Depression in perinatally HIV-infected pregnant women compared to non-perinatally HIV-infected and HIV-uninfected pregnant women

“Depression (as noted in chart by a physician)” was compared between HIV infected pregnant women and controls. Perinatally HIV-infected (PHIV), non-perinatally HIV-infected (NPHIV), and HIV-uninfected (HIV-U) pregnant women were all compared using a logistic regression model. Overall, HIV-infected women had higher rates of depression than HIV-U, with PHIV women demonstrating a clinically and statistically significant increased risk compared to HIV-U women [adjusted OR: 15.9, 95% CI?=?1.8–143.8]. Future studies in larger populations are warranted to confirm these findings and further elucidate mental health outcomes of PHIV and NPHIV pregnant women.     

Treatment of HIV-infected pregnant women

Several questions arise concerning the election and use of the various antiretroviral medicines in pregnant women, questions arising from the specific medical problems of many women at this stage of their lives. The authors use published data and their own experience to pose the following questions and draw conclusions: 1. During pregnancy women undergo a series of physiological changes that could affect the pharmacokinetics of the various antiretroviral medicines. Are adjustments to drug doses needed? 2. What are the real risks of antiretroviral drugs for the foetus or neonate? 3. Can pregnancy make women more sensitive to pharmacological toxicity? 4. Are there any other reasons, apart from the above, for changing a previously efficacious antiretroviral treatment because a woman becomes pregnant?     

Adherence to antiretroviral treatment among pregnant and postpartum HIV-infected women

Among women with HIV infection, pregnancy is a time when maintenance of maternal health and reduction of vertical HIV transmission are primary concerns. Few studies have examined adherence to Antiretroviral Treatment (ART) during pregnancy and in the postpartum period when the demands of childcare may significantly interfere with women's self-care behaviors. This study examined ART use and adherence in HIV-infected pregnant and postpartum women participating in the Women and Infants Transmission Study (WITS-IV) in the US. Adherence was assessed through a self-report interview during the third trimester of pregnancy and six-month postpartum. Data were also collected on demographics, biomedical markers and health related symptoms. During the third trimester visit, 77% (309/399) of women completed the self-report adherence measure; 61% (188/309) reported complete adherence. Factors associated with non-adherence included advanced HIV disease status, higher HIV-RNA viral load, more health-related symptoms and alcohol and tobacco use. At six-month postpartum, 55% (220/399) completed the measure; 44% (97/220) of these women reported complete adherence. Factors associated with non-adherence during the postpartum period were ethnicity, more health-related symptoms and WITS clinical site. Results of multivariate analyses using Generalized Estimated Equation analyses across the two visits revealed that more health-related symptoms, higher HIV-RNA viral load, increased alcohol use and clinical site were independently associated with ART non-adherence. These analyses indicate that medication adherence is more likely during pregnancy than postpartum in HIV-infected women, perhaps provoked by motivation to reduce vertical transmission and/or intensive antepartum surveillance. Further investigation is warranted to clarify factors implicated in women's decision-making process regarding ART medication adherence.     

Participation of HIV-infected pregnant women in research in the United States

Previous studies suggested that some groups of HIV-infected women were underrepresented in studies of antiretrovirals (ARVs). We assessed rates of and reasons for nonenrollment in a U.S. prospective cohort study (protocol P1025), and differences in the characteristics of HIV-infected pregnant women who were and were not enrolled. Forty-one percent of women invited to participate were not enrolled. Clinic-related reasons for nonenrollment included staffing or site resources (26.7% of women) and clinician refusal because of the woman's nonadherence to prenatal care and/or poor research candidacy (10.8%). Patient-related reasons for nonenrollment included unavailability of women for enrollment (e.g., difficulty enrolling during labor/delivery, loss of clinic contact) (20.3%), refusal because of mistrust (10.1%), refusal because of time requirements (8.3%), refusal because of distance to the clinic (4.7%), and spontaneous abortion (4.7%). P1025 participants (N = 530) were significantly more likely to be Hispanic (32.1% vs. 19.8%), and less likely to be non-Hispanic black), to present in the first or second trimester for prenatal care (91.5% vs. 77.6%), and to be ARV-naive (32.8% vs. 23.0%) than nonparticipants (N = 2222). This high rate of nonenrollment can bias study results and generate findings that are applicable only to particular groups of women. Efforts should be taken to design protocols that facilitate enrollment of HIV-infected pregnant women.     

Factors associated with viral load suppression in HIV-infected pregnant women in Rio de Janeiro, Brazil

Viral load (VL) near delivery is a determinant of mother-to-child transmission (MTCT) of HIV. To evaluate factors associated with an undetectable VL near delivery in HIV-infected pregnant women receiving highly active antiretroviral therapy (HAART) and non-HAART regimens, HIV-infected pregnant women with a detectable VL at entry and having used antiretrovirals for ≥4 weeks before delivery were selected. Multivariate analysis was employed using binary logistic unconditional models; the dependent variable was having a VL <400 copies/mL near delivery. VL suppression was achieved in 403/707 women (57%): 65.4% in the HAART group, but only 26% in the non-HAART group P = 0.001. Duration of HAART was correlated with VL suppression, with maximum benefit seen after ≥12 weeks of therapy (odds ratio [OR]: 2.51; 95% confidence interval [CI]: 1.72-3.65). CD4+ cell count near delivery (OR: 1.53; 95% CI: 1.06-2.20) and baseline VL (OR: 0.74; 95% CI: 0.58-0.94) were also independently associated with VL suppression. Overall MTCT rate was 1.6%. HAART for ≥12 weeks, baseline VL and CD4 cell count near delivery were independently associated with viral suppression near delivery.     

Nevirapine-associated toxicity in HIV-infected Thai men and women, including pregnant women

OBJECTIVES: The aim of the study was to determine the incidence of, and risk factors for, nevirapine (NVP)-associated hepatotoxicity and rash in HIV-infected Thai men and women, including pregnant women, receiving NVP-containing highly active antiretroviral therapy (HAART). METHODS: NVP-containing HAART was prescribed to eligible men and women enrolled in the Prevention of Mother-To-Child Transmission of HIV (PMTCT) and MTCT-Plus programmes. All pregnant women received zidovudine (ZDV)/lamivudine (3TC)/NVP from >14 weeks of gestational age if their CD4 cell count was 28 weeks if their CD4 cell count was >200 cells/microL. Patients followed for at least 8 weeks after starting HAART or until delivery were included in the analyses. RESULTS: Of 409 patients, 244 were pregnant women, 87 were nonpregnant women and 78 were men. Hepatotoxicity occurred in 15.6% of all patients. Men had a significantly higher rate of asymptomatic hepatotoxicity (P=0.021). Pregnant women receiving HAART for PMTCT (92% had CD4 cell counts >250 cells/microL) had a significantly higher rate of symptomatic hepatotoxicity (P=0.0003) than pregnant women receiving HAART for therapy. Rash occurred in 16.1% of all patients. The patients' sex and baseline CD4 cell count were not associated with the risk of hepatotoxicity or rash. NVP was discontinued in 4.2% and 6.8% of patients because of hepatotoxicity and rash, respectively. CONCLUSIONS: The incidence of NVP-related hepatotoxicity and rash in Thai adults is similar to incidences reported for other populations. While larger studies are needed, our data support continued use of NVP-containing regimens as first-line treatment in developing countries for HIV-infected patients, including pregnant women. Pregnant women with high CD4 cell counts may experience higher rates of symptomatic hepatotoxicity and thus require careful clinical and laboratory monitoring.     

Factors influencing acceptability of voluntary counselling and HIV-testing among pregnant women in Northern Tanzania

Guided by the conceptual framework of the Health Belief Model, this study aimed to identify factors associated with pregnant women's expressed willingness to accept voluntary counselling and HIV-testing (VCT). A cross-sectional interview survey of 500 pregnant women, complemented by focus group discussions, was conducted in the Kilimanjaro region of Tanzania. Constructs derived from the Health Belief Model explained 41.7% of women's willingness to accept VCT. Perceived high personal susceptibility to HIV/AIDS, barriers related to confidentiality and partner involvement, self-efficacy regarding alternative feeding methods and religion were all shown to be associated with willingness to accept VCT. The women's acceptance of VCT seems to depend upon their perceiving that VCT and alternative feeding strategies provide clear benefits, primarily for the child. Whether a positive attitude to VCT and alternative feeding strategies are transformed into actual behaviour depends on a set of complicated decisions in which several potential psychological consequences are assessed. Sharing the diagnosis with partners may not have the intended effect if there is a lack of sensitivity to the women's fear of blame and rejection. If pregnant women are to fully participate in and benefit from mother-to-child-transmission prevention efforts, their partners must be committed and involved in the process.     

49例HIV感染孕产妇流行病学特征调查

[摘要]　目的　分析深圳地区HIV感染孕产妇流行病学特征,为流动人口较多地区预防HIV母婴传播政策制定提供依据。方法　收集并分析2019年1月1日—2021年12月31日在深圳市第三人民医院接受HIV母婴传播阻断管理的49例孕产妇的人口学及临床资料。结果　49例HIV感染孕产妇平均年龄为（25.90±5.18）岁,89.8%（44/49）文化程度在大学水平以下,59.2%（29/49）为深圳户籍,40.8%（20/49）为非深圳户籍或流动人口。以被动诊断发现HIV感染为主,约占75.5%（37/49）,主动诊断发现HIV感染约占24.5%（12/49）。38.8%（19/49）为性接触传播感染,59.2%（29/49）传播途径未明。49例HIV感染孕产妇产后全部接受抗反转录病毒治疗。配偶/性伴侣HIV抗体或核酸检测率为93.9%（46/49）,其中32.6%（15/46）确诊HIV感染。100%（49/49）儿童在出生后6 h内使用阻断药物、进行早诊断及人工喂养。6.1%（3/49）儿童为高暴露风险儿童。结论　HIV感染孕产妇早诊断率低导致儿童暴露风险增高,加强孕产妇健康教育和管理可能是解决目前HIV母婴传播的重要环节。     

HIV-infected pregnant women have greater adherence with antiretroviral drugs than non-pregnant women

The objective of the study was to evaluate the influence of pregnancy on the level of adherence with antiretroviral (ARV) drugs, in a prospective cohort of 72 pregnant women and 79 non-pregnant women. Adherence was measured by pill counting and self-reporting. Women were deemed adherent if 95% or more of all ARV had been taken as prescribed, in two occasions. According to pill counting, 43.1 and 17.7% of pregnant and non-pregnant women, respectively, met the criteria of adherence (P = 0.001); in the postpartum, adherence declined to 20.6% (P = 0.002). In both groups, adherence rates by self-reporting were significantly higher as compared with pill counting (P = 0.001). In multivariate regression analysis, age >29 years (odds ratio [OR] 3.58, confidence interval [CI] 95% 0.10-0.75, P = 0.011), mean number of pills/day <6 (OR 2.53, CI 95% 1.07-6.01, P = 0.035), and being pregnant (OR 3.33, CI 95% 1.36-8.13, P = 0.008) were independently associated to greater adherence.     

Reproductive behaviour of HIV-infected women living in France, according to geographical origin.

Pregnancy rates were compared before and after HIV diagnosis according to geographical origin (sub-Saharan Africa versus Europe) among 533 HIV-infected women followed in the French SEROCO/SEROGEST cohorts between 1988 and 1996. Among European women, the incidence of deliveries and terminations decreased, respectively, by nearly twofold and fourfold after HIV diagnosis. Conversely, the pregnancy incidence increased among African women with fewer than two children. This study should help refine the reproductive counselling and management of HIV-infected women in France.     

Safety and exposure of once-daily ritonavir-boosted atazanavir in HIV-infected pregnant women

Objective

There are limited antiretroviral options for use in the treatment of HIV infection during pregnancy. The purpose of this study was to assess the safety, efficacy and appropriate dosing regimen for ritonavir (RTV)‐boosted atazanavir in HIV‐1‐infected pregnant women.

Methods

In this nonrandomized, open‐label study, HIV‐infected pregnant women were dosed with either 300/100 mg (n=20) or 400/100 mg (n=21) atazanavir/RTV once‐daily (qd) in combination with zidovudine (300 mg) and lamivudine (150 mg) twice daily in the third trimester. Pharmacokinetic parameters [maximum observed plasma concentration (C_max), trough observed plasma concentration 24 hour post dose (C_min) and area under concentration‐time curve in one dosing interval (AUC_τ)] were determined and compared with historical values (300/100 mg atazanavir/RTV) for HIV‐infected nonpregnant adults (n=23).

Results

At or before delivery, all mothers achieved HIV RNA <50 HIV‐1 RNA copies/mL and all infants were HIV DNA negative at 6 months of age. The third trimester AUC_τ for atazanavir/RTV 300/100 mg was 21% lower than historical data, but the C_min values were comparable. The C_min value for atazanavir/RTV 400/100 mg was 39% higher than the C_min for atazanavir/RTV 300/100 mg in historical controls, but the AUC_τ values were comparable. Twice as many patients in the 400/100 mg group (62%) had an increase in total bilirubin (>2.5 times the upper limit of normal) as in the 300/100 mg group (30%). Atazanavir (ATV) was well tolerated with no unanticipated adverse events.

Conclusions

In this study, use of atazanavir/RTV 300/100 mg qd produced C_min comparable to historical data in nonpregnant HIV‐infected adults. When used in combination with zidovudine/lamivudine, it suppressed HIV RNA in all mothers and prevented mother‐to‐child transmission of HIV‐1 infection. During pregnancy, the pharmacokinetics, safety and efficacy demonstrated that a dose adjustment is not required for ATV.     

广州市41例HIV感染孕产妇干预情况分析

目的了解广州市孕产妇艾滋病病毒（HIV）感染的特征及母婴阻断情况,为进一步做好艾滋病母婴阻断提供依据。方法 2009年10月至2010年9月,对接受婚检、产检及助产服务的孕产妇进行HIV筛查,阳性个案进行确诊试验。对HIV感染孕产妇及其新生儿的一般情况、干预效果进行分析。结果广州市全人口孕产妇HIV抗体阳性检出率为0.02%（41/178 029）。HIV感染孕产妇平均年龄27岁,绝大多数为汉族,受教育程度偏低,大部分无业或农民;最可能的感染途径是性传播。76.9%（30/39,2例失访）的孕产妇顺利分娩;分娩产妇中母亲用药率为56.7%（17/30）,婴儿用药率为60.0%（18/30）;46.7%（14/30）的婴儿成功随访至结案,未检出HIV感染个案。结论母婴阻断效果明显。在母婴阻断干预过程中,HIV感染孕产妇及其婴儿的随访工作难度较大,要根据孕产妇人群的特点有针对性地开展工作。     

Psychosocial and behavioral correlates of depression among HIV-infected pregnant women

This study addressed two aims: (1) to assess the level of depressive symptoms among pregnant, HIV-infected racial and ethnic minority women and (2) to identify potentially modifiable factors associated with prenatal depression in order to foster proactive clinical screening and intervention for these women. Baseline interview data collected from HIV-infected women participating in the Perinatal Guidelines Evaluation Project were analyzed. Participants were from prenatal clinics in four areas representative of the U. S. HIV/AIDS epidemic among women. Of the final sample (n = 307), 280 were minorities (218 blacks [African American and Caribbean], 62 Hispanic). Standardized interviews assessed potential psychosocial factors associated with pregnancy-related depression and psychological distress (life stressors, inadequate social support, and ineffective coping skills) in a population for whom little work has been done. Depressive symptomatology was considerable, despite excluding somatic items in order to avoid confounding from prenatal or HIV-related physical symptoms. The psychosocial factors significantly predicted the level of prenatal depressive symptoms beyond the effects of demographic and health-related factors. Perceived stress, social isolation, and disengagement coping were associated with greater depression, positive partner support with lower depression. These findings demonstrate that psychosocial and behavioral factors amenable to clinical intervention are associated with prenatal depression among women of color with HIV. Routine screening to identify those currently depressed or at risk for depression should be integrated into prenatal HIV-care settings to target issues most needing intervention.     

Hepatitis B or hepatitis C coinfection in HIV-infected pregnant women in Europe

Objectives

The aim of the study was to investigate the prevalence of and risk factors for hepatitis C or B virus (HCV or HBV) coinfection among HIV‐infected pregnant women, and to investigate their immunological and virological characteristics and antiretroviral therapy use.

Methods

Information on HBV surface antigen (HBsAg) positivity and HCV antibody (anti‐HCV) was collected retrospectively from the antenatal records of HIV‐infected women enrolled in the European Collaborative Study and linked to prospectively collected data.

Results

Of 1050 women, 4.9% [95% confidence interval (CI) 3.6–6.3] were HBsAg positive and 12.3% (95% CI 10.4–14.4) had anti‐HCV antibody. Women with an injecting drug use(r) (IDU) history had the highest HCV‐seropositivity prevalence (28%; 95% CI 22.8–35.7). Risk factors for HCV seropositivity included IDU history [adjusted odds ratio (AOR) 2.92; 95% CI 1.86–4.58], age (for ≥35 years vs. <25 years, AOR 3.45; 95% CI 1.66–7.20) and HBsAg carriage (AOR 5.80; 95% CI 2.78–12.1). HBsAg positivity was associated with African origin (AOR 2.74; 95% CI 1.20–6.26) and HCV seropositivity (AOR 6.44; 95% CI 3.08–13.5). Highly active antiretroviral therapy (HAART) use was less likely in HIV/HCV‐seropositive than in HIV‐monoinfected women (AOR 0.34; 95% CI 0.20–0.58). HCV seropositivity was associated with a higher adjusted HIV RNA level (+0.28log₁₀ HIV‐1 RNA copies/mL vs. HIV‐monoinfected women; P=0.03). HIV/HCV‐seropositive women were twice as likely to have detectable HIV in the third trimester/delivery as HIV‐monoinfected women (AOR 1.95; P=0.049).

Conclusions

Although HCV serostatus impacted on HAART use, the association between HCV seropositivity and uncontrolled HIV viraemia in late pregnancy was independent of HAART.