Prevention Of Vertical Transmission Research Articles

Realization of an AIDS-free generation: ensuring sustainable treatment for children.

According to a 2011 statement from the Joint United Nations Program on HIV/AIDS (UNAIDS), “by 2015 children everywhere can be born free of HIV and their mothers remain alive.” These ambitious goals were defined to provide renewed energy and to reinvigorate programs to realize the vision of an AIDS-free generation.1 Since the launch of the Global Plan Toward the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (focused on 22 countries with the highest estimated numbers of pregnant women, with a goal to reduce new HIV infection by 90% and HIV-related maternal deaths by 5%), there has been a substantive expansion of investments resulting in improved access to antiretroviral therapy (ART) in pregnant women as a means to eliminate vertical HIV transmission. As a result, at the end of 2012, 62% of pregnant women with HIV in low- and middle-income countries were receiving ART for prevention of vertical transmission, a significant increase from 14% in 2005.2 This progress has led to a reduction of new infections among children; between 2009 and 2012, it is estimated that 670 000 children in these countries were prevented from acquiring HIV infection.2

Prevention of vertical transmission of hepatitis B: an observational study.

For mothers with chronic hepatitis B virus (HBV) infection, the Centers for Disease Control and Prevention recommends immunoprophylaxis to decrease perinatal transmission. However, its effectiveness and risk factors for failure have not been well-studied in community practice. To investigate the effectiveness of a contemporary immunoprophylaxis protocol. Observational study. An HBV perinatal immunoprophylaxis program within Kaiser Permanente Northern California. 4446 infants born to 3253 HBV-positive mothers between 1997 and 2010. Adherence to immunoprophylaxis, follow-up testing rates, maternal risk factors for HBV transmission, and transmission rates. The infant infection rate was 0.75 per 100 births from 1997 to 2010 (Poisson 95% CI, 0.48 to 1.10). Rates per 100 births were 3.37 (CI, 2.08 to 5.14) for e antigen-positive mothers and 0.04 (CI, 0.001 to 0.24) for e antigen-negative mothers. Among mothers with viral load testing, the lowest level associated with transmission was 6.32×107 IU/mL. Infection rates per 100 births were 3.61 (CI, 0.75 to 10.56) among the 83 births to mothers with viral loads of 5×107 IU/mL or greater and 0 among the 831 births to mothers with viral loads less than 5×107 IU/mL, regardless of e antigen status. Testing for HBV immunity and infection was less complete in earlier years. Viral load testing was only consistently available starting in 2007. Prenatal HBV screening followed by postnatal prophylaxis is highly effective in preventing vertical transmission of HBV. A negative e antigen status or a viral load less than 5×107 IU/mL (90.9% of women tested) identifies women at extremely low risk for transmission after immunoprophylaxis who are unlikely to benefit from further interventions. Kaiser Permanente Community Benefit and National Institutes of Health.

Risk factors associated with immunoprophylaxis failure against mother to child transmission of hepatitis B virus and hepatitis B vaccination status in Yunnan province, China

ObjectiveTo explore the risk factors associated with immunoprophylaxis failure against mother to child transmission of hepatitis B virus (HBV) and hepatitis B vaccination status in Yunnan province, China. MethodsMulticenter cluster sampling was used to select pregnant women who were positive for hepatitis B surface antigen (HBsAg). HBV immunoprophylaxis was carried out for the newborns. Blood samples were collected and tested for HBV markers from 7 to 10 month old infants. The factors were analyzed by univariate and logistic regression. ResultsA total of 2765 mothers and their infants were enrolled. The failure rate of prevention of mother to child transmission (PMTCT) was 4.12%. The rate of timely HepB1 vaccination within 24h was 98.04%, the rate of three-dose vaccination was 92.30% and the rate of hepatitis B immune globulin (HBIG) administration was 68.97%. Place of residence, maternal education, gestational age and birth weight were related to administration of HBV immunoprophylaxis. It was remarkable that the rate of HBIG administration of infants was only 63.89% with whose mothers were both HBsAg and hepatitis B e antigen (HBeAg)-positive. Further analysis showed that there were three risk factors associated with HBV immunoprophylaxis failure: mothers who were positive for HBsAg and HBeAg, maternal HBVDNA level, and HBIG administration or not. ConclusionsPMTCT of HBV was well implemented in Yunnan. However, in order to achieve optimal prevention of vertical HBV transmission, it is mandatory to make additional efforts to improve the implementation of regulatory HBV immunoprophylaxis, especially for HBsAg-positive pregnant women.

HCV adaptations to altered CD8+ T-cell immunity during pregnancy.

Robust, polyfunctional CD8+ T-cell responses targeted to multiple viral epitopes have been associated with successful resolution of acute HCV infection. In most individuals, however, immunity fails and chronic viremia ensues as CD8+ T cells become functionally exhausted or select viral variants with escape mutations in class I epitopes. During pregnancy, dysfunctional HCV-specific CD8+ T-cell responses may be further impaired by maternal–fetal tolerance processes such as the expansion of regulatory T-cell populations or hormonal changes. Recent evidence suggests that HCV adapts to relaxed maternal CD8+ T-cell pressure in pregnancy by shedding unfit escape mutations in certain class I epitopes, resulting in the selection of viruses with more efficient replication. Emergence of HCV variants with enhanced replicative capacity during pregnancy has ramifications for mother-to-child transmission, the primary route of HCV infection in children, and could potentially be relevant to other important, vertically transmissible, persistent viruses such as HBV and HIV. HCV has infected over 185 million people worldwide and persists in approximately 75% of these individuals, predisposing to liver inflammation, cirrhosis and hepatocellular carcinoma [1]. More than 1 million children are born to HCV-infected mothers each year, and 3–5% acquire the infection in utero or at delivery, making vertical transmission the leading route of pediatric HCV infection in the developed world [2]. Here, we review the critical role of CD8+ T-cell immunity in HCV infection, its modulation in pregnancy and recent evidence that HCV takes advantage of the unique immunologic niche of pregnancy to improve replicative fitness and potentially promote vertical transmission.

The Importance of Gut Symbionts in the Development of the Brown Marmorated Stink Bug, Halyomorpha halys (Stål)

The invasive brown marmorated stink bug, Halyomorpha halys (Stål), has become a severe agricultural pest and nuisance problem since its introduction in the U.S. Research is being conducted to understand its biology and to find management solutions. Its symbiotic relationship with gut symbionts is one aspect of its biology that is not understood. In the family Pentatomidae, the reliance on gut symbionts for successful development seems to vary depending on the species of stink bug. This research assessed the role of gut symbionts in the development, survivorship, and fecundity of H. halys. We compared various fitness parameters of nymphs and adults reared from surface sterilized and untreated egg masses during two consecutive generations under laboratory conditions. Results provided direct evidence that H. halys is negatively impacted by the prevention of vertical transmission of its gut symbionts and that this impact is significant in the first generation and manifests dramatically in the subsequent generation. Developmental time and survivorship of treated cohorts in the first generation were significantly affected during third instar development through to the adult stage. Adults from the sterilized treatment group exhibited longer pre-oviposition periods, produced fewer egg masses, had significantly smaller clutch sizes, and the hatch rate and survivorship of those eggs were significantly reduced. Observations following hatch of surface sterilized eggs also revealed significant effects on wandering behavior of the first instars. The second generation progeny from adults of the sterilized cohorts showed significantly lower survival to adulthood, averaging only 0.3% compared to 20.8% for the control cohorts. Taken together, results demonstrate that H. halys is heavily impacted by deprival of its gut symbionts. Given the economic status of this invasive pest, further investigations may lead to management tactics that disrupt this close symbiotic relationship in the biology of H. halys.

Cascade of access to interventions to prevent HIV mother to child transmission in the metropolitan area of Rio de Janeiro, Brazil

ObjectivesTo describe the access to the interventions for the prevention of Human Immunodeficiency Virus (HIV) mother to child transmission and mother to child transmission rates in the outskirts of Rio de Janeiro, from 1999 to 2009. MethodsThis is a retrospective cohort study. Prevention of HIV mother to child transmission interventions were accessed and mother to child transmission rates were calculated. ResultsThe study population is young (median: 26 years; interquartile range: 22.0–31.0), with low monthly family income (40.4% up to one Brazilian minimum wage) and schooling (62.1% less than 8 years). Only 47.1% (n=469) knew the HIV status of their partner; of these women, 39.9% had an HIV-seronegative partner. Among the 1259 newborns evaluated, access to the antenatal, intrapartum and postpartum prevention of HIV mother to child transmission components occurred in 59.2%, 74.2%, and 97.5% respectively; 91.0% of the newborns were not breastfed. Overall 52.7% of the newborns have benefited from all the recommended interventions. In subsequent pregnancies (n=289), 67.8% of the newborns received the full package of interventions. The overall rate of HIV vertical transmission was 4.7% and the highest annual rate occurred in 2005 (7.4%), with no definite trend in the period. ConclusionsAccess to the full package of interventions for the prevention of HIV vertical transmission was low, with no significant trend of improvement over the years. The vertical transmission rates observed were higher than those found in reference services in the municipality of Rio de Janeiro and in the richest regions of the country.

Prevention of vertical HIV transmission and management of the HIV-exposed infant in Canada in 2014.

The standard of care for the prevention of vertical transmission (VT) of HIV in Canada and other developed countries includes routine prenatal HIV testing for all pregnant women, and for those testing positive: antepartum combination antiretroviral therapy (cART); intrapartum intravenous zidovudine; six weeks of postnatal oral zidovudine to the infant; and exclusive formula feeding of the infant. With these interventions, the rate of VT has been reduced from 25% to 40%, to 4 weeks before delivery. The purpose of the present article is to highlight recent changes in management guidelines and important caveats to these changes with regard to prevention of VT in the Canadian context. There is a global trend to replace the use of the previous conventional terminology of ‘mother-to-child transmission’ with ‘vertical transmission’ or ‘perinatal transmission’ to remove implications of blame from the mother. In the present article, ‘vertical transmission’ is used throughout. HIV testing during pregnancy HIV testing is recommended for all pregnant women in Canada, with appropriate pre- and post-test counselling. Women whose HIV status is unknown at the time of delivery should undergo rapid HIV antibody testing. For women at increased risk for HIV infection (eg, intravenous drug use, commercial sex work, frequent unprotected intercourse with multiple partners, HIV-negative woman of a serodiscordant couple) who test negative early in pregnancy, repeat testing late in pregnancy (beginning of the third trimester) and at delivery is strongly encouraged. When such women present in labour, advice regarding maternal HIV diagnosis and management should be sought from obstetric and adult HIV experts on an urgent basis; similarly, pediatric HIV experts should be consulted regarding infant management in such situations. Women living with HIV, either previously diagnosed or identified during pregnancy, should be followed by a specialist with expertise in the management of HIV during pregnancy, treated with cART and monitored for viral suppression. Prelabour elective Cesarean section delivery should be planned for those not on cART and/or anticipated or documented to have inadequate viral suppression near delivery (viral load >1000 copies/mL). For women who were previously diagnosed with HIV in whom viral load is not documented to be fully suppressed in the four weeks preceding onset of labour and for women diagnosed with HIV infection at the time of labour, urgent consultation with adult and pediatric HIV experts and an obstetrician with expertise in the management of HIV is essential. Recommendation 1: Pediatricians and other health care providers involved in the care of HIV-infected pregnant women and their children should advocate for universal HIV testing of all pregnant women with appropriate pre- and post-test counselling so that appropriate preventive measures can be implemented in a timely manner. When this fails, testing of the mother at delivery, or of the infant if maternal testing is not possible, should be ensured. Ideally, no infant should be discharged from hospital without the HIV status of the mother being known. Pediatricians and family physicians who perform routine neonatal examinations should verify that the HIV status of the mother or child is known and documented. Recommendation 2: Urgent consultation with an obstetrician with HIV expertise and an adult HIV expert is recommended for diagnosis and management of women deemed to be at high risk for HIV infection with unknown status at the time of labour. Similarly, a pediatric HIV expert should be consulted regarding infant management in such situations.

The cost and cost-effectiveness of gender-responsive interventions for HIV: a systematic review.

IntroductionHarmful gender norms and inequalities, including gender-based violence, are important structural barriers to effective HIV programming. We assess current evidence on what forms of gender-responsive intervention may enhance the effectiveness of basic HIV programmes and be cost-effective.MethodsEffective intervention models were identified from an existing evidence review (“what works for women”). Based on this, we conducted a systematic review of published and grey literature on the costs and cost-effectiveness of each intervention identified. Where possible, we compared incremental costs and effects.ResultsOur effectiveness search identified 36 publications, reporting on the effectiveness of 22 HIV interventions with a gender focus. Of these, 11 types of interventions had a corresponding/comparable costing or cost-effectiveness study. The findings suggest that couple counselling for the prevention of vertical transmission; gender empowerment, community mobilization, and female condom promotion for female sex workers; expanded female condom distribution for the general population; and post-exposure HIV prophylaxis for rape survivors are cost-effective HIV interventions. Cash transfers for schoolgirls and school support for orphan girls may also be cost-effective in generalized epidemic settings.ConclusionsThere has been limited research to assess the cost-effectiveness of interventions that seek to address women's needs and transform harmful gender norms. Our review identified several promising, cost-effective interventions that merit consideration as critical enablers in HIV investment approaches, as well as highlight that broader gender and development interventions can have positive HIV impacts. By no means an exhaustive package, these represent a first set of interventions to be included in the investment framework.

The challenge of referring HIV-positive pregnant women with treatment indication from PMTCT to ART services: a retrospective follow-up study in Mbeya, Tanzania

Providing full antiretroviral therapy (ART) to all HIV-positive, pregnant women with treatment indication could significantly reduce overall mother-to-child transmission. However, the effectiveness of referring HIV-positive antenatal care (ANC) clients with a treatment indication to ART services has rarely been assessed to date. We retrospectively followed-up data of a cohort of treatment-eligible ANC clients in Mbeya Region, Tanzania by retracing and merging registries of ANC, Care and Treatment Centers (CTC), and Infant Care. ART initiation and ART duration before delivery served as primary outcome indicators to assess referral effectiveness. We retraced data of 60 ANC clients with treatment indication: 39 (65%) started predelivery ART and 21 (35%) remained untreated during pregnancy. Eight (13.3%) did not initiate ART at all within the observation period. Women starting ART before delivery had significantly lower CD4-cell counts at enrollment than nonstarters (medians: 207.5 vs. 292 cells/µl; p = 0.013). Predelivery ART starters had experienced a significantly shorter duration between staff-declared “ART readiness” and actual ART start (medians: 0 vs. 28 days; p = 0.0004). The median ART duration prior to delivery was 57 days; only eight women (13.3%) accomplished ≥90 days ART intake during pregnancy. Early enrollment in ANC at ≤24 gestational weeks was associated with longer duration of predelivery ART. At maternity wards, 24.3% of treatment-eligible mothers and newborns with retraceable delivery data had received no or inadequate antiretrovirals. Within 6 months postdelivery, women attended on average 3.5 out of 6 requested CTC visits. Concluding, every third treatment-eligible woman in this cohort was not covered through ART before delivery, and predelivery ART duration was mostly suboptimal regarding vertical transmission prevention. HIV-positive women need to be encouraged to approach ANC early in pregnancy, and health services need to address unnecessary time gaps before ART initiation. In addition, inclusive ART services for HIV-positive ANC clients should be seriously discussed.

Pregnancy and birth in HIV seropositive women - present stage results

Background Since 1992, the Clinical Hospital of Obstetrics and Gynecology “Prof. Dr. Panait Sârbu”, Bucharest has been the medical unit to consult, record and monitor pregnancies, births and miscarriages associated with transmittable diseases including HIV positive patients from Bucharest and the surrounding counties, as the hospital had the necessary professional expertise and intrahospital networks. In time, within the “Prof. Dr. Panait Sârbu” Clinic, we have systematized and implemented an obstetric protocol for the prevention of HIV vertical transmission.

Pre-eclampsia and gestational hypertension are less common in HIV infected women.

To determine whether pre-eclampsia and gestational hypertension are less common in HIV infected women. This prospective cohort study was performed in the Western Cape province of South Africa. HIV negative and positive pregnant women without chronic renal or chronic hypertensive disease were continuously recruited. During the study period HIV positive patients received either mono- or triple (HAART) antiretroviral therapy for prevention of vertical transmission or maternal care. Only routine clinical management was performed. The development of hypertensive disease during pregnancy was recorded. 1093 HIV positive and 1173 HIV negative cases were identified during pregnancy and evaluated again after delivery. Significantly fewer cases of pre-eclampsia n=35 (3.2%) were recorded in the HIV positive group than in the HIV negative group, n=57 (4.9%) (p=0.045; OR 0.65 95% CI 0.42-0.99). There were also significantly fewer cases of gestational hypertension recorded in the HIV positive group compared to the HIV negative group (p=0.026; OR 0.53 95% CI 0.30-0.94). Multiple logistic regression analysis confirmed the reductive effect of HIV on pre-eclampsia and gestational hypertension. Pre-eclampsia and gestational hypertension are less common in HIV infected women being managed with mono- or triple anti-retroviral therapy.

Safety of Tenofovir Disoproxil Fumarate Treatment in Late Pregnancy in Highly Viremic Mothers with Chronic Hepatitis B

Purpose: Tenofovir disoproxil fumarate (TDF) is a pregnancy category B antiviral, and is widely used in HIV mothers. However, data are lacking on its use in CHB mothers for the prevention of vertical transmission (VT). We investigated the safety of TDF use at the third trimester in mono-infected mothers with CHB. Methods: Data were retrospectively collected from chronic hepatitis B (CHB) mothers who received TDF (300 mg daily) at the third trimester from April, 2010 to January, 2013. Mothers with no antiviral treatment during pregnancy at the same period were included as controls. All infants received appropriated immunoprophylaxis. Primary endpoints were maternal or fetal complications and congenital defects/deformities at birth. Secondary endpoints included infants' HBsAg positivity beyond the age of 28 weeks and maternal postpartum adverse events (AEs). Results: Of 34 mothers enrolled, 26 received TDF, and 8 were controls, with their baseline values in Table 1. In the control group, maternal mean HBV DNA levels were lower than antiviral treatment in these mothers was rarely indicated. In the TDF-treated group, the mean (SD) fetal exposure to TDF was 7.3±2.57 weeks. Maternal complications, including preeclampsia (n=1) and prolong laboring (n=3), were reported in TDF-treated mothers, resulting in 15.38% (4/26) in TDF treated mothers vs. 0% of complications in controls (p=0.58). There was no TDF discontinuation due to AEs. At delivery, there was a significant reduction of maternal HBV DNA levels in TDF-treated mothers when compared to the control group (2.0 logs vs. 0 logs copies/mL, respectively; p=0.003). The mean HBV DNA in the TDF group was 5.37log10 copies/mL. There were 25 and eight infants born to TDF-treated mothers (one mother was not due yet) and mothers in the control group, respectively. There were no birth defects or congenital deformities observed in the entire cohort. The gestational age, infants' height/weight, or Apgar scores between the two groups were comparable. All infants in this cohort received timely immunoprophylaxis. Eight mothers discontinued TDF soon after postpartum (mean 6.17±3.92 weeks on TDF after delivery) with no severe hepatitis (ALT>10XULN or >5 x baseline). By the time of this abstract submission, nine infants in the TDF group, and four in the control group with age beyond 28 weeks had HBsAg tested, and all were negative.Table 1: Maternal baseline valuesConclusion: The use of TDF at the third trimester for highly viremic mothers was safe and well-tolerated, with a high successful rate on preventing vertical transmission. No congenital defects/deformities were observed at birth. TDF cessation during postpartum appears to be safe. A large prospective randomization trial is needed to verify our findings. Disclosure - Dr. Pan is a speaker and consultant for Gilead, other authors have none to disclose.

AZT 5’-Phosphonates: Achievements and Trends in the Treatment and Prevention of HIV Infection

Despite the numerous drawbacks, 3'-azido-3'-deoxythymidine (AZT, Zidovudine, Retrovir) remains one of the key drugs used in the treatment and prevention of HIV infection in both monotherapy and HAART. A strategy in searching for new effective and safe AZT agents among latent (depot) forms of AZT has yielded its first positive results. In particular, the sodium salt of AZT 5'-H-phosphonate (Nikavir, phosphazide) has demonstrated clinical advantages over parent AZT: first and foremost, lower toxicity and better tolerability. It can be effectively used for the prevention of vertical transmission from mothers to babies and as an alternative drug for HIV-infected patients with low tolerance to Zidovudine. Preclinical studies of another phosphonate, AZT 5'-aminocarbonylphosphonate, have demonstrated that it releases AZT when taken orally. Pharmacokinetic studies have shown a prolonged action potential. Based on the analysis of both toxicological and pharmacological data, AZT 5'-aminocarbonylphosphonate has been recommended for clinical trials.

Knowledge, attitudes and practices of nurses and doctors about the vertical transmission of hepatitis B

To identify knowledge, attitudes and practices of physicians and nurses of the Family Health Strategy and a maternity hospital unit about vertical transmission of hepatitis B. A cross-sectional study with a self-administered questionnaire applied to professionals. The data were analyzed according to professional category and site of action, whose differences were tested by χ2 and significance <5%. Professionals recognize viral hepatitis as a disease of compulsory notification; however, not everyone knows its mechanisms of transmission. A large portion of professionals requested serological tests, specifying the marker, especially physicians. The majority of family health nurses did not indicate hepatitis B vaccine for pregnant women, although they knew the immunization schedule. The majority of physicians on the maternity unit had proper knowledge about prevention of vertical transmission. The differences in the knowledge, attitudes and practices about vertical transmission of hepatitis B revealed that the population is at risk, since not all the professionals involved know or properly perform control strategies for vertical transmission of hepatitis B. Nurses dominated vaccination aspects and physicians dominated aspects related to the management of cases with positive serology.

Gestantes portadoras de HIV/AIDS: aspectos psicológicos sobre a prevenção da transmissão vertical

A gestação, em geral, repercute emocionalmente na mulher e, mais intensamente, quando associada a uma situação clínica comprometedora da saúde do filho, como na possibilidade de transmissão vertical do HIV. Nesse contexto, o presente estudo teve por objetivo investigar as significações subjetivas das gestantes portadoras de HIV sobre a realização das ações de prevenção da transmissão vertical. Para tanto, recorreu-se a uma investigação do tipo transversal, de natureza descritiva e exploratória, com abordagem qualitativa, da qual, segundo o critério de saturação do conteúdo, participaram 12 gestantes. Os resultados demonstraram que as gestantes têm dificuldades imediatas para aderir aos medicamentos antirretrovirais, relutância em aceitar a possível indicação do parto cesáreo e frustração, permeada por sentimentos de culpa, diante da impossibilidade de amamentação do filho. Observa-se, assim, a necessidade de ações de apoio socioemocional a serem desenvolvidas pelos profissionais de saúde, especialmente os psicólogos, para favorecer o enfrentamento da transmissão vertical.

P2.118 The Importance of HIV Testing During Pregnancy - a Case Report

A 7 year old Austrian girl presented with a 20-month history of oral thrush as well as onychomycosis of the hands. In addition, dysphagia suggested esophageal involvement. Her family history...

P2.159 Knowledge and Practice of Nurses in the Prevention of Vertical Transmission of HIV in Selected Hospital of Eastern Region of Nepal

Vertical transmission remains the main mode of acquisition of HIV infection in children. A total of 700,000 children were newly infected in 2003, mainly through mother-to-child transmission of HIV. 1...

Hepatitis C Virus in Pregnancy

Despite recent advances in the pathogenesis, treatment, and public health response to hepatitis C virus (HCV), HCV as it specifically relates to pregnancy has been a neglected condition. HCV-monoinfected pregnant women have a 2-8% risk of viral transmission to their infant, but the mechanism and timing of mother to child transmission (MTCT) are not fully understood, nor is the natural history of the illness in pregnant women and their offspring. Recognition of HCV-infected pregnant women is relevant because of the long-term health implications for the mother, potential adverse effects of infection on pregnancy outcomes, and the possibility of transmission to their infants. Certain risk factors for MTCT of HCV appear similar to those for human immunodeficiency virus (HIV); however, unlike HIV, effective methods for prevention of HCV vertical transmission have not been developed. It is possible that a better understanding of HCV MTCT and pathogenesis in pregnancy will guide development of useful prevention strategies, particularly as we enter an era where interferon-free drug cocktails may emerge as viable treatment options for HCV.

Prevention of vertical transmission of HIV in India through service integration: lessons from Mysore District, Karnataka.

Meeting the needs of HIV-positive pregnant women and their offspring is critical to India's political and financial commitment to achieving universal access to HIV prevention, treatment, care and support. This review of the strategy to prevent vertical transmission of HIV in Mysore district, Karnataka, highlights the need to integrate prevention of parent-to-child transmission (PPTCT) and reproductive and child health (RCH) services. All key officials who were involved in the integration of services at the state and district levels were interviewed by use of semistructured protocols. Policy documents and guidelines issued by the Department of Health and Family Welfare and Karnataka State AIDS Prevention Society were reviewed, as were records and official orders issued by the office of District Health and Family Welfare Officer and District HIV/AIDS Programme Office, Mysore. Routine data were also collected from all health facilities. This review found that 4.5 years of PPTCT-RCH integration resulted not only in a rise in antenatal registrations but also in almost all pregnant women counselled during antenatal care undergoing HIV tests. Based on the findings, we propose recommendations for successful replication of this strategy. Integration of PPTCT services with RCH should take place at all levels - policy, administration, facility and community. The increased demand for HIV counselling and testing resulting from service integration must be met by skilled human resources, sufficient facilities and adequate funds at the facility level.

Efficacy and safety of tenofovir disoproxil fumarate in pregnancy for the prevention of vertical transmission of HBV infection

To evaluate the effects of tenofovir disoproxil fumarate (TDF) use during late pregnancy to reduce hepatitis B virus (HBV) transmission in highly viremic mothers. This retrospective study included 45 pregnant patients with hepatitis B e antigen (+) chronic hepatitis B and HBV DNA levels > 10⁷ copies/mL who received TDF 300 mg/d from week 18 to 27 of gestation (n = 21). Untreated pregnant patients served as controls (n = 24). All infants received 200 IU of hepatitis B immune globulin (HBIG) within 24 h postpartum and 20 μg of recombinant HBV vaccine at 4, 8, and 24 wk. Perinatal transmission rate was determined by hepatitis B surface antigen and HBV DNA results in infants at week 28. At week 28, none of the infants of TDF-treated mothers had immunoprophylaxis failure, whereas 2 (8.3 %) of the infants of control mothers had immunoprophylaxis failure (P = 0.022). There were no differences between the groups in terms of adverse events in mothers or congenital deformities, gestational age, height, or weight in infants. At postpartum week 28, significantly more TDF-treated mothers had levels of HBV DNA < 250 copies/mL and normalized alanine aminotransferase compared with controls (62% vs none, P < 0.001; 82% vs 61%, P = 0.012, respectively). TDF therapy during the second or third trimester reduced perinatal transmission rates of HBV and no adverse events were observed in mothers or infants.