Pregnant Human Immunodeficiency Virus Research Articles

A case report: recurrent anemia related to long term acyclovir use in a pregnant HIV infected Ugandan

Abstract: This case report describes a pregnant patient with recent diagnosis of Human Immuno-Deficiency Virus (HIV) infection initiated on Anti-Retroviral Therapy (ART) in the second trimester, as well as high dose acyclovir high for large infected genital warts. She had no other HIV related opportunistic infections, and no prior anti tuberculosis treatment or preventive medication. Despite little response to acyclovir, patient was continuing on acyclovir for over 4 months. She subsequently developed recurrent anemia requiring frequent transfusion (14 units in total) over a 6-week period.
 On stopping acyclovir, the anemia subsided, a few weeks later she had a normal delivery, followed by surgical removal of the warts. At a follow-up 8 months later, she was well, with a healthy baby, and reported no other episodes of blood transfusion.
 Keywords: Recurrent anemia; acyclovir; herpes genitalis; HIV; ART.

An analysis of the uptake of anti-retroviral treatment among pregnant women in Nigeria from 2015 to 2020.

The percentage of Human Immunodeficiency Virus (HIV) positive pregnant women that receive anti-retroviral treatment in Nigeria is low and has been declining. Consequently, 14% of all new infections among children in 2020 occurred in Nigeria. A detailed analysis of available data was undertaken to generate evidence to inform remedial actions. Data from routine service delivery, national surveys and models were analyzed for the six-year period from 2015 to 2020. Numbers and percentages were calculated for antenatal registrations, HIV testing, HIV positive pregnant women and HIV positive pregnant women on antiretroviral treatment. The Mann-Kendall Trend Test was used to determine the presence of time trends when the p-value was less than 0.05. In 2020, only 35% of an estimated 7.8 million pregnant women received antenatal care at a health facility that provided and reported PMTCT services. Within these facilities, the percentage of HIV-positive pregnant women on anti-retroviral treatment from 71% in 2015 to 88% in 2020. However, declining HIV positivity rates at these antenatal clinics and an absence of expansion of PMTCT services to other pregnant women due to cost-efficiency considerations contributed to a progressive decline in national PMTCT coverage rates. To achieve elimination of mother-to-child transmission of HIV, all pregnant women should be offered a HIV test, all who are HIV positive should be given anti-retroviral treatment, and all PMTCT services should be reported.

HUBUNGAN PENGETAHUAN IBU HAMIL TENTANG HIV/AIDS SERTA DUKUNGAN SUAMI DENGAN KESEDIAAN IBU DALAM MELAKUKAN VCT DI PUSKESMAS BALOI PERMAI KOTA BATAM.

A normal and healthy pregnancy is what every woman desires. Diseases experienced during pregnancy will be at risk for the baby. One of the most feared diseases is the Human Immunodeficiency Virus (HIV). The VCT strategy is at the core of all HIV / AIDS prevention and control efforts. Therefore, preventive service of HIV transmission from a mother to a child is one of the efforts to combat HIV and AIDS integrated with health services. The purpose of this study was to determine whether the Relationship between Knowledge of Pregnant Women and HIV / AIDS and the Support of Husbands in Their Willingness to Perform VCT. The research design used in this study was an Analytical Survey using the Cross Sectional approach. The study was conducted in April to August at the Public Health Center Baloi Permai in Batam. The population in this study was 273 respondents with a sample of 73 respondents, using a point time approach technique. Data collection using questionnaire instruments filled out by respondents. Data in tabular and textual form was analyzed using Chi-Square. The statistical test results obtained 66 respondents with good knowledge, husband less-support was 40 respondents and the willingness of pregnant women 73 respondents There is a significant relationship between Knowledge (p = 0,000) and husband support (p = 0.007) with the willingness of mothers to conduct VCT. It is expected to improve socialization about HIV / AIDS and VCT services at the Public Health Center and motivate health workers to play a role in increasing public knowledge about VCT testing through counseling in more creative ways. Hence, the community is interested in participating in these activities, and providing educative information so as to increase the knowledge of pregnant women related to VCT.

Improving depression screening in HIV positive pregnant women

IntroductionDepression is a common complication of pregnancy and the postpartum period. Up to 70% percent of women report depressive symptoms during their pregnancy, and approximately 10-16% meet full criteria for major depressive disorder. Women with a history of perinatal or non-perinatal major depression are likely to relapse during pregnancy. Research shows that exposure to untreated depression and stress can have negative consequences on the birth outcome and child development. Given the harmful effects of this disease on both the mother and child, it is essential that all pregnant patients be screened for depression. Literature review did not reflect many studies that focus on depression screening in this population, let alone in pregnant patients with Human Immunodeficiency Virus (HIV). Our study focuses on the impact the mandatory screening tool had on the incidence of depression screening in pregnant HIV patients.Objectives- Gain understanding of the Family Focused HIV Health Care Program for Women - Understand the importance of a mandatory screening tool for depressionMethodsUsing standardized Quality Improvement tools Implementation of screening tool in notes & enforcing a hard stop in the medical recordsResultsWe noted both qualitative & quantitative improvement in depression screening. Qualitatively the screening has been standardized by creating a universal workflow by the inclusion of screening tools (PHQ2 and PHQ9) in Electronic Medical records. Quantitatively there has been a 34.9% improvement in screening by the case managers in the post interventional quarter.ConclusionsSignificant improvement noted in the incidence of depression screening by implementation a mandatory screening tool

Usage of Lysosomal Nanoparticles in Delivering Antibody Cocktail to Developing Fetuses in HIV Mothers

Introduction: The placenta is a crucial organ which allows for transfer of nutrients between the mother and fetus. Importantly, the placenta allows for transport of antibodies to the fetal bloodstream through the FcRn receptors inducing passive immunity. However, in HIV-positive mothers who cannot produce antibodies, passive immunity against toxoplasmosis, other, rubella, cytomegalovirus, and herpes (T.O.R.C.H) infections in utero is not plausible. A potential solution utilizing new nanoparticle technology was researched in hopes of delivering IgG antibodies to the developing fetus. Methods: We propose using a liposomal nanoparticle filled with the IgG antibody cocktail to deliver the antibodies necessary for the fetal development. We will use pl-chondroitin sulfate A binding protein (plCSA-BP) to guide our nanoparticle towards the FcRn receptors on the trophoblast membranes of the placenta. Once attached the nanoparticle will degrade after its half-life and release antibodies. We will measure the transfer of antibodies through the ex vivo placental lobule system in combination with western blot. Please note that one side of the placental lobule system would represent the fetal side and one would represent the maternal side. Results: It's expected that the nanoparticles will attach to trophoblastic layers through the plCSA-BP. The natural FcRn receptors will transfer the antibodies across the placenta to the fetal bloodstream inducing passive immunity in an ex-vivo model. Discussion: These results may have a noticeable impact on pregnant human immunodeficiency virus (HIV) positive mothers due their ability to enter the fetal system, which will offer passive immunity against T.O.R.C.H viral infections and prevent developmental issues. The absence of antibodies for the fetus can, in some cases, lead to fatality. Conclusion: We expect the study to show the utility of our nanoparticle design in combating fetal infections, especially in HIV women. This research should be furthered via research into the impacts of medication administration at different trimesters as this has immense potential in advancing a field often on the outskirts of medicine.

Development of High Resolution Melting Analysis as a Diagnostic Tool for Molecular Detection of Toxoplasma Infection in Pregnant Women and HIV Positive Cases.

Background:Toxoplasma gondii is an obligate intracellular protozoan with worldwide distribution. Diagnosis of toxoplasmosis is a very critical issue, especially in pregnant women and immunocompromised patients. The aim of this study was rapid detection of T. gondii DNA in peripheral blood samples (PBS) employing HRM technique and using RE gene.Methods:Totally, 242 samples from pregnant women and human immunodeficiency virus (HIV) patients were collected from different hospitals and medical centers of Tehran during Oct 2017 to Dec 2018. High resolution melting analysis (HRM) using partial sequences of repetitive element (RE) gene was done and compared with ELISA test.Results:Overall, 51 were positive for acute toxoplasmosis that among them, 12 and 20 reported as positive in pregnant women and HIV+ patients, respectively using HRM technique. Among 70 patients in chronic phase of disease, 10 and 3 samples were reported as positive for pregnant women and HIV+ patients respectively. From 121 negative control, 3 (4.62%) samples associated with HIV+ patients, showed positive real-time PCR and HRM analysis results.Conclusion:For the first time, HRM technique via employing RE gene was used for detection of T. gondii infection in PBS. This method is suitable, helpful and in parallel with serological methods for early diagnosis of acute as well as active form of toxoplasmosis in pregnant women and HIV+ patients. The use of techniques based on melt curve and through employing next-generation dyes for diagnosis of T. gondii would be accessible for patients in developing countries.

Gambaran Kepatuhan Pemeriksaan PPIA (Pencegahan Penularan HIV dari Ibu Ke Anak) Ibu Hamil dengan Risiko HIV (Human Immunodeficiency Virus)

Human Immunodeficiency Virus (HIV) is an infectious disease with a death rate and the number of disease incidence is high and requires the diagnosis and the therapy long enough. The success of the program depends on the PPIA socialization of HIV and Syphilis in pregnant women, as well as compliance checked her pregnancy during pregnancy for early detection of HIV and Syphilis that is useful for the treatment of early and proper while the results the examination showed reactive. The purpose of this research to know description of compliance inspection of PPIA (prevention of HIV transmission from mother to child) of pregnant women with HIV risk in public health II in Baturraden. The method is observational approach time crosssectional tests. Population in the study are all pregnant women and pregnant women throughout the research sample of trimester I, timester II, and trimester III who programme PPIA in public health II in Baturraden of this year in 2018 as many as 100 people. The research results obtained compliance examination of the PPIA pregnant women HIV risk i.e. age 35-44 in 76%; secondary education diploma 100%; and employment status of civil servant or the student as much as 100%. While 55% of disobedience at 15-24 years old; elementary school level 73%; and a housewife 59%. The higher the education, age, and occupation of a person then the PPIA program to carry out compliance higher.

Predicting Optimal Dihydroartemisinin-Piperaquine Regimens to Prevent Malaria During Pregnancy for Human Immunodeficiency Virus-Infected Women Receiving Efavirenz.

A monthly treatment course of dihydroartemisinin-piperaquine (DHA-PQ) effectively prevents malaria during pregnancy. However, a drug-drug interaction pharmacokinetic (PK) study found that pregnant human immunodeficiency virus (HIV)-infected women receiving efavirenz-based antiretroviral therapy (ART) had markedly reduced piperaquine (PQ) exposure. This suggests the need for alternative DHA-PQ chemoprevention regimens in this population. Eighty-three HIV-infected pregnant women who received monthly DHA-PQ and efavirenz contributed longitudinal PK and corrected QT interval (QTc) (n = 25) data. Population PK and PK-QTc models for PQ were developed to consider the benefits (protective PQ coverage) and risks (QTc prolongation) of alternative DHA-PQ chemoprevention regimens. Protective PQ coverage was defined as maintaining a concentration >10 ng/mL for >95% of the chemoprevention period. PQ clearance was 4540 L/day. With monthly DHA-PQ (2880 mg PQ), <1% of women achieved defined protective PQ coverage. Weekly (960 mg PQ) or low-dose daily (320 or 160 mg PQ) regimens achieved protective PQ coverage for 34% and >96% of women, respectively. All regimens were safe, with ≤2% of women predicted to have ≥30 msec QTc increase. For HIV-infected pregnant women receiving efavirenz, low daily DHA-PQ dosing was predicted to improve protection against parasitemia and reduce risk of toxicity compared to monthly dosing. NCT02282293.

Non-blood management of severe anaemia in pregnant human immunodeficiency virus positive Jehovah's Witness patients in the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

Background: Blood transfusion is clinically used to treat severe anaemia, but some people refuse it for its adverse effects and religious reasons. Aim: To present two Jehovah's Witness pregnant human immunodeficiency virus (HIV) positive women who were managed successfully without blood at the University of Port Harcourt Teaching Hospital. Methods: Case series - The first case, a 27-year-old Jehovah's Witness woman was found to be retropositive with severe anaemia. She had a packed cell volume (PCV) of 14% in her second trimester in pregnancy. She was treated with oral haematinics, and the PCV rose to 34% before an elective caesarean section. The second case was a 29-year-old Jehovah's Witness woman who was admitted for chronic cough and fever in her second trimester. On further investigation, she was found to have pulmonary tuberculosis, septicaemia and severe anaemia with a PCV of 17%. She declined blood transfusion and was managed with parenteral iron and erythropoietin. Both cases had safe deliveries with good fetomaternal outcome. Conclusion: Pregnant patients who decline blood transfusion can be adequately managed if they register in the first trimester or the early second trimester and such cases need good team management and cooperation between the patient and the teams for a good outcome.

Role of GeneXpert MTB/Rif Assay in Diagnosing Tuberculosis in Pregnancy and Puerperium

Presentation of tuberculosis (TB) in pregnancy may be atypical with diagnostic challenges. Two patients with complicated pregnancy outcomes, foetal loss and live premature delivery at 5 and 7 months of gestation, respectively, and maternal loss, were diagnosed with pulmonary TB. Chest radiography and computed tomography showed widespread reticuloalveolar infiltrates and consolidation with cavitations, respectively. Both patients were Human Immunodeficiency Virus (HIV) seronegative and sputum smear negative for TB. Sputum GeneXpert MTB/Rif (Xpert MTB/RIF) was positive for Mycobacterium tuberculosis. To strengthen maternal and childhood TB control, screening with same-day point-of-care Xpert MTB/RIF is advocated among both HIV positive pregnant women and symptomatic HIV negative pregnant women during antenatal care in pregnancy and at puerperium.

Anatomopathological characterization of placentas from HIV+ patients associated with p24 expression

INTRODUCTION: The study of placentas from pregnant human immunodeficiency virus (HIV) positive women has become the subject of numerous studies in the literature. Morphological, viral, immune and inflammatory placental aspects have been analyzed in order to grasp the vertical transmission of the virus. OBJECTIVE: To identify the most frequent findings in the placentas by associating them with a viral antigen and correlating them with the infection of newborns. MATERIAL AND METHODS: Thirty-five placentas from HIV- positive pregnant women were pathologically and immunohistochemically analyzed with the use of p24 antibody in the period from 1992 to1997 in accordance with the routine laboratory testing from the Anatomopathological Department - Hospital Universitário Antônio Pedro - Universidade Federal Fluminense (APD/HUAP/UFF). RESULTS: The microscopic alterations detected in all cases, including those with vertical transmission, were arteriopathy in the fetal blood circulation, chorioamnionitis, perivillous fibrin deposition, syncytial knotting, villous edema and villous immaturity. No specific macroscopic or histopathological changes were found in these placentas. The neonatal infection was observed in five cases. Vertical transmission was identified in two out of five placentas that had low weight for the respective stage of pregnancy. Immunohistochemical analysis revealed 14 positive cases, two of which showed vertical transmission. The viral protein was not identified in 10 out of 14 placentas from patients who had been medicated with zidovudine (AZT). CONCLUSION: Our study has contributed to the anatomopathological investigation into placentas from HIV-positive patients, although p24 expression per se did not allow a definite and early diagnosis of the vertical transmission.

Acute hepatitis C in a pregnant HIV infected woman: Case report and literature review

Sexual transmission of Hepatitis C Virus (HCV) in monogamous heterosexual couples is less than 3% per year and condoms are not recommended in this setting. The risk increases if the partner is coinfected with Human Immunodeficiency Virus (HIV) and if there are lesions of the vaginal/anal mucosa.Usually asymptomatic (in 70–80% of the cases), acute HCV infection is rarely diagnosed. Pregnancy progresses with a tolerance to the hemiallograft (the fetus) and fragility of the vaginal mucosa.Scarce studies of acute HCV infection during pregnancy reported no serious effects on the pregnant or the fetus, although there is a higher incidence of prematurity.We present a case of acute hepatitis C during pregnancy in a patient with HIV1 infection. She had a longtime sexual partner, coinfected with HIV/HCV, with no previous treatment for HCV nor antiretroviral therapy. They had occasional unprotected intercourse with no other risk factor. At the time of conception, the partner had a high HIV and HCV viral load. HCV infection presented with acute diarrhea and cholestatic hepatitis.We discuss the infrequent HCV sexual transmission and the contribution of the various facilitating factors described in literature, some of those present in this case. In this particular situation we emphasize the need for condom use in serodiscordant couples for HCV.

Efficacy of Low-Dose Boosted Saquinavir Once Daily Plus Nucleoside Reverse Transcriptase Inhibitors in Pregnant HIV-1-Infected Women With a Therapeutic Drug Monitoring Strategy

The efficacy of low-dose, ritonavir-boosted saquinavir (SQV/rtv) once daily plus 2 nucleoside retrotranscriptase inhibitors (NRTIs) in pregnant human immunodeficiency virus (HIV)-1-infected women was prospectively evaluated, ensuring a SQV minimum concentration (Cmin) >/=100 ng/mL with a therapeutic drug monitoring strategy. The primary clinical endpoint was the percentage of women with an HIV-RNA viral load (VL) of <50 copies/mL at the time of delivery. Forty-nine pregnancy episodes were included, with a median CD4 count and VL of 441/muL and 3710 copies/mL, respectively. Two patients were lost to follow-up and 1 patient discontinued treatment because of abdominal discomfort. SQV levels were in excess of the target Cmin in 43 of 46 episodes (93.4%) in which the end of pregnancy was reached on 1200/100 mg daily. The dosage was increased to 1600/100 mg in the remaining 3 episodes to achieve the target levels. By an intention-to-treat analysis, VL was undetectable at delivery in 43 episodes (87.7%; 95% confidence interval, 78.5-96.9) after a median of 18 weeks of treatment (range, 3-39). In the 3 episodes remaining, VLs of 110,400 copies/mL and no available data were observed after only 3 weeks of treatment. Mild adverse events attributable to SQV/rtv occurred in 6 of 49 pregnancies (12.2%). No cases of HIV vertical transmission were observed. The pharmacokinetics, efficacy, and tolerability of this regimen suggest that once-daily low-dose boosted SQV may be considered an appropriate option in PI-naive or limited-PI-experienced HIV-infected pregnant women. Nevertheless, therapeutic drug monitoring is advisable to maintain appropriate levels throughout pregnancy.

Drug rash with eosinophilia and systemic symptoms syndrome and renal toxicity with a nevirapine-containing regimen in a pregnant patient with human immunodeficiency virus

Background Antiretroviral therapy is associated with serious adverse events. We report the case of a pregnant human immunodeficiency virus type 1–infected woman who developed drug rash with eosinophilia and systemic symptoms syndrome and renal failure shortly after initiation of a nevirapine-containing antiretroviral regimen at 27 weeks’ gestation. Case A 26-year-old primigravida presented with a fever of 40.2C, urticarial rash, and icteric sclera 6 weeks after starting a nevirapine-containing antiretroviral regimen. Eosinophils, serum creatinine, bilirubin, and liver enzymes were markedly elevated, and abnormal coagulation studies were noted on admission. Serology testing was negative for viral hepatitis and microbiologic cultures were negative for growth. Abnormal laboratory findings at discharge resolved within 4 months after discontinuation of antiretroviral agents and systemic corticosteroid therapy. Conclusion Our case suggests the need for close monitoring of liver and renal function after initiation of nevirapine-containing antiretroviral regimens.

Antiretroviral resistance mutations among pregnant human immunodeficiency virus type 1-infected women and their newborns in the United States: vertical transmission and clades.

To assess the impact of antiretroviral resistance on perinatal transmission prevention efforts, human immunodeficiency virus type 1 (HIV-1) genotypic resistance testing was done for 220 HIV-1-infected, zidovudine (AZT)-exposed pregnant women and 24 of their infected infants. The women were prospectively enrolled in 4 US cities in 1991-1997. Phylogenetic and sequencing analyses revealed 5 women with non-clade B infections traced to western African origins. AZT-associated mutations were detected in 17.3% of pregnant women, whereas genotypic resistance to nonnucleoside reverse-transcriptase inhibitors and protease inhibitors was infrequent. No significant association was detected between perinatal transmission and the presence of either AZT or nucleoside reverse-transcriptase inhibitor resistance-associated mutations. AZT resistance mutations were detected in 2 (8.3%) neonatal samples, but the mutation pattern was not identical to the mother's. Although no effect of viral resistance on mother-infant transmission was demonstrated, the advent of more-potent drug classes and the potential for the rapid emergence of resistance warrant prospective surveillance.

Ethical theory and principles: Do they have any relevance to problems arising in everyday practice?

This review of ethical theories with application to two difficult obstetric cases will allow the practicing obstetrician and gynecologist to use these theories to help resolve difficult ethical dilemmas. In the first case a pregnant human immunodeficiency virus–infected woman refuses to take triple preventive therapy, with potential fetal harm. In the second case a couple with a quintuplet multifetal pregnancy needs assistance to decide about selective termination to effect fetal reduction. (Am J Obstet Gynecol 2000;183:301-8.)

Trichomoniasis in pregnant human immunodeficiency virus–infected and human immunodeficiency virus–uninfected Congolese women: Prevalence, risk factors, and association with low birth weight

Objective: We sought to assess the prevalence of and risk factors for vaginal trichomoniasis in human immunodeficiency virus–infected and human immunodeficiency virus–uninfected pregnant Congolese women and its relationship to pregnancy outcomes. Study Design: We performed a nested case-control study of 215 infected and 206 uninfected mothers who responded to questionnaires, underwent sexually transmitted disease testing (including culture for trichomoniasis shortly after delivery), and underwent assessment of infant outcomes. Maternal variables and birth outcomes were assessed according to presence or absence of trichomoniasis and human immunodeficiency virus. Results: Trichomoniasis was present in 18.6% of human immunodeficiency virus–positive and 10.2% of human immunodeficiency virus–negative women, respectively (odds ratio, 2.0; 95% confidence interval, 1.1-3.6), and was significantly associated with low birth weight (odds ratio, 2.4; 95% confidence interval, 1.2-4.5). In multivariate analyses trichomoniasis remained associated with low birth weight, and adjustments were made for other risk factors associated with low birth weight. Conclusion: These findings suggest an association between trichomoniasis and low birth weight independent of human immunodeficiency virus infection and other risk factors. Further studies are needed to assess the impact of antenatal screening and treatment for trichomoniasis on pregnancy outcomes. (Am J Obstet Gynecol 1999;181:656-62.)

Maternal predictors of perinatal human immunodeficiency virus transmission. The New York City Perinatal HIV Transmission Collaborative Study Group.

This analysis sought to identify characteristics of pregnant human immunodeficiency virus type 1 (HIV-1)-infected women that predict mother-to-child HIV-1 transmission. Pregnant and immediately postpartum women at risk for HIV were enrolled at obstetric and pediatric care settings in New York City from 1986 to 1992. Demographic and behavioral characteristics, clinical illness, T lymphocyte subsets, immunoglobulin concentration and syphilis serology were collected on the women. Infants were followed to determine HIV infection classification according to Centers for Disease Control and Prevention criteria for HIV-1 in children. Transmission rates were calculated for women who gave birth more than 15 months before the analysis. Of 172 HIV-1-infected women with known outcome 49 (28%) had infected infants. The transmission rate (TR) was significantly higher among women with < 280 CD4+ cells/microliters (lowest CD4+ quartile) than with CD4+ counts > 280 (48% vs. 22%; P = 0.004; odds ratio, 3.4; 95% confidence interval (1.5, 7.8)); a similar trend was seen by CD4+% quartile. No difference in TR was seen comparing women by CD8+ count quartile but marginally higher TR was seen among women with CD8+% > or = 51% than with CD8+% < 51% (TR = 41% vs. 24%; P = 0.076; odds ratio, 2.2; confidence interval (1.0, 5.1)). The highest TR, 62% was seen in women with both CD8+ count above the median and CD4+ count in the lowest quartile. No significant difference in TR was seen between women with and without HIV-related illness, although the TR was 53% among women hospitalized in the previous year for pneumonia compared with 25% in others (P = 0.03). TR was somewhat lower in women who delivered by cesarean section than vaginally (entire cohort: 18% vs. 32%, P = 0.11; prenatal enrollees only, 17% vs. 38%, P = 0.045). No factor or combination of factors was both highly sensitive and specific for predicting mother-to-child HIV transmission. A possible relationship between transmission and mode of delivery deserves further investigation.