Host Factors that Influence Mother-to-Child Transmission of HIV-1: Genetics, Coinfections, Behavior and Nutrition

Ellington, Sascha; King, Caroline C.; Kourtis, Athena P.

doi:10.2217/fvl.11.119

Cited by 17 publications

(12 citation statements)

References 238 publications

(253 reference statements)

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“…Co-infections can trigger the release of inflammatory agents that increase tissue permeability and cytokines that stimulate HIV replication [46,47]. Several co-infections in the HIV-infected mother or exposed infant have been shown to increase MTCT risk, and addressing these co-infections may reduce MTCT and improve overall maternal and child health (Table 1) [48].…”

Section: Introductionmentioning

confidence: 99%

The Role of Co-Infections in Mother-to-Child Transmission of HIV

King

Ellington²,

Kourtis³

2013

CHR

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In HIV-infected women, co-infections that target the placenta, fetal membranes, genital tract, and breast tissue, as well as systemic maternal and infant infections, have been shown to increase the risk for mother-to-child transmission of HIV (MTCT). Active co-infection stimulates the release of cytokines and inflammatory agents that enhance HIV replication locally or systemically and increase tissue permeability, which weakens natural defenses to MTCT. Many maternal or infant co-infections can affect MTCT of HIV, and particular ones, such as genital tract infection with herpes simplex virus, or systemic infections such as hepatitis B, can have substantial epidemiologic impact on MTCT. Screening and treatment for co-infections that can make infants susceptible to MTCT in utero, peripartum, or postpartum can help reduce the incidence of HIV infection among infants and improve the health of mothers and infants worldwide.

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Section: Introductionmentioning

confidence: 99%

The Role of Co-Infections in Mother-to-Child Transmission of HIV

King

Ellington²,

Kourtis³

2013

CHR

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“…This is a well-documented phenomenon among both final outcome [ 19 , 22 ] and early MTCT studies [ 21 , 30 ]. Prior studies have established that lack of; or inadequate HIV treatment or prophylaxis results in a higher maternal viral load during pregnancy, delivery or breastfeeding [ 31 – 33 ].…”

Section: Discussionmentioning

confidence: 99%

Final HIV status outcome for HIV-exposed infants at 18 months of age in nine states and the Federal Capital Territory, Nigeria

et al. 2022

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Introduction While antiretroviral therapy (ART) coverage for pregnant women has undergone steady scale-up, Nigeria’s final mother- to-child transmission of HIV (MTCT) rate remains unacceptably high at 10%. This study aimed to determine final outcomes (MTCT rates) and their correlates among HIV-exposed infants (HEI) in nine states and the Federal Capital Territory, Nigeria. Methods This retrospective, cross-sectional study was conducted at 96 primary, secondary and tertiary health facilities supported by the Institute of Human Virology Nigeria. Data was abstracted for a birth cohort of HEI born between October 30, 2014 and April 30, 2015 whose 18–24 month final outcome was assessed by October 30, 2016. Only infants with a six-week first DNA PCR result, and a rapid HIV antibody test result at age 18 to 24 months were included. Multivariate logistic regression (adjusted odds ratios [aORs]) evaluated for predictors of HIV positivity at ≥18 months. Results After testing at ≥18 months, 68 (2.8%) of the 2,405 exposed infants in the birth cohort were HIV-positive. After a minimum of 18 months of follow-up, 51 (75%) HIV-positive infants were alive on ART; 7 (10%) had died, 5 (7.3%) were lost to follow-up and 5 (7.3%) were transferred out. Rural maternal residence, lack of maternal ART/ARV prophylaxis, mixed infant feeding and infant birth weight less than 2.5 kg correlated with an HIV-positive status for infant final outcomes. Conclusion The final HIV positivity rate of 2.8% is encouraging, but is not population-based. Nevertheless, supported by our findings, we recommend continued programmatic focus on early access to quality prenatal care and maternal ART for pregnant women, especially for women living with HIV in rural areas. Furthermore, implementation of nationwide sensitization and education on six-months’ exclusive infant breastfeeding with concurrent maternal ART should be strengthened and sustained to reduce MTCT rates.

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“…The most essential factor to reduce MTCT of HIV is a nondetectable maternal plasma viral load of HIV during pregnancy and at birth [8]. Therefore, undergoing HAART is absolutely necessary throughout pregnancy.…”

Section: Antenatal Managementmentioning

confidence: 99%

Fetal-Maternal Surgery for Spina Bifida in a HIV-Infected Mother

et al. 2022

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INTRODUCTION: In select cases, in utero surgery for MMC leads to better outcomes than postnatal repair. However, maternal HIV infection constitutes a formal exclusion criterion due to the potential of vertical HIV transmission. Encouraged by a previous case of a successful fetal spina bifida repair in a Hepatitis Bs antigen positive woman, a plan was devised allowing for fetal surgery. CASE REPORT: In utero MMC repair was performed although the mother was HIV-infected. To minimize the risk of in utero HIV transmission, the mother was treated by HAART throughout gestation as well as intravenous zidovudine administration during maternal-fetal surgery. The mother tolerated all procedures very well without any sequelae. The currently 20 month-old toddler, is HIV negative and has significantly benefitted from fetal surgery. DISCUSSION/CONCLUSION: This case shows that maternal HIV is not a priori a diagnosis that excludes fetal surgery. Rather, it might be a surrogate for moving towards personalized medicine and away from applying too rigorous exclusion criteria in the selection of candidates for maternal-fetal surgery.

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Host Factors that Influence Mother-to-Child Transmission of HIV-1: Genetics, Coinfections, Behavior and Nutrition

Cited by 17 publications

References 238 publications

The Role of Co-Infections in Mother-to-Child Transmission of HIV

The Role of Co-Infections in Mother-to-Child Transmission of HIV

Final HIV status outcome for HIV-exposed infants at 18 months of age in nine states and the Federal Capital Territory, Nigeria

Fetal-Maternal Surgery for Spina Bifida in a HIV-Infected Mother

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