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HIV and pregnancy: Maternal and neonatal evolution
Cecchini,Diego; Urue?a,Analía; Trinidad,Patricia; Vesperoni,Fernando; Mecikovsky,Débora; Bologna,Rosa;
Medicina (Buenos Aires) , 2011,
Abstract: data regarding epidemiological aspects, antiretroviral drug safety, and outcomes of hiv-infected pregnant women and their newborns are limited in argentina. we underwent a retrospective analysis of registries of hiv-infected pregnant women assisted at helios salud, buenos aires, argentina (1997-2006). variables associated with preterm delivery and neonatal complications were analyzed by univariate and logistic regression analyses. a total of 204 mother-child binomium were included. maternal age (median): 29 years; 32.5% without prior diagnosis of hiv-infection. baseline median cd4 t-cell count: 417 cell/μl; 98% received antiretroviral drugs during pregnancy [2 nucleoside analogs plus either nevirapine (55%) or a protease inhibitor (32%)]. overall incidence of toxicity was 12.5%: rash (8%), anemia (3.5%) and hepatotoxicity (1%). rash was associated with exposure to nevirapine. eighty one percent and 50% reached hiv-viral loads <1000 and <50 copies/ml at the end of pregnancy, respectively. twenty six percent had obstetric complications and 16% had preterm delivery. of the newborns, 1.6% had congenital defects and 9% had neonatal complications. overall neonatal mortality was 1% and perinatal transmission was 0.7%. protease inhibitor use and obstetric complications were associated to preterm delivery while obstetric complications were associated with neonatal complications. in our population, hepatotoxicity was low despite frequent use of nevirapine. protease inhibitor use was associated to preterm delivery. a favorable virological response and a low rate of perinatal transmission was observed, what supports the consensus that antiretroviral therapy benefits during pregnancy outweigh risks of maternal and neonatal adverse events.
Understanding Methods for Estimating HIV-Associated Maternal Mortality  [PDF]
James E. Rosen,Isabelle de Zoysa,Karl Dehne,Viviana Mangiaterra,Quarraisha Abdool-Karim
Journal of Pregnancy , 2012, DOI: 10.1155/2012/958262
Abstract: The impact of HIV on maternal mortality and more broadly on the health of women, remains poorly documented and understood. Two recent reports attempt to address the conceptual and methodological challenges that arise in estimating HIV-related maternal mortality and trends. This paper presents and compares the methods and discusses how they affect estimates at global and regional levels. Country examples of likely patterns of mortality among women of reproductive age are provided to illustrate the critical interactions between HIV and complications of pregnancy in high-HIV-burden countries. The implications for collaboration between HIV and reproductive health programmes are discussed, in support of accelerated action to reach the Millennium Development Goals and improve the health of women. 1. Introduction While recent reports indicate declining trends in maternal mortality [1, 2], at the current rate of progress, most countries remain unlikely to reach the Millennium Development Goal 5 and its target of reducing the maternal mortality ratio (MMR) by 75% between 1990 and 2015. The adverse effect of HIV on women's health in sub-Saharan Africa appears to be an important reason for poor progress [1, 3]. The contribution of HIV to maternal mortality has been recognized for over a decade [4, 5], but it remains poorly documented and understood. The number and proportion of maternal deaths associated with HIV have been difficult to determine with precision because of various conceptual and measurement challenges [1, 2]. This information is critical to plan services for women in need, including HIV-infected pregnant women. This paper aims to enhance the understanding of the methods used to estimate HIV-associated maternal deaths and how they affect global, regional, and country estimates. Country examples of likely patterns of mortality among women of reproductive age are provided to illustrate the critical interactions between HIV and maternal mortality in high-HIV-burden countries. 2. Methods for Estimating HIV-Associated Maternal Deaths 2.1. Definitions In the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, 1992 (ICD-10), WHO defines maternal death as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes [6]. Maternal deaths are either direct obstetric deaths resulting from obstetric complications of the
HIV-Associated Tuberculosis in the Newborn and Young Infant
M. Adhikari,P. Jeena,R. Bobat,M. Archary,K. Naidoo,A. Coutsoudis,R. Singh,N. Nair
International Journal of Pediatrics , 2011, DOI: 10.1155/2011/354208
Abstract: Each year, approximately 250 000 women die during pregnancy, delivery, or postpartum. Maternal mortality rates due to tuberculosis (TB) and HIV in Sub-Saharan Africa now supersede obstetric-related causes of mortality. The majority of cases occur in population-dense regions of Africa and Asia where TB is endemic. The vertical transmission rate of tuberculosis is 15%, the overall vertical transmission rate of HIV in resource-limited settings with mono- or dual-ARV therapy varies from 1.9% to 10.7%. If the millennium development goals are to be achieved, both HIV and TB must be prevented. The essential aspect of TB prevention and detection in the newborn is the maternal history and a positive HIV status in the mother. Perinatal outcomes are guarded even with treatment of both diseases. Exclusive breast feeding is recommended. The community and social impact are crippling. The social issues aggravate the prognosis of these two diseases.
Maternal plasma viral load and neutralizing/enhancing antibodies in vertical transmission of HIV: A non-randomized prospective study
Paul Kamara, Loyda Melendez-Guerrero, Miguel Arroyo, Heidi Weiss, Pauline Jolly
Virology Journal , 2005, DOI: 10.1186/1743-422x-2-15
Abstract: A nested PCR assay of the HIV-1 envelope V3 region and infant PBMC culture were performed to determine HIV status of the infants. Maternal and infant plasma were tested for HIV neutralization or enhancement in monocyte-derived macrophages.Twelve (26.7%) infants were positive by the HIV V3 PCR assay and 3 of the 12 were also positive by culture. There was a trend of agreement between high maternal viral load and HIV transmission by multivariate analysis (OR = 2.5, CI = 0.92, p = 0.0681). Both maternal and infant plasma significantly (p = 0.001 for both) reduced HIV replication at 10-1 dilution compared with HIV negative plasma. Infant plasma neutralized HIV (p = 0.001) at 10-2 dilution but maternal plasma lost neutralizing effect at this dilution. At 10-3 dilution both maternal and infant plasma increased virus replication above that obtained with HIV negative plasma but only the increase by maternal plasma was statistically significant (p = 0.005). There were good agreements in enhancing activity in plasma between mother-infant pairs, but there was no significant association between HIV enhancement by maternal plasma and vertical transmission.Although not statistically significant, the trend of association between maternal viral load and maternal-infant transmission of HIV supports the finding that viral load is a predictor of maternal-infant transmission. Both maternal and infant plasma neutralized HIV at low dilution and enhanced virus replication at high dilution. The antiretroviral treatments that the women received and the small sample size may have contributed to the lack of association between HIV enhancement by maternal plasma and vertical transmission.The rate of HIV-1 infection has been increasing rapidly among women of childbearing age. At the end of 2003 women accounted for 50% of adults living with HIV/AIDS worldwide [1]. Consequently, the number of pediatric AIDS cases due primarily to perinatal (peripartum or intrapartum) transmission is rapidly incre
Towards the Elimination of Pediatric HIV: Enhancing Maternal, Sexual, and Reproductive Health Services  [cached]
Alana F. Hairston, MSc,Emily A. Bobrow, PhD, MPH,Christian S. Pitter, MD, MPH
International Journal of MCH and AIDS , 2012,
Abstract: Almost 10 years ago, the United Nations adopted a comprehensive, four-pronged approach for the prevention of mother-to-child transmission of HIV (PMTCT). Despite all four prongs being central to the elimination of pediatric HIV, and the health of the mother being critical to reaching this goal, PMTCT programs have historically focused more attention on preventing HIV transmission from mother to child (prong 3) than on preventing HIV in women of reproductive age (prong 1) and preventing unintended pregnancies in women living with HIV (prong 2). In this commentary, experts from the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) argue that within the context of efforts to eliminate pediatric HIV, there are many ways to keep women living with HIV alive and at the center of the response to the global epidemic. One of the ways to do this is to enhance maternal and sexual and reproductive health (SRH) services. Within the elimination agenda, integration and linkages between PMTCT and comprehensive SRH services can keep mothers alive and at the center of the response. The commentary highlights some of the foundation’s global health work supporting, evaluating and enhancing maternal and SRH services provided to women living with HIV and proposes concrete actions for donors, researchers, policy makers and program implementers to further enhance maternal and SRH services within the context of PMTCT. If keeping women living with HIV is an integral component of the elimination of pediatric HIV agenda, maternal and SRH research, policies and programs need to be strengthened within the context of PMTCT. Donor funding and priorities for PMTCT also need to be more supportive of primary prevention of HIV infection among women of childbearing age and preventing unintended pregnancies among women living with HIV.
The Impact of HIV on Maternal Morbidity in the Pre-HAART Era in Uganda  [PDF]
Harriet Nuwagaba-Biribonwoha,Richard T. Mayon-White,Pius Okong,Peter Brocklehurst,Lucy M. Carpenter
Journal of Pregnancy , 2012, DOI: 10.1155/2012/508657
Abstract: Objective. To compare maternal morbidity in HIV-infected and uninfected pregnant women. Methods. Major maternal morbidity (severe febrile illness, illnesses requiring hospital admissions, surgical revisions, or illnesses resulting in death) was measured prospectively in a cohort of HIV-infected and uninfected women followed from 36 weeks of pregnancy to 6 weeks after delivery. Odds ratios of major morbidity and associated factors were examined using logistic regression. Results. Major morbidity was observed in 46/129 (36%) and 104/390 (27%) of the HIV-infected and HIV-uninfected women, respectively, who remained in followup. In the multivariable analysis, major morbidity was independently associated with HIV infection, adjusted odds ratio (AOR) 1.7 (1.1 to 2.7), nulliparity (AOR 2.0 (1.3 to 3.0)), and lack of, or minimal, formal education (AOR 2.1 (1.1 to 3.8)). Conclusions. HIV was associated with a 70% increase in the odds of major maternal morbidity in these Ugandan mothers. 1. Introduction Maternal morbidity is defined as illness in a woman who was or is pregnant from any cause related to the pregnancy, abortion, or child birth, excluding incidental or accidental causes [1]. In Uganda, the true level of maternal morbidity is unknown, but national estimates suggest that 5.1 maternal deaths occur for every 1,000 live births [2]. Although there has been a decline in maternal mortality since 2000 [3], child bearing is still associated with significant morbidity and mortality in this country. Like most sub-Saharan countries, Uganda has experienced a heavy burden of HIV-related disease in the last few decades. In men and non-pregnant women, HIV has been associated with at least a 2-fold increase in morbidity [4, 5] and 10–20-fold increase in mortality [6, 7]. Less is known about the association between HIV and maternal morbidity. We undertook a prospective observational study to describe, estimate, and compare the risk of maternal morbidity in HIV-infected and uninfected women in Uganda. 2. Methods 2.1. Setting The study was conducted at St. Raphael of St. Francis Hospital Nsambya, in Kampala, Uganda, between November 2002 and November 2003. The hospital is a catholic missionary hospital located in the capital city (Kampala). During the study year, there were a total of 24,461 antenatal visits (of whom 6,016 were new bookings) and 10,768 deliveries recorded. The hospital provided care to general and private patients who paid at total of about $10 (general) and $40 (private) for antenatal care and a normal vaginal delivery. This hospital was one of the
Effects of Maternal Age on Pregnancy and Fetal Prognosis  [cached]
Hakan Kiran,Gurkan Kiran,Melih Atahan Guven
Arsiv Kaynak Tarama Dergisi , 2003,
Abstract: Maternal age has important effects on maternal and fetal/neonatal health. Maternal age groups in which these effects are especially important are adolescent and advanced age groups. While adolescent pregnancies include below 20 ages, advanced age pregnancies include 35 and over. In this review, effects of maternal age on pregnancy and fetal health in adolescent and advenced age gropus are discussed. [Archives Medical Review Journal 2003; 12(2.000): 90-98]
Maternal Antiretroviral Therapy for the Prevention of Mother-To-Child Transmission of HIV in Malawi: Maternal and Infant Outcomes Two Years after Delivery  [PDF]
Marina Giuliano, Mauro Andreotti, Giuseppe Liotta, Haswell Jere, Jean-Baptiste Sagno, Martin Maulidi, Sandro Mancinelli, Ersilia Buonomo, Paola Scarcella, Maria F. Pirillo, Roberta Amici, Susanna Ceffa, Stefano Vella, Leonardo Palombi, Maria Cristina Marazzi
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0068950
Abstract: Background Optimized preventive strategies are needed to reach the objective of eliminating pediatric AIDS. This study aimed to define the determinants of residual HIV transmission in the context of maternal antiretroviral therapy (ART) administration to pregnant women, to assess infant safety of this strategy, and to evaluate its impact on maternal disease. Methodology/Principal Findings A total of 311 HIV-infected pregnant women were enrolled in Malawi in an observational study and received a nevirapine-based regimen from week 25 of gestation until 6 months after delivery (end of breastfeeding period) if their CD4+ count was > 350/mm3 at baseline (n = 147), or indefinitely if they met the criteria for treatment (n. 164). Mother/child pairs were followed until 2 years after delivery. The Kaplan-Meier method was used to estimate HIV transmission, maternal disease progression, and survival at 24 months. The rate of HIV infant infection was 3.2% [95% confidence intervals (CI) 1.0-5.4]. Six of the 8 transmissions occurred among mothers with baseline CD4+ count > 350/mm3. HIV-free survival of children was 85.8% (95% CI 81.4-90.1). Children born to mothers with baseline CD4+ count < 350/mm3 were at increased risk of death (hazard ratio 2.6, 95% CI 1.1-6.1). Among women who had stopped treatment the risk of progression to CD4+ count < 350/mm3 was 20.6% (95% CI 9.2-31.9) by 18 months of drug discontinuation. Conclusions HIV transmission in this cohort was rare however, it occurred in a significative proportion among women with high CD4+ counts. Strategies to improve treatment adherence should be implemented to further reduce HIV transmission. Mortality in the uninfected exposed children was the major determinant of HIV-free survival and was associated to maternal disease stage. Given the considerable proportion of women reaching the criteria for treatment within 18 months of drug discontinuation, life-long ART administration to HIV-infected women should be considered.
Does Maternal HIV Status Affect Infant Growth?: A Hospital Based Follow Up Study  [cached]
Sangeeta Trivedi,Prashant Kariya,Vijay Shah,Silky Mody
National Journal of Medical Research , 2012,
Abstract: Introduction: HIV infection is difficult to diagnose in infants, as most infected babies appear healthy and exhibit no signs and symptoms at birth. The present study was conducted to study the clinical profile & morbidity pattern of infants born to HIV positive mothers, their nutritional status and growth pattern and compare them with HIV non exposed infants. Methodology: This observational longitudinal study was conducted in Dec 2009 – Dec 2010 where all HIV exposed baby born in the hospital (n=44) were compared with suitable sample of HIV non exposed babies (n=140) in context of clinical profile & morbidity pattern. Results: In maternal weight <50 Kg category, mean weight, length and head circumference of HIV exposed infants is significantly lower than HIV non exposed infants. However, pattern of weight gain remain similar in both group. Grade 1 and grade 2 malnutrition was more in HIV exposed group at 3 month & 6 month. HIV exposed baby reported higher episodes of diarrhea (28.57%) as compared to non exposed group (15.33%) with statistically significant difference (p value<0.05). Conclusion: HIV exposure does not adversely affect growth potential of infants but because of their lower baseline values they seem to lag behind. Moreover maternal HIV status does not lead to severe degree of malnutrition if these babies were not themselves affected with HIV. [Natl J of Med Res 2012; 2(4.000): 512-517]
HIV-AIDS related maternal mortality in Benin city, Nigeria
JU Onakewhor, BN Olagbuji, AB Ande, MC Ezeanochie, OE Olokor, FE Okonofua
Ghana Medical Journal , 2011,
Abstract: Objective: To determine the causes and characteristics of maternal deaths in HIV-infected women. Design: A retrospective study of maternal deaths in a cohort of HIV-infected women. Setting: A facility-based maternal death review using case records and mortality summaries. Methods: Thirty seven maternal deaths which occurred in HIV-infected women were reviewed in a university teaching hospital in southern Nigeria over a 4- year period. Causes and circumstances surrounding each maternal death were identified. Result: One in every four maternal deaths occur in women with HIV infection. Majority (64.9%) of the women presented in advanced stage (WHO stage III/IV) of HIV syndrome while 86.5% had missed opportunities for antiretroviral programme. Pregnancyrelated sepsis was the commonest cause of maternal death. Other common causes were death from tuberculosis and pneumonia. Conclusion: HIV-related maternal death is emerging as a leading cause of pregnancy related death in Nigeria. There is need to scale-up preconception care and ensure comprehensive and sustainable prevention of mother -to-child transmission service for all pregnant women throughout Nigeria to reduce the burden of HIV/AIDS infection and minimize avoidable deaths from opportunistic infections.
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