforts to identify at-risk pregnant women through systematic HIV testing and counseling for early medical intervention and encourage them to start their PNCVs as scheduled.

Potential Role of Regulatory T Cells in Mother-to-Child Transmission of HIV.

Background: Mother-to-child transmission of HIV-1 occurs in a minority of HIV-infected mother-infant pairs, even without any interventions. The mechanisms that protect the majority of HIV-exposed infants from infection are unclear. T regulatory cells (Treg) have important immunomodulato-ry functions, but their role in the fetus as well as in mother-to-child transmission of HIV is under-studied.Methods: We studied available cryopreserved peripheral blood mononuclear cells from HIV-exposed infants from the Breastfeeding, Antiretrovirals and Nutrition (BAN) Study cohort in Malawi: 64 in-fants were HIV-uninfected and 28 infants were HIV-infected at birth. We quantified the frequency of Treg cells (CD4+CD25+FoxP3+), and activated CD4+ and CD8+ T cells (CD38+ HLADR+) by flow cytometry at birth, 6 weeks and 6, 9 and 12 months of age. Descriptive statistics were performed to describe the distributions of these lymphocyte markers according to the HIV infection status; and Student’s t tests and Wilcoxon-Rank Sum tests were performed to compare HIV- infected and unin-fected infants.Results: T cell activation increased rapidly in the first 6 weeks of life, more pronounced on CD8+ T cells; a further increase in activation was observed at the time of weaning from breastfeeding at 6 months of age. In contrast, the frequency of Treg was stable over the first 6 weeks of life (median, 0.5%), slightly decreased between 6 weeks and 6 months (median at 6 months, 0.3%) and then slight-ly increased between 6 months (time of weaning) and 12 months of age (median, 0.45%). HIV-infected infants had significantly higher frequencies of activated T cells than uninfected infants (P < 0.01). At the time of birth, HIV-exposed uninfected infants had higher levels of Treg, compared to in-fants infected in utero, even though this did not reach statistical significance in this small sample size (P = 0.08).Conclusion: This study provides initial evidence that Treg may play a role in preventing mother-to-child transmission of HIV, likely by suppressing immune activation in the fetus and infant, and needs to be substantiated in a larger study. Better characterization of the role of Treg in fetal and neonatal immunity may provide a valuable complementary approach to achieve eradication of mother-to-child transmission of HIV.

Brief Report: No HIV Transmission From Virally Suppressed Mothers During Breastfeeding in Rural Tanzania.

To what extent antiretroviral therapy (ART) reduces mother-to-child HIV transmission (MTCT) during breastfeeding remains unclear. We assessed the MTCT risk from mothers on ART to their infants during breastfeeding. Ifakara, rural Tanzania. We included infants born between January 2013 and May 2016 to mothers who initiated ART before delivery, had a negative HIV DNA polymerase chain reaction at 4-12 weeks and exclusively breastfed for ≥6 months. Mothers' plasma HIV-RNA viral loads (VLs) were measured up to 11 months postdelivery. Infants were tested for HIV following national guidelines. Among 214 women with 218 pregnancies and 228 infants (10 twins), the median age at delivery was 33 years (interquartile range 28-36 years), and the mean time on ART was 23 months (interquartile range, 4-52 months). VL was measured twice in 53% (113/218) of pregnancies. During breastfeeding, 91% of mothers (199/218) had VL of <1000 copies per milliliter, and 75% (164/218) had <100 copies per milliliter. To November 2017, 8% (19/228) of infants were lost to follow-up (LTFU), 2% (5/228) transferred, and 8% (18/228) died before the determination of final HIV serostatus. Among the remaining 186 infants, 2 (1%; 95% confidence interval: 0.3% to 4%) were HIV positive: 1 born from a mother with high VL 1-month postdelivery and 1 from a mother who interrupted ART. Assuming a 15% MTCT risk through breastfeeding among the 42 infants LTFU, transferred, or dead, the overall MTCT risk would be 4%. We found no MTCT from mothers who were retained in care and had suppressed VL. Breastfeeding signifies a very low risk when mothers adhere to ART. Adherence counseling, VL monitoring, and strategies to trace back those LTFU should be a priority.

Pregnancy outcomes in young mothers with perinatally and behaviorally acquired HIV infections in Rio de Janeiro

BackgroundPerinatally HIV-infected children are surviving into adulthood, and getting pregnant. There is a scarcity of information on health and pregnancy outcomes in these women. AimTo evaluate characteristics related to HIV disease and pregnancy outcomes in perinatally infected women, and to compare these women with a group of youth with behaviorally acquired HIV-infection, at a reference hospital in Rio de Janeiro, Brazil. MethodsA cohort study. Epidemiological, clinical, and laboratory data were compared between perinatally (PHIV) and behaviorally HIV-infected (BHIV) pregnant youth with the primary aim to study pregnancy outcomes in the PHIV group and compare with outcomes to BHIV group. ResultsThirty-two pregnancies occurred in PHIV group, and 595 in BHIV group. A total of seven (22%) PHIV women and 64 (11%) BHIV women had a premature delivery (p=0.04), however, when adjusting for younger age at pregnancy, and antiretroviral therapy initiation in 1st trimester of pregnancy (OR=18.66, 95%CI=5.52–63.14), the difference was no longer significant. No cases of mother-to-child HIV transmission (MTCT) were observed in the PHIV group while there was a 2% MTCT rate in BHIV group. ConclusionPregnancy among PHIV was as safe as among BHIV. The differences between those groups were probably related to treatment and prolonged care in the first group.

Implementation and outcomes of guideline revisions for the prevention of mother-to-child HIV transmission in Mother Support Programme, Addis Ababa, Ethiopia.

About 40% of the new HIV infections in Ethiopia are among children < 15 years of age. The great majority of these infections occur through Mother-to-child HIV transmission (MTCT). For prevention of MTCT, the national guidelines has been revised to incorporate scientific advances in HIV prevention, treatment and care. Since 2005, the country has been implementing a peer mentor programme called Mother Support Group (MSG), which provides psychosocial and adherence support for HIV positive mothers. This study examined implementation of PMTCT guidelines revisions and outcomes of HIV exposed babies in the MSG in Addis Ababa. Retrospective routine data were collected between 2005 and August 2013 from seven randomly selected primary health facilities. Odds ratios and 95% confidence intervals were calculated using logistic regression models. Several guidelines revisions were made between 2001 and 2013 in HIV testing approaches, prophylactic antiretroviral options, infant feeding recommendations and infant HIV testing algorithms. Revisions on the CD4 thresholds were associated with a significant increase in the proportion of women initiating antiretroviral treatment from 0 in 2005 to 62% in 2013. Revisions in infant feeding recommendations led to a 92.3% reported practice of exclusive breastfeeding in 2013 compared to 60.9% in 2005. Two and four percent of the HIV exposed babies were HIV positive by six and 18 months respectively. Not receiving prophylactic ART and receiving mixed feeding were independent predictors for babies having an HIV positive antibody test at 18 months. The rate of HIV status disclosure increased significantly year by year. Over the years, the PMTCT recommendations have moved from having a solo focus on PMTCT to holistic and inclusive approaches emphasizing survival beyond HIV prevention. The data reflect favourable outcomes of HIV exposed babies in terms of averted MTCT though serious gaps in data quality remain. For successful implementation of Option-B plus, the identified gaps in the MSG need to be addressed.

Factors Associated with Maternal-Child Transmission of HIV-1 in Southeastern Brazil: A Retrospective Study.

Mother-to-child transmission (MTCT) is the main mode of HIV-1 acquisition among young children worldwide. The goals of this study were to estimate the proportion of HIV MTCT and to identify factors associated with transmission. We reviewed data for HIV-infected pregnant women that had been reported to the National Information on Reportable Diseases System (SINAN) in Espírito Santo state, Brazil, between January 2007 and December 2012. HIV cases in children were followed until age 18months. The proportion of women who transmitted HIV to their babies was 14% (95% CI 11-17%). In a multivariate logistic regression model, pregnant women who had lower than primary school education (OR 2.74; 95% CI 1.31-5.71), had 2 or more pregnancies during the study period (OR 2.28; 95% CI 1.07-4.84), had emergency cesarean delivery (OR 4.32; 95% CI 1.57-11.9), and did not receive antiretroviral therapy during prenatal care (OR 2.41; 95% CI 1.09-5.31) had higher odds of HIV MTCT. Effort should be made to encourage health care workers and pregnant women to use services for the prevention of MTCT.

Similar HIV protection from four weeks of zidovudine versus nevirapine prophylaxis among formula-fed infants in Botswana.

BackgroundThe World Health Organization HIV guidelines recommend either infant zidovudine (ZDV) or nevirapine (NVP) prophylaxis for the prevention of intrapartum mother-to-child HIV transmission (MTCT) among formula-fed infants. No study has evaluated the comparative efficacy of infant prophylaxis with twice daily ZDV versus once daily NVP in exclusively formula-fed HIV-exposed infants.MethodsUsing data from the Mpepu Study, a Botswana-based clinical trial investigating whether prophylactic co-trimoxazole could improve infant survival, retrospective analyses of MTCT events and Division of AIDS (DAIDS) Grade 3 or Grade 4 occurrences of anaemia or neutropenia were performed among infants born full-term (≥ 37 weeks gestation), with a birth weight ≥ 2500 g and who were formula-fed from birth. ZDV infant prophylaxis was used from Mpepu Study inception. A protocol modification mid-way through the study led to the subsequent use of NVP infant prophylaxis.ResultsAmong infants qualifying for this secondary retrospective analysis, a total of 695 (52%) infants received ZDV, while 646 (48%) received NVP from birth for at least 25 days but no more than 35 days. Confirmed intrapartum HIV infection occurred in two (0.29%) ZDV recipients and three (0.46%) NVP recipients (p = 0.68). Anaemia occurred in 19 (2.7%) ZDV versus 12 (1.9%) NVP (p = 0.36) recipients. Neutropenia occurred in 28 (4.0%) ZDV versus 21 (3.3%) NVP recipients (p = 0.47).ConclusionsBoth ZDV and NVP resulted in low intrapartum transmission rates and no significant differences in severe infant haematologic toxicity (DAIDS Grade 3 or Grade 4) among formula-fed full-term infants with a birthweight ≥ 2500 g.

DEFB1 polymorphisms and HIV-1 mother-to-child transmission in Zambian population

Introduction: Human Beta Defensin-1 (hBD-1) is a component of the innate immune system, the first line of defence against pathogens, already reported as involved in the susceptibility to HIV-1 infection and HIV-1 mother-to-child transmission (MTCT) in different populations. We investigated the role of DEFB1 gene (encoding for hBD-1) functional polymorphisms in the susceptibility to HIV-1 MTCT in a population from Zambia.Methods: Four selected polymorphisms within DEFB1 gene, three at the 5′ untranslated region (UTR), namely -52G > A (rs1799946), -44C > G (rs1800972) and -20G > A (rs11362) and one in the 3′UTR, c.*87A > G (rs1800972), were genotyped in 101 HIV-1 positive mothers (26 transmitters -27% and 75 not transmitters -73%) and 331 infants born to HIV-1 infected mothers (85 HIV-1 positive -26% and 246 exposed but not infected -74%).Results: DEFB1 c.*87–A allele was more frequent among HIV− children with respect to HIV+ (with intrauterine MTCT). Concerning DEFB1 haplotypes, GCGA haplotype resulted more represented in HIV− than HIV+ infants and DEFB1 ACGG haplotype presented increased frequency in HIV− children respect to HIV+ (with intra-partum MTCT) (p = .02, p = .002 and p = .006, respectively).Conclusions: DEFB1 polymorphisms were significantly associated with decreased risk of HIV-1 infection acquisition in the studied Zambian population suggesting that they may play a role in HIV-1 MTCT.

Pregnancy outcomes of women with HIV in a district general hospital in the UK

The aim of this study was to describe the obstetrical and virological outcomes in HIV-infected pregnant women who delivered at a district general hospital in south London in the period from 2008 to 2014. Our review identified 137 pregnancies; most (60%, 63/105) of them were unplanned. The commonest mode of delivery was spontaneous vaginal delivery (SVD) (42%, 48/114) followed by emergency Caesarean section (32%, 36/114). Gestational age at delivery was ≥37 weeks in most (84%, 91/106) of the cases. Maternal HIV VL at or closest to delivery was undetectable (<40 copies/mL), <400 copies/mL and >1000 copies/mL in 73% (94/129), 90% (116/129) and 6% (8/129) of the pregnancies, respectively. None of the infants were infected with HIV making the rate of MTCT of HIV 0% (zero). Our study shows that favourable virological and obstetrical outcomes of HIV-infected pregnant women are achievable in non-tertiary HIV treatment centres.Impact StatementWhat is already known on this subject: Prevention of mother-to-child transmission (MTCT) of HIV has been one of the major public health successes in the last decades. This success was evident by the reduction of MTCT of HIV in the UK from 25.6% in the 1993 to only 0.46% in 2011. Furthermore, many reports from individual providers, mainly from tertiary centres, of HIV care in the UK also showed very low rates MTCT of HIV.What the results of this study add: Our study shows that favourable virological and obstetrical outcomes of HIV-infected pregnant women are achievable in non-tertiary HIV treatment centres. The MTCT of HIV rate in our hospital was zero in the period from 2008 to 2014.What the implications are of these findings for clinical practice and/or further research: Staff caring for pregnant HIV positive women in general hospitals and small-to-medium HIV clinics should liaise closely with each other and utilise the skill-mix within their hospital in order to provide a quality care that is similar to what is achieved in large teaching centres; however, a prompt referral to tertiary hospitals, when indicated, should be facilitated.

Mother to child transmission of HIV in Brazil: Data from the "Birth in Brazil study", a national hospital-based study.

Aimsto estimate the mother to child transmission (MTCT) of HIV among infected pregnant women identified in the "Birth in Brazil" study and to evaluate care practices provided in order to identify missed opportunities at preventing the MTCT of HIV infection in the country.MethodsDescriptive study using data obtained from the consultation of different databases: the “Birth in Brazil” study database and the Brazilian National Information Systems (NIS) databases. We used cases of pregnant women infected with HIV identified in the “Birth in Brazil” study, and cases of AIDS in children under 5 years old identified in the NIS, to estimate the MTCT of HIV infection in the country, with a 95% confidence interval. We also estimated the HIV cascade (HIV diagnosis; use of antiretroviral treatment (ART) during pregnancy, labour, and for the newborn; adequate care during childbirth considering viral load at birth; and no breastfeeding) using data from the same sources.ResultsMTCT of HIV of 2.0% (95% CI 0.3%-13.8%). At birth, 84.0% of HIV infected woman showed a positive HIV diagnosis, 74.9% received combined ART during pregnancy, 80.7% received ART during childbirth, 77.1% received adequate care during childbirth, 86.8% of newborns received ART within the first 24 hours after birth, and 2.8% of newborns were breastfed. Considering all steps, 61.3% of the women (95% CI 48.3%-72.8%) received all available medical interventions. In the analysis restricted to women identified in the NIS, 65.3% (95% CI 48.0%-79.3%) of HIV infected women received all available medical interventions.ConclusionBrazil has healthcare policies that guarantee free access to tests, ART and substitutes for maternal milk. However, missed opportunities to prevent MTCT of HIV were identified in at least one-third of women and may be making it difficult to reach HIV-elimination targets especially in the less developed country regions.

Prevention and Treatment of Pediatric HIV Infection

The goal of this paper is to review the prevention of mother-to-child HIV transmission (PMTCT) research that informed World Health Organization (WHO) guidelines for PMTCT and describe the impact of worldwide scale-up of PMTCT programs and antiretroviral therapy (ART) coverage. The impact of these interventions on new pediatric infections and infected children’s morbidity and mortality in sub-Saharan Africa are reviewed. The IMPAACT PROMISE study demonstrated that triple therapy consisting of tenofovir (TDF), lamivudine (3TC), and lopinavir/ritonavir (LPVr) or zidovudine (AZT), 3TC, and LPVr initiated in the first trimester reduced vertical transmission at 2 weeks of age to 0.6% and 0.5%, respectively, supporting the current WHO Option B+ recommendation for PMTCT. However, increased adverse pregnancy outcomes in the AZT- and TDF-based triple therapy arms were reported when compared with the AZT prophylaxis arm (low birth weight [20.4% and 16.9% vs. 8.9%; p = 0.004] and premature deliveries [19.7% and 18.5% vs. 13.5%; p = 0.09], respectively). Implementation of Option B+ for PMTCT has led to significant reductions in vertical transmission rates, including elimination of new pediatric infections in some countries. The WHO declared elimination of mother-to-child HIV transmission (MTCT) in Cuba in 2015 and in Armenia, Belarus, and Thailand in 2016. Globally, new pediatric HIV infections have declined significantly since the introduction of effective antiretroviral regimens for PMTCT. Perinatal HIV prevention clinical trials conducted in sub-Saharan Africa informed WHO PMTCT guidelines which led to implementation of PMTCT programs worldwide, leading to a 47% reduction in new pediatric infections since 2009. Support from The United States President's Emergency Plan for AIDS Relief (PEPFAR), the Global Fund for AIDS, Tuberculosis and Malaria, and UN agencies has enabled scale-up of national PMTCT programs, and increased antiretroviral coverage (47% globally) for infected children has led to a decline in HIV/AIDS-related mortality in children. Implementation strategies that improve retention in care and adherence to ART in pregnant and breastfeeding HIV-infected women is critical to ensure that more countries achieve the elimination of MTCT (eMTCT) targets. Assessing the effectiveness of new antiretroviral drugs, including fixed-dose combinations and long-acting formulations, is key to improving ART adherence and reducing the emergence of viral resistance mutations. In addition, interventions to prevent HIV transmission in adolescents and young adults is critical for reducing new HIV infections worldwide. Innovative interventions to improve adherence to ART are required to further improve the survival of HIV-infected children and adolescents.

Workforce patterns in the prevention of mother to child transmission of HIV in C\xf4te d\u2019Ivoire: a qualitative model

BackgroundCôte d’Ivoire continues to struggle with one of the highest rates of mother-to-child HIV transmission in West Africa, previously thought to be in part due to suboptimal workforce patterns. This study aimed to understand the process through which workforce patterns impact prevention of mother-to child transmission of HIV (PMTCT) program success, from the perspective of healthcare workers in Côte d’Ivoire.MethodsA total of 142 semi-structured interviews were conducted with physicians, midwives, nurses, community counselors, social workers, pharmacists, management personnel and health aides from a nationally representative sample of 48 PMTCT sites across Côte d’Ivoire.ResultsHealthcare workers described three categories of workforce patterns that they perceived to be affecting PMTCT success: workforce inputs, healthcare roles and responsibilities, and facilitators of task performance. According to their descriptions, PMTCT success depends on the presence of an adequate and trained PMTCT workforce, with an interdisciplinary team of healthcare workers with flexible roles and expanded task responsibilities, and whose tasks are translated into patient care through collaboration, ongoing trainings, and appropriate motivators.ConclusionsThis study provides a model for understanding the impact of workforce patterns on PMTCT success in Côte d’Ivoire and provides insight into workforce-related facilitators and barriers of program performance that should be targeted in future research and interventions. It highlights the importance of workforce integration and collaboration between healthcare workers.

Combined evaluation of sexually transmitted infections in HIV-infected pregnant women and infant HIV transmission

BackgroundSexually transmitted infections (STIs) including Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Treponema pallidum (TP), and cytomegalovirus (CMV) may lead to adverse pregnancy and infant outcomes. The role of combined maternal STIs in HIV mother-to-child transmission (MTCT) was evaluated in mother-infant pairs from NICHD HPTN 040.MethodologyUrine samples from HIV-infected pregnant women during labor were tested by polymerase chain reaction (PCR) for CT, NG, and CMV. Infant HIV infection was determined by serial HIV DNA PCR testing. Maternal syphilis was tested by VDRL and confirmatory treponemal antibodies.ResultsA total of 899 mother-infant pairs were evaluated. Over 30% had at least one of the following infections (TP, CT, NG, and/or CMV) detected at the time of delivery. High rates of TP (8.7%), CT (17.8%), NG (4%), and CMV (6.3%) were observed. HIV MTCT was 9.1% (n = 82 infants). HIV MTCT was 12.5%, 10.3%, 11.1%, and 26.3% among infants born to women with CT, TP, NG or CMV respectively. Forty-two percent of HIV-infected infants were born to women with at least one of these 4 infections. Women with these infections were nearly twice as likely to have an HIV-infected infant (aOR 1.9, 95% CI 1.1–3.0), particularly those with 2 STIs (aOR 3.4, 95% CI 1.5–7.7). Individually, maternal CMV (aOR 4.4 1.5–13.0) and infant congenital CMV (OR 4.1, 95% CI 2.2–7.8) but not other STIs (TP, CT, or NG) were associated with an increased risk of HIV MTCT.ConclusionHIV-infected pregnant women identified during labor are at high risk for STIs. Co-infection with STIs including CMV nearly doubles HIV MTCT risk. CMV infection appears to confer the largest risk of HIV MTCT.Trial registrationNCT00099359.

Prevention of Mother-to-Child Transmission of HIV in Delta State of Nigeria: Evaluation of the Early Infant Diagnosis Program

Background: The global public health issue of Mother-to-Child Transmission (MTCT) of HIV is being addressed with Prevention of MTCT (PMTCT) strategy. A narrative review has recently been published. Objective: The aim of this study was to determine from an early infant diagnosis program in Delta State if there is reduction in MTCT of HIV. Methods: This was a retrospective study. Three health institutions comprising of one from each of the three senatorial district in Delta State were used for the study. The records of 1080 prenatally exposed babies that had DNA PCR tests between 6 weeks to 18 months were evaluated descriptively. Data mining was from the period of August 2009 to December, 2016. Child followup register was reviewed for information that included, age the child had PCR done, commencement of Antiretroviral Therapy (ART) at birth, if mother was on ART, result of PCR and test done at 18 months. Results: 98.0% of HIV positive mothers were on ART during pregnancy, 98.9% of the infants were on ART at birth, and 93.1% were exclusively breast fed. The outcome of the PMTCT program obtained shows that compared to 100% effectiveness among infants who were compulsorily treated on the basis of their mothers being on treatment, there is 89% efficiency among those who either themselves or their mothers received treatment; but only 17% efficiency was achieved where neither mother nor child is receiving treatment. Conclusion: This study shows that with effective PMTCT intervention, reducing MTCT of HIV is being achieved by the public health service.

PMTCT Interventions and Outcome of Babies Born to HIV Positive Mothers: A Retrospective Study at a Secondary Health-Care Facility in Warri, Delta State, Nigeria

Mother to child transmission (MTCT) of the AIDS virus remains a persistent means for HIV acquisition and accounts for most cases of paediatric HIV infection. Maternal viral load, antiretroviral therapy for mother and infants, infant feeding pattern and mode of delivery have been implicated as factors that affects MTCT rates. The study evaluated the efficacy of the various PMTCT interventions in relation to HIV status of the babies. Early Infant Diagnosis (EID) register of exposed infants seeking care from January 2015-December 2016 was retrieved and reviewed. Data on mother’s antiretroviral therapy (ART) status, infants ART status, sex, feeding pattern and HIV status were extracted, recorded an analyzed using SPSS 23 and results expressed in simple frequency and percentage. Statistical association was assayed for using Chi-square and Fisher’s exact test. A total of 249 mother and infant pairs took part in the study. Approximately (50.2%) of the infants were females and virtually all (95.6%) of the participating mothers were on ART. Likewise, almost all (94.0%) of the infants were placed on ART while majority of them (71%) were exclusively breastfed. An incidence rate of 4.4% (11/249) for MTCT of the AIDS virus was recorded while variables such as maternal ART status, infant ART status and infant feeding pattern showed strong association with MTCT. Findings from this study revealed a reduced prevalence for the study region when compared to other regions and a hope for the complete eradication of MTCT of HIV when PMTCT interventions and strategies are properly implemented and utilized.

Mother-to-child transmission of HIV and its predictors among HIV-exposed infants at Bamenda Regional Hospital, Cameroon.

BackgroundMother-to-child transmission (MTCT) of HIV, has been a major global public health burden. Despite the use of antiretroviral prophylaxis by HIV-positive pregnant women and their infants, safe obstetric practice and safe infant feeding habits in the prevention of MTCT of HIV, the prevalence of HIV among HIV-exposed infants is still high in Cameroon.ObjectiveOur objectives were to determine the prevalence, assess the predictors and determine the effect of combination antiretroviral therapy (cART) on MTCT of HIV at the regional hospital in Bamenda, Cameroon.MethodsThis was a retrospective study. Secondary data from 877 HIV-exposed infants aged ≤ 72 weeks were extracted from the records between January 2008 and December 2014. The predictors and effect of cART on MTCT of HIV were analysed using a multivariable logistic regression model and risk analysis, respectively.ResultsOut of 877 HIV-exposed infants, 62 were positive for HIV, giving a prevalence of 7.1%. Maternal antiretroviral intervention and infant age group were statistically significant predictors of MTCT of HIV. HIV-positive mothers who were on cART were 2.49 times less likely to transmit HIV than those who were not on cART.ConclusionIn order to reduce the prevalence of HIV among HIV-exposed infants, maternal antiretroviral intervention should be targeted and the use of cART by HIV-positive pregnant women should be encouraged.

Knowledge about mother-to-child transmission of HIV, its prevention and associated factors among Ethiopian women.

BackgroundPoor awareness and knowledge of mother–to–child transmission (MTCT),that accounts for over 90% of new HIV infections among children, might contribute to the HIV epidemics. In Ethiopia, 898 400 children are orphaned due to HIV and AIDS and 200 300 were living with HIV in 2013. The main objective of this study was to examine the knowledge of MTCT of HIV, its prevention (PMTCT) and associated factors among Ethiopian women.MethodsWe conducted a cross–sectional analysis among 16 515 women from the Ethiopian Demographic Health Survey (EDHS) 2011. Chi–square test, univarate and multivariable logistic regression analysis were used to examine the associations of socio–demographic variables with women’s correct knowledge of MTCT and PMTCT, assessed through five specific questions.FindingsThe overall correct knowledge of Ethiopian women about MTCT and PMTCT (correct answers to all the five questions) was very low (34.9%). In the multivariable analysis, residing in urban area (adjusted odds ratio (AOR) = 1.56, 95% CI = 1.35–1.79; P < 0.001), having higher education (AOR = 3.25, 95% CI = 2.74–3.86; P < 0.001), belonging to higher wealth household (AOR = 1.85, 95% CI = 1.57–2.18; P < 0.001), currently in union (AOR = 1.25, 95% CI = 1.12–1.39; P < 0.001), occupation (AOR = 1.30, 95% CI = 1.17–1.44; P < 0.001) and being exposed to mass media (AOR = 1.55, 95% CI = 1.41–1.70; P < 0.001) were strongly associated with women’s correct knowledge of MTCT and PMTCT.ConclusionStrategies to improve the knowledge of MTCT and PMTCT in Ethiopia should focus on rural women, emerging regions, the poor, illiterate and unemployed women. Efforts are also needed to involve religious leaders and related organization in the prevention of mother to child transmission of HIV.

Breastfeeding Behaviors and the Innate Immune System of Human Milk: Working Together to Protect Infants against Inflammation, HIV-1, and Other Infections.

The majority of infants’ breastfeeding from their HIV-infected mothers do not acquire HIV-1 infection despite exposure to cell-free virus and cell-associated virus in HIV-infected breast milk. Paradoxically, exclusive breastfeeding regardless of the HIV status of the mother has led to a significant decrease in mother-to-child transmission (MTCT) compared with non-exclusive breastfeeding. Although it remains unclear how these HIV-exposed infants remain uninfected despite repeated and prolonged exposure to HIV-1, the low rate of transmission is suggestive of a multitude of protective, short-lived bioactive innate immune factors in breast milk. Indeed, recent studies of soluble factors in breast milk shed new light on mechanisms of neonatal HIV-1 protection. This review highlights the role and significance of innate immune factors in HIV-1 susceptibility and infection. Prevention of MTCT of HIV-1 is likely due to multiple factors, including innate immune factors such as lactoferrin and elafin among many others. In pursuing this field, our lab was the first to show that soluble toll-like receptor 2 (sTLR2) directly inhibits HIV infection, integration, and inflammation. More recently, we demonstrated that sTLR2 directly binds to selective HIV-1 proteins, including p17, gp41, and p24, leading to significantly reduced NFκB activation, interleukin-8 production, CCR5 expression, and HIV infection in a dose-dependent manner. Thus, a clearer understanding of soluble milk-derived innate factors with known antiviral functions may provide new therapeutic insights to reduce vertical HIV-1 transmission and will have important implications for protection against HIV-1 infection at other mucosal sites. Furthermore, innate bioactive factors identified in human milk may serve not only in protecting infants against infections and inflammation but also the elderly; thus, opening the door for novel innate immune therapeutics to protect newborns, infants, adults, and the elderly.