HIV-infected Pregnant Women Research Articles

Urinary tract infections and associated factors in HIV infected pregnant women at a tertiary hospital in Lusaka, Zambia

Introduction: urinary tract infections (UTIs) remain among significant causes of morbidity and mortality in pregnant women in sub-Saharan Africa. Zambia shares this burden disproportionately compared to other countries and it is unknown to what extent HIV affects UTIs. This study investigated the prevalence of UTIs and associated factors among HIV infected pregnant women attending antenatal care at a tertiary hospital in Zambia.

Effect of highly active antiretroviral therapy (HAART) on some specific clotting profile in Human Immunodeficiency Virus -(HIV) positive pregnant women.

Background:In many developing countries with a significant proportion of human immunodeficiency virus (HIV)-positive patients are women of child-bearing age and would require antiretroviral therapy. This study aimed at evaluating the effect of highly active antiretroviral therapy (HAART) on some specific clotting profile in HIV-positive pregnant women.Subjects and Methods:This study comprised 150 patients consisting of 50 blood samples from pregnant women on HAART as test subjects, 50 pregnant HIV-positive women that were not on HAART as test subjects, and 50 pregnant HIV-negative women which served as controls. The test subjects were attending the prevention of mother-to-child transmission Clinic at the Central Hospital, Benin City. Specific clotting factors assayed were factors 11, V, V11, V111, 1X, X, X1, and X11. All were done using ELISA methods.Results:Factors 11 and V were reduced significantly in HIV-infected pregnant women on HAART and those not on HAART (P < 0.05) when compared with HIV-negative pregnant women. A significant increase in factors V11, V111, 1X, X, and X11 were observed in HIV-positive patients on HAART and those not on HAART when compared with HIV-negative pregnant women (P < 0.05). However, when HIV-positive patients on HAART were compared to HIV-positive women not on HAART, no statistical difference were observed (P > 0.005).Conclusion:There are changes in clotting profile of HIV-positive women on HAART and on those not on HAART and these changes are not due to the administration of antiretroviral therapy.

Co-infection of &lt;i&gt;Toxoplasma gondii&lt;/i&gt; and &lt;i&gt;HIV&lt;/i&gt; Infections in Pregnancy in Bamako - A Case Report

Background: Toxoplasma gondii infections cause serious complications in HIV-infected pregnant women, leading to miscarriages, stillbirths, birth defects such as mental retardation, blindness, epilepsy, and could favour or enhance the mother-to-child transmission of HIV. Worldwide, 30% of the population have antibodies to the intracellular protozoan parasite Toxoplasma gondii and about 36.7 million people are infected with HIV, however little is known about the prevalence of co-infection of Toxoplasma gondii and HIV in pregnancy. We report co-infection of Toxoplasma gondii and HIV in pregnant women in Mali. Methods: Toxoplasma gondii anti- IgG, IgM and HIV Combi PT serology were performed in sera from pregnant women using the Elecsys system. The HIV genotyping was performed using the Tri-DOT technique. Results: One pregnant woman out of 247 screened was anti-Toxoplasma IgM positive and HIV type I positive. An anti-Toxoplasma gondii IgM positive reading is an indication of an acute/current infection. Conclusion: This suggests there is active toxoplasmosis transmission and therefore a possible risk for congenital infections in Bamako. HIV infection being endemic in Mali may accentuate toxoplasmosis pathology in this region. Toxoplasmosis surveillance and awareness are therefore necessary in Bamako to stem the scourge of this neglected infection.

Pregnancy outcomes following exposure to efavirenz based antiretroviral therapy in indian women.

OBJECTIVES:Mother-to-child transmission of HIV has witnessed a significant reduction due to effective antiretroviral therapy (ART). Efavirenz has been introduced as a part of ART since last few years in the national Prevention of Parent to Child Transmission (PPTCT) program for pregnant women living with HIV. However, data related to adverse pregnancy outcomes associated with efavirenz-based ART are limited in the Indian scenario. The present study evaluated pregnancy outcomes in HIV-infected pregnant women who were given efavirenz-based ART during pregnancy.MATERIALS AND METHODS:It is a retrospective, observational, analytic study carried out at a referral hospital in Western India. Collection of data was done for a period of 5 years, and various adverse outcomes were studied which included preterm delivery, low birth weight (LBW), stillbirths, congenital anomaly, and neonatal death.RESULTS:This study showed a preterm birth rate of 19% and LBW in 36% of cases. There was no significant association with congenital anomaly, stillbirth, or neonatal death.CONCLUSION:There was an association of exposure to efavirenz with an increased incidence of adverse pregnancy outcomes, especially LBW infants. This study emphasizes the requirement of large prospective studies to investigate fetomaternal outcomes in pregnant women exposed to efavirenz.

Experience with Integrase Inhibitors in HIV-Infected Pregnant Women in the Madrid Cohort: A Paired Cohort Study

Background: Minimizing the time to achieve complete suppression of HIV replication, is critical in pregnancy to decrease the risk of mother-to-child transmission (MTCT). Integrase inhibitors(INSTIs) are characterized by a rapid drop in viral load (VL) and a good transplacental penetration. Our objective was to determine the effectiveness of INSTIs in MTCT and present the experience in the Madrid Cohort of HIV infected mothers-infant pairs. Methods: Paired cohorts, multicentric and observational study, that includes retrospectively the cohort of pregnant women exposed to INSTIs during pregnancy and their infants (Cohort A) from 2000 to 2017, and another cohort of mothers without INSTIs treatment and their children matched by year of birth +/- one year (Cohort B). Maternal demographic, clinical and analytical characteristics were recorded. The follow-up of children was included. Results: 67 pregnant women exposed to INSTIs from Madrid cohort (n:1423) and their children were identified. Another group of 67 pregnant women without INSTI treatment were selected. Both groups were similar in maternal age, ethnicity and route of transmission. The percentage of pregnant women with detectable VL at the first trimester was statistically higher (p<0.01) in cohort A (46.7%) than in B (6.7%). There were no statistically significant differences in the percentage of low birthweight and preterm newborn. There were no cases of MTCT, nor differences in congenital birth defects.

Plasma efavirenz concentration inversely correlates with increased risk of cytomegalovirus infection in HIV-infected pregnant women.

Effective combination antiretroviral therapy (cART) has tremendously reduced HIV-associated morbidity, mortality and mother-to-child transmission. However, the benefits of cART are threatened by comorbidities, adverse drug reactions and virus resistance to existing treatment regimens. One of the most occurring comorbidities is cytomegalovirus (CMV) infection. To investigate the effects of cART on the occurrence of CMV infection among pregnant women. Using a cross-sectional study design, 175 HIV-infected pregnant women were recruited, and data were obtained from their clinical records. Blood samples were collected for host DNA, CMV DNA and plasma efavirenz (EFV) measurement. CMV DNA was measured using real-time polymerase chain reaction (PCR). CYP2B6 c.516G&gt;T and CYP2B6 c.983T&gt;C single nucleotide polymorphisms were characterised using PCR/restriction fragment length polymorphism and TaqMan assays, respectively. Plasma EFV concentrations were determined using high-performance liquid chromatography. There was an inverse association between plasma EFV concentration and CMV DNA. Participants with lower plasma EFV concentrations were significantly (p&lt;0.001) more likely to be CMV DNA positive than those with higher plasma concentrations. This result is also supported by the observation that carriers of CYP2B6 poor-metaboliser genotypes (CYP2B6 c.516T/Tand CYP2B6 c.983T/C) were less likely to be positive for CMV DNA. Furthermore, poor metabolism as denoted by CYP2B6 c.516T/T and CYP2B6 c.983T/C genotypes was significantly associated with lower CMV viral load. HIV treatment disrupts the balance between host and co-infecting microbes. Reduced or subtherapeutic levels of antiretroviral drugs, which could be exacerbated by genetic polymorphisms in drug metabolism genes and non-adherence, predispose infected individuals to an increased risk of CMV infection in pregnancy.

Improving Monitoring of Engagement in HIV Care for Women in Option B+: A Pilot Test of Biometric Fingerprint Scanning in Lilongwe, Malawi

Sustained engagement in HIV care is critical to the success of Option B+ for HIV-infected pregnant women. However, monitoring women's engagement in care across clinics and over time is challenging due to migration and clinic transfers. Improved strategies to identify and monitor women's engagement in HIV care across a network of clinics are needed, but have not been pilot tested. We evaluated the feasibility and acceptability of biometric fingerprint scanning to identify women and monitor HIV visit attendance among women in Option B+. Over a 3-month period, we enrolled HIV-infected pregnant women receiving care at two antenatal clinics in Lilongwe, Malawi and monitored their engagement in care using biometric fingerprint scanning and the standard-of-care electronic medical record (EMR) monitoring system. Biometric data was collected by trained research assistants, who uploaded and synced data across study sites daily using wireless internet. We collected data weekly on the biometric scanner performance, reliability, and usability. We assessed the feasibility and acceptability of using biometric fingerprint scanning to record HIV visits during exit interviews with a sample of participants and healthcare workers and by comparing visit concordance between the biometric fingerprint scanning and EMR systems. We enrolled 314 HIV-infected pregnant women and 51 HCWs (n = 365 total participants). The majority of participants felt the biometric fingerprint scanning system was easy to use (64%), required no additional assistance (69%) and met their expectations (76%). No major issues with data security, privacy, or scanner functionality were reported by HIV-infected women or healthcare workers. Of the 542 HIV visits captured during the study period among women in Option B+, 80% were recorded in the biometric fingerprint system versus 51% in the EMR system (PR 1.57, 95% CI 1.43, 1.72, p-value < 0.05). Among HIV-infected pregnant women engaged in HIV care, biometric fingerprint scanning is a feasible and acceptable way to monitor HIV visits and may improve the ability to monitor women's engagement in HIV care over time and across clinics. Biometric fingerprint scanning should be scaled-up and evaluated as an implementation strategy to support sustained engagement in HIV care for women during the perinatal period.

Comparison of two combined antiretroviral treatment regimens in the management of HIV in pregnancy: an observational study

Objective Combined antiretroviral therapy (cART) in pregnancy traditionally included two nucleoside reverse transcriptase inhibitors plus 1 protease inhibitor (PI). Recently, integrase strand transfer inhibitors (INSTI) have been approved for use in pregnancy. We sought to compare the rate of undetectable VL near delivery in pregnant HIV-infected women receiving INSTI-based versus PI-based cART. Material and methods Prospective cohort study (January 2010–March 2017) of pregnant HIV-infected pregnancies receiving care in a single obstetric infectious disease clinic. Included pregnancies (total = 171; INSTI − group = 111, PI − group = 60) had at least 2 VL (before and after intervention) during pregnancy. The primary outcome was the rate of undetectable VL near delivery. Results We found comparable rates of undetectable HIV VL near delivery in pregnancies treated with INSTI-cART (74/111, 66.7%) compared to PI-cART (34/60, 56.7%; [adjusted p = .116, RR 1.26, 95% CI 0.92–2.59]). Compared to the PI-group, pregnancies in the INSTI-group showed lower median HIV VL near delivery (20 versus 50 copies/mL; adjusted p = .0454) and greater VL reduction (adjusted p = .0185). There were 3/171 (1.75%) infants diagnosed with HIV, 1 in the INSTI-group and 2 in the PI-group (p = .5635, RR 0.51, 95% CI 0.10–2.53). Conclusion Pregnant HIV-infected women receiving either INSTI- or PI-based cART achieved comparable rates of undetectable HIV VL near delivery with similar perinatal transmission.

Mycoplasma genitalium infection among HIV-infected pregnant African women and implications for mother-to-child transmission of HIV.

Many sexually transmitted infections increase risk of mother-to-child transmission (MTCT) of HIV, but the effect of Mycoplasma genitalium is not known. We hypothesized that M. genitalium infection would be common among HIV-infected pregnant women and could be associated with in-utero and intrapartum MTCT. Observational case-cohort study. The current study used specimens from a Kenyan perinatal MTCT cohort (1999-2005) involving HIV-infected women and their infants, who received short-course zidovudine for prevention of MTCT. Vaginal swabs collected at 32 weeks gestation were tested for M. genitalium using a transcription-mediated amplification assay. Infant perinatal HIV infection was determined at birth and 4 weeks of age by DNA PCR. Using a case-cohort design, a random sample was generated with 3 : 1 control : case ratio; prevalence and correlates of M. genitalium were assessed with chi-squared and t tests; predictors of infant outcomes were analyzed using logistic regression. Among 220 HIV-infected pregnant women evaluated, 47 women (21.4%) had M. genitalium. Antenatal M. genitalium infection was associated with higher HIV RNA in plasma (5.0 vs. 4.6 log10 copies/ml in M. genitalium-positive vs. M. genitalium-negative women, P = 0.02) at 32 weeks. Women with M. genitalium were less likely to report prior sexually transmitted infections and genital ulcers (both P = 0.05). There was no association found between exposure to M. genitalium and perinatal MTCT (odds ratio = 0.72, 95% confidence interval 0.35, 1.51, P = 0.39). Vaginal M. genitalium infection was frequently detected among Kenyan HIV-infected pregnant women and was associated with higher plasma HIV levels, but was not associated with perinatal transmission of HIV.

Epidemiological characteristics of HIV infected pregnant women and exposed infants in Guangdong province, 2014-2017

Objective: To analyze the epidemiological characteristics of HIV-infected pregnant women and exposed infant in Guangdong province and identify the factors associated with infant HIV infection through mother-to-child transmission. Methods: National Information System for Prevention of mother-to-child HIV Transmission and Early Infant Diagnosis Information Management Platform were used to collect the individual information about HIV-infected pregnant women and exposed infants who were delivered in Guangdong from January 1, 2014 to December 31 in 2017. The differences in pregnant women's demographic data, history of pregnancy and childbirth, the utilization of mother-to-child transmission prevention services and early infant diagnosis between the infected HIV exposed infants and uninfected HIV exposed infants were compared, and univariate and multivariate logistic regression analyses were conducted to identify the factors associated with mother-to-child HIV transmission. Results: Among 349 HIV infected pregnant women, the proportions of the pregnant women whose HIV infection status were confirmed before pregnancy, during pregnancy and at or after childbirth were 30.4% (106/349), 49.6% (173/349) and 20.0% (70/349) respectively. The proportions of those with sexual partners whose HIV infection status were unknown and those receiving no antiviral treatment were 39.5% (138/349) and 13.2% (46/349) respectively. Among the HIV exposed infants, the mother-to-child transmission rate was 4.2%(15/353), the HIV exposed infants had the first or second early diagnosis tests within 44 (P(25)-P(75): 42-50) days and 96 (P(25)-P(75): 92-106) days after birth, respectively. Univariate logistic regression analysis indicated that the risk for mother-to-child HIV transmission increased in those whose HIV infection status were confirmed at or after childbirth compared with before pregnancy (OR=5.72, 95%CI: 1.52-21.61) and in the group that antiviral treatment was given to either mothers or infants compared with the group that antiviral treatment was given to both mothers and infants (OR=33.56, 95%CI: 9.04-124.55), while there was lower mother-to-child HIV transmission risk in artificial feeding group compared with breast feeding group (OR=0.07, 95%CI: 0.01-0.76). Conclusion: The risk of mother-to-child HIV transmission in Guangdong can be effectively reduced by the measures of early diagnosis, antiviral treatment and artificial feeding as well as the improvement of mother-to-child transmission prevention service.

Placental Malaria Associated With Low Birth Weight among HIV-Infected Pregnant Women on Cotrimoxazole Prophylaxis in Jos, Nigeria

Placental Malaria Associated With Low Birth Weight among HIV-Infected Pregnant Women on Cotrimoxazole Prophylaxis in Jos, Nigeria

Prevention of Mother-to-Child Transmission of HIV – an Update from Rural Africa.

Sub-Saharan Africa is home of 85 % of pregnant women living with HIV and 90 % of HIV-infected children. WHO issued the first prevention of mother-to-child transmission of HIV (PMTCT) recommendations in 2000. These guidelines have been revised to incorporate new evidence and align with the goal of universal treatment access and zero infections among children. Currently, 82 % of HIV-infected pregnant women receive antiretroviral treatment, and infections among children have halved since 2010. However, in 2018, 160,000 children became infected. Reasons hindering the success of PMTCT are: a) non-universal HIV testing during pregnancy; b) low retention through the PMTCT cascade; and c) missed opportunities to diagnose women who acquire HIV while pregnant or breastfeeding. To address these gaps innovative strategies are needed.

A tool for estimating antiretroviral medication coverage for HIV-infected women during pregnancy (PMTCT-ACT)

BackgroundIn the typical prevention of mother to child transmission (PMTCT) of HIV cascade of care discussion or analysis, the period of analysis begins at the first visit for antenatal care (ANC) for that pregnancy. This starting point is problematic for two reasons: (1) a large number of HIV-infected women are already on life-long antiretroviral therapy (ART) when presenting for ANC; and (2) women present to ANC at different gestational ages. The PMTCT ART Coverage Tool (PMTCT-ACT), which estimates the proportion of days covered (PDC) with ART, was developed to address each of these problems.MethodsPDC is a preferred method to measure adherence to chronic medications, such as ART. For evaluating the PMTCT cascade of care, as indicated by PDC with ART over various time periods, a “starting point” based on a specific day before delivery must be defined that applies to all women (treatment experienced or naïve at the first ANC visit at any gestational age). Using the example of 168 days prior to delivery (24 weeks), PMTCT-ACT measures PDC with ART during that period. PMTCT-ACT is provided as a STATA do-file. Using an example dataset for two women (ID1 is treatment experienced; ID2 is treatment naïve), the details of each major portion of the tool (Parts 1–5) are presented. PMTCT-ACT along with the intermediate datasets created during the analysis are provided as supplemental files.ConclusionsEvaluating the PMTCT cascade of care requires a standard definition of the follow-up period during pregnancy that applies to all HIV-infected pregnant women and a standard measure of adherence. PMTCT-ACT is a new tool that fits this purpose. PMTCT-ACT can also be easily adjusted to evaluate other ante- and post-natal periods (e.g., final 4 weeks, final 8 weeks, complete pregnancy period, initial 24 weeks postpartum, time periods consistent with infant HIV testing guidelines).

Highly diverse anaerobe-predominant vaginal microbiota among HIV-infected pregnant women in Zambia.

Vaginal dysbiosis has been shown to increase the risk of some adverse birth outcomes. HIV infection may be associated with shifts in the vaginal microbiome. We characterized microbial communities in vaginal swabs collected between 16–20 gestational weeks in the Zambian Preterm Birth Prevention Study to investigate whether HIV and its treatment alter the microbiome in pregnancy. We quantified relative abundance and diversity of bacterial taxa by whole-genome shotgun sequencing and identified community state types (CST) by hierarchical clustering. Associations between exposures—HIV serostatus (HIV+ vs HIV-) and preconceptional ART (ART+ vs ART-)—and microbiome characteristics were tested with rank-sum, and by linear and logistic regression, accounting for sampling by inverse-probability weighting. Of 261 vaginal swabs, 256 (98%) had evaluable sequences; 98 (38%) were from HIV+ participants, 55 (56%) of whom had preconceptional ART exposure. Major CSTs were dominated by: L. crispatus (CST 1; 17%), L.] iners (CST 3; 32%), Gardnerella vaginalis (CST 4-I; 37%), G. vaginalis & Atopobium vaginae (CST 4-II; 5%), and other mixed anaerobes (CST 4-III; 9%). G. vaginalis was present in 95%; mean relative abundance was higher in HIV+ (0.46±0.29) compared to HIV- participants (0.35±0.33; rank-sum p = .01). Shannon diversity was higher in HIV+/ART+ (coeff 0.17; 95%CI (0.01,0.33), p = .04) and HIV+/ART- (coeff 0.37; 95%CI (0.19,0.55), p < .001) participants compared to HIV-. Anaerobe-dominant CSTs were more prevalent in HIV+/ART+ (63%, AOR 3.11; 95%CI: 1.48,6.55, p = .003) and HIV+/ART- (85%, AOR 7.59; 95%CI (2.80,20.6), p < .001) compared to HIV- (45%). Restricting the comparison to 111 women in either CST 3 (L. iners dominance) or CST 1 (L. crispatus dominance), CST 3 frequency was similar in HIV- (63%) and HIV+/ART- participants (67%, AOR 1.31; 95%CI: (0.25,6.90), p = .7), but higher in HIV+/ART+ (89%, AOR 6.44; 95%CI: (1.12,37.0), p = .04). Pregnant women in Zambia, particularly those with HIV, had diverse anaerobe-dominant vaginal microbiota.

A cost-effectiveness analysis of antenatal influenza vaccination among HIV-infected and HIV-uninfected pregnant women in South Africa

BackgroundPregnant women and infants are at increased risk of severe disease from influenza. Antenatal influenza vaccination is safe and can reduce the risk of illness for women and their infants. We evaluated for South Africa the health effects of antenatal influenza vaccination among pregnant women and their infants aged <6 months old and assessed its cost-effectiveness. MethodsWe constructed a decision tree model to simulate the population of pregnant women and infants aged <6 months in South Africa using TreeAge Pro Suite 2015. The model evaluated the change in societal costs and outcomes associated with a vaccination campaign that prioritized HIV-infected over HIV-uninfected pregnant women compared with no vaccination. We also examined the impacts of a campaign without prioritization. Upper and lower 90% uncertainty intervals (90% UI) were generated using probabilistic sensitivity analysis on 10000 Monte Carlo simulations. The cost-effectiveness threshold was set to the 2015 per capita gross domestic product of South Africa, US$5724. ResultsAntenatal vaccination with prioritization averted 9070 (90% UI: 7407–11217) total cases of influenza among pregnant women and infants, including 411 (90% UI: 305–546) hospitalizations and 30 (90% UI: 22–40) deaths. This corresponds to an averted fraction of 13.5% (90% UI: 9.0–20.5%). Vaccinating without prioritization averted 7801 (90% UI: 6465–9527) cases of influenza, including 335 (90% UI: 254–440) hospitalizations and 24 (90% UI: 18–31) deaths. This corresponds to an averted fraction of 11.6% (90% UI: 7.8–17.4%). Vaccinating the cohort of pregnant women with prioritization had societal cost of $4689 (90% UI: $3128–$7294) per Quality Adjusted Life Year (QALY) gained while vaccinating without prioritization had a cost of $5924 (90% UI: $3992–$9056) per QALY. ConclusionsAntenatal influenza vaccination campaigns in South Africa would reduce the impact of influenza and could be cost-effective.

Recent advances in the epidemiology, diagnosis, and management of Trichomonas vaginalis infection.

Trichomonas vaginalis is the most common, curable non-viral sexually transmitted infection (STI) worldwide. Despite this burden of disease, it is not currently a reportable disease in the United States. Recent advances in the epidemiology, diagnosis, and management of T. vaginalis infection are described in this article. This includes updated global and U.S. prevalence data in women and men as well as recent epidemiological data in HIV-infected individuals and pregnant women. Advances in molecular diagnostics are also reviewed, as are data from recent clinical trials regarding the treatment of trichomonas in women.

Maternal and fetal outcome in HIV infected pregnant women-A two year study at tertiary hospital

Introduction: At present scenario Acquired immunodeficiency syndrome is currently one of the worst global health concerns. HIV has a dramatic impact on the health of women and their children. Objective: To find out the prevalence of HIV status among pregnant women in a tertiary care hospital to determine maternal and fetal outcome in HIV infected pregnant women. Materials and Methods: A retrospective study conducted in Cheluvamba Hospital a tertiary care hospital attached to MMCRI during January 2014 to December 2016. The case records of pregnant women with HIV positive status were selected from hospital records. Follow up details of both mother and babies were obtained from ICTC Centre. Results: Total deliveries during the study period were 19641. Of these the incidence of HIV Status was 80, the Incidence being 0.4%. primigravidas were found to be 43.75%. HIV seropositivity rate was more between 21 to 25years of age group, contributing to 56.25% of the total cases. CD4 count of >200 was found in 37.5% of cases, of which 25% were primigravida. Among all cases 31.25% were not put on Antiretroviral Therapy (ART). Vaginal deliveries were 83.5% and caesarean sections were 16.5%. Birth weight of >2.5 kg were seen in more than 50% of cases. Breast feeding was opted by 81.75 %. 93.8% neonates received nevirapine of the babies admitted in NICU 4 babies died (11.2%). 2 babies were found to be positive. Conclusion: Adverse outcomes were associated with untreated maternal HIV infection in pregnancy. PMTCT services were utilized sub optimally by the women with low level of education. Awareness and information is important for programs designed to increase access to PMTCT services including HAART from early pregnancy. Keywords: Antiretroviral Therapy (ART), Pregnancy with HIV.

OBSTETRIC PROBLEMS IN HIV-INFECTED WOMEN

Objective: to study the features of the course of pregnancy and childbirth in HIV-infected women in the Saratov region according to a retrospective analysis of case histories for 2013–2018. Materials and methods. A retrospective clinical and statistical analysis of the course of pregnancy, childbirth and the postnatal period was carried out according to medical records of 282 HIV-infected pregnant women who were treated at the State Agrarian Medical Center (Engels, Saratov Region, Russia) in 2013–2018. (main group). The comparison group consisted of patients who were not infected with HIV who were treated at the SAUS EOC in 2013–2018. To assess the statistical significance of differences, the standard statistical analysis software package STATISTICA 10,0 was used. Results. Compared to 2013, in 2018, the age of HIV-infected pregnant women has decreased (p&lt;0,05). HIV-infected people are less likely to go to a maternity clinic before the 12th week of pregnancy (p&lt;0,05). A high frequency of co-infection of HIV-infected women with urinary infection (p&lt;0,05) and genital tract (p&lt;0,05), hepatitis C viruses (p&lt;0,05) and B (p&lt;0,05), and syphilis was found anamnesis (p&lt;0,05). A high susceptibility of these women to viral infections was noted: acute respiratory viral infection (p&lt;0,05), genital herpes virus (p&lt;0,05), cytomegalovirus infection (p&lt;0,05). The incidence of sexually transmitted infections is high: urogenital chlamydia (p &lt;0,05), trichomonas colpitis (p&lt;0,05). HIV-infected pregnant women have an increased incidence of anemia (p&lt;0,05), chronic pyelonephritis (p&lt;0,05), and skin diseases (p&lt;0,05), and body mass deficiency is more common (p&lt;0,05). In case of HIV infection, the frequency of operative delivery (p&lt;0,05), premature birth (p&lt;0,05), the frequency of formation of a low-weight fetus at a time of gestation (p&lt;0,05), as well as perinatal mortality (p&lt;0,05). The reserve for reducing perinatal mortality for newborns from HIV-infected mothers is in the pregravid period, testing for HIV, hepatitis C virus, correction of the patient’s weight, elimination of the iron deficiency condition, detection and rehabilitation of urogenital foci. When taking to a dispensary account, control and correction of anemia, chronic infectious diseases, monitoring of the state of the vaginal biocenosis are necessary, in the second half of pregnancy — control of fetal growth.

DEMOGRAPHIC AND EPIDEMIOLOGICAL CHARACTERISTICS OF THE HIV-INFECTED PREGNANT WOMEN IN SAINT-PETERSBURG

Analysis of the epidemiological and demographic characteristics of HIV-infected pregnant women is important for organizing effective care for this group of patients and further reducing the frequency of mother-to-child transmission. Between 2014 and 2017 in Saint-Petersburg, there were 2524 deliveries in HIV-infected women who were observed during pregnancy, mainly in the Saint-Petersburg AIDS Center (AIDS Center). The average frequency of perinatal HIV transmission over the study period in the city was 1,3%, which is lower than the average for Russia. Out of 2524 women recently confined, 1858 HIV-infected women, who were observed during pregnancy at the AIDS Center in 2014–2017, were enrolled. Risk groups for perinatal HIV transmission in Saint-Petersburg are HIV-infected pregnant women: external or internal migrants, women with late registration at the dispensary registration for pregnancy in the antenatal clinic and the AIDS Center and, accordingly, late initiation of perinatal HIV transmission, active consumers of surfactants, pregnant women with low adherence to observation in medical institutions and to getting antiretroviral agents. The increase in coverage of the city’s population with HIV testing reveals new infections, including among women of reproductive age, as well as their partners. The timely use of ARV at the planning stage of pregnancy reduces perinatal HIV transmission and the risks of opportunistic diseases. The availability of medical care and free distribution of ARV drugs to all pregnant women who applied to the AIDS Center helps to reduce perinatal HIV transmission, including among internal and external migrants who do not have a permanent registration in Saint-Petersburg. Counseling women at the planning stage and during pregnancy by various specialists of the AIDS Center (gynecologists, infectious disease specialists, psychologists, narcologists) allows one to form a commitment to monitoring, to receiving ARV, giving up bad habits, to reduce the incidence of HIV-dissidence.

IgG abnormalities in HIV-positive Malawian women initiating antiretroviral therapy during pregnancy persist after 24 months of treatment

ObjectivesHypergammaglobulinemia and anomalies in the IgG subclass distribution are common in HIV-infected individuals and persist even after many years of antiretroviral therapy (ART). The aim of this study was to investigate the IgG profile and dynamics in pregnant HIV-infected Malawian women in the Option B era. MethodsThirty-seven treatment-naive women received ART from the third trimester of pregnancy to 6 months post delivery (end of the breastfeeding period). ART continuation (group C) or interruption (group I) was then decided on the basis of the CD4+ cell count at enrolment (>350 or ≤350/μl). Total IgG and IgG subclasses were determined in maternal serum using a nephelometric assay at baseline and at 6 and 24 months postpartum. ResultsAt enrolment, 36/37 women had IgG levels >15g/l and there was a predominance of the IgG1 isotype (more than 90%) in parallel with underrepresentation of IgG2 (5.0%). After 6 months of ART, both groups showed a significant median decrease in total IgG (−3.1g/l in group I, −3.5g/l in group C) and in IgG1 (−4.0g/l and −3.6g/l, respectively), but only a modest recovery in IgG2 levels (+0.16 in group I, +0.14g/l in group C). At month 24, hypergammaglobulinemia was still present in 73.7% of women in group C, although a significant reduction was observed in total IgG level and in IgG1 and IgG3 subclasses (p<0.0001 in all cases). IgG2 levels did not show any significant change. In group I at 24 months, total IgG and IgG subclasses had returned to levels comparable to those at baseline. ConclusionsThe beneficial effects of 24 months of ART appear to be limited in the B-cell compartment, with an incomplete reduction of total IgG levels and no recovery of IgG2 depletion. A short ART period did not have significant effects on IgG abnormalities in women who interrupted treatment.