HIV in pregnancy

Moodley, J.; Wennberg, J.L.

doi:10.1097/01.gco.0000162178.38231.1d

Cited by 8 publications

(4 citation statements)

References 33 publications

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“…Data on drug resistance in women and infants following treatments to reduce vertical HIV-1 transmission has been discussed in previous reviews [2,159,160]. Of greatest concern is the fact that resistance to NVP, a non-nucleoside reverse transcriptase inhibitor (NNRTI), arises quickly in both mothers and infants after exposure to sdNVP [161][162][163][164][165][166][167][168] and may compromise subsequent response to NNRTI-based HAART [169,170].…”

Section: Drug Resistancementioning

confidence: 99%

Biological mechanisms of vertical human immunodeficiency virus (HIV‐1) transmission

Lehman

Farquhar

2007

Reviews in Medical Virology

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In the absence of interventions, 30-45% of exposed infants acquire human immunodeficiency virus type 1 (HIV-1) through mother-to-child transmission. It remains unclear why some infants become infected while others do not, despite significant exposure to HIV-1 in utero, during delivery and while breastfeeding. Here we discuss the correlates of vertical transmission with an emphasis on factors that increase maternal HIV-1 levels, either systemically or locally in genital secretions and breast milk. Immune responses may influence maternal viral load, and data suggest that maternal neutralising antibodies reduce infection rates. In addition, infants may be capable of mounting HIV-specific cellular immune responses. We propose that both humoral and cellular responses are necessary to reduce infection because cell-free as well as cell-associated virus appears to play a role in vertical transmission. These distinct forms of the virus may be targeted most effectively by different components of the immune system. We also discuss the use of antiretrovirals to reduce transmission, focusing on the mechanisms of action of regimens currently used in developing country settings. We conclude that prevention relies not only on reducing maternal HIV-1 levels within blood, genital tract and breast milk, but also on pre- and/or post-exposure prophylaxis to the infant. However, HIV-1 has the capacity to mutate under drug pressure and rapidly acquires mutations conferring antiretroviral resistance. This review concludes with data on persistence of low-level resistance after delivery as well as recent guidelines for maternal and infant regimens designed to limit resistance.

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Section: Drug Resistancementioning

confidence: 99%

Biological mechanisms of vertical human immunodeficiency virus (HIV‐1) transmission

Lehman

Farquhar

2007

Reviews in Medical Virology

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“…The pandemic of human immunodeficiency virus (HIV) in pregnancy is one of the major health problems today [63]. Maternal HIV infection may increase the risk of stillbirth [64].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of interventions to screen and manage infections during pregnancy on reducing stillbirths: a review

et al. 2011

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BackgroundInfection is a well acknowledged cause of stillbirths and may account for about half of all perinatal deaths today, especially in developing countries. This review presents the impact of interventions targeting various important infections during pregnancy on stillbirth or perinatal mortality.MethodsWe undertook a systematic review including all relevant literature on interventions dealing with infections during pregnancy for assessment of effects on stillbirths or perinatal mortality. The quality of the evidence was assessed using the adapted Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach by Child Health Epidemiology Reference Group (CHERG). For the outcome of interest, namely stillbirth, we applied the rules developed by CHERG to recommend a final estimate for reduction in stillbirth for input to the Lives Saved Tool (LiST) model.ResultsA total of 25 studies were included in the review. A random-effects meta-analysis of observational studies of detection and treatment of syphilis during pregnancy showed a significant 80% reduction in stillbirths [Relative risk (RR) = 0.20; 95% confidence interval (CI): 0.12 - 0.34) that is recommended for inclusion in the LiST model. Our meta-analysis showed the malaria prevention interventions i.e. intermittent preventive treatment (IPTp) and insecticide-treated mosquito nets (ITNs) can reduce stillbirths by 22%, however results were not statistically significant (RR = 0.78; 95% CI: 0.59 – 1.03). For human immunodeficiency virus infection, a pooled analysis of 6 radomized controlled trials (RCTs) failed to show a statistically significant reduction in stillbirth with the use of antiretroviral in pregnancy compared to placebo (RR = 0.93; 95% CI: 0.45 – 1.92). Similarly, pooled analysis combining four studies for the treatment of bacterial vaginosis (3 for oral and 1 for vaginal antibiotic) failed to yield a significant impact on perinatal mortality (OR = 0.88; 95% CI: 0.50 – 1.55).ConclusionsThe clearest evidence of impact in stillbirth reduction was found for adequate prevention and treatment of syphilis infection and possibly malaria. At present, large gaps exist in the growing list of stillbirth risk factors, especially those that are infection related. Potential causes of stillbirths including HIV and TORCH infections need to be investigated further to help establish the role of prevention/treatment and its subsequent impact on stillbirth reduction.

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“…The ART reduce viral load through suppression of viral replication, which reduces number of virus in the blood plasma and improve health status of pregnant mother (Siegfried et al, 2011;WHO, 2015;Suksomboon et al, 2007). Reduced virus in blood offer protection in transmission of HIV infection from a mother to a new born, but also leaves room for rebuild up of immunity (Siegfried et al, 2011;Moodley & Wennberg, 2005;Tanzania PMTCT, 2016).Women that adhere to ART do not develop opportunistic infections, while the absence of clinical symptom is one of the indicators of good health and adherence to treatment (WHO, 2015; Tanzania PMTCT, 2016; Hill et al, 2013). The non-adherence to ART among pregnant women increases virus production in the blood, development of OIs, and reduces, fetus protection from being infected with HIV during pregnancy and delivery ( Hill et al, 2013; Kilewo et al, 2009; Kowalska et al, 2003;Suksomboon et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Opportunistic Infection and Associated Pregnancy Complication among HIV Positive Women Delivering in Tanzania

Kalolella¹

2017

TIJPH

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Objective: The objective of this study was to assess the prevalence of opportunistic Infections (OIs) and associated pregnancy complication among HIV Positive women giving birth in hospitals of Dar es salaam, Tanzania. Design: The cross sectional study design using OIs checklist was used to collect data among 105 participants. The Epi Data software was used for data entry. The complete data set was later transferred to SAS version 9.4 for data analysis and interpretations. The associations of categorical variables were determined by the Chi-squire test, in which, p-values <0.05 were considered as significant association. Result. Among 105 participants, 63(60%) of them were diagnosed with OIs, while 42(40%) did not show any symptoms of OIs. The most common OIs symptoms reported were; frequently fatigue 46(43.8%), Persistent profuse night sweats 43(40.9%), Persistent muscle aches 41(39%), and unexplained recurring fever 39(37.1%). Participants with recurrent memory loss, depression and neurological disorders had more 5(20.8%) babies born with body weight below 2500g, underweight baby, compared to 5(6.1%) women without these symptoms, P-Value <0.0316. Participants without recurrent severe pneumonia, 24(35.2%), which is among the late HIV stage OIs (WHO clinical stage 3 &4) are slightly protected to developed vaginal tears during birth compared to those 7 (18.9%) with recurrent severe pneumonia. P-Value <0.0693. Conclusion. In conclusion, the majority of HIV infected pregnant women giving birth suffer from OIs. Recurrent memory loss, depression and neurological disorders and recurrent severe pneumonia are risk factors for pregnancy complication

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HIV in pregnancy

Cited by 8 publications

References 33 publications

Biological mechanisms of vertical human immunodeficiency virus (HIV‐1) transmission

Biological mechanisms of vertical human immunodeficiency virus (HIV‐1) transmission

Effectiveness of interventions to screen and manage infections during pregnancy on reducing stillbirths: a review

Prevalence of Opportunistic Infection and Associated Pregnancy Complication among HIV Positive Women Delivering in Tanzania

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