Mother-to-child Transmission Of HIV Research Articles

Influence of infant feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa.

Previous studies on the effect of breastfeeding on mother-to-child transmission (MTCT) of HIV have not attempted to examine the influence of different types of breastfeeding practice. To attempt to address some of these inadequacies, infant feeding practices of 549 HIV-infected women involved in a trial in Durban, South Africa were documented prospectively. Women were counseled on infant feeding choices according to UNAIDS guidelines, and those who chose to breastfeed were encouraged to practice exclusive breastfeeding. The MTCT rates of HIV-1 at 3 months were compared in the three different feeding groups (never breastfed, exclusive breastfeeding, and mixed breastfeeding). At 3 months, 18.8% of 156 never-breastfed children were infected compared to 21.3% of 393 breastfed children (p = 0.50). Children exclusively breastfed to at least 3 months (n = 103) were less likely to be infected (14.3%) than those receiving mixed feeding before 3 months (24.1%) (p = 0.03). After adjustment for potential confounders (maternal CD4:CD8 ratio, syphilis screening test results, and preterm delivery), exclusive breastfeeding carried a significantly lower risk of HIV-1 transmission than mixed feeding (hazard ratio [HR] 0.52, 95% CI: 0.28-0.98) and an equivalent risk to no breastfeeding (HR 0.85, 95% CI: 0.51-1.42). Our findings have important implications for HIV and infant feeding policies in developing countries, and it is critical that further research be undertaken. In the meantime, breastfeeding policies for HIV-infected women require urgent review. If confirmed, exclusive breastfeeding may offer HIV-infected women in developing countries an affordable, culturally acceptable, and effective means of reducing MTCT of HIV-1 while maintaining the overwhelming benefits of breastfeeding.

Achievable Standard of Care in Low‐Resource Settings

The gap between rich and resource-poor countries has continued to grow as reproductive care providers integrate interventions to limit mother-to-child transmission (MTCT) of HIV in a manner consistent with existing information. There are two major reasons for this difference: access to prophylactic antiretroviral therapy (ARV) for HIV-infected pregnant mothers and availability of alternative feeding for babies. In resource-poor settings, these options are beyond reach for the majority of the women. Infant and under-five mortality rates from other infections are high in these settings and breastfeeding remains the norm. Answering the question, What is an achievable standard of care in resource-poor settings? still remains a major challenge today. Dialogue has begun in most resource-poor settings to address the key elements in the package of interventions to reduce MTCT of HIV. These elements include the following: (1) overall prevention of HIV in mothers and fathers; (2) provision of good-quality voluntary testing and counseling (VCT) in antenatal clinics; (3) a comprehensive package of interventions during pregnancy, during labor, and after delivery, including screening for sexually transmitted diseases (STDs), family planning, and--where possible--ARVs; (4) provision of infant and maternal nutrition within the socioeconomic realities; (5) advocacy and program communication; and (6) other supportive measures, including community mobilization to address issues such as stigmatization of and violence against HIV-infected women. This paper discusses the challenges faced by most resource-poor settings in integrating some of these activities into reproductive care services.

Exposure to HIV-1 during delivery and mother-to-child transmission.

The correlation between the presence of HIV-1 in maternal cervicovaginal secretions and in the infant's oro-pharyngal secretions at birth, and mother-to-child HIV transmission (MTCT) were examined to obtain a better understanding of its mechanism. Women without medical and obstetrical complications, living within a reasonable distance of the government hospital in Mombasa, Kenya, were recruited after informed consent. Maternal and infant characteristics were collected. Polymerase chain reaction was used to detect HIV-1 in cervico-vaginal and oro-pharyngal secretions. Infants were tested for HIV-1 by polymerase chain reaction within 48 h and at 6 weeks after delivery. Between April 1998 and April 1999, 228 woman-infant pairs were included in the study. HIV-1 DNA in cervico-vaginal secretions was independently associated with HIV-1 maternal viral load and with infant birth-weight, whereas HIV-1 RNA was associated with maternal viral load and maternal age. HIV-1 DNA in the oropharyngal secretions was also independently associated with maternal viral load. MTCT rate at the age of 6 weeks was 23.6%. Intrapartum and early postpartum HIV transmission was independently associated with maternal viral load [adjusted odds ratio (OR), 1.6; 95% confidence interval (CI),1.0-2.7], detection of HIV-1 RNA in cervico-vaginal secretions (adjusted OR, 3.2; 95% CI, 1.5-7.3) and of HIV-1 DNA in oro-pharyngeal secretions (adjusted OR, 3.2; 95% CI, 1.1-9.0). As far as is known, this is the first study showing that infant exposure to HIV-1 in the birth canal and the presence of HIV-infected cells in the infant's oropharyngeal cavity are independently associated with intrapartum and early postpartum MTCT. It supports the hypothesis that MTCT could occur through the oral route.

Trends in Prevention of Mother-to-Child Transmission of HIV-1

Mother-to-child transmission (MTCT) of HIV is the predominant mode of HIV transmission in children worldwide. It is estimated that around 1.3 million children are living with HIV and that approximately 1,600 children are infected with HIV each day. Numerous clinical trials using antiretroviral drugs to reduce MTCT of HIV-1 have shown that perinatal transmission can be reduced effectively. Based on the PACTG 076 study administering a long antenatal zidovudine regimen, a signific ant reduction in vertical HIV-1 transmission has been achieved in the developed world. Trials conducted in developing countries have shown that perinatal transmission can be reduced effectively even using shorter and less costly antiretroviral regimens. Prevention of MTCT interventions have been implemented on a large scale in a number of developing countries.

Impact of infant feeding practices on the risk of mother to child transmission of HIV-1 in Zimbabwe.

To determine the magnitude of the contribution of infant feeding practices on the risk of mother to child transmission (MTCT) of the HIV-1 infection. Prospective data from birth until 24 months of age on 236 infants born to HIV-positive mothers in Harare, Zimbabwe was analysed for this study. However, because only a small proportion of infants (2.1%) were HIV-1 polymerase chain reaction (PCR) tested shortly after birth, the PCR results for infants at birth were not incorporated into our analyses. The contribution of infant feeding practices on the risk of MTCT of HIV-1 was assessed using Cox Proportional Hazards Regression Models. The incidence of HIV-1 through MTCT was greatest among breastfed (8.33 per 100 child-months) and mixed fed (8.64 per 100 child-months) infants by 3 months. After adjustment for maternal age, marital status, education and infant antibody HIV-1 status, the cumulative relative risk of MTCT of HIV-1 was 4.19 (95% confidence interval (CI) 3.44, 5.09) among breastfed and 1.10 (95% CI 0.97, 1. 25) among mixed fed infants. The overall MTCT rate of HIV-1 in this study was 40.3%. Breastfed infants had the greatest cumulative relative risk of MTCT of HIV-1, followed by mixed fed infants, with the highest incidences occurring within the first 3 months.

Preventing mother-to-child transmission of HIV-1 in Africa in the year 2000.

Various approaches to preventing mother-to-child transmission (MTCT) of HIV have recently been, or are being, evaluated in developing countries, especially in Africa. New findings from these trials are now becoming available, the implications of which, for population-based intervention programmes, need urgent consideration. A critical review of 18 randomized trials and other relevant studies from developing and industrialized countries. Most African results relate to trials of antiretroviral agents (ARV). They demonstrate efficacy in reducing transmission in the first 6 months of life with short regimens of zidovudine (ZDV), with or without lamivudine (3TC), and nevirapine (NVP) alone. Preliminary results suggest the long-term efficacy of zidovudine. Antiseptic and nutritional interventions have been shown to reduce maternal and infant mortality and morbidity but not MTCT of HIV. HIV confidential voluntary counselling and testing for pregnant women, a short regimen of peripartum ARV with alternatives to breastfeeding such as early weaning or breast milk substitutes from birth currently represent the best option to reduce MTCTof HIV in Africa. However, the prevention of postnatal transmission requires further research, particularly in view of the consequences of different feeding options and the possibility of post-perinatal exposure prophylaxis of newborns with ARV. Issues relating to the implementation of currently validated strategies are discussed.

Haematological characteristics and HIV status of pregnant women in Abidjan, Côte d'Ivoire, 1995–1996

To describe the haematological profile of pregnant women and to compare these characteristics according to HIV serostatus in Abidjan, Côte d'Ivoire, a cross-sectional study was made in the context of a research intervention programme to reduce mother-to-child transmission (MTCT) of HIV (ANRS 049 trial). HIV testing was systematically proposed to pregnant women attending the mother and child health clinic of a community health centre. Blood samples were tested for HIV antibodies using Genelavia ™ and Peptilav ™. The haematological parameters were measured with a Coulter counter. From May 1995 to March 1996, 1646 pregnant women accepted HIV testing and had a full blood count available. The prevalence of HIV infection was 12·0% ( n = 197). The prevalence of anaemia (haemoglobin [Hb] <11 g/dL) was 70·1%, n = 1155 (95% confidence interval 68–72%) and significantly higher in HIV+ (81·7%, n = 161) than in HIV− women (68·9%, n = 994) ( P < 0·001). Severe anaemia (Hb < 7 g/dL) was present in 1·9% of the women ( n = 31), 4·6% ( n = 9) in HIV+ and 1·5% ( n = 22) in HIV− women ( P < 0·001). HIV infection, primigravidae and secundigravidae were factors independently associated with anaemia. Anaemia was highly prevalent in this population while severe anaemia was rare. HIV infection was a contributor to anaemia in pregnancy. As zidovudine, with its known haematological toxicity, has recently been introduced to prevent MTCT of HIV in developing countries, screening HIV+ women for severe anaemia is necessary.

HIV: mother to child transmission, current knowledge and on-going studies

It is estimated that approximately 6000 women of childbearing age, mostly living in the developing world, acquire HIV infection every day. Taking into account that approximately 98% of HIV infected children have acquired HIV from the mother, during pregnancy, at delivery or through breastfeeding, therefore, prevention of mother-to-child transmission (MTCT) is a major health priority. Several studies have showed how MTCT of HIV may be prevented using antiretrovirals. Results from a study conducted in Thailand have also recently showed how a short oral zidovudine course during pregnancy and labor may reduce the risk of HIV transmission by approximately 50%. These findings represent a major challenge for the International Health Agencies and Organizations that will have the major obligation to provide HIV tests, counseling and antiviral drugs in settings with high HIV prevalence.

Prevention of mother-to-child transmission of HIV in Africa

Before implementation of a tolerance and efficacy trial of zidovudine (ZDV) in Abidjan Ivory Coast the acceptability of HIV screening was probed among women attending the Yopougon Health Center for their first prenatal visit in 1996-97. Of the 2219 prenatal clients who were eligible for AZT 395 (17.8%) refused HIV testing--primarily because of fear of the result. Of the 1824 women who consented to testing 279 (15.3%) were HIV-positive (249 for HIV-1 21 for HIV-2 and 9 with dual reactions). 204 HIV-positive women returned for their test result. Of these women 3 refused the confirmation test and 29 were lost to follow-up after the second test leaving 172 women for pre-inclusion. However 101 of these women were subsequently excluded for reasons including return visit too late in pregnancy for AZT planned delivery outside of Abidjan change of mind and loss to follow-up before formal inclusion. Thus only 71 women received the trial treatment. The only significant difference between these 71 women and those who did not complete the selection process was that the former women were older (mean age 26 years) than the latter (mean age 24 years). The finding that it was necessary to perform HIV tests in 1824 women to recruit 71 women for a clinical trial of ZDV indicates a need for IEC campaigns aimed at women of childbearing age about maternal-child HIV transmission and its prevention.

Estimating the rate of mother-to-child transmission of HIV. Report of a workshop on methodological issues Ghent (Belgium), 17–20 February 1992

In the last 8 years, numerous cohort studies have been conducted to estimate the rate of mother-to-child transmission (MTCT) of HIV. Many of these have faced problems in data collection and analysis, making it difficult to compare transmission rates between studies. This workshop on methodological aspects of the study of MTCT of HIV-1 was held in Ghent (Belgium) in February 1992. Fourteen teams of investigators participated, representing studies from Central (five) and Eastern Africa (three), Europe (two), Haiti (one) and the United States (three). A critical evaluation of the projects was carried out, under four headings: (1) enrollment and follow-up procedures, (2) diagnostic criteria and case definitions, (3) measurement and comparison of MTCT rates and (4) determinants of transmission. Reported transmission rates ranged from 13 to 32% in industrialized countries and from 25 to 48% in developing countries. However, no direct comparisons could be made because methods of calculation differed from study to study. Based on this review, a common methodology was developed. Agreement was reached on definitions of HIV-related signs/symptoms, paediatric AIDS and HIV-related deaths. A classification system of children born to HIV-1-infected mothers according to their probable HIV infection status during the first 15 months of life, allowed the elaboration of a direct method of computation of the transmission rate and of an indirect method for studies with a comparison group of children born to HIV-seronegative mothers. This standardized approach was subsequently applied to selected data sets. The methodology can now be applied to all studies with sufficient follow-up and comparisons made between transmission rates. This step is essential for assessing determinants of transmission and for the development of a common approach for the evaluation of interventions aimed at reducing or interrupting MTCT of HIV.

Awareness of mother to child HIV transmission among women attending antenatal clinic, SMIMER, Surat

The study was conducted among 946 women attending antenatal clinic in SMIMER teaching hospital during 2008 to know their awareness regarding various aspects of mother-to-child transmission (MTCT) of HIV and it was found that though the general awareness of HIV is high, awareness of MTCT and its prevention is low which need to be improved through focused IEC campaign. Background : More than 90% of HIV infections in children aged &lt;15 years are due to mother-to-child transmission (MTCT). The MTCT may reverse the gains of the child survival strategy in the country. Awareness of HIV and MTCT among antenatal women plays crucial role in preventing MTCT. Objective : To evaluate the awareness and knowledge of HIV/AIDS, MTCT of HIV and the methods to prevent MTCT of HIV. Methods : This is a descriptive cross sectional study carried out among antenatal women at the SMIMER Teaching Hospital during 2008. Results : Out of 946 women interviewed, 78% had heard of HIV/AIDS and main sources of information were television (48.8%) and radio (37.8%). Ninety-one percent of women were aware of MTCT of HIV. Trans-placental route (41%) was the commonly identified route of transmission. Awareness of HIV/AIDS, HIV co-existence with pregnancy and Mother to child transmission was significantly higher among women with at least secondary education (P&lt;0.05). The level of knowledge and perceptions of MTCT of HIV is inadequate. Conclusion : There is an urgent need to scale up HIV awareness programme focusing on mother-to-child transmission in the region. Keywords: Awareness; education; mother-to-child transmission; prevention; HIV DOI: 10.3126/saarctb.v7i1.3956SAARC J. TUBER. LUNG DIS. HIV/AIDS 2010 VII(1) 8-12