Proportion Of HIV-infected Women Research Articles

Computer-based alcohol reduction intervention for alcohol-using HIV/HCV co-infected Russian women in clinical care: study protocol for a randomized controlled trial

BackgroundRussia has a high prevalence of human immunodeficiency virus (HIV) infections. In 2018, over one million persons were living with HIV (PLWH); over a third were women. A high proportion of HIV-infected women are co-infected with hepatitis C virus (HCV), and many consume alcohol, which adversely affects HIV and HCV treatment and prognosis. Despite the triple epidemics of alcohol use, HIV and HCV, and the need for interventions to reduce alcohol use among HIV/HCV co-infected women, evidence-based alcohol reduction interventions for this vulnerable population are limited. To address this gap, we developed a clinical trial to evaluate the efficacy of a computer-based intervention to reduce alcohol consumption among HIV/HCV co-infected women in clinical care.MethodsIn this two-arm parallel randomized controlled trial, we propose to evaluate the efficacy of a culturally adapted alcohol reduction intervention delivered via a computer for HIV/HCV co-infected Russian women. The study population consists of women 21–45 years old with confirmed HIV/HCV co-infection who currently use alcohol. Intervention efficacy is assessed by a novel alcohol biomarker, ethyl glucuronide (EtG), and biomarkers of HIV and HCV disease progression. Women are randomized to trial conditions in a 1:1 allocation ratio, using a computer-generated algorithm to develop the assignment sequence and concealment of allocation techniques to minimize assignment bias. Women are randomized to either (1) the computer-based alcohol reduction intervention or (2) the standard-of-care control condition. We will use an intent-to-treat analysis and logistic and linear generalized estimating equations to evaluate intervention efficacy, relative to the standard of care, in enhancing the proportion of women with a laboratory-confirmed negative EtG at each research study visit over the 9-month follow-up period. Additional analyses will evaluate intervention effects on HIV (viral load and CD4+ levels) and HCV markers of disease progression (FibroScan).DiscussionThe proposed trial design and analysis provides an appropriate conceptual and methodological framework to assess the efficacy of the computer-based intervention. We propose to recruit 200 participants.The intervention, if efficacious, may be an efficient and cost-effective alcohol reduction strategy that is scalable and can be readily disseminated and integrated into clinical care in Russia to reduce women’s alcohol consumption and enhance HIV/HCV prognosis.Trial registrationClinicalTrials.gov NCT03362476. Registered on 5 December 2017

REPRODUCTIVE DISORDERS AND THEIR PATHOGENETIC MECHANISMS IN WOMEN WITH HIV

Background . Highly active antiretroviral therapy (ART) has increased the life expectancy of people living with the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). Advances in scientific knowledge and, in particular, in the management of an HIV-infected pregnant woman have also reduced the risk of mother-to-child transmission of HIV. Aims . Consider the current problems of gynecological and reproductive health disorders and the pathophysiological aspects of these disorders in HIV-infected women. Methods . Review of Russian and international scientific publications related to gynecology, reproductive health and HIV infection from indexed online journals and relevant websites using Pubmed and Google search from 1990 to March 2019. Results. In recent years, the proportion of HIV-infected women has increased and the role of sexual transmission of infection has increased, as well as the active involvement of women of reproductive age in the HIV epidemic. In HIV-infected pregnant women who did not receive HAART, the frequency of obstetric complications, labor and adverse outcomes in children is increased. HIV infection can reduce the fertility of women at any stage of the disease, marked violations of the menstrual cycle and ovulation, reduced ovarian reserve and the quality of oocytes. In HIV-infected patients, weight loss and dystrophy, impaired thyroid function, adrenal glands and hypogonadism are recorded. Violations of the menstrual, ovulatory function can occur for a variety of reasons that are not directly related to their illness, but to multiple stressors. HIV-positive women suffer from increased frequency and severity of pelvic infections and precancerous and malignant lesions of the cervix. Conclusions. Gynecological, reproductive needs, as well as the specifics of monitoring an HIV-positive woman are not sufficiently assessed, are not optimal and are largely ignored, which can negatively affect their quality of life and efforts to combat the HIV epidemic.

Effect of prevention of mother-to-child transmission strategies on antiretroviral therapy coverage in pregnant women in Zambia: analysis using routinely collected data (2010–15)

BackgroundThe WHO recommendation for lifelong antiretroviral therapy (ART) for all pregnant and lactating women (Option B+) has been adopted by nearly all countries with the highest HIV burdens. In January, 2013, Zambia announced that it would revise its guidelines on prevention of mother-to-child transmission (PMTCT) and adopt Option B+. Accurate estimates of coverage of PMTCT services in pregnant women with HIV are vital for monitoring progress towards HIV elimination targets. We aimed to show trends in the coverage of PMTCT services in Zambia from 2010 to 2015. We describe the proportion of women attending antenatal care who are HIV positive, the proportion of HIV-positive pregnant women who started ART, the proportion of HIV-infected women already on ART, and time to treatment initiation.MethodsThis was a retrospective cohort study using routinely collected data from SmartCare, an electronic health record system. We included data from all pregnant women who attended antenatal care in the 889 health facilities using the SmartCare database in Zambia.FindingsWe included data for 104 155 pregnant women who attended antenatal services in SmartCare facilities between Jan 1, 2010, and Dec 31, 2015. Of these women, 9% (9262) tested HIV-positive during antenatal visits and 43% (44 387) had missing HIV test results. Almost half (47%, [4375]) the pregnant women who tested HIV-positive in their antenatal visit were recorded in 2010. Among HIV-positive women, there was an increase in those already on ART at first antenatal visit from 9% (40) in 2011 to 74% (1 155) in 2015. In our study, 65% (983/1501) of the women who started ART after testing HIV-positive during antenatal care were documented after the adoption of Option B+ (2013–15). Mean time lag between starting antenatal care and ART initiation was 7 months over the 6 year study period, but there were notable variations between provinces and years.InterpretationThe implementation of WHO PMTCT guidelines introduced after 2010 in Zambia has resulted in an increase in the proportion of HIV-infected pregnant women attending antenatal care who are already on ART. The SmartCare database could enable Zambian health policy makers to act on urgent PMTCT interventions and improve health-care quality and outcomes for mothers and their infants. However, there is a need first to improve procedures for data collection and entry. The number of missing data observations indicate the need for further qualitative research on why so many records were missing from the database.FundingSEARCH (Sustainable Evaluation through Analysis of Routinely Collected HIV data) and the Bill & Melinda Gates Foundation (grant number OPP1084472).

Determinants of Fertility Desires and Intentions among HIV Infected and Uninfected Women and Contraceptive use among HIV-infected women in the study atSix hospitals in two regions of Kenya

HIV epidemic in Kenya is geographically diverse ranging from a prevalence of 26 percent and 0.4 percent. Evidence indicates that a higher proportion of HIV infected women are more likely to be associated with unintended pregnancies.Despite this evidence, little is known about determinants of fertility desires and intentions of HIVinfectedand HIV-uninfected women in Kenya. 437 HIV-infected and 365 HIV-uninfected women were enrolled in the study. Using a cross-sectional mixed method, the study sought to investigate determinants of fertility desires and intentions among HIV-infected and uninfected women, and further determined factors associated with desire and intention to use contraceptives among HIV-infected women. Focus group discussions and key informant interviews were conducted with HIV-infected and uninfected women and Health providers respectively. Sampling was proportionate to the size based on client volumes at each study hospital. Similar factors including; age, region ofresidence, place of residence, level of education, employment and marital status were found to significantly influence desire and intention to have children among HIV-infected and uninfected women. Older women were more likely to desire or intend to have more children P<0.001), marital status was the only factor that influenced desire and intention to utilize contraceptives among HIV-infected women. Myths and misconception and poor provider -client interactions on family planning methods were some of the demand and supply system gaps that hinder utilization of family planning methods Innovative approaches are required to promote use of contraceptives among HIV infected women to reduce maternal morbidity, mortality and vertical transmission of HIV.

Variability of high risk HPV genotypes among HIV infected women in Mwanza, Tanzania- the need for evaluation of current vaccine effectiveness in developing countries.

BackgroundHigh risk (HR) human papilloma Virus (HPV) genotypes have been associated with cervical cancer. In Tanzania there is a limited data on the epidemiology of HPV and genotypes distribution among HIV infected women. Here we document varieties of HPV genotypes associated with cervical squamous intraepithelial lesions (SIL) among HIV- infected women at Bugando Medical Centre, Mwanza-Tanzania.MethodsA cross sectional hospital based study involving HIV infected women was conducted between August and October, 2014. Exfoliated cells from ectocervix and endocervix were collected using cytobrush. HPV genotypes were detected using polymerase chain reaction (PCR) followed by sequencing using specific primers targeting broad range of HPV types. Cytology was done to establish squamous intraepithelial lesions. Log binomial regression analysis was done to establish risk ratios (RR) associated with HPV infection using STATA version 11.ResultsA total of 255 HIV infected women with mean age 39.2 ± 9.1 years were enrolled in the study. HPV DNA was detected in 138/255 (54.1 %, 95 % CI: 47-60) of HIV infected women. Twenty six genotypes were detected in various combinations; of these 17(65.3 %) were of HR genotypes. HR genotypes were detected in 124(48.6 %) of HIV infected women. Common HR genotypes detected were HPV-52(26), HPV-58(21), HPV-35(20) and HPV-16(14). The risk of being HPV positive was significantly higher among women with CD4 counts <100 (RR: 1.20, 95 % CI: 1.05-1.35, P = 0.006) and women with SIL (RR: 1.37, 95 % CI: 1.11-1.68, P = 0.005)ConclusionSignificant proportion of HIV infected women with low CD4 counts have various grades of cervical SIL associated with varieties of uncommon HR genotypes. There is a need to evaluate the effectiveness of the current vaccine in preventing cervical cancer in developing countries where HIV is endemic.

Analysis of HIV-infection incidence in women in the Tatarstan Republic

Aim. To analyze the long-term dynamics and assess incidence territorial and age structure of infection caused by the human immunodeficiency virus (HIV-infection) in women in the Tatarstan Republic for the period from 1987 to 2015.Methods. Statistical and graphic-analytical methods were used. Intensive rates of HIV-infection incidence in women (aged 18 years and older), including certain age groups, were calculated and incidence territorial and age structure was analyzed. The incidence average prognostic index in 2016 and its possible maximum and minimum values were determined.Results.From 1996 to 2015 the incidence increased from 0.1 to 31.2 cases per 100 thousand female population. The incidence average prognostic index in 2016 was 37.2 per 100 thousand female population. In adult population (over 18 years) incidence structure the proportion of HIV-infected women in 2001 increased by 2.5 times: from 14.8±0.7% in 2001 to 36.3±1.3% in 2015 (pConclusion. Long-term dynamics of HIV-infection incidence in women in the Tatarstan Republic has a significant upward tendency; the shift to older age groups and significant rates variability by Republic districts in the incidence structure in women were revealed.

Low CD4 Counts and Early Sexual Debut Predict Genital Cytomegalovirus Infection among HIV Infected Women in Mwanza, Tanzania

Objective: Here we report the prevalence and predictors of genital CMV infection among HIV infected women in Mwanza, Tanzania. Methods: A total of 255 HIV seropositive women were investigated between August and October, 2014. Demographic and clinical data were collected using standardized data collection tool. Exfoliated cells from endocervix were obtained and detection of CMV DNA was done using real-time polymerase chain reaction (RTPCR). Results: A total number of 255 HIV infected women were enrolled with the mean age of 39.2 ± 9.1.The overall prevalence of genital CMV among HIV infected women was 43(16.7%, 95% CI: 12-21). Inflammatory changes and dysplasia did not show any association with genital CMV infection (p>0.05). Only good socio-economic status (OR=2.36, 95% CI; 1.1-5.02, p=.0.027), young age at first sexual intercourse (OR=2.18, 95% CI; 1.04-4.62, p=0.04) and lower CD4+ counts (OR=2.07, 95% CI; 1.23-3.48, p=.0.027) were found to be independent predictors of genital CMV infection among HIV infected women. Conclusion: A significant proportion of HIV infected women are genitally infected with CMV in the genital tract. More studies to ascertain the clinical role of this virus in the female genital tract are recommended especially in HIV infected women.

Minimally Abnormal Pap Testing and Cervical Histology in HIV-Infected Women

To assess the underlying histology of HIV-infected women with minimally abnormal Pap tests compared to HIV-uninfected women by evaluating their colposcopic and histologic outcomes. Retrospective analysis was performed to identify HIV-infected women who had at least one cervical Pap test from 2002 through 2008 at Boston Medical Center. We identified women who underwent colposcopy within 6 months of a minimally abnormal Pap test (atypical squamous cells of undetermined significance with positive high-risk human papillomavirus testing [ASCUS/HPV+] or low-grade squamous intraepithelial lesion (LSIL)). Our outcome was the proportion of HIV-infected women with histologic cervical intraepithelial neoplasia 2 or worse (CIN2+). We then compared these outcomes to those of a cohort of HIV-uninfected women from the same institution. There were 655 HIV-infected women who had Pap testing in the study time frame, and 146 (22%) had a minimally abnormal Pap test (ASCUS/HPV+ or LSIL). Of the 90 HIV-infected women who had subsequent colposcopy within 6 months, colposcopy was negative for 20 (22%), CIN1 for 41 (46%), and CIN2+ for the remaining 29 (32%). During the same time period, there were 747 HIV-uninfected women who underwent colposcopy within 6 months of a minimally abnormal Pap test. Colposcopy was negative for 336 (45%), CIN1 for 254 (34%), and CIN2+ for 157 (21%). After adjusting for differences in age and race, the HIV-infected women were more likely to have CIN2+ after a minimally abnormal Pap test (p=0.002) (adjusted odds ratio [OR] 2.17, 95% confidence interval [CI] 1.33-3.62). There were no diagnosed cases of cervical cancer. HIV-infected women have higher rates of underlying CIN2+ for minimally abnormal Pap tests compared with HIV-uninfected women.

Long‐Term Serologic Follow‐Up of Isolated Hepatitis B Core Antibody in HIV‐Infected and HIV‐Uninfected Women

Isolated antibody to hepatitis B core antigen (anti-HBc) is a common serologic finding in persons infected with human immunodeficiency virus (HIV), but the outcome and clinical significance are uncertain. We performed repeated hepatitis B virus (HBV) serologic tests on women who participated in the Women's Interagency HIV Study and who had isolated anti-HBc at study entry. Repeated serologic tests were performed for 322 women (282 HIV-infected and 40 HIV-uninfected) at a median of 7.5 years after study entry. Seventy-one percent of women retained isolated anti-HBc serologic status, 20% acquired antibody to hepatitis B surface antigen (anti-HBs), and 2% acquired hepatitis B surface antigen (HBsAg). In unadjusted analysis, increasing age, injection drug use, and hepatitis C viremia were negatively associated with acquisition of anti-HBs. For HIV-infected women, predictors of acquisition of anti-HBs were an increase in CD4 cell count and the use of highly active antiretroviral therapy (HAART). Receipt of drugs with activity against HBV and self-reported HBV vaccination did not predict anti-HBs acquisition. In the multivariable regression model, HAART use remained a significant predictor of anti-HBs acquisition, whereas women with hepatitis C viremia were more likely to retain isolated anti-HBc serologic status. Isolated anti-HBc status remained stable over time for the majority of women, especially women with chronic hepatitis C virus infection. Development of anti-HBs was predicted by HAART use and an increase in CD4 cell count. We conclude that a proportion of HIV-infected women with isolated anti-HBc have prior natural HBV infection with anti-HBs that is at an undetectable level because of immune dysfunction. Isolated anti-HBc in the presence of chronic hepatitis C virus infection may be attributable to a different phenomenon, such as dysfunctional antibody production.

Survey on prevalence and risk factors on HIV-1 among pregnant women in North-Rift, Kenya: a hospital based cross-sectional study conducted between 2005 and 2006

BackgroundThe HIV/AIDS epidemic in Kenya is a major public-health problem. Estimating the prevalence of HIV in pregnant women provides essential information for an effective implementation of HIV/AIDS control measures and monitoring of HIV spread within a country. The objective of this study was to determine the prevalence of HIV infection, risk factors for HIV/AIDS and immunologic (lymphocyte profile) characteristics among pregnant women attending antenatal clinics in three district hospitals in North-Rift, Kenya.MethodsBlood samples were collected from pregnant women attending antenatal clinics in three district hospitals (Kitale, Kapsabet and Nandi Hills) after informed consent and pre-test counseling. The samples were tested for HIV antibodies as per the guidelines laid down by Ministry of Health, Kenya. A structured pretested questionnaire was used to obtain demographic data. Lymphocyte subset counts were quantified by standard flow cytometry.ResultsOf the 4638 pregnant women tested, 309 (6.7%) were HIV seropositive. The majority (85.1%) of the antenatal attendees did not know their HIV status prior to visiting the clinic for antenatal care. The highest proportion of HIV infected women was in the age group 21–25 years (35.5%). The 31–35 age group had the highest (8.5%) HIV prevalence, while women aged more than 35 years had the lowest (2.5%).Women in a polygamous relationship were significantly more likely to be HIV infected as compared to those in a monogamous relationship (p = 0.000). The highest HIV prevalence (6.3%) was recorded among antenatal attendees who had attended secondary schools followed by those with primary and tertiary level of education (6% and 5% respectively). However, there was no significant relationship between HIV seropositivity and the level of education (p = 0.653 and p = 0.469 for secondary and tertiary respectively). The mean CD4 count was 466 cells/mm3 (9–2000 cells/mm3). Those that had less than 200 cells/mm3 accounted for 14% and only nine were on antiretroviral therapy.ConclusionSeroprevalence of HIV was found to be consistent with the reports from the national HIV sentinel surveys. Enumeration of T-lymphocyte (CD4/8) should be carried out routinely in the antenatal clinics for proper timing of initiation of antiretroviral therapy among HIV infected pregnant women.

Effectiveness of a city-wide program to prevent mother-to-child HIV transmission in Lusaka, Zambia

To determine the population effectiveness of a city-wide perinatal HIV prevention program. An anonymous surveillance of newborn cord blood for HIV serology and nevirapine (NVP). All 10 public-sector delivery centers in Lusaka, Zambia participated. All mother-infant pairs delivering during the 12-week surveillance period at the participating centers and who received antenatal care at a public-sector facility in Lusaka were included in the study. The main outcome measure was population NVP coverage, defined as the proportion of HIV-infected women and HIV-exposed infants in the population that ingested NVP. Of 8787 women in the surveillance population, 7204 (82%) had been offered antenatal HIV testing, of which 5149 (71%) had accepted, and of which 5129 (99%) had received a result. Overall, 2257 of 8787 (26%) were cord seropositive. Of the 1246 (55%) cord blood seropositive women who received an antenatal HIV test result, 1112 (89%) received a positive result; the other 134 comprise seroconverters and clerical errors. Only 751 of 1112 (68%) women who received a positive antenatal test result and a NVP tablet for ingestion at labor onset had NVP detected in the cord blood (i.e., maternal non-adherence rate was 32%). A total of 675 infants born to 751 adherent mothers (90%) received NVP before discharge. Thus, only 675 of 2257 (30%) seropositive mother-infant pairs in the surveillance population received both a maternal and infant dose of NVP. Successful perinatal HIV prevention requires each mother-infant pair to negotiate a cascade of events that begins with offering HIV testing and continues through adherence to the prescribed regimen. This novel surveillance demonstrates that failures occur at each step, resulting in reduced coverage and diminished program effectiveness.

Efficacy of strategies to reduce mother-to-child HIV-1 transmission in Argentina, 1993-2000.

This study evaluated the success of a national program for the prevention of mother-to-child transmission (MTCT) of HIV-1 in 874 mother-infant pairs from Buenos Aires and surroundings. This population was referred to the National Reference Center for AIDS for diagnosis of neonatal infection during 1993-2000. The data revealed an increase in the use of antiretroviral therapy during pregnancy from 3.2% in 1993-1994 to 73.1% in 1999-2000 and in the use of cesarean delivery (reaching 54.8% in 1999-2000). However, the proportion of HIV-infected women who continued to breast-feed their children remained steady (around 12%). General improvement of the conditions for decreasing MTCT resulted in a significant decrease in the proportion of infected infants from 37.3% before 1995 to 10.7% in 1999-2000 and even 6.5% during 2001. Data on the time of diagnosis indicated that only 42.7% of the women knew about their HIV status before pregnancy, 44.8 knew during pregnancy, and 12.3% knew after the birth of their child. The main risk factor for HIV infection in the mothers was heterosexual contact (73%), and in the fathers, it was injection drug use (67%). These results point out the urgent need to develop additional strategies for prevention of MTCT of HIV-1 to generalize education, counseling, and testing of young women.

Hospital Variation in Intrapartum Use of Zidovudine

To the Editor. —In August 1994, the US Public Health Service issued recommendations for administering zidovudine to pregnant women infected with the human immunodeficiency virus (HIV) and their newborns to reduce the risk of perinatal HIV transmission. 1 We conducted an anonymous, population-based study to estimate the proportion of HIV-infected women giving birth in Florida from October 1994 through March 1995 who received perinatal treatment with zidovudine. We used a modified radioimmunoassay for serum zidovudine to test dried-blood specimens that had been collected from newborns for routine metabolic screening. These specimens had been tested anonymously for maternal HIV antibody as part of a nationwide HIV serosurvey conducted under an existing protocol that had institutional review board approval. Performance characteristics of the modified assay are described elsewhere, 2 and studies are now in progress to develop a confirmatory test. The metabolism of zidovudine is delayed in neonates, resulting in