Migrant women living with HIV in Europe: are they facing inequalities in the prevention of mother-to-child-transmission of HIV?

Favarato, Graziella; Bailey, Heather; Burns, F; Prieto, Luís; Soriano‐Arandes, Antoni; Thorne, Claire

doi:10.1093/eurpub/ckx048

Cited by 16 publications

(14 citation statements)

References 34 publications

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“…Special multidisciplinary attention should be taken to reach these women as soon as possible after their immigration. Our figures of very late diagnosis were nonetheless substantially lower than in a recent European cohort study [15]. In that study, immigrants were more often diagnosed during pregnancy, diagnosed late in pregnancy and with a lower CD4 count than local women.…”

Section: Discussioncontrasting

confidence: 89%

“…diagnosis during pregnancy was 34% if all pregnancies were included; this is still higher than published elsewhere. Favarato et al concluded that pregnancy is an important opportunity to migrant women to learn their HIV status [15]. Our study in a very-low-prevalence setting extends this conclusion also to local women, since both groups were equally undiagnosed before the pregnancy.…”

supporting

confidence: 82%

“…The proportion of immigrants among HIV-positive parturients increased in our study although later and to a lesser extent than in many other European countries [15]. Women originating Epidemiology and Infection 1305 from sub-Saharan Africa formed the largest group, but the proportions of women from South-East Asia and Eastern Europe were substantial, unlike in many other countries.…”

contrasting

confidence: 57%

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Comprehensive nationwide analysis of mother-to-child HIV transmission in Finland from 1983 to 2013

et al. 2018

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HIV-positive children are still born in Europe despite low mother-to-child transmission (MTCT) rates. We aimed to clarify the remaining barriers to the prevention of MTCT. By combining the national registers, we identified all women living with HIV delivering at least one child during 1983-2013. Of the 212 women delivering after HIV diagnosis, 46% were diagnosed during the pregnancy. In multivariate analysis, age >30 years (P = 0.001), sexual transmission (P = 0.012), living outside of the metropolitan area (P = 0.001) and Eastern European origin (P = 0.043) were risk factors for missed diagnosis before pregnancy. The proportion of immigrants increased from 18% before 1999 to 75% during 2011-2013 (P < 0.001). They were diagnosed during the pregnancy equally to natives and achieved similar, good treatment results. No MTCT occurred when the mother was diagnosed before the delivery. In addition, 12 women had delivered in 2 years prior their HIV diagnosis, most before implementation of the national screening of pregnant women. Three of these children were infected, the last one in 2000. Our data demonstrate that complete elimination of MTCT is feasible in a high-income, low-prevalence country. This requires ongoing universal screening in early pregnancy and easy access to antiretroviral therapy to all HIV-positive people.

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Section: Discussioncontrasting

confidence: 89%

supporting

confidence: 82%

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confidence: 57%

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Comprehensive nationwide analysis of mother-to-child HIV transmission in Finland from 1983 to 2013

et al. 2018

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“…Universal antenatal HIV testing, combination antiretroviral therapy (cART) during pregnancy, labour and delivery, neonatal antiretroviral prophylaxis (NP), elective caesarean section (CS) for women without optimal viral suppression near delivery and the avoidance of breast feeding have led to a dramatic decline in the number of perinatally HIV‐infected children: currently, in the USA as well as in Western Europe, mother‐to‐child transmission (MTCT) rates are < 1% . However, there remain missed opportunities for prevention of MTCT (PMTCT) in these settings, including late diagnosis of HIV infection in pregnant women and failure to control viral replication during pregnancy as a consequence of inadequate or lack of cART, and low adherence .…”

Section: Introductionmentioning

confidence: 99%

Severe haematologic toxicity is rare in high risk HIV‐exposed infants receiving combination neonatal prophylaxis

Chiappini¹,

Ene²,

Galli³

et al. 2019

HIV Medicine

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Severe haematologic toxicity is rare in high risk HIVexposed infants receiving combination neonatal prophylaxis The European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) study group in EuroCoord* ObjectivesCombination neonatal prophylaxis (CNP) is recommended in high-risk situations for the prevention of mother-to-child HIV transmission, although data on its safety are limited. The aim of the study was to identify whether neonatal prophylaxis (NP) type is associated with the risk of severe anaemia or neutropaenia. MethodsAn individual patient data meta-analysis was conducted within six European cohorts, in infants at high risk for acquiring HIV infection. Adjusted logistic regression models were used to assess the risk of National Institute of Allergy and Infectious Diseases, Division of AIDS (DAIDS) grade 3-4 anaemia/ neutropaenia at ages 0-6 months. Mixture models of haemoglobin (Hb) level and log 10 -transformed neutrophil count (NC) were used to explore associations with NP type at ages 0-18 months. ResultsOf 1836 infants, 25% were preterm, 1149 (63%) had antenatal combination antiretroviral therapy (cART) exposure and 395 (22%) received NP (125 received CNP with three drugs). Overall, 117 (6.7%) infants had grade 3-4 anaemia at age 0-6 months and 140 (9.1%) had grade 3-4 neutropaenia. The presence of grade 3-4 anaemia or neutropaenia was not associated with NP type [adjusted odds ratio (aOR) 1.04 for one-drug NP and 1.60 for three-drug NP versus twodrug NP (P = 0.879 and P = 0.277, respectively) for anaemia; aOR 1.33 for one-drug NP and 1.98 for three-drug NP versus two-drug NP (P = 0.330 and P = 0.113, respectively) for neutropaenia], but was associated with preterm delivery. Overall, 7746 Hb and NC results were available for 1836 infants up to age 18 months; no significant differences in predicted Hb level or NC were apparent by NP type. ConclusionsA small proportion of infants experienced grade 3-4 haematological adverse events; risk of anaemia or netropenia was not associated with type of NP.

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“…B. auch aus Finnland [12], Spanien [13], Italien [14], Frankreich [3,15] und dem Vereinigten Königreich [4,[16][17][18] berichtet. Eine verbesserte Testung in der Schwangerschaft wird auch aus Spanien und Italien berichtet, und Zugangsprobleme zur Gesundheitsversorgung für Migrantinnen sind eine Problematik, die Deutschland mit vielen anderen europäischen Ländern teilt [19][20][21].…”

Section: Introductionunclassified

Infektionen mit dem humanen Immundefizienzvirus bei Kindern in Deutschland, 1999–2016

Marcus

Beck

2020

Monatsschr Kinderheilkd

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Zusammenfassung Hintergrund Mutter-Kind-Übertragungen von humanem Immundefizienz Virus (HIV) sind durch antiretrovirale Therapie der Schwangeren und weitere medizinische Maßnahmen (Sectio-Entbindung, Postexpositionsprophylaxe beim Neugeborenen, Stillverzicht) verhinderbar. Weiterhin erfolgende Übertragungen sind überwiegend Folge mangelhafter Umsetzung der bekannten wirksamen Maßnahmen. Stand und Probleme bei der Erreichung einer Eliminierung von Mutter-Kind-Übertragungen von HIV in Deutschland werden beschrieben. Methoden Hauptquelle der Daten sind pseudonymisierte Meldedaten des HIV-Melderegisters am Robert Koch-Institut (RKI). Mittels einer intensivierten Surveillance für HIV-Meldungen zu Kindern werden Angaben zum Geburtsland, zum mütterlichen Herkunftsland und zur Kenntnis und zum Management der mütterlichen HIV-Infektion in der Schwangerschaft bei seit 1999 geborenen, mit HIV infizierten Kindern erhoben. Ergebnisse Bis Ende 2018 wurden bei zwischen dem 01.01.1999 und dem 31.12.2016 geborenen Kindern im Alter unter 15 Jahren in Deutschland 331 HIV-Diagnosen gemeldet. Bei 313 war eine Mutter-Kind-Übertragung der wahrscheinlichste Übertragungsweg. Von diesen 313 Kindern wurden 162 (52 %) in Deutschland geboren, aber nur 26 % der Mütter waren deutscher Herkunft. Die HIV-Übertragungshäufigkeit bei in Deutschland geborenen Kindern sank von 1,8/100.000 Lebendgeburten im Zeitraum 1999–2007 auf 0,8/100.000 im Zeitraum 2008–2016. Bei 59 % der in Deutschland geborenen Kinder war der HIV-Status der Mutter den betreuenden Ärzt*innen zum Zeitpunkt der Geburt nicht bekannt. Schlussfolgerung Ein fehlendes HIV-Testangebot für die Schwangere war Hauptursache für Übertragungen bei bis 2007 geborenen Kindern; bei später geborenen Kindern waren die Gründe vielfältiger und hingen oft mit mütterlicher Migration und Zugangsbarrieren in das Versorgungssystem zusammen.

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Migrant women living with HIV in Europe: are they facing inequalities in the prevention of mother-to-child-transmission of HIV?

Abstract: Migrant women were more likely to be diagnosed in late pregnancy but once on ART virological response was good. Good access to antenatal care enables the implementation of PMTCT protocols and optimises both maternal and children health outcomes generally.

Cited by 16 publications

References 34 publications

Comprehensive nationwide analysis of mother-to-child HIV transmission in Finland from 1983 to 2013

Comprehensive nationwide analysis of mother-to-child HIV transmission in Finland from 1983 to 2013

Severe haematologic toxicity is rare in high risk HIV‐exposed infants receiving combination neonatal prophylaxis

Infektionen mit dem humanen Immundefizienzvirus bei Kindern in Deutschland, 1999–2016

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