BACKGROUND-Birth rates among women living with HIV (WLHIV) have increased recently, with many experiencing multiple pregnancies. Yet, viral suppression is often not sustained between pregnancies. Additionally, protease inhibitors (PIs) have been associated with preterm birth, but associations between integrase strand transfer inhibitors (INSTIs) and preterm birth are less well characterized.METHODS-We studied WLHIV with ≥2 liveborn infants enrolled into the Pediatric HIV/AIDS Cohort Study (PHACS) Surveillance Monitoring for ART Toxicities (SMARTT) study between 2007-2018, comparing CD4 counts and viral loads (VLs) between two consecutive SMARTT pregnancies. We evaluated associations of covariates with CD4 and viral suppression, and the association of PI/INSTI use during pregnancy with odds of preterm birth.RESULTS-There were 736 women who had ≥2 liveborn children enrolled in SMARTT (1695 pregnancies). Median CD4 counts remained stable over repeat pregnancies. While > 80% of women achieved VL suppression during pregnancy, more than half had detectable VL early in their subsequent pregnancy. In adjusted models including all singleton pregnancies, an increased odds of preterm birth was observed for women with 1 st trimester PI initiation (adjusted odds ratio [OR] 1.97; 95% CI 1.27, 3.07) compared to those not receiving PIs during pregnancy, and for 1 st trimester INSTI initiation (adjusted OR 2.39; 95% CI 1.04, 5.46) compared to those never using INSTIs during pregnancy. CONCLUSIONS-MostWLHIV achieved VL suppression by late pregnancy but many were viremic early in subsequent pregnancies. First trimester initiation of PIs or INSTIs was associated with higher risk of preterm birth.
Purpose of Review The COVID-19 pandemic, since 2020, has affected health care services and access globally. Although the entire impact of COVID-19 pandemic on existing global public health is yet to be fully seen, the impact of COVID-19 pandemic on global childhood immunization programs is of particular importance. Recent Findings Disruptions to service delivery due to lockdowns, challenges in vaccination programs, vaccine misinformation and hesitancy, and political and social economic inequalities all posed a threat to existing childhood immunization programs. These potential threats were especially critical in LMIC where childhood immunization programs tend to experience suboptimal implementation. Summary This review provides an overview of childhood immunizations and discusses past pandemics particularly in LMIC, factors contributing to disparities in childhood immunizations, and reviews potential lessons to be learned from past pandemics. Vaccine hesitancy, social determinants of health, and best practices to help lessen the pandemic’s influence are also further elaborated. To address current challenges that hindered the progress made in prevention of childhood illnesses through vaccination campaigns and increased vaccine availability, lessons learned through best practices explored from past pandemics must be examined to mitigate impact of COVID-19 on childhood immunization and in turn conserve health and improve economic well-being of children especially in LMIC.
The explosive epidemic of Zika virus with resultant central nervous system malformations in children born to infected mothers has now reached epidemic proportions. This disease is reminiscent of our struggle with rubella prior to the development of safe and effective vaccines in the 1960s. Both are benign infections in children and adults, but capable of affecting fetal brain development in pregnant women.
BackgroundWith improved treatment, women living with HIV (WLHIV) are increasingly becoming pregnant. Studies have shown suboptimal viral suppression following pregnancy. In addition, protease inhibitors (PI) have been associated with preterm birth (PTB).MethodsWe studied WLHIV with at least 2 live births while on the PHACS SMARTT study. We first compared CD4 counts and viral loads (VL) between the first and second pregnancies using Wilcoxon rank-sum tests. We then examined trends in these measures over all reported pregnancies using mixed-effect linear regression models adjusting for maternal age and birth year, with a random effect to account for repeated measures in the same woman over time. Finally, we evaluated the association of PI or non-PI use during pregnancy with PTB, using GEE logistic regression models to adjust for pregnancy number, maternal age, and birth year.ResultsBetween 2007 and 2018, 699 women had >1 pregnancy while on study, with a total of 1642 children. Their mean CD4 counts remained stable over repeat pregnancies. Their mean log10 VL decreased between the first and second pregnancies, both early and late in pregnancy (–0.42 cp/mL and –0.16 cp/mL respectively, P < 0.001 for each), but increased by 0.61 cp/mL (P < 0.001) between the end of the first pregnancy and early in the next pregnancy. Most women had VL suppression during pregnancy with VL rebound by the next pregnancy (figure). A majority of women (55%) received a PI in both their first and second pregnancies, with an increase in PTB rate of 4.3%, whereas those who changed from a PI to a non-PI had a decrease of 4.7% (table). Changing to a PI resulted in a stable rate, whereas remaining on a non-PI resulted in a drop of 2%. In adjusted models including all pregnancies, first trimester PI use was associated with an increased rate of PTB (adjusted OR 1.35; 95% CI 1.02, 1.97).ConclusionMost WLHIV achieved VL suppression during pregnancy, but many had a VL rebound after pregnancy. First trimester PI use was associated with higher risk of PTB.Table:Paired Group and PTBPaired Pregnancy Regimen GroupPercent of PTBFirst/second pregnancyfirst pregnancysecond pregnancyDifferenceNon-PI/Non-PI (n = 103) 11.7%9.7%-2.0%Non-PI/On PI (n = 91)15.4%15.4% 0%On PI/Non-PI (n = 86)16.3%11.6%-4.7%On PI/Stayed on PI (n = 351)14.8%19.1%+4.3%Figure:Percent of women with unsuppressed VL (>400 cp/mL)Disclosures E. Chadwick, Abbott Labs: Shareholder, stock dividends. AbbVie: Shareholder, stock dividends. R. B. Van Dyke, Giliad Sciences: Grant Investigator, Research grant.
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