Risk Of Perinatal Transmission Research Articles

Retrospective Cohort Study on the Impact of the COVID-19 Pandemic on Pregnancy Outcomes for Women Living With HIV in British Columbia.

For pregnant women living with HIV (WLWH), engagement in care is crucial to maternal health and reducing the risk of perinatal transmission. To date, there have been no studies in Canada examining the impact of the COVID-19 pandemic on pregnant WLWH. This was a retrospective cohort study assessing the impact of the pandemic on perinatal outcomes for pregnant WLWH using data from the Perinatal HIV Surveillance Program in British Columbia, Canada. We compared maternal characteristics, pregnancy outcomes, and clinical indicators related to engagement with care between a prepandemic (January 2017-March 2020) and pandemic cohort (March 2020-December 2022). We investigated preterm birth rates with explanatory variables using logistic regression analysis. The prepandemic cohort (n = 87) had a significantly (P < 0.05) lower gestational age at the first antenatal encounter (9.0 vs 11.8) and lower rates of preterm births compared with the pandemic cohort (n = 56; 15% vs 37%). Adjusted odds of preterm birth increased with the presence of substance use in pregnancy (aOR = 10.45, 95% confidence interval: 2.19 to 49.94) in WLWH. There were 2 cases of perinatal transmission of HIV in the pandemic cohort, whereas the prepandemic cohort had none. The pandemic had pronounced effects on pregnant WLWH and their infants in British Columbia including higher rates of preterm birth and higher gestational age at the first antenatal encounter. The nonstatistically significant increase in perinatal transmission rates is of high clinical importance.

Clinical Trials That Have Changed Clinical Practice and Care of Pregnant People With HIV.

Over the last 4 decades, significant advances in the care of HIV during pregnancy have successfully reduced, and nearly eliminated, the risk of perinatal HIV transmission. The baseline risk of transmission without intervention (25% to 30%) is now <1% to 2% in the United States with contemporary antepartum, intrapartum, and postnatal interventions. In this review, we discuss 3 landmark clinical trials that substantially altered obstetric practice for pregnant individuals with HIV and contributed to this extraordinary achievement: 1) the Pediatric AIDS Clinical Trials Group 076 Trial determined that antepartum and intrapartum administration of antiretroviral drug zidovudine to the pregnant individual, and postnatally to the newborn, could reduce the risk of perinatal transmission by approximately two-thirds; 2) the European Mode of Delivery Collaboration Trial demonstrated performance of a prelabor cesarean birth before rupture of membranes among pregnant people with viremia reduced the risk of perinatal transmission compared with vaginal birth; and 3) the International Maternal Pediatric Adolescent AIDS Clinical Trials Network 2010 Trial identified that dolutegravir-containing, compared with efavirenz-containing, antiretroviral regimens during pregnancy achieved a significantly higher rate of viral suppression at delivery with shorter time to viral suppression, with fewer adverse pregnancy outcomes. Collectively, these trials not only advanced obstetric practice but also advanced scientific understanding of the timing, mechanisms, and determinants of perinatal HIV transmission. For each trial, we will describe key aspects of the study protocol and outcomes, insights gleaned about the dynamics of perinatal transmission, how each study changed clinical practice, and relevant updates to current practice since the trial's publication.

Hepatitis-C during Pregnancy: Antenatal period challenges, management and the way forward.

Pregnant women and the general public are both directly impacted by cirrhosis which is a chronic liver disease. It is also widely known that women who have a history of injectable drug use and cirrhosis are more prone to experience unfavorable consequences that have a negative impact on the health of both the mother and the unborn child. Higher maternal Hepatitis-C Virus (HCV) in pregnancy viral load, length of labor, use of amniocentesis or fetal scalp monitoring and protracted membrane rupture are all the risk of perinatal transmission of HCV in newborns. Globally, a large number of childbearing-age women become affected by HCV every year and vertical transmission of HCV is still a serious public health concern. Pregnancy-related immune alterations have a significant impact on the course of HCV infection throughout the third trimester and provide favorable circumstances for the spread of the virus. The exacerbation of hepatic damage during pregnancy and the postpartum period is mostly responsible for HCV-specific cell-mediated immune responses. An extensive literature search done via electronic search engine including Cochrane library databases, PubMed, Google Scholar, Science Direct and HCV in pregnancy articles were included.

Viral Hepatitis in Pregnancy: ACOG Clinical Practice Guideline No. 6.

The purpose of this document is to describe the specific types of viral hepatitis, their implications during pregnancy, the risk of perinatal transmission, and issues related to both treatment and prevention of infection. Pregnant or postpartum women and individuals who screen positive for viral hepatitis infection. The onset of these conditions may have predated the perinatal period or may have occurred for the first time in pregnancy or the first year postpartum. This guideline was developed using an a priori protocol in conjunction with a writing team consisting of one specialist in obstetrics and gynecology appointed by the ACOG Committee on Clinical Practice Guidelines-Obstetrics and one external subject matter expert. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements. This Clinical Practice Guideline includes recommendations on hepatitis B virus and hepatitis C virus screening in pregnancy; prepregnancy, antepartum, intrapartum, and postpartum management for patients with hepatitis B virus infection or hepatitis C virus infection; management of accidental and occupational exposure to hepatitis B virus or hepatitis C virus in pregnant health care workers; and hepatitis A virus and hepatitis B virus vaccination in pregnancy. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence.

Perinatal Transmission of SARS-CoV-2 Infection and Its Clinical Attributes: A Single-Center Study From Western Uttar Pradesh.

Background Globally, severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) has infected millions of people to date. The morbidity and mortality associated with SARS-CoV-2 are higher in diabetics than those with chronic kidney disease and in the elderly. In pregnant women, it causes an increased risk for preeclampsia/eclampsia, infections, intensive care unit (ICU) admission, maternal mortality, and preterm birth. In neonates, SARS‑CoV‑2 infection has been found to cause stillbirths, growth retardation, premature delivery, increased neonatal intensive care unit (NICU) admission, and need for oxygen support. The neonate can get infected by vertical or horizontal transmission. As most studies have focussed on transmission at the time of birth only, in this study, we explored both vertical and horizontal transmission along with the clinical attributes of those born to mothers with SARS‑CoV‑2 infection. Methodology A prospective observational study was conducted in the Department of Pediatrics of a tertiary care hospital over 12 months from October 2020 to October 2021. All reverse transcription-polymerase chain reaction (RT-PCR) SARS-CoV-2-positive pregnant females admitted to the facility during the study duration were included.The enrolled mothers were followed till delivery. The mothers and neonates were managed per standard guidelines. Delivery details and neonatal outcomes were recorded. Coronavirus disease 2019 sampling in newborn babies was done at birth (within 24 hours) using a nasopharyngeal swab sample for RTPCR along with cord blood for SARS-CoV-2 immunoglobulin M (IgM). Complete blood count, C-reactive protein, serum electrolytes, random blood sugar, and chest X-ray were obtained for all babies at birth and thereafter according to requirement. In those roomed in with their mother, RT-PCR was repeated at the time of discharge or if they became symptomatic. Results A total of 44 mother-neonate dyads were included in the study. Cord blood IgM for SARS‑CoV‑2 was negative for all neonates, while throat swab RT-PCR was positive for two (4.5%) neonates immediately after birth. Overall, 13.6% of the neonates were premature, 27.2% of the neonates had low birth weight (<2,500 g), and 6.8%had very low birth weight (<1,500 g). Among those admitted to the NICU, 18.2% had respiratory distress; 4.5% had fever, lethargy, and poor feeding; and hyperbilirubinemia requiring phototherapy was observed in 11.3% of the neonates. Moreover, 4.5% of the neonates had hypocalcemia on initial investigations. Mortality was seen in 2.2% (1/44) of the neonates. Rooming-in and breastfeeding were seen in 68.2% of the neonates. The horizontal transmission was seen in one (3.3%) roomed-in neonate. Conclusions Perinatal transmission of SARS‑CoV‑2 infection does occur but its rate is not significant. Furthermore, with proper infection prevention and control measures, the risk of perinatal transmission can be decreased. Breastfeeding and rooming-in do not increase infection transmission if the mother takes all precautions.

Antiretroviral Options and Treatment Decisions During Pregnancy.

The majority of pediatric human immunodeficiency virus (HIV) infections are the result of vertical transmissions that occur during pregnancy, childbirth, and breastfeeding. The treatment of all pregnant persons living with HIV remains a global health initiative. Early and consistent use of antiretroviral therapy throughout pregnancy and childbirth drastically reduces the risk of perinatal transmission of HIV, resulting in fewer children living with the disease worldwide. Given that the maternal HIV viral load is the strongest predictor of perinatal transmission, suppressive antiretroviral treatment during pregnancy is the principal means to eliminate transmission of HIV from mother to child. With the use of combined antiretroviral therapy, typically with dual-nucleoside reverse transcriptase inhibitors plus an integrase strand transfer inhibitor or a ritonavir-boosted protease inhibitor, HIV-infected mothers can now achieve virologic suppression to undetectable levels and yield a perinatal transmission rate of less than 2%. Important considerations of HIV treatment in pregnancy include the safety and efficacy of antiretroviral drugs, altered pregnancy-related pharmacokinetics, potential for birth defects or adverse neonatal outcomes, and individualized delivery planning based on maternal viral load. This practical review article summarizes the options, considerations, and recommendations for antiretroviral treatment in pregnancy to reduce perinatal HIV transmission and optimize health outcomes for mothers and infants worldwide.

Electroanalytical sensors for antiretroviral drugs determination in pharmaceutical and biological samples: A review

• Review on the advancement of electroanalytical strategies for antiretroviral (ARV) drugs, dating back to 2012. • In-depth discussion on the reaction mechanisms and electrochemical behavior of ARV drugs. • Overview of antiretroviral drugs analysis in the context of pharmaceutical and clinical settings. The high human immune deficiency virus (HIV) pandemic has resulted in the discovery, development, and use of antiretroviral (ARV) drugs not only to improve patient well-being but also to reduce the risk of perinatal transmission of HIV. Due to drug-to-drug interactions, drug resistance, drug toxicity, and counterfeit drugs, there has been an urgent need for the development of portable, sensitive, selective, facile, and reliable detection strategies for ARV analysis in both pharmaceutical and clinical settings. Electroanalytical techniques are of particular interest because they offer the advantages of onsite monitoring of ARV drugs due to their flexible nature and real-time analysis compared to traditional analytical techniques. It is evident from literature dating back a decade ago that voltammetry is the most used electroanalytical technique for ARV analysis. Hence, the present review aims to discuss how detection strategies for ARV have evolved over the years and focus on recent advances in ARV analysis. Furthermore, the review will focus on different types of ARV drugs and their respective mechanisms.

A Large Data Set; Hepatitis B and C Infection in Pregnant Females

Background: Hepatitis B and C virus (HBV &amp; HCV) infection is on the surge among pregnant women as a result of unsaved dental and cosmetic procedures, reuse of needles, raising the risk of perinatal transmission and HBV &amp; HCV infection in children. Although few studies on the prevalence of HBV and HCV infection during pregnancy have been conducted but the majority of the studies are on very low sample size. The current study is based on large data set. Objectives: The major goal of this study was to find out the frequency of HBV &amp; HCV in pregnant women. Methods: We conducted a retrospective cohort study in Alkhidmat Raazi Hospital Rawalpindi. A total of 31911 pregnant women who delivered between 2016 and 2021 were analyzed and categorized as HBV &amp; HCV infected or HBV &amp; HCV uninfected by billing codes. The birth certificate and hospital discharge records were used to identify infant records related to HBV and HCV-infected pregnant mothers. Pregnant women's plasma samples were tested for HBV and HCV using chemiluminescence ARCHITECT i1000SR® Abbott Diagnostics. Data were analyzed using packages within SPSS software and P ≤ 0.05 was considered significant. Cross-tabulation chi-square analysis was performed with a significance level of 5%. Results: The pregnant women with age under 25 years were 12699 (39.8%), women with age from 26 to 29 years were 9734 (30.5%), while women with age 30 and older were 9478 (29.7). The patients who were primigravida were 9514 (29.8%), multipara having 1-4 children 18545 (58.1%) and those having more than five children were 3852 (12.1%). The prevalence of HBV and HCV in 31911 pregnant women were 170/31911 (0.5%) and 478/31911 (1.5%), respectively. The mean age was 27.9 years. Conclusions: HBV and HCV infection is present in pregnant females, which may ultimately increase the treatment cost and vertical transmission. Keywords: Hepatitis B, Hepatitis C, Infection, Pregnant females

Dolutegravir in late pregnancy: where to from here?

Strategies to eliminate the perinatal transmission of HIV include initiation of effective antiretroviral therapy (ART) as soon as possible before or during pregnancy and maintaining a suppressed viral load throughout pregnancy and postpartum. Late initiation of ART in pregnant women with HIV has been associated with increased risk of perinatal transmission and perinatal mortality in infants.1 In the DolPHIN-2 study,2 268 pregnant women with HIV (median gestational age 31 weeks) from Cape Town, South Africa and Kampala, Uganda, were enrolled and randomly assigned to receive either dolutegravir-based or efavirenz-based ART.

72 weeks post-partum follow-up of dolutegravir versus efavirenz initiated in late pregnancy (DolPHIN-2): an open-label, randomised controlled study

Late initiation of antiretrovirals in pregnancy is associated with increased risk of perinatal transmission and higher infant mortality. We report the final 72-week postpartum results for efficacy and safety of dolutegravir-based compared with efavirenz-based regimens in mothers and infants. DolPHIN-2 was a randomised, open-label trial. Pregnant women in South Africa and Uganda aged at least 18 years, with untreated but confirmed HIV infection and an estimated gestation of at least 28 weeks, initiating antiretroviral therapy in third trimester were eligible for inclusion. Eligible women were randomly assigned (1:1) to receive either dolutegravir-based (50 mg dolutegravir, 300 mg tenofovir disoproxil fumarate, and either 200 mg emtricitabine in South Africa or 300 mg lamivudine in Uganda) or efavirenz-based (fixed dose combination 600 mg tenofovir disoproxil fumarate plus either emtricitabine in South Africa or lamivudine in Uganda) therapy. The primary efficacy outcome was the time to a viral load of less than 50 copies per mL measured at 6, 12, 24, 48, and 72 weeks postpartum with a Cox model adjusting for viral load and CD4 cell count. Safety endpoints were summarised by the number of women and infants with events. This trial is registered with ClinicalTrials.gov, NCT03249181. Between Jan 23 and Aug 15, 2018, 280 women were screened for inclusion, of whom 268 (96%) women were randomly assigned: 133 (50%) to the efavirenz group and 135 (50%) to the dolutegravir group. 250 (93%; 125 [50%] in the efavirenz group and 125 [50%] in the dolutegravir group) women were included in the intention-to-treat analysis of efficacy. Median time to viral load of less than 50 copies per mL was 4·1 weeks (IQR 4·0-5·1) in the dolutegravir group compared with 12·1 weeks (10·7-13·3) in the efavirenz group (adjusted hazard ratio [HR] 1·93 [95% CI 1·5-2·5]). At 72 weeks postpartum, 116 (93%) mothers in the dolutegravir group and 114 (91%) in the efavirenz group had a viral load of less than 50 copies per mL. Of 57 (21%) mothers with a severe adverse event, three (2%) in the dolutegravir group and five (4%) in the efavirenz group were related to the drug (dolutegravir drug-related events were one woman each with suicidal ideation, suicide attempt, herpes zoster meningitis; efavirenz drug-related events were one woman each with suicide attempt and liver cirrhosis, and three people with drug-induced liver injury). Of 136 (56%) infants in whom severe adverse events were recorded, none were related to the study drugs. In addition to the three infant HIV infections detected at birth in the dolutegravir group that have been previously reported, an additional transmission in the efavirenz group occurred during breastfeeding despite optimal maternal viral suppression and serial negative infant tests in the first year of life. Dolutegravir was safe and well tolerated, supporting updated WHO treatment recommendations in pregnant and breastfeeding women. Infant HIV transmissions can occur during breastfeeding despite persistently undetectable maternal viral load highlighting the need for continued infant testing. Unitaid.

The risks of perinatal HIV/HCV co-infection and the evolution of treatment tactics of the disease in children (clinical case)

HIV infection and HCV infection are still serious and widespread infections that lead to high morbidity and mortality of the population worldwide.The aim is to assess the risks of perinatal transmission of HIV/HCV co-infection and the choice of modern treatment tactics in children.Аnalyzed data in foreign and domestic literature. A clinical case of perinatal transmission of HIV/HCV co-infection is described.Results. Тhe features of perinatal transmission of infection depending on its variants (mono-HIV infection, hepatitis C and co-infection with HIV/HCV) and risk factors are shown. A clinical example demonstrates the implementation of perinatal transmission of HIV/HCV co-infection in the presence of major risk factors. The improvement of therapeutic tactics in a child with co-infection is shown.Conclusion: in the described clinical case, numerous risk factors for perinatal transmission of HIV/HCV co-infection are demonstrated, the presence of which led to the realization of co-infection in a child. The effectiveness of modern tactics for the treatment of HIV infection and chronic viral hepatitis C has been demonstrated.

Psychosocial health in pregnancy and postpartum among women living with - and without HIV and non-pregnant women living with HIV living in Nordic countries \u2013 Results from a longitudinal survey study

BackgroundThe success of antiretroviral therapy has normalized pregnancy among women living with HIV (WWH) with a very low risk of perinatal transmission of HIV. Despite these advances, WWH still face complex medical and psychosocial issues during pregnancy and postpartum. The aim of this study was to assess differences in psychosocial health outcomes between pregnant WWH, non-pregnant WWH, and pregnant women without HIV, and further identify factors associated with probable depression in the third trimester and postpartum.MethodsIn a longitudinal survey study, participants were included from sites in Denmark, Finland, and Sweden during 2019–2020. Data was collected in the 3rd trimester, 3 and 6 months postpartum using standardized questionnaires assessing depression, perceived stress, loneliness, and social support. Mixed regression models were used to assess changes over time within and between groups. Logistic regression models were used to identify factors associated with depression in pregnancy and postpartum.ResultsA total of 47 pregnant WWH, 75 non-pregnant WWH, and 147 pregnant women without HIV were included. The prevalence of depression was high among both pregnant and non-pregnant WWH. There was no significant difference between pregnant and non-pregnant WWH in depression scores, perceived stress scores, or social support scores at any time point. Compared to pregnant women without HIV, pregnant WWH reported worse outcomes on all psychosocial scales. Social support and loneliness were associated with an increased odds of depressive symptoms in the adjusted analysis.ConclusionsA high burden of adverse psychosocial outcomes was observed in both pregnant and non-pregnant women living with HIV compared to pregnant women without HIV. Loneliness and inadequate social support were associated with increased odds of depression in pregnancy and should be a focus in future support interventions.

Распространенность ко-инфекции ВИЧ/ВГС у беременных. Факторы риска перинатальной передачи ВИЧ/ВГС

The review provides up-to-date statistical data on the prevalence, transmission routes, and risks of perinatal transmission of hepatitis C virus, immunodeficiency virus, and variants of their co-infections from mother to child. The increase in the number of HIV/HCV co-infected women of reproductive age makes it urgent to develop a strategy for the prevention of vertical transmission of HIV/HCV co-infection based on the treatment of viral hepatitis C during pregnancy planning and three-stage prevention of perinatal transmission of HIV infection at the onset of pregnancy. Key words: HIV infection, chronic viral hepatitis C, HIV/HCV co-infection, perinatal HIV transmission, perinatal transmission of viral hepatitis C infection, risks of perinatal HIV transmission, risks of perinatal hepatitis C virus transmission, risk factors for perinatal HIV/HCV co-infection transmission

The experience of pregnancy among women living with HIV in Nordic countries: A qualitative narrative enquiry.

Objective:The success of antiretroviral therapy has resulted in the normalization of pregnancy among women living with HIV and a very low risk of perinatal transmission of HIV. Despite these advances, women living with HIV still face complex medical and psychosocial issues during pregnancy. The purpose of this study is to describe experiences of pregnancy and the relevance of social support among women living with HIV in Nordic countries.Methods:This qualitative study examined data from pregnant women living with HIV from sites in Denmark, Sweden and Finland from 2019 to 2020. Data were collected in the third trimester via individual interviews using a hybrid, narrative/semistructured format. The transcribed interviews were analyzed using narrative thematic analysis.Results:In total, 31 women living with HIV were enrolled, of whom 61% originated from an African country and 29% from a Nordic country. The analysis generated four primary narrative themes: just a normal pregnancy, unique considerations and concerns, interactions with healthcare, and social support. Women living with HIV have a strong desire to have normal pregnancies and to be treated like any other pregnant woman. However, this normality is fragile, and being pregnant and living with HIV does come with unique considerations and concerns, such as fear of transmission, antiretroviral therapy, and the need for specialized care, which are fundamental to the women’s experiences. Interactions with healthcare providers and social support influence their experiences in both positive and negative ways.Conclusion:The findings emphasize a sense of normality in pregnancy among women living with HIV. However, pregnancy does come with unique considerations and concerns, which highly influence the women’s experience of pregnancy. Healthcare providers should focus on person-centered care, ensuring continuity and that women living with HIV do not feel discriminated against throughout their pregnancy.

Dried blood spot (DBS) testing for infants born to mothers with hepatitis B

Hepatitis B is a vaccine preventable disease that can lead to serious complications such as cirrhosis, liver failure and death. Globally, the most common route of HBV acquisition is via perinatal transmission: from mother to baby at the time of birth. Pregnant women in the UK are tested for hepatitis B infection to reduce the risk of perinatal transmission by ensuring early identification, treatment and management of any pregnant women, and their unborn babies, who test positive. If infants born to women with hepatitis B infection receive post-exposure vaccination (+/− hepatitis B immunoglobulin) within the recommended timescales, 90% of them will be protected from chronic persistent infection and serious complications such as cirrhosis, liver failure and death. However, HBV infection in infants can be asymptomatic so testing them at 1 year old is essential to detect whether they are infected and require treatment. Public Health England provide a national dried blood spot (DBS) testing service for infants born to mothers with hepatitis B infection during pregnancy. Practice nurses can play a key role in this process, helping to protect infants.

Equitable Timing of HIV Diagnosis Prior to Pregnancy: A Canadian Perspective.

Initiating antiretrovirals prior to conception leads to a negligible risk of perinatal transmission. This study aimed to determine the timing of HIV diagnosis among pregnant women with HIV in Ontario. A retrospective population-level cohort study using linked health administrative databases was conducted to establish maternal HIV status and timing of HIV diagnosis of all women living with HIV who gave birth in 2006-2018. The majority of the 1012 women living with HIV who gave birth in Ontario were diagnosed prior to pregnancy (87.9%); however, many were not (12.1%). Among those diagnosed during pregnancy, only 23% were diagnosed in the first trimester. While HIV screening tests are being well directed towards young women, several women still enter pregnancy undiagnosed and are not diagnosed early. This calls for a continuous effort to promote universal pre-conception screening and to use HIV point-of-care testing for at-risk pregnant women and those presenting late to prenatal care.

Perinatal transmission of SARS-CoV-2 and transfer of maternal IgG/neutralizing anti-SARS-CoV-2 antibodies from mothers with asymptomatic infection during pregnancy.

PurposeCOVID-19 pandemic remains a serious public health threat worldwide. In view of the limited data on the risk of perinatal transmission of SARS-CoV-2 and transfer of maternal anti-SARS-CoV-2 antibodies, the present study was undertaken.MethodsA prospective study including 57 pregnant women with a positive SARS-CoV-2 RNA test (SARS-CoV-2-RNA+) and 59 neonates born to them was conducted at Pune, India. 39 viral RNA negative (SARS-CoV-2-RNA-negative) pregnant women and their 39 neonates were included as controls. Neonatal nasal swab/cord blood samples were subjected to SARS-CoV-2 RNA detection by RT-PCR for investigation of perinatal transmission. Transfer of maternal antibodies was studied using ELISA and PRNT.Results10/57 SARS-CoV-2-RNA+ mothers were symptomatic. The duration between COVID-19 diagnosis and delivery was ≤ 7 days for 82.4%. Perinatal transmission as evidenced by viral RNA in the neonatal nasal swab/cord blood (CB) was 3.6%. IgG-anti-SARS-CoV-2 positivity was 21.6%. Of the 39 neonates born to SARS-CoV-2-RNA-negative mothers, 20 (51%) and none, respectively, were positive for IgG-anti-SARS-CoV-2 and viral RNA. Preterm deliveries were higher in SARS-CoV-2-RNA+ (18.6%) than SARS-CoV-2 RNA-negative (0/39) mothers (p < 0.005). Respiratory distress at birth (< 4 h) was higher among neonates of SARS-CoV-2-RNA+ (20/59, 33.9%) than SARS-CoV-2-RNA-negative mothers (3/39, 7.7%; p < 0.001). ~ 75% IgG-positives exhibited neutralization potential with mean PRNT titers of 42.4 ± 24 (SARS-CoV-2-RNA+) and 72.3 ± 46.7 (SARS-CoV-2 RNA-negative); higher in the latter (p < 0.05).ConclusionThe rate of perinatal transmission was low. Transfer of maternal antibodies was lower among SARS-CoV-2-RNA+ mothers than SARS-CoV-2-RNA-negative mothers with subclinical infection during pregnancy. Presence of neutralizing antibodies in majority of IgG-positives suggests protection from SARS-CoV-2 in early life.

Cost-effectiveness of adding a birth dose of hepatitis B vaccine in the Dafra district of the Hauts-Bassins Region in Burkina Faso (NéoVac Study)

BackgroundThe World Health Organization (WHO) recommends a first hepatitis B vaccine dose within 24 h of birth (HepB-BD) to prevent mother-to-child transmission. Evidence for this strategy’s economic value in Africa is limited. We assessed the costs and cost-effectiveness of adding HepB-BD to the current three-dose pentavalent schedule (HepB3) in the Dafra district of the Hauts-Bassins Region in Burkina Faso. MethodsUsing a decision tree combined with a Markov model, we estimated the expected number of life-years (LY) and disability-adjusted life-years (DALYs) saved, incremental costs, and incremental cost-effectiveness ratios (ICER) of HepB-BD + HepB3 versus HepB3 alone in Dafra’s 2017 birth cohort (n = 11,462). Institutional delivery rates, vaccine coverage, and vaccination costs from a health system perspective were estimated from field-collected data. We estimated the effectiveness of HepB-BD, age-specific transition probabilities, and horizontal transmission risks using data from previous African studies. Costs and health outcomes were discounted at an annual rate of 3%. We conducted one-way and probabilistic sensitivity analyses to assess uncertainty. ResultsIn the base-case analysis without discounting, HepB-BD + HepB3 yielded a net cost saving of US$18,979 and saved 163 DALYs compared with HepB3 alone. With discounting, HepB-BD + HepB3 compared with HepB3 resulted in an incremental cost of US$554 and 31 DALYs averted, translating into an ICER of US$18/DALY averted.In one-way sensitivity analyses, HepB-BD + HepB3 remained cost-effective (at the cost-effectiveness threshold of US$671 i.e. the Burkina Faso per-capita gross domestic product) for all parameter changes. However, results were very sensitive to variations in HepB-BD unit cost per vaccinated neonate and perinatal transmission risk in mothers carrying the hepatitis B e antigen. The probabilities of HepB-BD + HepB3 being cost-effective were 71.7% and 86.7%, at the cost-effectiveness thresholds of US$335 and US$671, respectively. ConclusionIntroducing HepB-BD in Burkina Faso is likely to be cost-effective.

Housing instability is associated with failure to achieve virologic control among pregnant individuals with HIV

Homelessness and housing instability, which are on the rise nationally, are considered important social determinants of health. Among nonpregnant adults living with HIV, both have been associated with decreased linkage to medical care and virologic nonsuppression. This association may be particularly concerning in pregnancy, because virologic control is the primary determinant of HIV perinatal transmission. In addition, housing instability in pregnancy may be an independent risk factor for adverse perinatal outcomes, further amplifying perinatal risks in pregnant individuals living with HIV. However, the role of housing as a social determinant of health among such individuals is largely unstudied. The objective was to examine the association between housing instability and virologic control among pregnant individuals living with HIV. This was a retrospective cohort study of pregnant individuals seeking perinatal care in a specialty HIV clinic from 2007 to 2018. Markers of virologic control, including time from antiretroviral therapy initiation to virologic suppression, antiretroviral therapy adherence, and viral load at 36 weeks and at delivery, were assessed. All patients underwent assessment of housing status with a licensed clinical social worker and were classified as experiencing housing instability (ie, staying with family or friends, transitional housing, treatment program, shelter, outdoors or vehicle, hotel, or incarcerated) vs not experiencing instability (renting or owning). Multivariable regression models assessed the associations of housing instability with virologic control. Of 232 pregnant patients living with HIV with documented housing status, 41.4% (n=96) experienced housing instability. Patients with housing instability were younger and more likely to self-identify as non-Hispanic Black, have public or no insurance, and have a mental health or substance use disorder. They were less likely to be married, be employed, or have greater than a high school education. There were no differences in parity, number of prenatal visits, or timing of HIV diagnosis between groups. On adjusted analyses, patients with housing instability required an adjusted 2.45 weeks (95% confidence interval, 0.16-4.74) longer to achieve initial viral suppression and had greater odds of missing 5 or more doses of antiretroviral medications (adjusted odds ratio, 2.09; 95% confidence interval, 1.07-4.09) and having a detectable viral load at delivery (adjusted odds ratio, 2.13; 95% confidence interval, 1.02-4.47). Housing instability among pregnant individuals living with HIV is common and is associated with decreased virologic control during pregnancy. Given the association between virologic control and perinatal transmission, housing instability may be an important social determinant of HIV-related perinatal outcomes. Addressing housing instability during pregnancy may be a critical avenue to improve maternal and neonatal health and reduce the risk of perinatal transmission.

Reverse transcriptase and protease inhibitors mutational viral load in HIV infected pregnant women with transmitted drug resistance in Argentina.

ABSTRACTObjectiveArgentina has reported high levels of transmitted drug resistance (TDR), in HIV-infected pregnant women by population sequencing. We aimed to describe, in patients with TDR, the percentage of quasispecies harboring resistance mutations (RAMs) and mutational load (ML).Patients and MethodsRetrospective study in a cohort of 40 naïve HIV-infected pregnant women, whose pretreatment samples had been genotyped by TRUGENE (period 2008-2014). Samples were re-sequenced with Ultra-deep Sequencing and ML was calculated considering baseline HIV-1 RNA load multiplied by the frequency of quasispecies harboring RAMs.ResultsTDR for NNRTIs, NRTIs and PIs was 17.5% (n=7 patients), 10% (n=4), 12.5% (n=5) respectively. Predominant NNRTI RAMs were K103N (n=4; 10%) and G190A/E/S (n=3; 7.5%). For NNRTIs, 78% of RAMs were present in >93.5% of viral population and ML was >1000 copies/mL (c/mL) for 89%, with a median (IQR) of 8330 c/ml (7738-29796). The following NRTI RAMs were described (per patient: % of quasispecies, ML): T215I (99.7%, 11014 c/ml); D67G (1.28%, 502 c/mL); M41L (79.8%, 88578 c/mL) and M184I (1.02%, 173 c/mL). Most frequent PI-RAMs were I85V, M46I, I50V and L90M (n=2, 5% each). For PIs, quasispecies with RAMs were <2.3% of viral population and ML was <350 c/mL for 77.8% of them.ConclusionNNRTI-RAMs are predominant within the viral population, usually exceeding the threshold of 1000 c/mL, indicating potential higher risk of perinatal transmission. Conversely, PI mutations appear mostly as minority variants, with potential lower risk of transmission. Among NRTI, quasispecies harboring RAMs and ML values were variable.