Prevention of mother to child transmission of HIV: Our experience in South India

Objectives

To determine the outcomes of various ARV (Anti-Retroviral) prophylactic regimes given to HIV positive pregnant mothers, based on time of presentation, for prevention of vertical transmission.

Methods

During a four year period, 92 pregnant HIV positive women and their newborn infants received various ARV prophylactic regimes for prevention of vertical transmission. The outcome, in terms of presence of HIV infection in the infants born to these mothers was studied.

Results

The prevalence of HIV infection in the antenatal group studied was 0.62%. Of the 92 HIV positive pregnant mothers who delivered live babies, 91.3% received ARV prophylaxis or HAART, and 95.6% of the 92 live infants received ARV prophylaxis. The risk of vertical transmission was only 3.3%.

Conclusions

Judicious PMTCT regimes, even if they appear complex, are possible in the Indian setting, and can result in significant decline of HIV positive children. Duration of treatment and mode of delivery should be based on the time of presentation of the HIV positive pregnant mother.     

Pregnancy outcome among HIV-infected women in the Helsinki metropolitan area

BACKGROUND: Antiretroviral medication and good obstetric practice have greatly reduced the rate of vertical transmission of human immunodeficiency virus (HIV) infection. The incidence of HIV infection has remained low in Finland. Universal antenatal screening has been offered to all pregnant women since 1998. METHODS: We analyzed the outcomes of 52 pregnancies among 45 HIV-infected mothers delivering at our department during 1993-2003. A multidisciplinary team planned the management strategy individually and supported the mother's adherence to treatment. RESULTS: The incidence of HIV infection among women delivering in our hospital district increased from 0.6/10,000 (95% CI 0-1.6) to 4.8/10,000 (95% CI 1.4-8.2) between 1993 and 2002. HIV infection was diagnosed during pregnancy in 40% (18/45) of the mothers. Antiretroviral medication was used prior to pregnancy in 17 (33%) cases; in 34 (66%) cases of the pregnancies, medication was started during the pregnancy. A good virological response (i.e. HIV RNA load <1000/ml during the last trimester) to antiretroviral medication was achieved in 90% (36/40) of the patients; in 60% (24/40) of cases, the HIV RNA load was below the assay detection limit. One mother with advanced HIV infection succumbed to pneumonia shortly after delivery. Of the infants, 92% were born at term, and their mean (+/-SD) birth weight was 3350 +/- 395 g. The Caesarean section (CS) rate was 25% (13/52). All newborns were in good condition, and their mean umbilical pH was 7.23. All newborns received antiretroviral medication. One infant was infected with HIV, the mother was found HIV-positive postpartum. None of the infants born to mothers known to be HIV positive were infected. CONCLUSIONS: A combination of universal antenatal screening and multidisciplinary management allows individualized treatment and prevents vertical transmission of HIV infection.     

中国部分地区HIV阳性孕产妇的调查分析

目的:了解我国部分地区育龄妇女感染人类免疫缺陷病毒(HIV)的情况;调查研究各种阻断方式的效果,探讨适合我国国情的HIV母婴阻断措施。方法:2004年至2007年间,选择我国部分地区为调查地点,对来院进行孕检的妇女及孕期未曾检测HIV住院分娩的产妇进行HIV抗体筛查检测;对HIV阳性孕产妇采取相应阻断措施,此后追踪检测HIV母婴传播状况,综合分析各阻断方案的效果。结果:共筛查119616例孕产妇,检测HIV阳性65例,阳性率0.05%。65例阳性孕产妇中终止妊娠24例,分娩40例,待产1例;孕期、产时及产后发现的HIV阳性孕产妇分别占60.0%、15.4%及24.6%;性途径感染44例(67.7%),血途径感染21例(32.3%),以性传播途径为主;采取完全阻断措施20例(50.0%),1例HIV(+);不完全阻断措施15例(37.5%),1岁内死亡3例,失访2例;未实施阻断5例(12.5%),3例死产,1例HIV(+)。结论:孕产期做好HIV的自愿检测,有利于预防艾滋病母婴传播及阻断工作的开展,根据疫情不同,筛检措施应因地制宜;目前我国部分地区艾滋病流行以性传播为主;HIV母婴阻断应提倡早期发现早期预防,以免错过接受阻断传播的最佳时机;当前预防HIV母婴传播的策略降低了传播率,但也存在一些问题。     

‘I was told not to do it but…’: Infant feeding practices amongst HIV-positive women in southern Thailand

Background and objectivesmothers living with HIV are encouraged not to breastfeed as it can transmit HIV to their infants. However, there is little known about how Thai women with HIV perceive and experience their infant feeding practices. This paper explores the breastfeeding experiences among Thai women living with HIV in southern Thailand.Methodssemi-structured interviews and drawing methods were used with 30 HIV-positive women in rural communities of southern Thailand. Thematic analysis was used for data analysis.FindingsHIV-positive mothers had ambivalent feelings about not being able to breastfeed their infants. They perceived themselves as a ‘contaminated mother’. Healthcare centres and hospitals supply free infant formula for HIV-positive mothers up to one and a half years. Despite this, many mothers had to deal with some difficulties. Some infants developed an allergy to the infant formula. The free infant formula was not sufficient for some infants and the mothers had to find alternative means for the well-being of their infants: many mothers relied on condensed milk whereas some fed mashed banana. The women made every effort to fulfill their ideology of being a good and responsible mother.Conclusionthis paper contributes a conceptual understanding about the lived experiences of breastfeeding among women living with HIV in southern Thailand. The findings have implications for midwifery care and health policy. The provision of different options of feeding should be made available to infants along with accessible resources and professional support and guidance.     

Prevention of mother-to-child transmission of HIV: antiretroviral strategies

The World Health Organization's Strategic Approaches to the Prevention of HIV Infection in Infants includes 4 components: primary prevention of HIV-1 infection; prevention of unintended pregnancies among HIV-1-infected women; prevention of transmission of HIV-1 infection from mothers to children; and provision of ongoing support, care, and treatment to HIV-1-infected women and their families. This review focuses on antiretrovirals for secondary prevention of HIV-1 infection-prevention of HIV-1 transmission from an HIV-1-infected woman to her child. Antiretroviral strategies to prevent the mother-to-child transmission of HIV-1 in nonbreastfeeding populations comprise antiretroviral treatment of HIV-1-infected pregnant women needing antiretrovirals for their own health, antiretroviral prophylaxis for HIV-1-infected pregnant women not yet meeting criteria for treatment, and antiretroviral prophylaxis for infants of HIV-1-infected mothers. The review primarily addresses antiretroviral strategies for nonbreastfeeding, HIV-1-infected women and their infants in resource-rich settings, such as the United States. Antiretroviral strategies to prevent antepartum, intrapartum, and early postnatal transmission in resource-poor settings are also addressed, albeit more briefly.     

Human immunodeficiency virus infection in pregnant women, transmission and zidovudine therapy.

OBJECTIVE: To determine the rate of mother to child transmission of HIV infection in women treated with zidovudine (ZDV). PATIENTS AND METHODS: A consecutive series of 52 HIV-positive pregnant women who either received antenatal care or delivered at our institution. Forty-three women were known to be HIV positive before delivery. Forty were treated with ZDV, 36 intravenously. Twelve had no antenatal care and one refused antenatal treatment. All neonates were treated with ZDV. RESULTS: The HIV transmission rate in children born to mothers treated with ZDV was 6.6%. This compares with a transmission rate of 14% before we used ZDV. All three mothers who transmitted infection had low compliance, initiated therapy late in pregnancy or had advanced disease. CONCLUSION: Our experience supports the idea that ZDV treatment has reduced HIV transmission rate.     

Human cytomegalovirus infection and clinical status of infants born to human immunodeficiency virus type 1 infected mothers

Objective.?Human cytomegalovirus (HCMV) is one of the most common congenital infections worldwide and a frequent opportunistic infection that aggravates the condition of human immunodeficiency virus (HIV)-infected patients. The aim of the study was to evaluate the frequency and factors influencing HCMV infection among infants of HIV-positive women.

Methods.?The study included 35 infants born to HIV-1-infected mothers examined for congenital infections. Children were evaluated for human immunodeficiency virus type 1 (HIV-1), HCMV, and HCV infection by serological and molecular methods.

Results.?HIV-1 infection was found in one child whose mother did not receive antiretroviral treatment during pregnancy, and HCV infection in another infant. HCMV-DNA in the urine was present in 13/35 infants (37.14%) on the 10th day and 24/35 infants (68.57%) in the 4th week of life. The majority of HCMV-infected infants were asymptomatic, although they manifested microcephaly and low birth weight significantly more frequently (p = 0.006 and p = 0.02, respectively). Type HIV prophylaxis did not influence HCMV transmission.

Conclusions.?Although often asymptomatic, HCMV infection in infants born to HIV-infected mothers is frequent and may be associated with prematurity, low birth weight, and microcephaly. Diagnostic procedures in children of HIV-infected mothers should involve HCMV.     

Obstetric and perinatal consequences of human immunodeficiency virus (HIV) infection: a review

Pediatric acquired immune deficiency syndrome (AIDS) was known to be a new disease that could be acquired from the mother even before human immunodeficiency virus (HIV) was identified. The suggested routes of transmission of infection are intrauterine, perinatal--from contact with infected maternal genital secretions, or through breastfeeding. At this time the problem in Europe concerns primarily women in high-risk groups: intravenous drug abusers, prostitutes, women from countries where the prevalence of HIV is high, and women whose sexual partners are in a high-risk group. In the future, the infection may extend beyond women in high-risk groups as the disease becomes more prevalent in the community. It has been claimed that pregnancy accelerates symptoms in women who are HIV positive, yet this is based on only a series of case reports of severe infection in pregnancy and on the development of AIDS in asymptomatic women in pregnancy subsequent to the birth of an AIDS child. The only data capable of shedding some light on this issue would be a prospective followup of both pregnant and nonpregnant HIV-positive women from similar high-risk groups. Such a study is ongoing in the US. An increasing number of case reports suggest intrauterine transmission of infection. The following 3 case reports provide clear evidence of intrauterine transmission. Sprecher et al. (1986) detected HIV antigen in amniotic fluid and fetal tissues from a pregnancy termination at 15 weeks gestation in a woman with stage IV AIDS and Kaposi sarcoma. Lapointe et al. (1985) reported an infant born by cesarean section at 28 weeks gestation to a mother with terminal aids. A new dysmorphic syndrome recently has been described in children with symptomatic HIV infection (Marion et al., 1986). HIV has been isolated from cervical secretions (Fogt et al., 1986; Wofsy et al., 1986), which suggests that this cold be another source of infection. There is 1 report of isolation of HIV from the noncellular fraction of breast milk (Thirty et al., 1985). Several case reports have described acquired immunodeficiency in infants for whom the only known risk factor was neonatal transfusion from an individual later found to be suffering from AIDS. The risk of transmission from an infected mother to her infant is unknown, but the best available evidence comes from a study of children born to women who had previously given birth to a child with AIDS (Scott et al, 1985). Of 12 children, 4 developed AIDS or Aids-related complex. Clinical problems among children with AIDS or AIDS-related complex have been fully described. The fatality rate of children with AIDS is high, but the ultimate progress of children with less severe disease or who have asymptomatic infection is known.     

Breast feeding and immunoprophylaxis efficacy of mother-to-child transmission of hepatitis B virus

Abstract

Objective: This study was designed to explore if hepatitis B virus (HBV) may be transmitted via breast milk through mother-to-child transmission (MTCT), and assay the immunoprophylaxis efficacy after passive–active immunization.

Method: From year 2008 to 2012, 67?720 pregnant women were screened and 1186 HBsAg-carrier mothers and their infants aged 8–12 months were followed in multi-centers of China, among whom HBV markers (HBsAg, HBsAb, HBeAg, HBeAb and HBcAb) and HBV-DNA were measured.

Results: HBsAg positive rate of pregnant women was 6.7% (4533/67?720) and infants’ immunoprophylaxis failure rate was 3.3% (39/1186). Immunoprophylaxis failure infants were all born to mothers of HBeAg positive and HBV-DNA >6 log₁₀ copies/ml. Among infants of HBeAg positive mothers, HBV infection rate was 9.0% and HBsAg positive rate was 8.3% in breast-feeding group versus 9.2% in formula-feeding group, P?=?0.761. Occurrence of perinatal HBV infection was indicated in uterus or during delivery. Different feeding patterns had no effects on HBsAb conversion of infants with the implementation of immunization.

Conclusions: HBsAg prevelance rate of pregnant women enrolled was 6.7% and immunoprophylaxis failure rate of infants was 3.3%, while the infection rate reached 9.0% in infants of HBeAg positive mothers. Breast feeding did not increase the occurrence of HBV MTCT.     

Distribution of maternal and infant human papillomavirus: risk factors associated with vertical transmission

Objective

To evaluate the rate of human papillomavirus (HPV) infection in pregnant women and their neonates, and the risk factors associated with vertical transmission of HPV infection from mothers to neonates.

Study design

Cervical HPV testing was undertaken in pregnant women over 36 weeks of gestation, and mouth secretions and oral mucosa of neonates were tested for HPV immediately after delivery. HPV-positive neonates were rechecked 2 months postpartum to identify the persistence of HPV infection. In HPV-positive mothers, the placenta, cord blood and maternal peripheral blood were also analysed for HPV to confirm whether transplacental HPV infection occurred.

Results

HPV was detected in 72 of 469 pregnant women (15.4%) and in 15 neonates (3.2%). Maternal HPV positivity was associated with primiparity and abnormal cervical cytology. The rate of vertical transmission was 20.8%, and all HPV-positive neonates were born from HPV-positive mothers. Vertical transmission was associated with vaginal delivery and multiple HPV types in the mother. Neonates with HPV showed a tendency for higher maternal total HPV copy number than neonates without HPV, but this difference was not significant (p = 0.081). No cases of HPV infection were found in the infants at 2 months postpartum, and no HPV was detected in placenta, cord blood or maternal blood.

Conclusions

Vertical transmission of HPV is associated with vaginal delivery and multiple HPV types in the mother; however, neonatal HPV infection through vertical transmission is thought to be a transient.     

孕妇的输血传播病毒感染及母婴垂直传播

目的 探讨广州市妊娠妇女的输血传播病毒（ＴＴＶ）感染情况和ＴＴＶ透过胎盘屏障进行入胎儿体内（垂直传播）的可能性。方法 应用套式ＰＣＲ对２５２例广州市发及其新生铁配对血清标本进行ＴＴＶＤＮＡ扩增。结果 ３９例孕妇血清和４例新生儿脐血清检测出ＴＴＶＤＮＡ,孕母ＴＴＶ感染率为１５．５％,母婴垂直传播率为１０．２％。结论 妊娠妇女存在下ＴＴＶ感染且可经胎盘传递给胎儿     

HIV drug resistance and mother-to-child transmission of HIV

This article covers HIV drug resistance among pregnant women and the implications of transmission of resistant HIV to the infant. Resistance to antiretroviral drugs may be acquired or can emerge while HIV-infected pregnant women are on antiretroviral therapy, either before or during pregnancy. Resistance to antiretroviral drugs among HIV-infected infants may be acquired from the mother in utero or during the intrapartum period. Resistance may also emerge from exposure to antiretroviral drugs given to the infant for prophylaxis against HIV transmission. In settings where breastfeeding is practiced, ongoing transmission of HIV from breastfeeding may lead to transmission of resistant HIV from the mother. If the mother is taking antiretroviral drugs while breastfeeding, resistance to antiretroviral drugs may emerge in an HIV-infected infant from ingestion of antiretroviral drugs via breast milk. The magnitude and implications of antiretroviral resistance among HIV-infected pregnant women and HIV-infected infants are summarized.     

HIV exposure: neonatal considerations

The presence of human immunodeficiency virus (HIV) in pregnant women puts infants at risk for exposure through placental infection and contact with contaminated maternal blood and genital secretions. Efforts to combat this inevitably fatal disease continue to focus on preventing transmission of the virus from a mother who has HIV to her newborn during the prenatal, intrapartum, and postnatal periods. Prophylaxis against transmission and vigilant assessment for indicators of infection are hallmarks of appropriate health care for infants exposed to HIV.     

My life as Mae Tid Chua [mothers who contracted HIV disease]: Motherhood and women living with HIV/AIDS in central Thailand

Backgroundliterature suggests that many women living with HIV/AIDS have a desire to become mothers and indeed many of them have done so (Thiangtham and Bennett, 2009, Barnes, 2013, Cogna et al., 2013, Lazarus et al., 2013, Ross, 2013, Yeatman and Trinitapoli, 2013). However, there is still a lack of knowledge about the lived experiences of Thai women living with HIV/AIDS who have become mothers. In this paper, we explored the experiences of pregnancy and birth, motherhood, and infant feeding practices among women living with HIV/AIDS in Thailand.Methodin-depth interviews were conducted with 26 women living with HIV/AIDS in Thailand.Findingsmotherhood was considered desirable by women living with HIV/AIDS who participated in our study. Despite living with a serious illness, becoming a mother permitted them to have a meaningful life. Motherhood prompted the women to stay alive for their children. However, the women lived with constant anxiety about the condition of their infants. Reproductive needs of the women in our study were often questioned by their health care providers. Many were advised by their doctors and nurses not to breast feed their newborn babies as this could transmit HIV to the child. Most women took into account their ability to care for their children in the future and thus did not wish to have many children.Conclusionthis paper contributes to conceptual understanding about the lived experiences of motherhood among women living with HIV/AIDS in Thailand. The findings have implications for midwifery care.     

The effect of empowerment program on “perceived readiness for discharge” of mothers of premature infants

Objectives: Poor readiness of mothers to take care of their premature infant at the time of hospital discharge is associated with potential adverse consequences. The aim of this study was to examine the effect of empowerment program on “perceived readiness for discharge” of mothers of premature infants at the time of discharge.

Methods: A quasi-experimental before–after study design with consecutive inclusion of all mother–child pairs was used to conduct the study. Eighty mothers and their premature infants (40 pairs of mother–infant in the experimental group and 40 pairs of mother–infant in the control group) were recruited in the study. The program to empower the parents was implemented as a 3-stage training plan for the experimental group. “Parent discharge readiness” questionnaire was completed by mothers before intervention and at discharge time, and was evaluated by nurses at discharge time. The groups were compared in terms of readiness for discharge according to the scores given by mothers and nurses.

Results: At discharge time, there was a statistically significant difference between technical readiness of control and experimental groups according to mothers’ self-report (p?<?0.001) and nurse evaluation (p?<?0.0001). Also, there was a statistically significant difference between emotional readiness of mothers in control and experimental groups according to mothers’ self-report (p?<?0.0001) and nurse evaluation (p?=?0.003).

Conclusion: The implementation of empowerment program is an effective strategy to promote the readiness of mothers of premature infants at discharge time.     

Neurodevelopment of high and low-risk pregnancy babies at 6 months of age

Objectiveto compare neurodevelopment differences between babies born from low-risk pregnancies and babies born from high-risk pregnancies.Study designLongitudinal designSettingSpainParticipantsA total of 91 women participated in the study, divided into two groups: 49 women in the low-risk pregnancy group and 42 women in the high-risk group.Measurement and findingsThe average amount of cortisol in pregnant mothers’ hair was determined in both groups. Following their birth, the babies’ neurodevelopment was evaluated using the Bayley-III instrument at 6 months of age and a new sample of cortisol was obtained from both the baby and the mother. The results showed that pregnancy risk group could predict cognitive, fine motor, gross motor and general motor neurodevelopment.Key ConclusionsThese results seem to show that an appropriate treatment tailored to the needs of individualised pregnancies may favor babies’ neurodevelopment, including that of babies born from high-risk pregnancies.Implications for researchIt is essential to take special care of pregnant women no matter their medical condition and offer them the best medical care available.     

Maternal and neonatal seroprevalence of human immunodeficiency virus antibodies in Benin City, Nigeria.

The prevalence of human immunodeficiency virus antibodies in mothers and their neonates was determined through unlinked anonymous HIV testing at delivery. Two hundred and forty-six apparently healthy volunteer anonymous parturients at the University of Benin Teaching Hospital, Nigeria, and their neonates were recruited for the study. Blood samples were collected from the mothers and cord blood from their neonates at delivery. The blood samples were coded and assayed for HIV antibodies using ImmunoComb HIV 1 and 2 bispot test and ImmunoComb II HIV-1 and 2 CombFirm, both from PBS Orgenics, France. The results for maternal and neonatal blood sample pairs were matched. The maternal seroprevalence for HIV antibodies was 2.4% (6/246) while only two infants had HIV antibodies. The mother-to-child transmission of HIV antibodies was 33.3%. The study highlights the increasing HIV infection among pregnant women in this hospital. The risk of vertical transmission is therefore high. Universal antenatal HIV testing with an opt-out system is suggested. The need for our maternity centres and special care baby units to establish management protocols and anti-retroviral therapy for HIV infected women and their neonates is recommended.     

Mother-to-infant vertical transmission of transfusion transmitted virus in South China

A nested PCR was used to detect TTV DNA in serum from 490 mother-infant pairs to determine the rate of vertical transmission of TTV in Guangzhou City, P.R. China. TTV DNA was positive in 87 mothers and 12 of their babies, giving a prevalence of 17.8% in pregnant women and a mother-to-child transmission rate of 13.8%. In eight mother-infant pairs, TTV DNA nucleotide sequences from the mothers and their corresponding infants were identical. The homology of Guangzhou TTV and Japanese TTV ranged from 85.3%-98.2% at nucleotide level. TTV infection is common in pregnant women in South China and vertical transmission can occur. Guangzhou's and Japanese TTV isolates belong to the same genotype.     

Perinatal addiction: outcome and management.

The care of the pregnant drug-dependent woman and her newborn infant has become a major and controversial health problem requiring specific approaches to this high-risk mother and neonate. A comprehensive approach to the care of 278 pregnant drug-dependent women and their infants at the Philadelphia General Hospital has significantly reduced maternal and infant morbidity heretofore associated with pregnancies complicated by opiate addiction. Most significantly, the incidence of low birth weight has been reduced to below 20 per cent, and a decrease in severe withdrawal in infants born to mothers in the comprehensive care program has occurred. We propose that application of this approach to women whose pregnancies are complicated by drug dependency is a significant factor in successful management.