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 Adherence to Combination Antiretroviral Therapy among Pregnant Women Enrolled in a HIV Prevention Program in Rural North-central Nigeria

2020 ◽  
Vol 9 (1) ◽  
pp. 81-92
Author(s):  
Cedrina L. Calder ◽  
Heather O ◽  
Mohammad Tabatabai ◽  
Celia J. Maxwell ◽  
Salisha Marryshow ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Pregnant Women ◽  
Hiv Transmission ◽  
Secondary Analysis ◽  
Self Report ◽  
Hiv Positive ◽  
Combination Antiretroviral Therapy ◽  
North Central ◽  
Hiv Positive Women ◽  
Mother To Child

Objective: Adherence to combination antiretroviral therapy (ART) among pregnant women is essential to attaining the goal of eliminating mother-to-child HIV transmission. The objective of this study was to determine which factors affect adherence to ART among HIV-positive women enrolled in a large prevention of mother-to-child HIV transmission (PMTCT) trial in rural north-central Nigeria. Methods: The parent study included 372 HIV-positive pregnant women enrolled in a cluster-randomized control trial conducted at 12 health facilities in Nigeria between 2013 and 2015. This secondary analysis included HIV-positive women (and their infants) from the original trial with documented adherence data (n=210, 56.5%). The primary outcome was maternal adherence to ART, determined by self-report and based on the visual analogue scale (VAS) of a validated medication adherence tool. Participants with a VAS score of ? 95% were classified as adherent. We employed multivariate logistic regression to evaluate the predictors of maternal ART adherence in the study sample. Results: Approximately 61.0% of study participants (128/210) were adherent to ART. The majority of adherent participants (62.5%, 80/128) were enrolled in the trial intervention arm. The most common cited response for non-adherence was fear of status disclosure. Adherence to ART was associated with study arm (intervention arm vs. control arm, adjusted Odds Ratio (aOR) [95% CI]: 16.95 [5.30-54.23]), maternal ethnicity (Gwari vs. Other, aOR = 0.13 [0.05-0.38]), and partner HIV status (HIV-positive vs. unknown, aOR = 3.14 [1.22-8.07]). Conclusion and Global Health Implications: Adherence to ART among a cohort of pregnant women enrolled in a PMTCT trial in rural North-Central Nigeria was associated with trial arm, maternal self- reported ethnicity, and partner

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.

scholarly journals A five-year review of vertical HIV transmission in a specialized service: cross-sectional study

2016 ◽  
Vol 134 (6) ◽  
pp. 508-512 ◽  
Author(s):  
Izabel Cristina Hoffmann ◽  
Wendel Mombaque dos Santos ◽  
Stela Maris de Mello Padoin ◽  
Sonia Maria Oliveira de Barros
Keyword(s):  
Antiretroviral Therapy ◽  
Pregnant Women ◽  
Hiv Transmission ◽  
Transmission Rate ◽  
Cross Sectional Study ◽  
Hiv Positive ◽  
Sectional Study ◽  
Cross Sectional ◽  
Vertical Transmission Rate ◽  
Specialized Service

ABSTRACT CONTEXT AND OBJECTIVE: Healthcare professionals need to instill the process of prevention, control and treatment of people infected with HIV into care practice. Through maintaining preventive treatment among HIV-infected pregnant women, it has been demonstrated that prophylactic antiretroviral therapy, scheduled cesarean section and the prohibition of breastfeeding significantly reduce vertical HIV transmission. This study aimed to assess the rates of vertical HIV transmission in a specialized service and identify the factors associated with it. DESIGN AND SETTING: Cross-sectional study developed at the University Hospital of Santa Maria (RS), Brazil. METHODS: A cross-sectional study was conducted on a sample of 198 notification forms and medical records of HIV-positive pregnant women and exposed children. RESULTS: The vertical transmission rate was 2.4%, and three children had been infected by vertical HIV transmission. The statistically significant risk factor was the use of injectable drugs. Delayed reporting of pregnancy, absence of antiretroviral therapy during pregnancy, lack of proper prenatal care, incapacity to perform viral load detection tests and CD4+ T cell counts and obstetric and maternal clinical complications were reported. CONCLUSIONS: The vertical transmission rate was high and the recommended intervention measures were not adopted in full. Adequate prophylactic measures need to be implemented in HIV-positive pregnant women prenatally and during the antenatal, delivery and postpartum periods.

scholarly journals Effect of triple drug antiretroviral therapy on CD4+ count in pregnant women with HIV and prevention of parent to child transmission

2020 ◽  
Vol 9 (11) ◽  
pp. 4462
Author(s):  
Akanksha Dwivedi ◽  
Ratan Gupta ◽  
Kailash C. Agarwal ◽  
Kumari U. Rani
Keyword(s):  
Antiretroviral Therapy ◽  
Pregnant Women ◽  
Hiv Transmission ◽  
Cd4 Count ◽  
Hiv Positive ◽  
P Value ◽  
New Delhi ◽  
Child Transmission ◽  
Nicu Admission ◽  
A Prospective Study

Background: India has moved from single drug Antiretroviral Therapy (ART) in 2002 to triple drug ART in 2013 to prevent parent to child transmission of HIV. The aim of the study was to know the effects of triple drug ART on maternal CD4+ count and prevention of HIV transmission to baby along with its adherence, side effects and pregnancy outcome.Methods: A prospective study wsas done in Safdarjung Hospital, New Delhi on 40 HIV positive pregnant women who received single dose combination of triple drug ART. CD4+ count, LFT and KFT were done before beginning of ART and repeated after 6 months of ART. The infants received nevirapine prophylaxis and HIV status was determined by DBS PCR at 6 weeks.Results: The median CD4+ count was 317 and 397 pre and post ART for 6 months respectively (p value<0.001. Low birth weight (LBW) was seen in 43.59% which was statistically significant but confounded as 76.4% of these babies were preterm. 23.08% of babies had an APGAR of < 7 at 1 minute, out of which 77.7% were preterm. Nine out of 39 infants (one had abortion) needed NICU admission. Only one baby (2.56%) was HIV positive who died at 4 months of age due to pneumonia. There was no defaulter and no statistically significant changes in LFT and KFT after 6 months of ART.Conclusions: Triple drug ART offers greater convenience improves fetomaternal outcome and minimize the risk of HIV transmission from mother to child.

scholarly journals ACE2, TMPRSS2 and L-SIGN expression in placentae from HIV-positive pregnancies exposed to antiretroviral therapy–implications for SARS-CoV-2 placental infection

2021 ◽  
Author(s):  
Smriti Kala ◽  
Ksenia Meteleva ◽  
Lena Serghides
Keyword(s):  
Antiretroviral Therapy ◽  
Pregnant Women ◽  
Viral Entry ◽  
Cell Entry ◽  
Hiv Positive ◽  
Mrna Levels ◽  
Black Race ◽  
Entry Receptor ◽  
Lower Expression ◽  
Human Placentae

Abstract Background SARS-CoV-2 binding receptor ACE2 and the spike protein priming protease TMPRSS2 are co-expressed in human placentae. It is unknown whether their expression is altered in the context of HIV infection and antiretroviral therapy (ART). Methods We compared mRNA levels of SARS-CoV-2 cell-entry mediators ACE2, TMPRSS2 and L-SIGN (an alternative entry receptor) by qPCR in 105 placentae: 45 from pregnant women with HIV (WHIV) exposed to protease inhibitor (PI)-based ART, 17 from WHIV on non-PI-based ART, and 43 from HIV-uninfected women. Results ACE2 levels were lower, while L-SIGN levels were higher in placentae from WHIV on PI-based ART as compared to those on non-PI-based ART and to HIV-uninfected women. TMPRSS2 levels were similar between groups. Black race was significantly associated with lower expression of ACE2 and higher expression of L-SIGN. ACE2 levels were significantly higher in placentae of female fetuses. Discussion We have identified pregnant women of Black race and WHIV who are on PI-based ART to have relatively lower expression of placental ACE2 than those of White race and HIV-uninfected women. This effect may potentially contribute to altered susceptibility to COVID-19 in these women, either favorably; by reduced viral entry, or detrimentally; by loss of ACE2 protection against hyperinflammation.

scholarly journals EMBOLIZATION OF RENAL ANGIOMYOLIPOMA: CASE SERIES

2015 ◽  
Vol 1 (2) ◽  
Author(s):  
Ghania Masood ◽  
Iffat Rehman ◽  
Saquib Khawar ◽  
Khurram A Mufti ◽  
Imran K. Niazi
Keyword(s):  
Minimally Invasive ◽  
Key Words ◽  
Case Series ◽  
Invasive Procedure ◽  
Standard Of Care ◽  
Renal Angiomyolipoma ◽  
Minimally Invasive Procedure ◽  
Benign Lesions ◽  
Current Standard ◽  
Spontaneous Haemorrhage

Renal angiomyolipomas (AML) are benign lesions usually left alone. However, lesions larger than 4 cm carry the risk of spontaneous haemorrhage and need treatment. Angiography and embolisation are the current standard of care particularly in patients with high operative risks. Angio-embolisation is a safe, minimally invasive procedure preserving maximum renal parenchyma, with the added advantage of preventing peri-procedural morbidity. Two cases of AML are presented in this case series. Key words: Angiomyolipoma, embolisation, renal 

scholarly journals Systematic Review of HIV Transmission between Heterosexual Serodiscordant Couples where the HIV-Positive Partner Is Fully Suppressed on Antiretroviral Therapy

PLoS ONE ◽  
2013 ◽  
Vol 8 (2) ◽  
pp. e55747 ◽  
Author(s):  
Mona R. Loutfy ◽  
Wei Wu ◽  
Michelle Letchumanan ◽  
Lise Bondy ◽  
Tony Antoniou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Antiretroviral Therapy ◽  
Hiv Transmission ◽  
Hiv Positive ◽  
Serodiscordant Couples
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