scholarly journals Update on Prevention of Mother-to-Child HIV Transmission

2004 ◽  
Vol 12 (3-4) ◽  
pp. 152-213
Author(s):  
Lynne M. Mofenson
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Pregnant Women ◽  
Hiv Transmission ◽  
Standard Of Care ◽  
Perinatal Transmission ◽  
Developed Countries ◽  
Pediatric Hiv ◽  
The Us ◽  
The Impact

The pediatric HIV epidemic in the US and other more developed countries changed dramatically after February 1994, when the results of PACTG 076 demonstrated that a triple regimen of ZDV reduced the risk of perinatal transmission by nearly 70%. Incorporation of ZDV prophylaxis into clinical practice, together with increased prenatal HIV counseling and testing, rapidly resulted in a significant decline in perinatal transmission and a concomitant decrease in the number of reported pediatric AIDS cases in the US. Transmission rates of 3–6% have been reported in various cohort studies with ZDV prophylaxis alone, and of 1–2% when ZDV is combined with elective Cesarean delivery or when women are treated with highly active antiretroviral regimens that reduce maternal viral load to unquantifiable levels. Additionally, several short antiretroviral regimens, including those that require administration only during the intrapartum and early postpartum periods, have been shown to decrease perinatal transmission. These regimens provide effective intervention even for HIV-infected pregnant women who have not received antiretroviral therapy and are identified late in pregnancy or for the first time at delivery through rapid HIV testing.However, this success has been partially offset by increasing HIV infection rates among young women, high adolescent pregnancy rates among at-risk populations, continued failure to identify HIV infection during pregnancy and inadequate prenatal care among HIV-infected women, particularly those using drugs. Additionally, the impact of evolving patterns of antiretroviral drug resistance on efficacy of prophylaxis is not known. As combination antiretroviral therapy becomes the standard of care for pregnant women in developed countries, evaluation of their infants for short- or long-term adverse consequences of intrauterine antiretroviral exposure is also a priority. Finally, clinical trials have identified short-course antiretroviral prophylaxis regimens that are effective and safe in resource-poor countries; however, transmission of HIV via breast milk remains a concern.

Syphilis and HIV Infection among Displaced Pregnant Women in Rural Mozambique

1994 ◽  
Vol 5 (2) ◽  
pp. 117-123 ◽  
Author(s):  
H A Cossa ◽  
S Gloyd ◽  
R G Vaz ◽  
E Folgosa ◽  
E Simbine ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Pregnant Women ◽  
Hiv Transmission ◽  
Perinatal Transmission ◽  
Anal Intercourse ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Hiv Seroprevalence ◽  
High Prevalence ◽  
History Of

A cross-sectional study was conducted among displaced pregnant women in Mozambique to determine the prevalence and correlates of HIV infection and syphilis. Between September 1992 and February 1993, 1728 consecutive antenatal attendees of 14 rural clinics in Zambézia were interviewed, examined, and tested for HIV and syphilis antibodies. The seroprevalence of syphilis and HIV were 12.2% and 2.9%, respectively. Reported sexual abuse was frequent (8.4%) but sex for money was uncommon. A positive MHA-TP result was significantly associated with unmarried status, history of past STD, HIV infection, and current genital ulcers, vaginal discharge, or genital warts. Significant correlates of HIV seropositivity included anal intercourse, history of past STD, and syphilis. In summary, displaced pregnant women had a high prevalence of syphilis but a relatively low HIV seroprevalence suggesting recent introduction of HIV infection in this area or slow spread of the epidemic. A syphilils screening and treatment programme is warranted to prevent perinatal transmission and to reduce the incidence of chancres as a cofactor for HIV transmission.

scholarly journals Overview of genotypic and clinical profiles of human immunodeficiency virus type 1-infected children in Rio de Janeiro, Brazil

2004 ◽  
Vol 76 (4) ◽  
pp. 727-741 ◽  
Author(s):  
Elizabeth S. Machado ◽  
John S. Lambert ◽  
Adriana O. Afonso ◽  
Silvia M. Cunha ◽  
Ricardo H. Oliveira ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Rio De Janeiro ◽  
Hiv Transmission ◽  
Clinical Laboratory ◽  
Adult Population ◽  
Developed Countries ◽  
Pediatric Hiv ◽  
Resistance Mutations ◽  
Drug Naïve ◽  
Hiv 1

Although mother-to-child HIV transmission prevention has slowed down pediatric HIV infection in developed countries, large numbers of infants still become infected in developing nations. Data on pediatric HIV infection is however largely scarce. In this study, we have overviewed clinical, laboratory and genotypic data from a large cohort of HIV-infected infants regularly followed at two pediatric HIV outpatient clinics in Rio de Janeiro, Brazil. Children on antiretroviral therapy, as well as drug-naïve, newly diagnosed infants were analyzed. Prevalence of drug resistance mutations, as well as immunological and virological responses to therapy were evaluated. Additionally, HIV-1 subtype frequencies and their distribution over the course of the epidemic were studied. We have found a high prevalence of mutations among ARV-experienced children, whereas mutations were absent in the drug-naïve group. Despite the high levels of resistance among treated infants, an important improvement of their immunological status was observed. HIV-1 subtype distribution followed the trends of the adult population, with the appearance of non-B subtypes and recombinant forms after 1990. To our knowledge, this is the largest pediatric cohort ever analyzed in Brazil, and the data provided is of paramount importance to a better understanding of HIV/AIDS evolution in pediatric settings.

Legal Barriers to Implementing Recommendations for Universal, Routine Prenatal HIV Testing

2004 ◽  
Vol 32 (1) ◽  
pp. 137-147 ◽  
Author(s):  
Leslie E. Wolf ◽  
Bernard Lo ◽  
Lawrence O. Gostin
Keyword(s):  
United States ◽  
Antiretroviral Therapy ◽  
Pregnant Women ◽  
Hiv Testing ◽  
Hiv Transmission ◽  
Perinatal Transmission ◽  
The United States ◽  
Hiv Status ◽  
Mother To Child ◽  
Legal Barriers

Administraation of antiretroviral therapy to women during pregnancy, labor and delivery, and to infants postnatally can dramatidy reduce mother-to- child HIV transmission (MTCT). However, pregnant women need to know that they are HIV-infected to take advantage of antiretroviral therapy, and many women do not know their HIV status. One-half of HIV-infected infants in the United States were bornto women who had not been tested for HIV or for whom the time of testing was not known. Although fewer than 400infants are infected perinatally in the United States each year, that number could be reduced even further through policies aimed at HIV testing during pregnancy.The reasons toadopt such a policy are strong: the pathophysiology of perinatal transmission is clear, prophylaxis is effective and safe, and the intended beneficiaries of the intervention - babies - cannot protect themselves.

scholarly journals Amniocentesis in the HIV-Infected Pregnant Woman: Is There Still Cause for Concern in the Era of Combination Antiretroviral Therapy?

2013 ◽  
Vol 24 (3) ◽  
pp. e91-e95 ◽  
Author(s):  
Nisha Andany ◽  
Michelle Letchumanan ◽  
Lise Bondy ◽  
Kellie Murphy ◽  
Mona R Loutfy
Keyword(s):  
Pregnant Woman ◽  
Antiretroviral Therapy ◽  
Pregnant Women ◽  
Hiv Transmission ◽  
Present Report ◽  
Single Gene ◽  
Invasive Procedure ◽  
Standard Of Care ◽  
Hiv Positive ◽  
Current Standard

The current standard of care in Canadian obstetrical practice is to offer pregnant women the opportunity for prenatal investigation to diagnose congenital abnormalities. Prenatal amniocentesis is Canada’s most commonly practiced invasive procedure for the diagnosis of chromosomal and single gene disorders. The potential risk of intrapartum HIV transmission during amniocentesis raises several ethical concerns and limits the availability of prenatal genetic testing for HIV-positive pregnant women. Complete virological suppression with antiretroviral therapy may alleviate the risk of mother-to-child transmission during amniocentesis and increase accessibility of this important diagnostic tool in the HIV-positive population. The present report describes a case involving a 32-year-old HIV-positive pregnant woman whose plasma viral load was undetectable on antiretroviral therapy; she underwent successful prenatal amniocentesis without transmission of HIV to her infant.

scholarly journals Monitoring Prevention Impact of Mother-to-Child Transmission of HIV in Concentrated Epidemics With Program and Survey Data (Preprint)

2017 ◽  
Author(s):  
Thi Thuy Van Nguyen ◽  
Keith Sabin ◽  
Thi Quynh Trang Ho ◽  
Ai Kim Anh Le ◽  
Chika Hayashi ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Pregnant Women ◽  
Survey Data ◽  
Hiv Transmission ◽  
Late Diagnosis ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Increased Risk ◽  
The Impact ◽  
Mother To Child

BACKGROUND The prevention of mother-to-child transmission (PMTCT) of HIV program was introduced in Vietnam in 2005. Despite the scaling up of PMTCT programs, the rate of mother-to-child HIV transmission in Vietnam was estimated as high as 20% in 2013. OBJECTIVE The objective of this study was to assess the outcomes of PMTCT and identified factors associated with mother-to-child transmission and infant survival using survey and program data in a high HIV burden province in Vietnam. METHODS This community-based retrospective cohort study observed pregnant women diagnosed with HIV infection in Thai Nguyen province from October 2008 to December 2012. Data were collected through interviews using a structured questionnaire and through reviews of log books and medical charts in antenatal care and HIV clinics. Logistic regression and survival analysis were used to analyze data using Stata (StataCorp). RESULTS A total of 172 pregnant women living with HIV were identified between 2008 and 2012. Most of these women had acquired the HIV infection from their husband (77/119, 64.7%). Significant improvement in the PMTCT program was documented, including reduction in late diagnosis of HIV for pregnant women from 62.5% in 2008 to 30% in 2012. Access to antiretrovirals (ARVs) improved, increasing from a rate of 18.2% (2008) to 70.0% (2011) for mothers and from 36.4% (2008) to 93.3% (2012) for infants. For infants, early diagnosis within 2 months of birth reached 66.7% in 2012 compared with 16.7% in 2009. Transmission rate reduced from 27.3% in 2008 to 6.7% in 2012. Late diagnosis was associated with increased risk for HIV transmission (odds ratio [OR] 14.7, 95% CI 1.8-121.4, P=.01), whereas ARV therapy for mother and infant in combination with infant formula feeding were associated with reduced risk for HIV transmission (OR 0.01, 95% CI 0.001-0.1; P<.001). Overall survival rate for HIV-exposed infants at 12 months was 97.7%. CONCLUSIONS A combination of program and survey data measured the impact of prevention of HIV transmission from mother-to-child interventions. Significant improvement in access to the interventions was documented in Thai Nguyen province. However, factors that increased the risk of HIV transmission, such as late diagnosis, remain to be addressed.

scholarly journals Exploring the impact of HIV infection and antiretroviral therapy on placenta morphology

Placenta ◽  
2021 ◽  
Vol 104 ◽  
pp. 102-109
Author(s):  
Michael Yampolsky ◽  
Oleksandr Shlakhter ◽  
Dianna Deng ◽  
Smriti Kala ◽  
Sharon L. Walmsley ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
The Impact

Antiretroviral Therapy of Pediatric HIV Infection: Making Hope a Reality

1999 ◽  
Vol 13 (10) ◽  
pp. 587-599 ◽  
Author(s):  
DOUGLAS C. WATSON ◽  
TERESA L. COLLINS-JONES ◽  
SUSAN LOVELACE
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Pediatric Hiv

Perinatal Human Immunodeficiency Virus (HIV) Testing

PEDIATRICS ◽  
1992 ◽  
Vol 89 (4) ◽  
pp. 791-794
Author(s):  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Vertical Transmission ◽  
Task Force ◽  
Perinatal Transmission ◽  
Pediatric Hiv ◽  
Number Of Children ◽  
Perinatal Hiv ◽  
Seroprevalence Data ◽  
Immunodeficiency Virus

PERINATAL INFECTIONS The primary route of human immunodeficiency virus (HIV) infection in infants is vertical transmission from HIV-infected mothers. This is of particular concern as the number of infected women and the number of children infected by perinatal transmission continue to increase rapidly. The number of perinatally acquired acquired immunodeficiency syndrome (AIDS) cases increased 17% in 1989 and 21% in 1990. Similarly, the number of heterosexually acquired AIDS cases increased 27% in 1989 and 40% in 1990. There is evidence that vertical transmission of HIV can occur in utero (congenital/transplacental, similar to rubella),1,2 in the postpartum period (breast-feeding), and perhaps in the intrapartum period (similar to hepatitis B).3 The relative frequency and efficiency of transmission during each of these periods remains uncertain. The best estimates of vertical transmission from an HIV-seropositive mother to the fetus range from 12.9% to 39%4-6 Although the risk of transmission appears to be increased in women who are symptomatic, this point is still unclear.5 Preliminary information suggests that the presence of high levels of high-affinity/avidity antibodies to specific epitopes of the gp 120 of HIV may be protective and may decrease or prevent vertical transmission,7-10 although others have not been able to confirm this finding.11 More detailed information on perinatal HIV infection,12 and infection control13 in pediatric HIV infection is available in previously published statements from the AAP Task Force on Pediatric AIDS. SEROPREVALENCE Anonymous seroprevalence data from newborn specimens are being collected in 44 states, Puerto Rico, and the District of Columbia. In some states, seroprevalence data are available by metropolitan area and/or by hospital of birth.

Minimising medical litigation: a review of key tort and legal reforms

2009 ◽  
Vol 5 (2) ◽  
pp. 179-233 ◽  
Author(s):  
Harold Tan
Keyword(s):  
Medical Malpractice ◽  
Developed Countries ◽  
Economic Sustainability ◽  
Legal Reforms ◽  
The Us ◽  
Tort System ◽  
Medical Litigation ◽  
Tort Reforms ◽  
The Uk ◽  
The Impact

The traditional tort system in medical malpractice is increasingly perceived as being incapable of addressing the mismatch between claims and negligent injuries. Tort reforms have been introduced in various developed countries in an attempt to bring about greater fairness and economic sustainability in the compensation of medical injuries and to reduce the overall rate of medical litigation. This paper reviews the key tort reforms that have been used in various countries, notably the US and the UK, and discusses the arguments that had been put forth by advocates and opponents of such reforms. The impact of these tort reforms, where studied and available, is also reviewed and discussed in the paper.

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