scholarly journals Insufficient antiretroviral therapy in pregnancy: missed opportunities for prevention of mother-to-child transmission of HIV in Europe

2011 ◽  
Vol 16 (6) ◽  
pp. 895-903 ◽  
Author(s):  
Keyword(s):  
Antiretroviral Therapy ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Missed Opportunities ◽  
Mother To Child ◽  
In Pregnancy

scholarly journals Viral and antiretroviral dynamics in HIV mother-to-child transmission fluids (VADICT) – Protocol and data analysis plan for a cohort study

2019 ◽  
Vol 4 ◽  
pp. 34
Author(s):  
Adeniyi Olagunju ◽  
Damien Anweh ◽  
Ogechi Okafor ◽  
Laura Dickinson ◽  
Douglas Richman ◽  
...  
Keyword(s):  
Drug Disposition ◽  
Population Pharmacokinetic ◽  
Mother To Child Transmission ◽  
Sample Collection ◽  
Child Transmission ◽  
Link Type ◽  
Early Postpartum ◽  
Mother To Child ◽  
Hiv 1 ◽  
In Pregnancy

Background: Pregnancy and polymorphisms in drug disposition genes alter the clearance of key antiretrovirals used as part of regimens for prevention of mother-to-child transmission of HIV (PMTCT). The clinical significance of these in women initiating therapy late in pregnancy has not been investigated. The primary objective of the Viral and Antiretroviral Dynamics in HIV Mother-To-Child Transmission Fluids (VADICT) study is to investigate viral and antiretroviral dynamics in matrices associated with mother-to-child transmission (MTCT) (plasma, genital fluid and breastmilk) in women (stratified by CYP2B6 genotypes) who initiate antiretroviral therapy (ART) before or early in pregnancy versus late in pregnancy or early postpartum. Methods: A cohort of HIV-1 infected women who initiated ART containing 600 mg efavirenz before or early in pregnancy (n = 120), during the third trimester (n = 60), or early postpartum (n = 60) will be studied.  Eligible patients will be recruited from four hospitals in Benue State, North Central Nigeria and followed until the end of breastfeeding. Procedures at follow up visits will include sample collection for drug quantification and HIV-1 RNA and DNA in plasma, genital fluid and breastmilk; adherence monitoring; and newborn and infant assessment. Using newborn exposure to maternal efavirenz at birth for validation, prenatal pharmacogenetics of efavirenz will be explored using physiologically-based pharmacokinetic modelling. Three integrated methods will be used to monitor patterns and correlates of adherence across pregnancy and the breastfeeding period. A population pharmacokinetic-pharmacodynamic model will be developed to describe the observed data and simulate what to expect in women initiating ART containing 400 mg efavirenz (recently approved for non-pregnant adults) late in pregnancy or early postpartum. Discussion: This study will help in understanding residual MTCT in women receiving ART and reasons for the rise in MTCT risk during the breastfeeding period. Trial registration: ClinicalTrials.gov: NCT03284645 (15/09/2017)

scholarly journals The case for Option B and Optional B+: Ensuring that South Africa’s commitment to eliminating mother-to-child transmission of HIV becomes a reality

2012 ◽  
Vol 13 (4) ◽  
pp. 178 ◽  
Author(s):  
D Besada ◽  
G Van Cutsem ◽  
E Goemaere ◽  
N Ford ◽  
H Bygrave ◽  
...  
Keyword(s):  
South African ◽  
Population Level ◽  
World Health ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Trade Offs ◽  
The Individual ◽  
Mother To Child ◽  
African Journal ◽  
In Pregnancy

In a previous issue of the Southern African Journal of HIV Medicine, Pillay and Black summarised the trade-offs of the safety of efavirenz use in pregnancy (Pillay P, Black V. Safety, strength and simplicity of efavirenz in pregnancy. Southern African Journal of HIV Medicine 2012;13(1):28-33.). Highlighting the benefits of the World Health Organization’s proposed options for the prevention of mother-to-child transmission (PMTCT) of HIV, the authors argued that the South African government should adopt Option B as national PMTCT policy and pilot projects implementing Option B+ as a means of assessing the individual- and population-level effect of the intervention. We echo this call and further propose that the option to remain on lifelong antiretroviral therapy, effectively adopting PMTCT Option B+, be offered to pregnant women following the cessation of breastfeeding, for their own health, following the provision of counselling on associated benefits and risks. Here we highlight the benefits of Options B and B+.

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