Prevention Of Perinatal Transmission Research Articles

Higher HIV-1 evolutionary rate is associated with cytotoxic T lymphocyte escape mutations in infants.

Escape from cytotoxic T lymphocyte (CTL) responses toward HIV-1 Gag and Nef has been associated with reduced control of HIV-1 replication in adults. However, less is known about CTL-driven immune selection in infants as longitudinal studies of infants are limited. Here, 1,210 gag and 1,264 nef sequences longitudinally collected within 15 months after birth from 14 HIV-1 perinatally infected infants and their mothers were analyzed. The number of transmitted founder (T/F) viruses and associations between virus evolution, selection, CTL escape, and disease progression were determined. The analyses indicated that a paraphyletic-monophyletic relationship between the mother-infant sequences was common (80%), and that the HIV-1 infection was established by a single T/F virus in 10 of the 12 analyzed infants (83%). Furthermore, most HIV-1 CTL escape mutations among infants were transmitted from the mothers and did not revert during the first year of infection. Still, immune-driven selection was observed at approximately 3 months after HIV-1 infection in infants. Moreover, virus populations with CTL escape mutations in gag evolved faster than those without, independently of disease progression rate. These findings expand the current knowledge of HIV-1 transmission, evolution, and CTL escape in infant HIV-1 infection and are relevant for the development of immune-directed interventions in infants.IMPORTANCEDespite increased coverage in antiretroviral therapy for the prevention of perinatal transmission, paediatric HIV-1 infection remains a significant public health concern, especially in areas of high HIV-1 prevalence. Understanding HIV-1 transmission and the subsequent virus adaptation from the mother to the infant's host environment, as well as the viral factors that affect disease outcome, is important for the development of early immune-directed interventions for infants. This study advances our understanding of vertical HIV-1 transmission, and how infant immune selection pressure is shaping the intra-host evolutionary dynamics of HIV-1.

Cost-Effectiveness of Dolutegravir Compared With Efavirenz for Prevention of Perinatal Transmission in Women Presenting With HIV in Late Pregnancy in Uganda

ObjectivesDolutegravir (DTG) has proved to be more efficacious, tolerable, and safer than efavirenz (EFV) among mothers living with HIV and their infants in Uganda. This study assessed the cost-effectiveness of the DTG-based antiretroviral therapy (ART) compared with the standard of care for preventing perinatal transmissions among pregnant women initiating ART in late pregnancy in Uganda. MethodsWe used data from a randomized open-label trial (DolPHIN-2) and a 2-part cost-effectiveness model composed of a short-term decision tree to estimate the perinatal transmission rate and costs and an individual-based 3-state Markov model (HIV, advanced HIV, dead) to estimate the long-term costs and health outcomes from the Ugandan payer perspective using a lifetime horizon and a 1-year Markov cycle. The main outcomes were the mean annual costs in US dollars ($), disability-adjusted life-years (DALYs), and incremental cost-effectiveness ratio. Both the deterministic and probabilistic sensitivity analyses were conducted to assess the effect of parameter uncertainties on the ultimate results and the model’s robustness. ResultsCompared with the EFV-based ART, the DTG-based ART was associated with fewer mean annual costs ($43.58 vs $68.44) and DALYs (0.33 vs 0.56), leading to cost savings of $110 per DALY averted. In the incremental analysis, the DTG-based ART dominated the EFV-based ART; that is, it was less costly and more effective. These results were robust to deterministic and probabilistic sensitivity analyses. ConclusionThe DTG-based ART is a highly cost-effective strategy compared with the EFV-based ART among women initiating treatment in the third trimester of pregnancy in a low-income setting.

Brief Report: T-Cell Receptor α Repertoire Diversity at Birth After in utero Exposure to HIV Integrase Strand-Transfer Inhibitors.

Effectiveness of anti-HIV in the prevention of perinatal transmission has been established. Assessing the tolerance of drug exposure during pregnancy is of the utmost importance given the number of children exposed. HIV integrase and the recombinase-activating gene enzyme involved in the establishment of the T-lymphocyte repertoire show structural similarity. The inhibition of recombinase-activating (RAG) gene by anti-integrases is observed in vitro, in a variable way according to the molecules. Here, we show that in utero exposure to raltegravir did not alter the T-lymphocyte repertoire of 12 newborns. These reassuring data merit verification for other anti-integrases. ( ClinicalTrial.org NCT04024150).

Review of Medical Approaches for the Prevention of Perinatal Transmission of HIV Infection

Although advancements in antiretroviral therapies have reduced the rates of HIV transmission, HIV remains an international public health concern. Perinatal HIV transmission continues to be one of the most common modes of transmission, with most new pediatric HIV infections beginning in utero. In this review, we provide background on the current standard of care in HIV-positive pregnant women. This includes a discussion of antiretroviral monotherapy vs polytherapy, vaginal delivery vs elective cesarean delivery, and avoidance of breastfeeding in the prevention of perinatal transmission of HIV infection. We also review several methods of HIV treatment that are currently under investigation, including shock and kill, block and lock, and gene editing techniques. Further, we discuss the significance of perinatal HIV transmission from a public health perspective both on a global level and on a local level in Washington, DC.

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

Effectiveness of hepatitis B hyperimmunglobulin and vaccine in preventing perinatal transmission in children born from a mother with chronic B hepatitis

Background. Viral hepatitis is still one of the important health problems all over the world today. Hepatitis B is a life-threatening liver infection that can cause chronic infections. It increases the risk of death from cirrhosis and hepatocellular carcinoma. One of the most important factors in chronic or acute hepatitis B infection is the age of infection. The earlier the virus is encountered, the greater the risk of chronicity of the disease. Prevention of perinatal transmission of the disease is of great importance. The most effective way to control hepatitis B infection is to prevent contamination and ensure immunity. There is a safe and effective vaccine available that provides 98–100% protection against hepatitis B. Prevention of hepatitis B infection control the development of complications, including chronic disease and liver cancer. The purpose of this study is to evaluate the efficacy of the vaccine and hepatitis immunoglobulin administered to prevent perinatal hepatitis B infection transmission in babies born to mothers with chronic hepatitis B infection. Materials and methods. Fifty-five children born to mothers with chronic hepatitis B infection in our hospital between January 1, 2013 and January 1, 2019 and accepted to participate in the study were included in our study. In retrospective file examination, maternal gestational age, maternal hepatitis B test, delivery method, baby birth weight, baby birth week, whether immunoglobulin and hepatitis B vaccine were administered to these babies in the first 24 hours after birth, hepatitis B vaccine and immunoglobulin administration time, bathroom status, infant hepatitis B tests, additional studies on the child’s viral diseases (hepatitis C, human immunodeficiency virus) and the baby’s liver transaminase tests (aspartate aminotransferase, alanine aminotransferase) were evaluated. The vaccination program of the baby, the control of the mother’s hepatitis B status, the time of the breast milk intake, the height and weight of the baby, the follow-up of the mother during pregnancy and the drug use status were collected. Children previously diagnosed with chronic B hepatitis were excluded from the study. Results. Hepatitis B surface antigen tests were positive in two infants who received three doses of hepatitis B vaccine. The mothers of both of these babies were positive for hepatitis B surface antigen and hepatitis B envelope antigen. Forty-three (78.2 %) patients had a protective antibodies to hepatitis B surface antigen, while 12 (21.8 %) didn’t have it. Conclusions. Hepatitis B serology should be checked in women who live in countries with high risk of chronic hepatitis B infection and who are pregnant, and babies born to these mothers should have hepatitis B vaccine and immunoglobulin.

Machine Learning Algorithms Using Routinely Collected Data Do Not Adequately Predict Viremia to Inform Targeted Services in Postpartum Women Living With HIV.

Adherence to antiretroviral treatment (ART) among postpartum women with HIV is essential for optimal health and prevention of perinatal transmission. However, suboptimal adherence with subsequent viremia is common, and adherence challenges are often underreported. We aimed to predict viremia to facilitate targeted adherence support in sub-Saharan Africa during this critical period. Data are from PROMISE 1077BF/FF, which enrolled perinatal women between 2011 and 2014. This analysis includes postpartum women receiving ART per study randomization or country-specific criteria to continue from pregnancy. We aimed to predict viremia (single and confirmed events) after 3 months on ART at >50, >400, and >1000 copies/mL within 6-month intervals through 24 months. We built models with routine clinical and demographic data using the least absolute shrinkage and selection operator and SuperLearner (which incorporates multiple algorithms). Among 1321 women included, the median age was 26 years and 96% were in WHO stage 1. Between 0 and 24 months postpartum, 42%, 31%, and 28% of women experienced viremia >50, >400, and >1000 copies/mL, respectively, at least once. Across models, the cross-validated area under the receiver operating curve ranged from 0.74 [95% confidence interval (CI): 0.72 to 0.76] to 0.78 (95% CI: 0.76 to 0.80). To achieve 90% sensitivity predicting confirmed viremia >50 copies/mL, 64% of women would be classified as high risk. Using routinely collected data to predict viremia in >1300 postpartum women with HIV, we achieved moderate model discrimination, but insufficient to inform targeted adherence support. Psychosocial characteristics or objective adherence metrics may be required for improved prediction of viremia in this population.

A systematic review and meta-analysis of the prevalence of hepatitis B virus infection among pregnant women in Nigeria.

BackgroundNigeria has a high burden of hepatitis B virus (HBV) infection, commonly acquired through vertical transmission. However, there is a lack of an efficient surveillance system for monitoring and understanding the epidemiology of HBV among pregnant women. Building on a previous review on the prevalence of HBV in Nigeria (2000–2013), we conducted a systematic review and meta-analysis of HBV prevalence among pregnant women in Nigeria.MethodsFour electronic databases PubMed, Embase, Global Health, and Scopus were systematically searched from January 2014 to February 2021. We also searched the African Journal Online and manually scanned the reference lists of the identified studies for potentially eligible articles. Observational studies that reported the prevalence of HBsAg and/or HBeAg among pregnant women in peer-reviewed journals were included in the study. We performed a meta-analysis using a random-effects model. We defined HBV infection as a positive test to HBsAg.ResultsFrom the 158 studies identified, 20 studies with a total sample size of 26, 548 were included in the meta-analysis. The pooled prevalence of HBV infection among pregnant women across the studies was 6.49% (95% confidence interval [CI] = 4.75–8.46%; I2 = 96.7%, p = 0.001; n = 20). The prevalence of HBV was significantly lower among pregnant women with at least secondary education compared with those with no education or primary education (prevalence ratio = 0.7, 95% CI = 0.58–0.87; n = 10). However, the prevalence of HBV was not significantly different by age, religion, marital status, or tribe. The prevalence of HBV was not significantly different among pregnant women with previous surgery, blood transfusion, multiple lifetime sex partners, tribal marks, tattoos, scarification, or sexually transmitted infections, compared with those without these risk factors. From a total sample size of 128 (n = 7), the pooled prevalence of HBeAg among HBV-infected pregnant women was 14.59% (95% CI = 4.58–27.99%; I2 = 65.5%, p = 0.01). Subgroup analyses of HBV infection by study region and screening method, and meta-regression analysis of the study year, sample size, and quality rating were not statistically significant.ConclusionsThere is an intermediate endemicity of HBV infection among pregnant women in Nigeria. Interventions, such as routine antenatal HBV screening, antiviral prophylaxis for eligible pregnant women, and infant HBV vaccination should be scaled up for the prevention of perinatal transmission of HBV infection in Nigeria.

Evaluation of infants with HIV-infected mothers and perinatal transmission in Turkey: A single-center experience.

OBJECTIVE:The most common route of HIV infection in children is through perinatal transmission. In this study, we aimed to evaluate the characteristics of infants with HIV-infected mothers and perinatal HIV transmission.METHODS:We conducted a retrospective, single-center study of HIV-exposed infants in between December 2017 and October 2019 in a Marmara University Pendik Training and Research Hospital.RESULTS:A total of 18 infants were examined. All babies were born by cesarean section, and none of them were breastfed. Seventeen mothers were diagnosed with HIV before pregnancy. These mothers had received antiretroviral therapy (ART) during pregnancy, and their viral loads before delivery were negative. An antiretroviral prophylaxis with oral zidovudine was started in all infants within their 1st day of birth and continued for at least 6 weeks. All infants were tested for their HIV viral load within the first 48 h of birth, with negative results, and 12 infants were tested for anti-HIV antibodies at the 18th month, again with negative results. In this study, we determined that none of the infants had been infected with HIV.CONCLUSION:Our findings highlight the importance of initiating ART for all HIV-infected pregnant women and the importance of protection modalities during pregnancy, delivery, and the postnatal period for the prevention of perinatal transmission of HIV.

Efficacy and Safety of Tenofovir in the Prevention of Perinatal Transmission of Hepatitis B, a Meta-Analysis

Tenofovir disoproxil fumarate (TDF) is recommended for the prevention of perinatal transmission of the hepatitis B virus (HBV). This study aimed to systematically assess the efficacy and safety of TDF in pregnant women with chronic HBV and their infants. Database searches were performed to identify studies blocking the mother-to-child transmission of the hepatitis B virus with tenofovir. The search included pregnant women with chronic HBV infection administered with TDF compared to the no treatment controls, and data from individual studies were pooled using RevMan v5.3 for meta-analysis. Seven studies with a total of 911 patients met the inclusion criteria: 433 patients in the TDF group and 478 patients in the non-TDF group. The HBV mother-to-child transmission rate in the tenofovir group was effectively reduced compared to the control group (RR: 0.18, 95% CI: 0.08-0.40). HBV-DNA positivity was also significantly low in infants from TDF group (RR: 0.17, 95% CI: 0.10-0.30) and the TDF treatment resulted in significantly higher anti-HBs production (RR: 1.11, 95% CI: 1.04-1.18). Similarly, maternal HBV-DNA was suppression was significantly high in the TDF group (RR: 34.16, 95% CI: 16.40-71.13). Women treated with TDF and their infants did not result in serious adverse events that are statistically different as compared to the women who did not receive any treatment. Treatment of HBV infected pregnant women with TDF can effectively and safely prevent the perinatal transmission of chronic hepatitis B. El fumarato de disoproxilo de tenofovir (FDT) se recomienda para la prevención de la transmisión perinatal del virus de la hepatitis B (VHB). El objetivo de este estudio fue evaluar de manera sistemática la eficacia y la seguridad del FDT en las mujeres embarazadas con VHB crónico y en sus hijos lactantes. Se realizaron búsquedas en las bases de datos para identificar los estudios sobre el bloqueo de la transmisión del virus de la hepatitis B de madre a hijo con el tenofovir. La búsqueda incluyó a mujeres embarazadas con infección crónica por el VHB que recibieron FDT en comparación con controles sin tratamiento, y los datos de los estudios individuales se agruparon mediante el uso de RevMan v5.3 para el metaanálisis. Los criterios de inclusión se cumplieron en siete estudios con un total de 911 pacientes: 433 pacientes en el grupo de FDT y 478 pacientes en el grupo sin FDT. La tasa de transmisión de madre a hijo del VHB en el grupo de tenofovir se redujo efectivamente en comparación con el grupo de control (RR: 0,18, IC del 95 %: 0,08-0,40). Los resultados positivos del ADN del VHB también fueron significativamente bajos en los infantes del grupo de FDT (RR: 0,17, IC del 95 %: 0,10-0,30) y el tratamiento con FDT dio como resultado una producción significativamente mayor de anti-HB (RR: 1,11, IC del 95 %: 1,04-1,18). Del mismo modo, la supresión del ADN del VHB materno fue significativamente alta en el grupo del FDT (RR: 34,16, IC del 95 %: 16,40-71,13). El tratamiento de las mujeres con FDT y sus hijos lactantes no provocó acontecimientos adversos graves en ellas ni en sus hijos que fueran estadísticamente diferentes de los de las mujeres que no recibieron ningún tratamiento. El tratamiento con FDT de las mujeres embarazadas infectadas por el VHB puede prevenir de manera eficaz y segura la transmisión perinatal de la hepatitis B crónica.

Evaluation and Management of the Infant Exposed to HIV in the United States.

Pediatricians play a crucial role in optimizing the prevention of perinatal transmission of HIV infection. Pediatricians provide antiretroviral prophylaxis to infants born to women with HIV type 1 (HIV) infection during pregnancy and to those whose mother's status was first identified during labor or delivery. Infants whose mothers have an undetermined HIV status should be tested for HIV infection within the boundaries of state laws and receive presumptive HIV therapy if the results are positive. Pediatricians promote avoidance of postnatal HIV transmission by advising mothers with HIV not to breastfeed. Pediatricians test the infant exposed to HIV for determination of HIV infection and monitor possible short- and long-term toxicity from antiretroviral exposure. Finally, pediatricians support families living with HIV by providing counseling to parents or caregivers as an important component of care.

Efficacy and Safety of Tenofovir in the Prevention of Perinatal Transmission of Hepatitis B, a Meta-Analysis

BackgroundTenofovir disoproxil fumarate (TDF) is recommended for the prevention of perinatal transmission of the hepatitis B virus (HBV). This study aimed to systematically assess the efficacy and safety of TDF in pregnant women with chronic HBV and their infants. Material and methodsDatabase searches were performed to identify studies blocking the mother-to-child transmission of the hepatitis B virus with tenofovir. The search included pregnant women with chronic HBV infection administered with TDF compared to the no treatment controls, and data from individual studies were pooled using RevMan v5.3 for meta-analysis. ResultsSeven studies with a total of 911 patients met the inclusion criteria: 433 patients in the TDF group and 478 patients in the non-TDF group. The HBV mother-to-child transmission rate in the tenofovir group was effectively reduced compared to the control group (RR: 0.18, 95% CI: 0.08-0.40). HBV-DNA positivity was also significantly low in infants from TDF group (RR: 0.17, 95% CI: 0.10-0.30) and the TDF treatment resulted in significantly higher anti-HBs production (RR: 1.11, 95% CI: 1.04-1.18). Similarly, maternal HBV-DNA was suppression was significantly high in the TDF group (RR: 34.16, 95% CI: 16.40-71.13). Women treated with TDF and their infants did not result in serious adverse events that are statistically different as compared to the women who did not receive any treatment. ConclusionTreatment of HBV infected pregnant women with TDF can effectively and safely prevent the perinatal transmission of chronic hepatitis B.

Role of tenofovir disoproxil fumarate in prevention of perinatal transmission of hepatitis B virus from mother to child: a systematic review and meta-analysis.

Background/AimsTo prevent the perinatal transmission of hepatitis B virus (HBV) from mother to child, administration of an antiviral agent during pregnancy has been attempted in women who are either hepatitis B e antigen positive or have a high viral load. In this systematic review and meta-analysis with randomized controlled trials, we analyzed the efficacy and safety of tenofovir disoproxil fumarate (TDF) in preventing the perinatal transmission of HBV in pregnant women who have high HBV DNA titers.MethodsMultiple comprehensive databases (PubMed, EMBASE, and Cochrane databases) were searched for studies evaluating the efficacy of TDF for the prevention of perinatal transmission of HBV.ResultsTwo studies (one open label study and one double blind study) were included and analyzed. Intention-to-treat analysis (527 pregnancies) showed that the preventive effect of TDF was not significant (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.13 to 2.17; p = 0.38, I2 = 81%). However, the per-protocol analysis showed that TDF significantly reduced perinatal transmission (OR, 0.10; 95% CI, 0.01 to 0.77; p = 0.03, I2 = 0%). There was no significant difference between the TDF group and the control group with respect to maternal and fetal safety outcomes.ConclusionsIn pregnant women who have high HBV DNA titers, TDF can reduce the perinatal transmission from mother to child without significant adverse events.

Use of Modeling and Simulations to Determine Raltegravir Dosing in Neonates: A Model for Safely and Efficiently Determining Appropriate Neonatal Dosing Regimens: IMPAACT P1110.

Population modeling and simulations can be used to facilitate the conduct of phase I studies to develop safe and effective dosing regimens in neonates. P1110 is an international, multicenter trial to determine safe and effective raltegravir doses in neonates at risk for HIV infection. P1110 used a 2-cohort adaptive design incorporating population pharmacokinetic modeling and simulations. An initial cohort of neonates received 2 single oral doses of raltegravir with standard-of-care therapy for prevention of perinatal transmission-one within 48 hours of birth and a second at 7-10 days of life. Raltegravir concentration data after administration of these doses were combined with data from a previous study of infants aged 4 weeks to 2 years. The combined database was used for population pharmacokinetic modeling and simulations to select a daily dosing regimen for investigation in a second cohort of neonates. Raltegravir concentration data from 6 neonates were combined with data from infants aged 4 weeks to 2 years receiving raltegravir twice daily. The combined data set allowed for successful development of a population pharmacokinetic model with reasonable precision of parameter estimates. Monte Carlo simulations were run to evaluate potential daily dosing regimens from birth to 6 weeks of age, allowing for selection of a regimen to be evaluated in a subsequent cohort of neonates receiving chronic raltegravir dosing. An adaptive design incorporating population pharmacokinetic modeling and simulations was used to select a developmentally appropriate neonatal raltegravir dosing regimen in the first 6 weeks of life.

In pursuit of control and elimination: update on hepatitis A and B epidemiology and prevention strategies.

This review describes the impact of recommendations for routine immunization of infants and children against hepatitis A and hepatitis B, the changing epidemiology of these infections, and the remaining challenges to controlling or eliminating these diseases in the United States. Rates of hepatitis A and B have significantly declined because of childhood vaccination programs and long-term protection provided by infant immunization. However, hepatitis A immunization rates remain lower than other vaccines, and outbreaks continue to occur in part due to a growing number of susceptible adults. The Advisory Committee on Immunization Practice has updated pre and postexposure prophylaxis and travel recommendations for hepatitis A prevention in young infants, as well as recommendations to reduce ongoing perinatal transmission of hepatitis B. Pediatric healthcare providers should continue to immunize all infants against hepatitis A and B and ensure that no child outgrows the pediatric practice without being vaccinated. To address hepatitis A, providers should be aware of new recommendations for unimmunized travelers, use vaccines to prevent and control outbreaks, and ensure postexposure prophylaxis. Universal vaccination of infants against hepatitis B should begin before hospital discharge. The prevention of perinatal transmission is critical for control and possible eradication of hepatitis B.

ACOG Committee Opinion No. 752: Prenatal and Perinatal Human Immunodeficiency Virus Testing.

Given the enormous advances in the prevention of perinatal transmission of human immunodeficiency virus (HIV), it is clear that early identification and treatment of all pregnant women with HIV is the best way to prevent neonatal infection and also improve women's health. Furthermore, new evidence suggests that early initiation of antiretroviral therapy in the course of infection is beneficial for individuals infected with HIV and reduces the rate of sexual transmission to partners who are not infected. Screening should be performed after women have been notified that HIV screening is recommended for all pregnant patients and that they will receive an HIV test as part of the routine panel of prenatal tests unless they decline (opt-out screening). Human immunodeficiency virus testing using the opt-out approach, which is currently permitted in every jurisdiction in the United States, should be a routine component of care for women during prepregnancy and as early in pregnancy as possible. Repeat HIV testing in the third trimester, preferably before 36 weeks of gestation, is recommended for pregnant women with initial negative HIV antibody tests who are known to be at high risk of acquiring HIV infection; who are receiving care in facilities that have an HIV incidence in pregnant women of at least 1 per 1,000 per year; who are incarcerated; who reside in jurisdictions with elevated HIV incidence; or who have signs and symptoms consistent with acute HIV infection (eg, fever, lymphadenopathy, skin rash, myalgias, arthralgias, headache, oral ulcers, leukopenia, thrombocytopenia, or transaminase elevation). Rapid screening during labor and delivery or during the immediate postpartum period using the opt-out approach should be done for women who were not tested earlier in pregnancy or whose HIV status is otherwise unknown. Results should be available 24 hours a day and within 1 hour. If a rapid HIV test result in labor is reactive, antiretroviral prophylaxis should be immediately initiated while waiting for supplemental test results. If the diagnosis of HIV infection is established, the woman should be linked into ongoing care with a specialist in HIV care for comanagement.

ACOG Committee Opinion No. 752 Summary: Prenatal and Perinatal Human Immunodeficiency Virus Testing.

Given the enormous advances in the prevention of perinatal transmission of human immunodeficiency virus (HIV), it is clear that early identification and treatment of all pregnant women with HIV is the best way to prevent neonatal infection and also improve women's health. Furthermore, new evidence suggests that early initiation of antiretroviral therapy in the course of infection is beneficial for individuals infected with HIV and reduces the rate of sexual transmission to partners who are not infected. Screening should be performed after women have been notified that HIV screening is recommended for all pregnant patients and that they will receive an HIV test as part of the routine panel of prenatal tests unless they decline (opt-out screening). Human immunodeficiency virus testing using the opt-out approach, which is currently permitted in every jurisdiction in the United States, should be a routine component of care for women during prepregnancy and as early in pregnancy as possible. Repeat HIV testing in the third trimester, preferably before 36 weeks of gestation, is recommended for pregnant women with initial negative HIV antibody tests who are known to be at high risk of acquiring HIV infection; who are receiving care in facilities that have an HIV incidence in pregnant women of at least 1 per 1,000 per year; who are incarcerated; who reside in jurisdictions with elevated HIV incidence; or who have signs and symptoms consistent with acute HIV infection (eg, fever, lymphadenopathy, skin rash, myalgias, arthralgias, headache, oral ulcers, leukopenia, thrombocytopenia, or transaminase elevation). Rapid screening during labor and delivery or during the immediate postpartum period using the opt-out approach should be done for women who were not tested earlier in pregnancy or whose HIV status is otherwise unknown. Results should be available 24 hours a day and within 1 hour. If a rapid HIV test result in labor is reactive, antiretroviral prophylaxis should be immediately initiated while waiting for supplemental test results. If the diagnosis of HIV infection is established, the woman should be linked into ongoing care with a specialist in HIV care for comanagement.

Women's reproductive health knowledge, attitudes and practices in relation to the Zika virus outbreak in northeast Brazil.

ObjectivesTo assess knowledge, pregnancy attitudes and contraceptive practices in relation to the Zika virus outbreak in Brazil.MethodsWe interviewed 526 women 18 to 49 years old in primary health services in a Northeastern capital of Brazil, in 2016. They provided information about their knowledge of Zika transmission and health consequences, their receipt of counseling related to sexual and perinatal transmission of Zika, their pregnancy intentions and reassessment of contraceptive options in the context of the Zika virus outbreak.ResultsAwareness about Zika congenital syndrome was high, but knowledge about sexual transmission was low. Few women had changed pregnancy intentions or contraceptive practices in response to Zika. Pregnant women were more likely to access counseling about family planning, condom use and pregnancy postponement due to Zika virus than non-pregnant women, which may suggest that health system responses followed pregnancy occurrence.ConclusionsWe observed missed opportunities for prevention of perinatal transmission of Zika virus through behavioral change, including effective contraception to prevent pregnancy and condoms to prevent perinatal transmission, as a complement to vector control.

Serologic status at 10 months of infants born to hepatitis B positive mothers given prophylaxis - A prospective cohort study

Rationale: Perinatal exposure is the most common mode of transmission of hepatitis B (HB) infection in neonates. Prevention of perinatal transmission of HB is important to decrease overall carrier state. Objectives: To estimate the rate of HB carrier status among children born to HB surface antigen (HBsAg) positive mothers at 10 months of age measured by HBsAg status and to assess the efficacy of prophylaxis (HB vaccine [HBV] and HB immunoglobulin [HBIG] administration) as measured by the anti-HBs titer at 10th month of age. Methodology: This was a hospital based prospective cohort study of infants born to HBsAg positive motherbetween April 2008 and October 2008 with a follow-up at 6 weeks, 14 weeks, and 10 months of age. After informed consent from the parents, 0.5 ml of recombinant vaccine was given to all. HBIG was given to only those who could afford to buy it. At 6 and 14 weeks of age, 0.5 ml of recombinant vaccine was given according to the IAP immunization schedule along with other UIP vaccines to all neonates. At 10 months of age (plus 1 week), 69 infants completed 3 doses of HBV. Anti-HBs titer and HBsAg status were measured. Anti-HBs titer >100 IU/L was taken as a good responder. Results: Total 125 infants were initially recruited. Allwere vaccinated with HBV within 12 h of birth. HBIG was given to 96 infants (76.8%) and only 69 (55.2%) completed 3rd visit. Carrier state in infants born to HBsAg positive mothers at 10 months of age was 1/69 (1.44%). 43/69 (62.35%) had good antibody response out of which, 41 were given both HBV and HBIG. In those given only vaccine, 2/7 (28.55%) had good antibody response (p=0.02). Conclusion: Combined HB vaccine and immunoglobulin had a better antibody response in the study as reported earlier. The carrier state was 1.44%.

No. 342-Hepatitis B and Pregnancy.

To review the epidemiology, natural history, evaluation, and treatment of hepatitis B virus (HBV) infection during pregnancy. This will aid obstetric care providers in counseling their patients regarding perinatal risks and management options available to pregnant women with hepatitis B. Outcomes evaluated include thresholds for HBV anti-viral treatment for prevention of perinatal transmission and for invasive procedures during pregnancy for women with hepatitis B infection. Medline, EMBASE, and CINAHL were searched for articles in English on subjects related to HBV infection, pregnancy, and perinatal transmission from 1966 to March 2016. Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. Other (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical speciality societies. The quality of the evidence is rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table1). Recommendations for practice are ranked according to the method described in this Report. The guideline will be reviewed 5 years after publication to decide if an update is required. However, if important new evidence is published prior to the 5-year cycle, the review process may be accelerated for a more rapid update of some recommendations. This guideline was developed with resources funded by the Society of Obstetricians and Gynaecologists of Canada.