Incident HIV during Pregnancy and Postpartum and Risk of Mother-to-Child HIV Transmission: A Systematic Review and Meta-Analysis

Drake, Alison L.; Wagner, Anjuli D.; Richardson, Barbra A.; John‐Stewart, Grace

doi:10.1371/journal.pmed.1001608

Cited by 385 publications

(335 citation statements)

References 56 publications

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“…In a recent meta‐analysis, Drake et al . reported the pooled cumulative incidence of HIV during pregnancy to be 1.5% (95% CI 1.2% to 1.8%), although African countries had a higher rate when compared to non‐African countries (3.6% vs. 0.3%, respectively, p < 0.001) 18. They also reported a pooled incidence rate of 4.7 (95% CI 3.3 to 6.1) per 100 person‐years 18.…”

Section: Discussionmentioning

confidence: 99%

Implementation of repeat HIV testing during pregnancy in southwestern Kenya: progress and missed opportunities

et al. 2017

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IntroductionRepeat HIV testing during the late antenatal period is crucial to identify and initiate treatment for pregnant women with incident HIV infection to prevent perinatal HIV transmission and keep mothers alive. In 2012, the Kenya Ministry of Health adopted international guidelines suggesting that pregnant women be offered retesting three months after an initial negative HIV test. Our objectives were to determine the current rate of antenatal repeat HIV testing; identify successes, missed opportunities and factors associated with retesting; and estimate the incidence of HIV during pregnancy.MethodsRetrospective analysis of longitudinal data was conducted for a cohort of 2145 women attending antenatal care clinic at a large district hospital in southwestern Kenya. Data were abstracted from registers for all women who attended the clinic from the years 2011 to 2014.ResultsAlthough 90.2% of women first came to clinic prior to their third trimester and 27.5% had at least four clinic visits, 58.0% of all women went to delivery without a retest. Missed opportunities for retesting included not returning to clinic at all, not returning when eligible, or late gestational age (>28 weeks) at first clinic visit making them ineligible for retesting (accounting for 14.2%, 26.8% and 9.6% of all clinic attendees respectively); and failure to be retested even when eligible at one or more visits (accounting for 73.2% of eligible returnees). Being unmarried and aged 20 or younger was associated with an increase in mean gestational age of first visit by 2.52 weeks (95% CI: 1.56, 3.48) and a 2.59 increased odds (95% CI: 1.90, 3.54) of failing to return to clinic, compared to those who were married and over 20 years of age. On retest, two women tested HIV positive, suggesting an incidence rate of 4.4 per 100 person‐years. After adjusting for potential confounders, only later year of last menstrual period (2013 vs. 2012 and 2011) was associated with retesting.ConclusionsAdoption of retesting guidelines in 2012 appears to have successfully increased retesting rates, but missed opportunities to identify incident HIV infection during pregnancy may contribute to continuing high rates of perinatal HIV transmission in southwestern Kenya.

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Section: Discussionmentioning

confidence: 99%

Implementation of repeat HIV testing during pregnancy in southwestern Kenya: progress and missed opportunities

et al. 2017

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“…Our results also show that the insecurity of HIV and its contagiousness can be related to a gap in knowledge about the risk of MTCT when breastfeeding. The estimated risk of MTCT when breastfeeding is as high as between 15% to 45% when no strategies to reduce HIV transmission are taken (De Cock et al, 2000; Drake, Wagner, Richardson, John-Stewart, & Mofenson, 2014; Hira et al, 1990; Humphrey et al, 2010). More studies on breast feeding and transmission risk in women on ART are needed to close this gap of knowledge.…”

Section: Discussionmentioning

confidence: 99%

Sexuality and childbearing as it is experienced by women living with HIV in Sweden: a lifeworld phenomenological study

Carlsson-Lalloo

Berg

Mellgren

et al. 2018

International Journal of Qualitative Studies on Health and Well

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The effectiveness of antiretroviral treatment has reduced sexual HIV transmission and mother-to-child-transmission. To optimally support women living with HIV, health care providers need deepened knowledge about HIV, sexuality and childbearing. The aim of this study was to describe the phenomenon sexuality and childbearing as experienced by women living with HIV in Sweden. Data were collected by phenomenon-oriented interviews with 18 HIV-positive women. A reflective lifeworld analysis based on phenomenological philosophy was conducted, describing the meaning structure of the phenomenon. The essence of the phenomenon is that perceptions about HIV and its contagiousness profoundly influence sexual habits and considerations in relation to pregnancy and childbearing. These perceptions are formed in combination with knowledge and interpretations about HIV by the women themselves and by their environments. The essence is further described by its constituents: Risk of transmission imposes demands on responsibility; The contagiousness of HIV limits sexuality and childbearing; Knowledge about HIV transmission provides confident choices and decisions; and To re-create sexuality and childbearing. Although HIV has a low risk of transmission if being well treated, our study shows that HIV-positive women feel more or less contagious, which influences sexuality and decision-making in relation to become pregnant and give birth.

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“…In addition, HIV infection rates in women aged 15 to 24 only declined by 6% between 2005 and 2015 (2). Women experiencing acute HIV infection, especially late in pregnancy and/or during the breastfeeding period, are most likely to transmit infection to their babies (3). Even when mothers are diagnosed with HIV and started on ART during the breastfeeding period, the risk of MTCT remains high due to poor maternal adherence (4)(5)(6).…”

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confidence: 99%

Impact of Poxvirus Vector Priming, Protein Coadministration, and Vaccine Intervals on HIV gp120 Vaccine-Elicited Antibody Magnitude and Function in Infant Macaques

Phillips

Fouda

Eudailey

et al. 2017

Clin Vaccine Immunol

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Despite success in reducing vertical HIV transmission by maternal antiretroviral therapy, several obstacles limit its efficacy during breastfeeding, and breast-milk transmission is now the dominant mode of mother-to-child transmission (MTCT) of HIV in infants. Thus, a pediatric vaccine is needed to eradicate oral HIV infections in newborns and infants. Utilizing the infant rhesus macaque model, we compared 3 different vaccine regimens: (i) HIV envelope (Env) protein only, (ii) poxvirus vector (modified vaccinia virus Ankara [MVA])-HIV Env prime and HIV Env boost, and (iii) coadministration of HIV Env and MVA-HIV Env at all time points. The vaccines were administered with an accelerated, 3-week-interval regimen starting at birth for early induction of highly functional HIV Env-specific antibodies. We also tested whether an extended, 6-week immunization interval using the same vaccine regimen as in the coadministration group would enhance the quality of antibody responses. We found that pediatric HIV vaccines administered at birth are effective in inducing HIV Env-specific plasma IgG. The vaccine regimen consisting of only HIV Env protein induced the highest levels of variable region 1 and 2 (V1V2)-specific antibodies and tier 1 neutralizing antibodies, whereas the extended-interval regimen induced both persistent Env-specific systemic IgG and mucosal IgA responses. Antibodydependent cell-mediated cytotoxicity (ADCC) antibodies in plasma were elicited by all vaccine regimens. These data suggest that infant immunizations beginning at birth are effective for the induction of functional HIV Env-specific antibodies that could potentially protect against breast milk transmission of HIV and set the stage for immunity prior to sexual debut.

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Incident HIV during Pregnancy and Postpartum and Risk of Mother-to-Child HIV Transmission: A Systematic Review and Meta-Analysis

Cited by 385 publications

References 56 publications

Implementation of repeat HIV testing during pregnancy in southwestern Kenya: progress and missed opportunities

Implementation of repeat HIV testing during pregnancy in southwestern Kenya: progress and missed opportunities

Sexuality and childbearing as it is experienced by women living with HIV in Sweden: a lifeworld phenomenological study

Impact of Poxvirus Vector Priming, Protein Coadministration, and Vaccine Intervals on HIV gp120 Vaccine-Elicited Antibody Magnitude and Function in Infant Macaques

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