Increased risk of incident HIV during pregnancy in Rakai, Uganda: a prospective study

Gray, Ronald H.; Li, Xianbin; Kigozi, Godfrey; Serwadda, David; Brahmbhatt, Heena; Wâbwire-Mângen, Fred; Nalugoda, Fred; Kiddugavu, Mohamed; Sewankambo, Nelson; Quinn, Thomas C.; Reynolds, Steven J.; Wawer, Maria J.

doi:10.1016/s0140-6736(05)67481-8

Cited by 322 publications

(276 citation statements)

References 24 publications

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“…Multiple observational studies conducted in sub-Saharan Africa have demonstrated that the risk of HIV acquisition among at risk women is increased almost twofold during pregnancy compared with the postpartum period [52][53][54] ; however, a recent cohort study conducted in Zimbabwe and Uganda did not find an association between pregnancy and HIV acquisition. 55 It is postulated that higher levels of progesterone and estrogen mediate increased susceptibility to HIV infection in pregnancy through inducing structural changes in the genital tract mucosa and immunologic effects.…”

Section: Pregnancymentioning

confidence: 96%

Anatomic and Hormonal Changes in the Female Reproductive Tract Immune Environment during the Life Cycle: Implications for HIV/STI Prevention Research

Venkatesh

Cu‐Uvin

2014

American J Rep Immunol

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Section: Pregnancymentioning

confidence: 96%

Anatomic and Hormonal Changes in the Female Reproductive Tract Immune Environment during the Life Cycle: Implications for HIV/STI Prevention Research

Venkatesh

Cu‐Uvin

2014

American J Rep Immunol

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“…For example, there seems to be a correlation between levels of sexual hormones (eg, progesterone) and transmission risk. 188 Observational studies also highlight the relation between abnormal vaginal flora and increased risk of HIV-1 infection. 189,190 The high prevalence of vaginal infections such as bacterial vaginosis (30-50%), vulvovaginal candidosis (10-13%), and trichomonas vaginalis (7-23%) in African women is associated with a substantial risk of HIV-1 acquisition.…”

Section: Sexual Transmissionmentioning

confidence: 99%

HIV/AIDS epidemiology, pathogenesis, prevention, and treatment

2006

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The HIV-1 pandemic is a complex mix of diverse epidemics within and between countries and regions of the world, and is undoubtedly the defining public-health crisis of our time. Research has deepened our understanding of how the virus replicates, manipulates, and hides in an infected person. Although our understanding of pathogenesis and transmission dynamics has become more nuanced and prevention options have expanded, a cure or protective vaccine remains elusive. Antiretroviral treatment has transformed AIDS from an inevitably fatal condition to a chronic, manageable disease in some settings. This transformation has yet to be realised in those parts of the world that continue to bear a disproportionate burden of new HIV-1 infections and are most a % ected by increasing morbidity and mortality. This Seminar provides an update on epidemiology, pathogenesis, treatment, and prevention interventions pertinent to HIV-1. HIV pandemicAn estimated 38·6 (33·4-46·0) million people live with HIV-1 worldwide, while about 25 million have died already. 1 In 2005 alone, there were 4·1 million new HIV-1 infections and 2·8 million AIDS deaths. 1 These estimates mask the dynamic nature of this evolving epidemic in relation to temporal changes, geographic distribution, magnitude, viral diversity, and mode of transmission. Today, there is no region of the world untouched by this pandemic (figure 1). 2 Heterosexual transmission remains the dominant mode of transmission and accounts for about 85% of all HIV-1 infections. Southern Africa remains the epicentre of the pandemic and continues to have high rates of new HIV-1 infections. 3 Although overall HIV-1 prevalence remains low in the emerging epidemics in China and India, the absolute numbers, which are fast approaching those seen in southern Africa, are of concern. 1 Outside of sub-Saharan Africa, a third of all HIV-1 infections are acquired through injecting drug use, most (an estimated 8·8 million) of which are in eastern Europe and central and southeast Asia. 1 The rapid spread of HIV-1 in these regions through injecting drug use is of importance, since it is a bridge for rapid establishment of more generalised epidemics. NIH-PA Author ManuscriptA defining feature of the pandemic in the current decade is the increasing burden of HIV-1 infections in women, 4 which has additional implications for mother-to-child transmission. Women now make up about 42% of those infected worldwide; over 70% of whom live in sub-Saharan Africa. 1 Overall, a quarter of all new HIV-1 infections are in adults aged younger than 25 years. 1 HIV-1 infection rates are three to six times higher in female adolescents than in their male counterparts, 1,5-7 and this difference is attributed to sexual coupling patterns of young women with older men. Population prevalence of HIV-1 infection, concurrent sexual relationships, partner change, sexual practices, the presence of other sexually transmitted diseases, [8][9][10][11] and population mobility patterns 12-14 for economic and other reasons (eg, natu...

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“…Condom promotion needs particularly to be reinforced during pregnancy and the post-partum period, especially among HIV negative women with an HIV positive partner. 121 Family planning in HIV testing and counselling services HIV testing and counselling services represent a unique opportunity to reach a lot of people with HIV who may need contraception and condoms and may not be attending family planning services. Moreover, family planning services attract women while counselling and testing services draw couples and men as well as individual women.…”

Section: Family Planning In Pmtct Servicesmentioning

confidence: 99%

Reproductive Choice for Women and Men Living with HIV: Contraception, Abortion and Fertility

Delvaux¹,

Nöstlinger

2007

Reproductive Health Matters

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From a policy and programmatic point of view, this paper reviews the literature on the fertility-related needs of women and men living with HIV and how the entry points represented by family planning, sexually transmitted infection and HIV-related services can ensure access to contraception, abortion and fertility services for women and men living with HIV. Most contraceptive methods are safe and effective for HIV positive women and men. The existing range of contraceptive options should be available to people living with HIV, along with more information about and access to emergency contraception. Potential drug interaction must be considered between hormonal contraception and treatment for tuberculosis and certain antiretroviral drugs. Couples living with HIV who wish to use a permanent contraceptive method should have access to female sterilisation and vasectomy in an informed manner, free of coercion. How to promote condoms and dual protection and how to make them acceptable in long term-relationships remains a challenge. Both surgical and medical abortion are safe for women living with HIV. To reduce risk of vertical transmission of HIV and in cases of infertility, people with HIV should have access to sperm washing and other assisted conception methods, if these are available. Simple and cost-effective procedures to reduce risk of vertical transmission should be part of counselling for women and men living with HIV who intend to have children. Support for the reproductive rights of people with HIV is a priority. More operations research on best practices is needed. A2007 Reproductive Health Matters. All rights reserved.

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Increased risk of incident HIV during pregnancy in Rakai, Uganda: a prospective study

Cited by 322 publications

References 24 publications

Anatomic and Hormonal Changes in the Female Reproductive Tract Immune Environment during the Life Cycle: Implications for HIV/STI Prevention Research

Anatomic and Hormonal Changes in the Female Reproductive Tract Immune Environment during the Life Cycle: Implications for HIV/STI Prevention Research

HIV/AIDS epidemiology, pathogenesis, prevention, and treatment

Reproductive Choice for Women and Men Living with HIV: Contraception, Abortion and Fertility

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