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Sample records for pregnant hiv-infected women

  1. Etravirine Pharmacokinetics in HIV-Infected Pregnant Women

    NARCIS (Netherlands)

    Mulligan, N.; Schalkwijk, S.J.; Best, B.M.; Colbers, A.; Wang, J; Capparelli, E.V.; Molto, J.; Stek, A.M.; Taylor, G.; Smith, E.; Tenorio, C.H.; Chakhtoura, N.; Kasteren, M. van; Fletcher, C.V.; Mirochnick, M.; Burger, D.M.

    2016-01-01

    BACKGROUND: The study goal was to describe etravirine pharmacokinetics during pregnancy and postpartum in HIV-infected women. METHODS: IMPAACT P1026s and PANNA are on-going, non-randomized, open-label, parallel-group, multi-center phase-IV prospective studies in HIV-infected pregnant women.

  2. Tuberculosis prevention in HIV-infected pregnant women in South ...

    African Journals Online (AJOL)

    2012-11-02

    Nov 2, 2012 ... settings, and 15 - 34% of indirect obstetric maternal mortality.10. In SA between 2008 and ... TB prevention, diagnosis and treatment in HIV-infected pregnant women should be ..... Bothamley G. Drug treatment for tuberculosis.

  3. Management of HIV infected pregnant women in Chonburi Hospital.

    Science.gov (United States)

    Pinchun, P

    1994-04-01

    This study on birth control methods used, and HIV infection protection of the HIV infected pregnant women in the obstetrics-gynecology department of Chonburi Hospital from 1 January 1990 to 31 December 1993 revealed that there were 27 HIV infected women with less than 24 weeks gestational age, using birth control methods as such 12 women (44.44%) had tubal resection after abortion, 8 women (29.62%) oral contraceptive pills, 5 women (15.51%) injectable contraception, and 2 women (7.40%) norplants. The 106 HIV infected women with more than 24 weeks gestational age were allowed to deliver. The birth control methods were as follows: 19 women (17.92%) tubal resection, 38 women (35.84%) oral contraceptive pills, 49 women (46.22%) injectable contraception. They were all encouraged to use a condom while having sexual intercourse. Only 40 women of this group are still seen in the follow-up clinic and all are found to be healthy, the birth control is effective and HIV infection is in the early stage. The new born babies were not allowed to be breast fed and were followed-up periodically to 18 months old. Twenty five babies received HIV blood test; 7 babies (28%) were found to be HIV infected. The birth control and HIV infection protection used in this study demonstrate no adverse effects on the disease, and the unexpected problems of these women, as well as the health personnel concerned are reduced both economically and socially. This study provides the guidelines of good care for HIV infected pregnant women.

  4. Etravirine pharmacokinetics in HIV-infected pregnant women

    NARCIS (Netherlands)

    N. Mulligan (Nikki); S. Schalkwijk (Stein); B.M. Best (Brookie); A. Colbers (Angela); J. Wang (Jiajia); E.V. Capparelli (Edmund V.); J. Moltó (José); A.M. Stek (Alice M.); G. Taylor (Graham); E. Smith (Elizabeth); C.H. Tenorio (Carmen Hidalgo); N. Chakhtoura (Nahida); M.E.E. van Kasteren (Marjo); C.V. Fletcher (Courtney V.); M. Mirochnick (Mark); D.M. Burger (David); A. Antinori (Andrea); I.E. van der Ende (Ineke); G. Faetkenheuer (Gerd); C. Giaquinto (Carlo); Y. Gilleece (Yvonne); A. Gingelmaier (Andrea); A. Haberl (Annette); D. Hawkins (David); J. Ivanovic (Jelena); K. Kabeya (Kabamba); J. Lambert (Julien); F. Lyons (Fyona); J.F.J.B. Nellen (Jeannine); E. Nicastri (Emanuelle); J. Rockstroh (Jürgen); C. Schwarze-zander; A. Ruiter (Annemiek de); T. Sadiq (Tariq); A. Ven (André van der); K. Weizsäcker (Katharina); C. Wood (Chris); C. Wyen (Christoph)

    2016-01-01

    markdownabstract__Background__ The study goal was to describe etravirine pharmacokinetics during pregnancy and postpartum in HIV-infected women. __Methods__ IMPAACT P1026s and PANNA are on-going, non-randomized, open-label, parallel-group, multi-center phase-IV prospective studies in HIV-infected

  5. Etravirine pharmacokinetics in HIV-infected pregnant women

    NARCIS (Netherlands)

    N. Mulligan (Nikki); S. Schalkwijk (Stein); B.M. Best (Brookie); A. Colbers (Angela); J. Wang (Jiajia); E.V. Capparelli (Edmund V.); J. Moltó (José); A.M. Stek (Alice M.); G. Taylor (Graham); E. Smith (Elizabeth); C.H. Tenorio (Carmen Hidalgo); N. Chakhtoura (Nahida); M.E.E. van Kasteren (Marjo); C.V. Fletcher (Courtney V.); M. Mirochnick (Mark); D.M. Burger (David); A. Antinori (Andrea); I.E. van der Ende (Ineke); G. Faetkenheuer (Gerd); C. Giaquinto (Carlo); Y. Gilleece (Yvonne); A. Gingelmaier (Andrea); A. Haberl (Annette); D. Hawkins (David); J. Ivanovic (Jelena); K. Kabeya (Kabamba); J. Lambert (Julien); F. Lyons (Fyona); J.F.J.B. Nellen (Jeannine); E. Nicastri (Emanuelle); J. Rockstroh (Jürgen); C. Schwarze-zander; A. Ruiter (Annemiek de); T. Sadiq (Tariq); A. Ven (André van der); K. Weizsäcker (Katharina); C. Wood (Chris); C. Wyen (Christoph)

    2016-01-01

    markdownabstract__Background__ The study goal was to describe etravirine pharmacokinetics during pregnancy and postpartum in HIV-infected women. __Methods__ IMPAACT P1026s and PANNA are on-going, non-randomized, open-label, parallel-group, multi-center phase-IV prospective studies in HIV-infected

  6. Acute HIV Infection among Pregnant Women in Malawi

    Science.gov (United States)

    Gay, Cynthia L.; Mwapasa, Victor; Murdoch, David M.; Kwiek, Jesse J.; Fiscus, Susan A.; Meshnick, Steven R.; Cohen, Myron S.

    2009-01-01

    Introduction There are limited data on acute HIV infection (AHI) prevalence during pregnancy. Methods Malawian pregnant women admitted in the third trimester and meeting eligibility criteria underwent dual HIV rapid antibody testing. AHI prevalence was retrospectively detected through HIV RNA pooling of seronegative plasma. Results Among 3825 pregnant women screened, dual HIV rapid testing indicated that 30.2% were HIV positive, 69.7% were HIV negative and 0.1% were indeterminate. Sensitivity and specificity of dual rapid testing was 99.0% and 98.7%, respectively. Of 2666 seronegative specimens, 2327 had samples available for HIV RNA pooling; 5 women (0.21%) (95% CI: 0.03, 0.40%) had AHI with a median peripartum viral load of 1,324,766 copies/mL. Discussion Pregnant women are at risk for AHI, warranting counseling of all women and their sexual partners about incident HIV during pregnancy. Dual HIV rapid tests have high sensitivity and specificity. HIV testing should be repeated in the third trimester and/or at delivery. PMID:20226326

  7. Etravirine Pharmacokinetics In HIV-Infected Pregnant Women

    Directory of Open Access Journals (Sweden)

    Nikki Mulligan

    2016-08-01

    Full Text Available Background: The study goal was to describe etravirine pharmacokinetics during pregnancy and postpartum in HIV-infected women. Methods: IMPAACT P1026s and PANNA are on-going, nonrandomized, open-label, parallel-group, multi-center phase-IV prospective studies in HIV-infected pregnant women. Intensive steady-state 12 or 24 hour pharmacokinetic profiles were performed from 2nd trimester through postpartum. Etravirine was measured at two labs using validated ultra performance liquid chromatography (detection limits: 0.020 mcg/mL and 0.026 mcg/mL. Results: Fifteen women took etravirine 200 mg twice-daily dosing and one took 400 mg once-daily. Etravirine AUC0-12 was significantly higher in the 3rd trimester compared to paired postpartum data by 45% (median 8.3 mcg*hr/mL versus 5.7 mcg*hr/mL, p = 0.086. Etravirine apparent oral clearance was significantly lower in the 3rd trimester of pregnancy compared to paired postpartum data (median 24 L/h versus 35 L/h, p = 0.038. The median ratio of cord blood to maternal plasma concentration at delivery was 0.56 (range: 0.19 - 4.25 and no perinatal transmission occurred. Conclusion: Etravirine apparent oral clearance is reduced and exposure increased during the third trimester of pregnancy. Based on prior dose-ranging and safety data, no dose adjustment is necessary for maternal health but the effects of etravirine in utero are unknown. Maternal health and infant outcomes should be closely monitored until further infant safety data are available. The IMPAACT protocol P1026s and PANNA study are registered at ClinicalTrials.gov under NCT00042289 and NCT00825929.

  8. Etravirine Pharmacokinetics in HIV-Infected Pregnant Women

    Science.gov (United States)

    Mulligan, Nikki; Schalkwijk, Stein; Best, Brookie M.; Colbers, Angela; Wang, Jiajia; Capparelli, Edmund V.; Moltó, José; Stek, Alice M.; Taylor, Graham; Smith, Elizabeth; Hidalgo Tenorio, Carmen; Chakhtoura, Nahida; van Kasteren, Marjo; Fletcher, Courtney V.; Mirochnick, Mark; Burger, David

    2016-01-01

    Background: The study goal was to describe etravirine pharmacokinetics during pregnancy and postpartum in HIV-infected women. Methods: IMPAACT P1026s and PANNA are on-going, non-randomized, open-label, parallel-group, multi-center phase-IV prospective studies in HIV-infected pregnant women. Intensive steady-state 12-h pharmacokinetic profiles were performed from 2nd trimester through postpartum. Etravirine was measured at two labs using validated ultra performance liquid chromatography (detection limits: 0.020 and 0.026 mcg/mL). Results: Fifteen women took etravirine 200 mg twice-daily. Etravirine AUC0–12 was higher in the 3rd trimester compared to paired postpartum data by 34% (median 8.3 vs. 5.3 mcg*h/mL, p = 0.068). Etravirine apparent oral clearance was significantly lower in the 3rd trimester of pregnancy compared to paired postpartum data by 52% (median 24 vs. 38 L/h, p = 0.025). The median ratio of cord blood to maternal plasma concentration at delivery was 0.52 (range: 0.19–4.25) and no perinatal transmission occurred. Conclusion: Etravirine apparent oral clearance is reduced and exposure increased during the third trimester of pregnancy. Based on prior dose-ranging and safety data, no dose adjustment is necessary for maternal health but the effects of etravirine in utero are unknown. Maternal health and infant outcomes should be closely monitored until further infant safety data are available. Clinical Trial registration: The IMPAACT protocol P1026s and PANNA study are registered at ClinicalTrials.gov under NCT00042289 and NCT00825929. PMID:27540363

  9. Impaired glucose metabolism in HIV-infected pregnant women: a retrospective analysis.

    LENUS (Irish Health Repository)

    Moore, Rebecca

    2015-05-20

    Metabolic complications including diabetes mellitus have been increasingly recognised in HIV-infected individuals since the introduction of antiretroviral therapy, particularly protease inhibitors (PIs). Pregnancy is also a risk factor for impaired glucose metabolism, and previous studies have given conflicting results regarding the contribution of PIs to impaired glucose tolerance (IGT) and gestational diabetes mellitus (GDM) in pregnant HIV-infected women.

  10. Infection with Hepatitis C Virus among HIV-Infected Pregnant Women in Thailand

    Directory of Open Access Journals (Sweden)

    Denise J. Jamieson

    2008-01-01

    Full Text Available Objective. The purpose of this study was to describe the epidemiology of coinfection with hepatitis C virus (HCV and HIV among a cohort of pregnant Thai women. Methods. Samples from 1771 pregnant women enrolled in three vertical transmission of HIV studies in Bangkok, Thailand, were tested for HCV. Results. Among HIV-infected pregnant women, HCV seroprevelance was 3.8% and the active HCV infection rate was 3.0%. Among HIV-uninfected pregnant women, 0.3% were HCV-infected. Intravenous drug use by the woman was the factor most strongly associated with HCV seropositivity. Among 48 infants tested for HCV who were born to HIV/HCV coinfected women, two infants were HCV infected for an HCV transmission rate of 4.2% (95% 0.51–14.25%. Conclusions. HCV seroprevalence and perinatal transmission rates were low among this Thai cohort of HIV-infected pregnant women.

  11. RESEARCH Safety of nevirapine in HIV-infected pregnant women ...

    African Journals Online (AJOL)

    11 SAMJ. In January 2005, the United States (US) Food and Drug Administration ... therapy (ART) for pregnant women with CD4 ≤350 cells/µl,7 based on their ... Department of Obstetrics and Gynaecology, University of the Witwatersrand and.

  12. Pregnant women's knowledge of perinatal HIV infection in a resource limited setting

    Institute of Scientific and Technical Information of China (English)

    Onwere S; Okoro O; Chigbu B; Kamanu C; Aluka C; Feyi-Waboso P

    2008-01-01

    The purpose of the study was to assess pregnant women's knowledge of perinatal human immunodeficiency virus (HIV)infection.A descriptive study involving 100 consecutive and consenting patients at the antenatal clinic of Abia State University Teaching Hospital (ABSUTH),Aba,South Eastern Nigeria,over the period 1st No-vember,2007 to 15th January,2008 was done.Using a structured questionnaire,the respondents'sociodemo-graphic data were recorded as well as their knowledge of perinatal HIV infection.Although 85% of the preg-nant women were aware of perinatal HIV transmission,only 69% knew that if a baby tested positive to HIV at delivery,it meant that the mother is infected with HIV.Fifty one percent of the pregnant women wrongly thought that all babies born to mothers with HIV also get infected whilst 83% knew that HIV can be transmitted through breast feeding.The pregnant women demonstrated an incomplete knowledge of perinatal HIV transmis-sion.The findings of this study underscore the continued need for intensified health education about prevention of perinatal HIV infection in our community in order to reduce the impact of HIV,especially in children.

  13. Syphilis and HIV infection among displaced pregnant women in rural Mozambique.

    Science.gov (United States)

    Cossa, H A; Gloyd, S; Vaz, R G; Folgosa, E; Simbine, E; Diniz, M; Kreiss, J K

    1994-01-01

    A cross-sectional study was conducted among displaced pregnant women in Mozambique to determine the prevalence and correlates of HIV infection and syphilis. Between September 1992 and February 1993, 1728 consecutive antenatal attendees of 14 rural clinics in Zambézia were interviewed, examined, and tested for HIV and syphilis antibodies. The seroprevalence of syphilis and HIV were 12.2% and 2.9%, respectively. Reported sexual abuse was frequent (8.4%) but sex for money was uncommon. A positive MHA-TP result was significantly associated with unmarried status, history of past STD, HIV infection, and current genital ulcers, vaginal discharge, or genital warts. Significant correlates of HIV seropositivity included anal intercourse, history of past STD, and syphilis. In summary, displaced pregnant women had a high prevalence of syphilis but a relatively low HIV seroprevalence suggesting recent introduction of HIV infection in this area or slow spread of the epidemic. A syphilis screening and treatment programme is warranted to prevent perinatal transmission and to reduce the incidence of chancres as a cofactor for HIV transmission.

  14. Chlamydia and Gonorrhea in HIV-infected Pregnant Women and Infant HIV Transmission

    Science.gov (United States)

    Adachi, Kristina; Klausner, Jeffrey D.; Bristow, Claire C.; Xu, Jiahong; Ank, Bonnie; Morgado, Mariza G; Watts, D. Heather; Weir, Fred; Persing, David; Mofenson, Lynne M.; Veloso, Valdilea G.; Pilotto, Jose Henrique; Joao, Esau; Nielsen-Saines, Karin

    2015-01-01

    BACKGROUND Sexually transmitted infections (STIs) such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) can lead to adverse pregnancy and neonatal outcomes. STI prevalence and its association with HIV mother-to-child transmission (MTCT) were evaluated in a sub-study analysis from a randomized, multi-center clinical trial. METHODOLOGY Urine samples from HIV-infected pregnant women collected at the time of labor and delivery were tested using polymerase chain reaction (PCR) testing for the detection of CT and NG (Xpert® CT/NG, Cepheid, Sunnyvale, CA). Infant HIV infection was determined by HIV DNA PCR at 3 months. RESULTS Of the 1373 urine specimens, 249 (18.1%) were positive for CT and 63 (4.6%) for NG; 35 (2.5%) had both CT and NG detected. Among 117 cases of HIV MTCT (8.5% transmission) the lowest transmission rate occurred among infants born to CT and NG uninfected mothers (8.1%) as compared to those infected with only CT (10.7%) and both CT and NG (14.3%), (p = 0.04). Infants born to CT-infected mothers had almost a 1.5-fold increased risk for HIV acquisition (OR 1.47, 95% CI 0.9–2.3, p=0.09). CONCLUSION This cohort of HIV-infected pregnant women are at high risk for infection with CT and NG. Analysis suggests that STIs may predispose to an increased HIV MTCT risk in this high risk cohort of HIV-infected women. PMID:26372927

  15. Hepatitis B virus infection among HIV-infected pregnant women in Malawi and transmission to infants

    Science.gov (United States)

    Chasela, Charles S.; Kourtis, Athena P.; Wall, Patrick; Drobeniuc, Jan; King, Caroline C.; Thai, Hong; Teshale, Eyasu H.; Hosseinipour, Mina; Ellington, Sascha; Codd, Mary B.; Jamieson, Denise J.; Knight, Rod; Fitzpatrick, Patricia; Kamili, Saleem; Hoffman, Irving; Kayira, Dumbani; Mumba, Noel; Kamwendo, Deborah D.; Martinson, Francis; Powderly, William; Teo, Chong-Gee; van der Horst, Charles

    2015-01-01

    Background & Aims The extent of HBV infection to infants of HBV/HIV-coinfected pregnant women in sub-Saharan Africa is unknown. The aim of this study was to assess prevalence of HBV infection among antiretroviral-naïve, HIV-infected pregnant women in Malawi and examine HBV transmission to their infants. Methods Plasma from 2048 HIV-infected, Malawian women and their infants were tested for markers of HBV infection. Study participants were provided standard-of-care health services, which included administration of pentavalent vaccine to infants at 6, 10, and 14 weeks of age. Results One-hundred and three women (5%) were HBsAg-positive; 70 of these HBsAg-positive women were also HBV-DNA-positive. Sixteen women (0.8%) were HBV-DNA-positive but HBsAg-negative. Five of 51 infants (9.8%) born to HBsAg-positive and/or HBV-DNA-positive women were HBV-DNA-positive by 48 weeks of age. HBV DNA concentrations of two infants of mothers who received extended lamivudine-containing anti-HIV prophylaxis were Elsevier B.V. on behalf of the European Association for the Study of the Liver. PMID:24211737

  16. Chlamydia trachomatis and Neisseria gonorrhoeae in HIV-infected Pregnant Women and Adverse Infant Outcomes

    Science.gov (United States)

    Adachi, Kristina; Klausner, Jeffrey D.; Xu, Jiahong; Ank, Bonnie; Bristow, Claire C.; Morgado, Mariza G.; Watts, D. Heather; Weir, Fred; Persing, David; Mofenson, Lynne M.; Veloso, Valdilea G.; Pilotto, Jose Henrique; Joao, Esau; Gray, Glenda; Theron, Gerhard; Santos, Breno; Fonseca, Rosana; Kreitchmann, Regis; Pinto, Jorge; Mussi-Pinhata, Marisa M.; Ceriotto, Mariana; Machado, Daisy Maria; Bryson, Yvonne J.; Grinsztejn, Beatriz; Bastos, Francisco I.; Siberry, George; Nielsen-Saines, Karin

    2016-01-01

    BACKGROUND Sexually transmitted infections (STIs) in pregnancy such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) may lead to adverse infant outcomes. METHODOLOGY Individual urine specimens from HIV-infected pregnant women diagnosed with HIV during labor were collected at the time of infant birth and tested by polymerase chain reaction for CT and NG. Infant HIV infection was determined at 3 months with morbidity/mortality assessed through 6 months. RESULTS Of 1373 maternal urines, 277 (20.2%) were positive for CT and/or NG; 249 (18.1%) for CT, 63 (4.6%) for NG, and 35 (2.5%) for both CT and NG. HIV infection was diagnosed in 117 (8.5%) infants. Highest rates of adverse outcomes (sepsis, pneumonia, congenital syphilis, septic arthritis, conjunctivitis, low birth weight, preterm delivery, death) were noted in infants of women with CT and NG (23/35, 65.7%) compared to NG (16/28, 57.1%), CT (84/214, 39.3%), and no STI (405/1096, 37%, p=0.001). Death (11.4% vs. 3%, p=0.02), low birth weight (42.9% vs. 16.9%, p=0.001), and preterm delivery (28.6% vs. 10.2%, p=0.008) were higher among infants of CT and NG co-infected women. Infants who had any adverse outcome and were born to women with CT and/or NG were 3.5 times more likely to be HIV-infected after controlling for maternal syphilis (OR 3.5, 95% CI 1.4-8.3). By adjusted multivariate logistic regression, infants born to mothers with any CT and/or NG were 1.35 times more likely to have an adverse outcome (OR 1.35, 95% CI 1.03-1.76). CONCLUSION STIs in HIV-infected pregnant women are associated with adverse outcomes in HIV-exposed infected and uninfected infants. PMID:27164464

  17. Retention in Care among HIV-Infected Pregnant Women in Haiti with PMTCT Option B

    Science.gov (United States)

    Massaro, Courtney; Li, Zhongze; Deschamps, Marie-Marcelle; Destine, Cleonas Junior; Senecharles, Redouin; Aristhene, Moleine Moles; Domercant, Joseph Yves; Rouzier, Vanessa; Wright, Peter F.

    2016-01-01

    Background. Preventing mother-to-child transmission of HIV relies on engagement in care during the prenatal, peripartum, and postpartum periods. Under PMTCT Option B, pregnant women with elevated CD4 counts are provided with antiretroviral prophylaxis until cessation of breastfeeding. Methods. Retrospective analysis of retention in care among HIV-infected pregnant women in Haiti was performed. Logistic regression was used to identify risk factors associated with loss to follow-up (LFU) defined as no medical visit for at least 6 months and Kaplan-Meier curves were created to show LFU timing. Results. Women in the cohort had 463 pregnancies between 2009 and 2012 with retention rates of 80% at delivery, 67% at one year, and 59% at 2 years. Among those who were LFU, the highest risk period was during pregnancy (60%) or shortly afterwards (24.4% by 12 months). Never starting on antiretroviral therapy (aRR 2.29, 95% CI 1.4–3.8) was associated with loss to follow-up. Conclusions. Loss to follow-up during and after pregnancy was common in HIV-infected women in Haiti under PMTCT Option B. Since sociodemographic factors and distance from home to facility did not predict LFU, future work should elicit and address barriers to retention at the initial prenatal care visit in all women. Better tracking systems to capture engagement in care in the wider network are needed. PMID:27651953

  18. Safety of protease inhibitors in HIV-infected pregnant women

    Directory of Open Access Journals (Sweden)

    Chougrani I

    2013-09-01

    Full Text Available Imène Chougrani,1 Dominique Luton,1,2 Sophie Matheron,3 Laurent Mandelbrot,2,4 Elie Azria1,2 1Department of Obstetrics and Gynecology, Bichat Claude Bernard Hospital, Paris Diderot University, Paris, 2Departement Hospitalo-Universitaire "Risk and Pregnancy", Paris, 3Department of Infectious and Tropical Diseases, Bichat Claude Bernard Hospital, Paris Diderot University, Paris, 4Department of Obstetrics and Gynecology, Louis Mourier Hospital, Paris Diderot University, Colombes, France Abstract: The dire conditions of the human immunodeficiency virus/acquired immune deficiency syndrome epidemic and the immense benefits of antiretroviral prophylaxis in prevention of mother-to-child transmission far outweigh the potential for adverse effects and undeniably justify the rapid and widespread use of this therapy, despite incomplete safety data. Highly active antiretroviral therapy has now become standard care, and more than half the validated regimens include protease inhibitors. This paper reviews current knowledge of the safety of these drugs during pregnancy, in terms of maternal and fetal outcomes. Transfer of protease inhibitors across the placenta is known to be minimal, and current data about birth defects and fetal malignancies are reassuring. Maternal liver function and glucose metabolism should be monitored in women treated with protease inhibitor-based regimens, but concerns about the development of maternal resistance, should treatment be discontinued, have been shown to be groundless. Neonates should be screened for hematologic abnormalities, although these are rarely severe or permanent and are not usually related to the protease inhibitor component of the antiretroviral combination. Current findings concerning pre-eclampsia and growth restriction are discordant, and further research is needed to address the question of placental vascular complications. The increased risk of preterm birth attributed to protease inhibitors should be

  19. Dietary Patterns and Maternal Anthropometry in HIV-Infected, Pregnant Malawian Women

    Directory of Open Access Journals (Sweden)

    Roshan T. Ramlal

    2015-01-01

    Full Text Available Diet is a modifiable factor that can contribute to the health of pregnant women. In a sample of 577 HIV-positive pregnant women who completed baseline interviews for the Breastfeeding, Antiretrovirals, and Nutrition Study in Lilongwe, Malawi, cluster analysis was used to derive dietary patterns. Multiple regression analysis was used to identify associations between the dietary patterns and mid-upper arm circumference (MUAC, arm muscle area (AMA, arm fat area (AFA, and hemoglobin at baseline. Three key dietary patterns were identified: animal-based, plant-based, and grain-based. Women with relatively greater wealth were more likely to consume the animal-based diet, which had the highest intake of energy, protein, and fat and was associated with higher hemoglobin levels compared to the other diets. Women with the lowest wealth were more likely to consume the grain-based diet with the lowest intake of energy, protein, fat, and iron and were more likely to have lower AFA than women on the animal-based and plant-based diets, but higher AMA compared to women on the animal-based diet. Pregnant, HIV-infected women in Malawi could benefit from nutritional support to ensure greater nutrient diversity during pregnancy, when women face increased nutrient demands to support fetal growth and development.

  20. Posttest counseling and social support from health staff caring for HIV-infected pregnant women in Vietnam

    DEFF Research Database (Denmark)

    Hanh, Nguyen Thi Thúy; Rasch, Vibeke; Chi, Bùi Kim

    2010-01-01

    Women with HIV who want to have children face a range of challenges, quandaries, and hard decisions. This article examines the role of health staff in supporting HIV-infected pregnant women who desire to maintain their pregnancies. The article is derived from anthropological research conducted in...

  1. Pro-Inflammatory Cytokine Levels in HIV Infected and Uninfected Pregnant Women with and without Preeclampsia

    Science.gov (United States)

    Maharaj, Niren Ray; Phulukdaree, Alisa; Nagiah, Savania; Ramkaran, Prithiksha; Tiloke, Charlette; Chuturgoon, Anil Amichund

    2017-01-01

    Introduction Preeclampsia and HIV/AIDS are inflammatory conditions that contribute significantly to adverse maternal and foetal outcomes. The immune reconstitution effects of HAART on inflammatory mediators has not been adequately studied in pregnancy and may impact on the inflammatory cytokine network in women with co-morbid preeclampsia. Our study evaluated changes in pro-inflammatory cytokines IL-2, TNF-α, IFN-γ and IL-6 in HIV infected preeclamptic women on HAART. Methods A prospective experimental study was conducted at Prince Mshiyeni Memorial Hospital between July 2013 and September 2014. One hundred and ninety three pregnant women were recruited into 4 groups: uninfected normotensive (50; 26%), infected normotensive (45; 23%), uninfected preeclamptic (53; 28%) and infected preeclamptic women (45; 23%). Serum levels of cytokines TNF-α, IFN- γ, IL-2 and IL-6 were determined using commercially available kits and a Cytometric Bead Array (CBA). Comparative data was recorded and analysed descriptively. Results In the control groups (normotensive), significantly lower values were found in IL-2 (p = 0.010), TNF-α (p = 0.045), and IL-6 (p = 0.005); and a non-significant decrease was observed in IFN-γ (p = 0.345) in HIV infected women on HAART compared to uninfected controls. In the experimental group (preeclamptic) women, significantly reduced levels were observed in IL-2 and TNF-α (p = 0.001; p = 0.000) and non-significant decreases were observed in IFN-γ and IL-6 (p = 0.023; p = 0.086) in HIV infected women on HAART compared with uninfected preeclamptic women. Non-significant differences were observed between uninfected preeclamptic and normotensive women. Conclusion In uncomplicated/normotensive pregnancies, HIV/HAART is associated with significant decreases in IL-2, TNF-α and IL-6, and in preeclamptic women significant decreases in IL-2 and TNF-α were observed. These findings suggest that HIV/HAART impacts on pro-inflammatory cytokines in women with co

  2. Efficacy of raltegravir in late-presenting HIV-infected pregnant women: a case series presentation

    Directory of Open Access Journals (Sweden)

    A Travassos

    2012-11-01

    Full Text Available The risk of HIV perinatally transmition is highest in the 3rd trimester and is correlated with the imune status and especially with the maternal viral load close to delivery. The speed of the viral load decay is an importante strategy for the prevention of mother-to-child transmition (MTCT in late-presenting pregnant women. Poor access to prenatal care and HIV late diagnosis during pregnancy remains a major problem in Bahia, Brazil. The integrase inhibitor raltegravir has significantly higher first and second phase viral decay rates, has a high placental transfer with a potential preloading effect for neonate, and demonstrated effective accumulation in cervicovaginal secretions. These characteristics make RGV a potential candidate to treat late-presenting pregant women. We report 13 cases in which raltegravir (400 mg twice daily was used late in pregnancy, as part of the antirretroviral regimen for MTCT prophylaxis. Table 1 contains the main characteristics of the 13 cases.Four mothers for whom viral load data were available had undetectable levels (<50 HIV-RNA cp/ml at the time of delivery. The remaining 9 women had viral load <460 cp/ml one week before delivery. All but one infant's HIV-RNA were undetectable at 1 and 3 months. The only positive case was an intrauterine transmission, since the baby viral loads at birth and at 1 month were>500.000 cp/ml and mother had 64 cp/ml at delivery (elective C-section. In conclusion, this and other previous reports suggest that RGV is an useful and safe ARV drug to reduce the MTCT in late-presenting HIV-infected pregnant women.

  3. Facilitators and barriers to uptake and adherence to lifelong antiretroviral therapy among HIV infected pregnant women in Uganda: a qualitative study

    National Research Council Canada - National Science Library

    Esther Buregyeya; Rose Naigino; Aggrey Mukose; Fred Makumbi; Godfrey Esiru; Jim Arinaitwe; Joshua Musinguzi; Rhoda K Wanyenze

    2017-01-01

    ... (PMTCT) in line with the WHO 2012 guidelines. This study explored experiences of HIV infected pregnant and breastfeeding women regarding barriers and facilitators to uptake and adherence to lifelong ART...

  4. Timing of antenatal care and ART initiation in HIV-infected pregnant women before and after introduction of NIMART

    Directory of Open Access Journals (Sweden)

    Coceka Nandipha Mnyani

    2014-05-01

    Full Text Available In this review of routinely collected data from five community health centres in the Johannesburg Health District, we assess timing of antenatal care and antiretroviral therapy (ART initiation in HIV-infected pregnant women before and after the introduction of nurse-initiated management of ART in antenatal clinics. There are important lessons to be learnt as we reflect on the South African prevention of mother-to-child transmission of HIV programme.

  5. [Serum vitamin A during pregnancy and effects on obstetrics and perinatal outcomes in HIV infected pregnant women].

    Science.gov (United States)

    El Beitune, Patrícia; Duarte, Geraldo; Vannucchi, Hélio; Quintana, Silvana Maria; Figueiró-Filho, Ernesto Antonio; de Morais, Edson Nunes; Nogueira, Antonio Alberto

    2004-12-01

    To evaluate serum vitamin levels and its association with obstetrics and perinatal results in HIV infected pregnant women. Observational and prospective study carried out at Division of Infectious-Contagious Diseases in Gynecology and Obstetrics of the University Hospital, Medicine School of Ribeirão Preto, University of São Paulo, involving 57 pregnant women divided into 3 groups: Group 1, with 12 normal pregnant women, it was the control group; Group 2, with 20 HIV infected pregnant women, using ZDV; and Group 3, with 25 HIV infected pregnant women, using therapy I contend ZDV, 3TC and nelfinavir. The evaluation of the serum vitamin level was obtained three times during pregnancy at equidistant time intervals and in the immediate period after birth. We also evaluated the levels of this vitamin and the hemoglobin in the blood of the umbilical cord. We obtained maternal and newborn infant anthropometric data, as well as the counting of lymphocyte TCD4 and viral load of the HIV during the pregnancy. Reduced serum vitamin levels were observed in the Group 1(25%), the Group 2(29,4%) and the Group 3(28,6%). Association was not observed between serum levels of maternal retinol and the duration of the gestation in groups 2 and 3. In groups 1 and 3, an association was observed between the maternal concentration of retinol and the newborn hemoglobin (p=0.05). In distinct way to the Control group, association was not observed between the retinol levels of the umbilical cord and the weight of the newborn in gestations of Group 2, while a trend to this association was observed in gestations of Group 3 (p=0.06). We observed high prevalence of hipovitaminosis A in the population of this study, regardless of antiretroviral scheme used.

  6. High prevalence of pulmonary tuberculosis but low sensitivity of symptom screening among HIV-infected pregnant women in South Africa.

    Directory of Open Access Journals (Sweden)

    Christopher J Hoffmann

    Full Text Available Symptom screening is a recommended component of intensified case-finding (ICF for pulmonary tuberculosis (TB among HIV-infected individuals. Symptomatic individuals are further investigated to either exclude or diagnose pulmonary TB, thus reducing the number of individuals requiring costly laboratory investigation. Those with laboratory evaluations negative for pulmonary TB or who lack symptoms may be eligible for antiretroviral therapy (ART and/or TB isoniazid preventive therapy (IPT. A four-part symptom screen has been recommended by the World Health Organization (WHO for identifying TB suspects and those unlikely to have TB. A meta-analysis of studies among HIV-infected individuals calculated a sensitivity of 90.1% for the four-part symptoms screen--of any of cough, fever, night sweats, or weight loss--among patients in clinical care, making it an effective tool for identifying most patients with TB. An important population for intensified case-finding not included in that meta-analysis was HIV-infected pregnant women. We undertook a cross-sectional survey among HIV-infected pregnant women receiving prenatal care at community clinics in South Africa. We obtained a four-symptom review and sputum smear microscopy and mycobacterial culture on all participants. Among 1415 women, 226 (16% had a positive symptom screen, and 35 (2.5% were newly diagnosed with culture-positive TB. Twelve were on TB treatment at the time of screening, yielding 47 (3.3% women with prevalent TB. Symptom screening among women without known TB had a sensitivity of 28% and specificity of 84%. The poor performance of symptom screening to identify women with TB suggests that other approaches may be needed for intensified case-finding to be effective for this population.

  7. The effect of telephone support on depressive symptoms among HIV-infected pregnant women in Thailand: an embedded mixed methods study.

    Science.gov (United States)

    Ross, Ratchneewan; Sawatphanit, Wilaiphan; Suwansujarid, Tatirat; Stidham, Andrea W; Drew, Barbara L; Creswell, John W

    2013-01-01

    Depressive symptoms negatively impact the lives of HIV-infected individuals and are correlated with faster progression to AIDS. Our embedded mixed methods study examined and described the effects of telephone support on depressive symptoms in a sample of HIV-infected pregnant Thai women. HIV-infected pregnant Thai women (n = 40) were randomly assigned to either the control or the intervention group. A registered nurse provided telephone support to the intervention group. Depressive symptoms were measured at three points in both groups. In-depth interviews were conducted at Time 2 and Time 3. Results show that depressive symptoms in the intervention group decreased over time. Qualitative results describe how telephone support can work, but also reveal that telephone support did not work for everyone. We recommend that a larger mixed methods study be conducted to examine the effects of telephone support on depressive symptoms among HIV-infected women, including the costs and benefits of such support.

  8. [Guidelines for the management of patients with HIV infection. II. Pregnant women and children. Liege Working Group on HIV Infection].

    Science.gov (United States)

    Schmitz, V; Nkoghe, D; Hoyoux, C; Dresse, M F

    2000-05-01

    The management of the HIV infected child is nearly identical to the adult. Nevertheless, there are many clinical, immunological and virological details. Difficulties evoked for the adult have an even bigger importance, in view of the foreseeable longevity of these children under treatment. The reduction of the mother to child transmission, thanks to the AZT-caesarean association, must be continued. The use of anti-retroviral drugs during pregnancy requires a sustained attention because of the potential risks and benefits for the foetus and mother. The long-term impact of these drugs, in children exposed during pregnancy, remains unknown. The follow-up of these children therefore remains important.

  9. Utility of therapeutic drug monitoring in the management of HIV-infected pregnant women in receipt of lopinavir.

    LENUS (Irish Health Repository)

    Caswell, R J

    2011-01-01

    The pharmacokinetics of antiretroviral drugs in pregnancy is poorly understood. We reviewed the use of therapeutic drug monitoring (TDM) in clinical settings to document plasma concentrations of lopinavir during pregnancy and investigated how clinicians acted upon TDM results. A retrospective review was carried out of all HIV-infected pregnant women taking boosted lopinavir-based highly active antiretroviral therapy (HAART) at five National Health Service (NHS) centres in the UK between May 2004 and March 2007. Seventy-three women in receipt of lopinavir were identified, of whom 89% had plasma lopinavir concentrations above the suggested minimum recommended for wild-type HIV. Initial TDM results prompted dosage change in 10% and assessment of adherence and\\/or pharmacist review in 11%. TDM was repeated in 29%. TDM can play an important role in the clinical management of HIV-positive pregnant women, allowing informed dose modification and an alternative measure of adherence.

  10. Prevalence of malaria and anaemia among HIV infected pregnant women receiving co-trimoxazole prophylaxis in Tanzania: a cross sectional study in Kinondoni Municipality.

    Science.gov (United States)

    Manyanga, Vicent P; Minzi, Omary; Ngasala, Billy

    2014-04-24

    HIV-infected pregnant women are particularly more susceptible to the deleterious effects of malaria infection particularly anaemia. In order to prevent opportunistic infections and malaria, a policy of daily co-trimoxazole prophylaxis without the standard Suphadoxine-Pyrimethamine intermittent preventive treatment (SP-IPT) was introduced to all HIV infected pregnant women in the year 2011. However, there is limited information about the effectiveness of this policy. This was a cross sectional study conducted among HIV-infected pregnant women receiving co-trimoxazole prophylaxis in eight public health facilities in Kinondoni Municipality from February to April 2013. Blood was tested for malaria infection and anaemia (haemoglobin anaemia. Pearson chi-square test, Fischer's exact test and multivariate logistic regression were used in the statistical analysis. This study enrolled 420 HIV infected pregnant women. The prevalence of malaria infection was 4.5%, while that of anaemia was 54%. The proportion of subjects with poor adherence to co-trimoxazole was 50.5%. As compared to HIV infected pregnant women with good adherence to co-trimoxazole prophylaxis, the poor adherents were more likely to have a malaria infection (Adjusted Odds Ratio, AOR = 6.81, 95% CI = 1.35-34.43, P = 0.02) or anaemia (AOR = 1.75, 95% CI = 1.03-2.98, P = 0.039). Other risk factors associated with anaemia were advanced WHO clinical stages, current malaria infection and history of episodes of malaria illness during the index pregnancy. The prevalence of malaria was low; however, a significant proportion of subjects had anaemia. Good adherence to co-trimoxazole prophylaxis was associated with reduction of both malaria infection and anaemia among HIV infected pregnant women.

  11. Selected hematologic and biochemical measurements in African HIV-infected and uninfected pregnant women and their infants: the HIV Prevention Trials Network 024 protocol

    Directory of Open Access Journals (Sweden)

    Urassa Willy

    2009-08-01

    Full Text Available Abstract Background Reference values for hematological and biochemical assays in pregnant women and in newborn infants are based primarily on Caucasian populations. Normative data are limited for populations in sub-Saharan Africa, especially comparing women with and without HIV infection, and comparing infants with and without HIV infection or HIV exposure. Methods We determined HIV status and selected hematological and biochemical measurements in women at 20–24 weeks and at 36 weeks gestation, and in infants at birth and 4–6 weeks of age. All were recruited within a randomized clinical trial of antibiotics to prevent chorioamnionitis-associated mother-to-child transmission of HIV (HPTN024. We report nearly complete laboratory data on 2,292 HIV-infected and 367 HIV-uninfected pregnant African women who were representative of the public clinics from which the women were recruited. Nearly all the HIV-infected mothers received nevirapine prophylaxis at the time of labor, as did their infants after birth (always within 72 hours of birth, but typically within just a few hours at the four study sites in Malawi (2 sites, Tanzania, and Zambia. Results HIV-infected pregnant women had lower red blood cell counts, hemoglobin, hematocrit, and white blood cell counts than HIV-uninfected women. Platelet and monocyte counts were higher among HIV-infected women at both time points. At the 4–6-week visit, HIV-infected infants had lower hemoglobin, hematocrit and white blood cell counts than uninfected infants. Platelet counts were lower in HIV-infected infants than HIV-uninfected infants, both at birth and at 4–6 weeks of age. At 4–6 weeks, HIV-infected infants had higher alanine aminotransferase measures than uninfected infants. Conclusion Normative data in pregnant African women and their newborn infants are needed to guide the large-scale HIV care and treatment programs being scaled up throughout the continent. These laboratory measures will help

  12. Psychosocial correlates of patient–provider family planning discussions among HIV-infected pregnant women in South Africa

    Directory of Open Access Journals (Sweden)

    Rodriguez VJ

    2017-04-01

    Full Text Available Violeta J Rodriguez,1 Ryan R Cook,1 Stephen M Weiss,1 Karl Peltzer,2–4 Deborah L Jones1 1Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; 2HIV/AIDS/STIs and TB (HAST Research Programme, Human Sciences Research Council, Pretoria, South Africa; 3ASEAN Institute for Health Development, Mahidol University, Salaya, Thailand; 4Department of Psychology, University of Limpopo, Turfloop, South Africa Abstract: Patient–provider family planning discussions and preconception counseling can reduce maternal and neonatal risks by increasing adherence to provider recommendations and antiretroviral medication. However, HIV-infected women may not discuss reproductive intentions with providers due to anticipation of negative reactions and stigma. This study aimed to identify correlates of patient–provider family planning discussions among HIV-infected women in rural South Africa, an area with high rates of antenatal HIV and suboptimal rates of prevention of mother-to-child transmission (PMTCT of HIV. Participants were N=673 pregnant HIV-infected women who completed measures of family planning discussions and knowledge, depression, stigma, intimate partner violence, and male involvement. Participants were, on average, 28 ± 6 years old, and half of them had completed at least 10–11 years of education. Most women were unemployed and had a monthly income of less than ~US$76. Fewer than half of the women reported having family planning discussions with providers. Correlates of patient–provider family planning discussions included younger age, discussions about PMTCT of HIV, male involvement, and decreased stigma (p < 0.05. Depression was indirectly associated with patient–provider family planning discussions through male involvement (b = −0.010, bias-corrected 95% confidence interval [bCI] [−0.019, −0.005]. That is, depression decreased male involvement, and in turn, male involvement

  13. Accuracy of a rapid real-time polymerase chain reaction assay for diagnosis of group B Streptococcus colonization in a cohort of HIV-infected pregnant women.

    Science.gov (United States)

    Gouvea, Maria Isabel S; Joao, Esau C; Teixeira, Maria de Lourdes B; Read, Jennifer S; Fracalanzza, Sergio E L; Souza, Claudia T V; Souza, Maria José de; Torres Filho, Helio M; Leite, Cassiana C F; do Brasil, Pedro E A A

    2017-05-01

    There are limited data regarding Xpert performance to detect Group B Streptococcus (GBS) in HIV-infected pregnant women. We evaluated the accuracy of a rapid real-time polymerase chain reaction (PCR) test in a cohort of HIV-infected women. At 35-37 weeks of pregnancy, a pair of combined rectovaginal swabs were collected for two GBS assays in a cohort of sequentially included HIV-infected women in Rio de Janeiro: (1) culture; and (2) real-time PCR assay [GeneXpert GBS (Cepheid, Sunnyvale, CA)]. Using culture as the reference, sensitivity, specificity, positive and negative-likelihood ratios were estimated. From June 2012 to February 2015, 337 pregnant women met inclusion criteria. One woman was later excluded, due to failure to obtain a result in the index test; 336 were included in the analyses. The GBS colonization rate was 19.04%. Sensitivity and specificity of the GeneXpert GBS assay were 85.94% (95% CI: 75.38-92.42) and 94.85% (95% CI: 91.55-96.91), respectively. Positive and negative predictive values were 79.71% (95% CI: 68.78-87.51) and 96.63% (95% CI: 93.72-98.22), respectively. GeneXpert GBS is an acceptable test for the identification of GBS colonization in HIV-infected pregnant women and represents a reasonable option to detect GBS colonization in settings where culture is not feasible.

  14. Pharmacokinetics of lopinavir/ritonavir and efavirenz in food insecure HIV-infected pregnant and breastfeeding women in Tororo, Uganda.

    Science.gov (United States)

    Bartelink, Imke H; Savic, Rada M; Mwesigwa, Julia; Achan, Jane; Clark, Tamara; Plenty, Albert; Charlebois, Edwin; Kamya, Moses; Young, Sera L; Gandhi, Monica; Havlir, Diane; Cohan, Deborah; Aweeka, Francesca

    2014-02-01

    Pregnancy and food insecurity may impact antiretroviral (ART) pharmacokinetics (PK), adherence and response. We sought to quantify and characterize the PK of lopinavir/ritonavir (LPV/r) and efavirenz (EFV) by pregnancy and nutritional status among HIV-infected women in Tororo, Uganda. In 2011, 62/225 ante-partum/post-partum single dried blood spot samples DBS and 43 post-partum hair samples for LPV/r were derived from 116 women, 51/194 ante-/post-partum DBS and 53 post-partum hair samples for EFV from 105 women. Eighty percent of Ugandan participants were severely food insecure, 26% lost weight ante-partum, and median BMI post-partum was only 20.2 kg/m(2) . Rich PK-data of normally nourished (pregnant) women and healthy Ugandans established prior information. Overall, drug exposure was reduced (LPV -33%, EFV -15%, ritonavir -17%) compared to well-nourished controls (P Hair concentrations correlated with plasma-exposure (P hair concentrations. Addressing malnutrition as well as ART-PK in this setting should be a priority.

  15. Depression, alcohol use, and stigma in younger versus older HIV-infected pregnant women initiating antiretroviral therapy in Cape Town, South Africa.

    Science.gov (United States)

    Wong, Marcia; Myer, Landon; Zerbe, Allison; Phillips, Tamsin; Petro, Greg; Mellins, Claude A; Remien, Robert H; Shiau, Stephanie; Brittain, Kirsty; Abrams, Elaine J

    2017-02-01

    HIV-infected pregnant women in sub-Saharan Africa are at risk for depression and alcohol abuse. Young women may be more vulnerable, but little is known about the psychosocial functioning of this population. We compared younger (18-24 years old) and older (≥25 years old) HIV-infected pregnant women initiating antiretroviral therapy (ART) in Cape Town, South Africa. Women were assessed on a range of psychosocial measures, including the Alcohol Use Disorders Identification Test and the Edinburgh Postnatal Depression Scale (EPDS). Among 625 women initiating ART, 16 % reported risky alcohol use and 21 % alcohol-related harm; these percentages were similar across age groups. When younger women were stratified by age, 37 % of 18-21 years old versus 20 % of 22-24 years old reported alcohol-related harm (p = 0.02). Overall, 11 % of women had EPDS scores suggesting probable depression, and 6 % reported self-harming thoughts. Younger women reported more depressive symptoms. Report of self-harming thoughts was 11 % in younger and 4 % in older women (p = 0.002). In multivariable analysis, age remained significantly associated with depressive symptoms and report of self-harming thoughts. Level of HIV-related stigma and report of intimate partner violence modified the association between age and depressive symptoms. Young HIV-infected pregnant women in South Africa were more likely to report depressive symptoms and self-harming thoughts compared to older women, and the youngest women reported the highest levels of alcohol-related harm. HIV-related stigma and intimate partner violence may be moderating factors. These findings have implications for maternal and infant health, underscoring the urgent need for effective targeted interventions in this vulnerable population.

  16. The cost-effectiveness of directly observed highly-active antiretroviral therapy in the third trimester in HIV-infected pregnant women.

    Directory of Open Access Journals (Sweden)

    Caitlin J McCabe

    Full Text Available BACKGROUND: In HIV-infected pregnant women, viral suppression prevents mother-to-child HIV transmission. Directly observed highly-active antiretroviral therapy (HAART enhances virological suppression, and could prevent transmission. Our objective was to project the effectiveness and cost-effectiveness of directly observed administration of antiretroviral drugs in pregnancy. METHODS AND FINDINGS: A mathematical model was created to simulate cohorts of one million asymptomatic HIV-infected pregnant women on HAART, with women randomly assigned self-administered or directly observed antiretroviral therapy (DOT, or no HAART, in a series of Monte Carlo simulations. Our primary outcome was the quality-adjusted life expectancy in years (QALY of infants born to HIV-infected women, with the rates of Caesarean section and HIV-transmission after DOT use as intermediate outcomes. Both self-administered HAART and DOT were associated with decreased costs and increased life-expectancy relative to no HAART. The use of DOT was associated with a relative risk of HIV transmission of 0.39 relative to conventional HAART; was highly cost-effective in the cohort as a whole (cost-utility ratio $14,233 per QALY; and was cost-saving in women whose viral loads on self-administered HAART would have exceeded 1000 copies/ml. Results were stable in wide-ranging sensitivity analyses, with directly observed therapy cost-saving or highly cost-effective in almost all cases. CONCLUSIONS: Based on the best available data, programs that optimize adherence to HAART through direct observation in pregnancy have the potential to diminish mother-to-child HIV transmission in a highly cost-effective manner. Targeted use of DOT in pregnant women with high viral loads, who could otherwise receive self-administered HAART would be a cost-saving intervention. These projections should be tested with randomized clinical trials.

  17. Level of CD8 T Lymphocytes Activation in HIV-Infected Pregnant Women: In the Context of CD38 and HLA-DR Activation Markers

    Directory of Open Access Journals (Sweden)

    Stanslaus Musyoki

    2014-01-01

    Full Text Available Background. To date the effect of pregnancy on the immune activation of CD8 T cells that may affect HIV disease progression has not been well studied and remains unclear. Objective. To determine the effect of pregnancy on CD8 T lymphocyte activation and its relationship with CD4 count in HIV infected pregnant women. Study Design. Case control. Study Site. AMPATH and MTRH in Eldoret, Kenya. Study Subjects. Newly diagnosed asymptomatic HIV positive pregnant and nonpregnant women with no prior receipt of antiretroviral medications. Study Methods. Blood samples were collected from the study participants and levels of activated CD8 T lymphocytes (CD38 and HLA-DR were determined using flow cytometer and correlated with CD4 counts of the study participants. The descriptive data focusing on frequencies, correlation, and cross-tabulations was statistically determined. Significance of the results was set at P<0.05. Results. HIV positive pregnant women had lower activated CD8 T lymphocyte counts than nonpregnant HIV positive women. Activated CD8 T lymphocyte counts were also noted to decrease in the second and third trimesters of pregnancy. Conclusion. Pregnancy has a significant suppression on CD8+ T lymphocyte immune activation during HIV infections. Follow-up studies with more control arms could confirm the present study results.

  18. Dysregulation of CD4+CD25+CD127lowFOXP3+ regulatory T cells in HIV-infected pregnant women

    DEFF Research Database (Denmark)

    Kolte, Lilian; Gaardbo, Julie C; Karlsson, Ingrid

    2010-01-01

    prospectively during pregnancy and postpartum. A significant expansion of CD4(+)CD25(+)CD127(low)FoxP3(+) regulatory T cells indicating alteration of peripheral tolerance was seen during second trimester, but only in HIV-negative women. HIV-infected women had lower CD4 counts, lower thymic output and Th-2...... course of HIV infection. However, despite HAART during pregnancy, HIV-infected women display different immunologic profiles from HIV-negative women, which may have importance for the induction of fetal-maternal tolerance and in part explain the increased risk of abortion in HIV-infected women....

  19. Pharmacokinetics of lopinavir/ritonavir and efavirenz in food insecure HIV-infected pregnant and breastfeeding women in Tororo, Uganda

    OpenAIRE

    Bartelink, Imke H.; Savic, Rada M.; Mwesigwa, Julia; Achan, Jane; CLARK, Tamara; Plenty, Albert; Charlebois, Edwin; Kamya, Moses; Young, Sera L.; Gandhi, Monica; Havlir, Diane; Cohan, Deborah; Aweeka, Francesca

    2013-01-01

    Pregnancy and food insecurity may impact antiretroviral (ART) pharmacokinetics (PK), adherence and response. We sought to quantify and characterize the PK of lopinavir/ritonavir (LPV/r) and efavirenz (EFV) by pregnancy and nutritional status among HIV-infected women in Tororo, Uganda. In 2011, 62/225 ante-partum/post-partum single dried blood spot samples DBS and 43 post-partum hair samples for LPV/r were derived from 116 women, 51/194 ante-/post-partum DBS and 53 post-partum hair samples for...

  20. Moderate prevalence of transmitted drug resistance mutations among antiretroviral-naive HIV-infected pregnant women in Rio de Janeiro, Brazil.

    Science.gov (United States)

    Pilotto, José H; Grinsztejn, Beatriz; Veloso, Valdilea G; Velasque, Luciane S; Friedman, Ruth K; Moreira, Ronaldo I; Rodrigues-Pedro, Adriana; Oliveira, Sandra M; Currier, Judith S; Morgado, Mariza G

    2013-04-01

    Transmission of drug-resistant HIV-1 strains has been gaining attention and is becoming a growing problem throughout the world. The aim of this study was to determine the prevalence of transmitted drug resistance mutations (TDRM) among antiretroviral (ARV)-naive HIV-infected pregnant women in Rio de Janeiro, Brazil. ARV-naive pregnant women were recruited at Hospital Geral de Nova Iguacu (HGNI), Rio de Janeiro, from 2005 to 2008. HIV genotyping was carried out using ViroSeq (Abbott v. 2.0). TDRM were detected using the Calibrated Population Resistance Tool-CPR v. 6.0.The prevalence of mutations associated with resistance in the protease and reverse transcriptase regions of the HIV genome were assessed in samples collected prior to initiation of ARV prophylaxis or treatment. Among 238 eligible specimens that were collected, 197 samples were successfully amplified using reverse transcription polymerase chain reaction. Eighty-one percent of women were infected with HIV subtype B, 10% with subtype F1 viruses, 1.0% with subtype C virus, and 8.0% with recombinant forms of the virus. The prevalence of HIV TDRM was 5.6% for nucleoside reverse transcriptase inhibitors, 2.0% for nonnucleoside reverse transcriptase inhibitors, and 3.0% for protease inhibitors. The overall prevalence of any drug resistance was 10.7%. There were no multiclass resistant strains identified in the analyzed samples. The prevalence of HIV TDRM among the pregnant women in our cohort was moderate. Resistance testing should be encouraged in Rio de Janeiro, among other locations, for all HIV-infected pregnant women prior to prevention of mother-to-child transmission of HIV.

  1. HIV感染孕妇妊娠结局选择的伦理学探讨%Ethical Analysis of the Choice of Pregnant Outcome among HIV-infected Pregnant Women

    Institute of Scientific and Technical Information of China (English)

    唐焜; 邹从清

    2012-01-01

    社会中妇女所处的不利的文化环境和偏低的社会经济地位等因素决定了妇女更容易受到艾滋病的侵袭,HIV感染女性尤其是孕产妇应当受到社会的关怀和帮助.然而在HIV感染孕妇妊娠的选择过程中存在着尖锐的伦理学冲突,是选择终止妊娠还是其他措施,已不再是一个为防止母婴传播的简单临床决策问题,尊重原则、有利不伤害原则和公正原则是艾滋病防治过程中也是HIV感染孕妇妊娠结局选择过程中的重要原则.%In most societies, women are more vulnerable than men to the imbalance of powers, inequality of opportunities, social discrimination and violation of human rights. Unfavorable cultural environment, low socioeconomic status and other adverse factors increase the vulnerability of women to HIV infection. In the view of this, HFV-infected women, especially pregnant women deserve social care and help. However, plenty of fierce ethic conflicts which arc worth consdering deeply are brought in the choice of pregnant outcome of HIV infected pregnant women and it is no longer a simple clinic decision of either terminate pregnancy or other measures to prevent mother-to-child transmission. Respect, beneficence/nonmalefieence and justice are the important principles notonly in the process of prevent AIDS but also in the choice of pregnant outcome of HIV infected pregnant women.

  2. A Systematic Review of Health System Barriers and Enablers for Antiretroviral Therapy (ART) for HIV-Infected Pregnant and Postpartum Women

    Science.gov (United States)

    Colvin, Christopher J.; Konopka, Sarah; Chalker, John C.; Jonas, Edna; Albertini, Jennifer; Amzel, Anouk; Fogg, Karen

    2014-01-01

    Background Despite global progress in the fight to reduce maternal mortality, HIV-related maternal deaths remain persistently high, particularly in much of Africa. Lifelong antiretroviral therapy (ART) appears to be the most effective way to prevent these deaths, but the rates of three key outcomes—ART initiation, retention in care, and long-term ART adherence—remain low. This systematic review synthesized evidence on health systems factors affecting these outcomes in pregnant and postpartum women living with HIV. Methods Searches were conducted for studies addressing the population of interest (HIV-infected pregnant and postpartum women), the intervention of interest (ART), and the outcomes of interest (initiation, adherence, and retention). Quantitative and qualitative studies published in English since January 2008 were included. A four-stage narrative synthesis design was used to analyze findings. Review findings from 42 included studies were categorized according to five themes: 1) models of care, 2) service delivery, 3) resource constraints and governance challenges, 4) patient-health system engagement, and 5) maternal ART interventions. Results Low prioritization of maternal ART and persistent dropout along the maternal ART cascade were key findings. Service delivery barriers included poor communication and coordination among health system actors, poor clinical practices, and gaps in provider training. The few studies that assessed maternal ART interventions demonstrated the importance of multi-pronged, multi-leveled interventions. Conclusions There has been a lack of emphasis on the experiences, needs and vulnerabilities particular to HIV-infected pregnant and postpartum women. Supporting these women to successfully traverse the maternal ART cascade requires carefully designed and targeted interventions throughout the steps. Careful design of integrated service delivery models is of critical importance in this effort. Key knowledge gaps and research

  3. Características epidemiológicas e nutricionais de gestantes vivendo com o HIV Epidemiological and nutritional characteristics of pregnant HIV-infected women

    Directory of Open Access Journals (Sweden)

    Thelma Brandão

    2011-08-01

    Full Text Available OBJETIVO: Caracterizar o perfil epidemiológico e nutricional de gestantes com o vírus da imunodeficiência humana (HIV e os efeitos dessa infecção sobre o estado nutricional dessas mulheres durante a gravidez. MÉTODOS: Foi feito um estudo de coorte retrospectivo onde foram incluídas 121 gestantes com diagnóstico de infecção pelo HIV, gestação de feto único, que frequentaram pré-natal e fizeram o parto em uma unidade de referência para gestantes vivendo com HIV, no período de 1997 a 2007. Desfechos do estudo foram o estado nutricional inicial e final, avaliado pelo índice de massa corporal, o ganho ponderal, a anemia (hemoglobina PURPOSE: To describe the epidemiological profile and nutritional status of pregnant women infected with human immunodeficiency virus (HIV and its effect on the nutritional status of these women during pregnancy. METHODS: A retrospective cohort study was conducted on 121 pregnant women with HIV infection, single fetus pregnancies, who received prenatal care and delivered at a referral unit for HIV-infected pregnant women during the period from 1997 to 2007. Outcomes of the study were the initial and final nutritional status as measured by body mass index, weight gain, anemia (hemoglobin <11 g/dL and low birth weight. Bivariate analysis investigated the association of these outcomes with socio-demographic, clinical-care and dietary characteristics. We estimated the relative risks (RR with 95% confidence intervals (CI. RESULTS: At the beginning of pregnancy, 11.0% of the women were underweight, and in late pregnancy, the prevalence was 29.3%. Low educational level, urinary infection and worm infestation were associated with low gestational weight in late pregnancy. The percentage of insufficient weight gain was 47.5%, with well-nourished pregnant women (RR=3.3 95%CI 1.3-8.1 and women with no companion (RR=1.5 95%CI 1.1-2.2 having a higher risk for this outcome. The prevalences of overweight at the beginning

  4. TLR7/TLR8 Activation Restores Defective Cytokine Secretion by Myeloid Dendritic Cells but Not by Plasmacytoid Dendritic Cells in HIV-Infected Pregnant Women and Newborns

    Science.gov (United States)

    Cardoso, Elaine Cristina; Pereira, Nátalli Zanete; Mitsunari, Gabrielle Eimi; Oliveira, Luanda Mara da Silva; Ruocco, Rosa Maria S. A.; Francisco, Rossana Pulcineli Vieira; Zugaib, Marcelo; da Silva Duarte, Alberto José; Sato, Maria Notomi

    2013-01-01

    Mother-to-child transmission (MTCT) of HIV-1 has been significantly reduced with the use of antiretroviral therapies, resulting in an increased number of HIV-exposed uninfected infants. The consequences of HIV infection on the innate immune system of both mother-newborn are not well understood. In this study, we analyzed peripheral blood and umbilical cord blood (CB) collected from HIV-1-infected and uninfected pregnant women. We measured TNF-α, IL-10 and IFN-α secretion after the stimulation of the cells with agonists of both extracellular Toll-like receptors (TLRs) (TLR2, TLR4 and TLR5) and intracellular TLRs (TLR7, TLR7/8 and TLR9). Moreover, as an indicator of the innate immune response, we evaluated the responsiveness of myeloid dendritic cells (mDCs) and plasmacytoid DCs (pDCs) to TLRs that are associated with the antiviral response. Our results showed that peripheral blood mononuclear cells (PBMCs) from HIV-1-infected mothers and CB were defective in TNF-α production after activation by TLR2, TLR5, TLR3 and TLR7. However, the TNF-α response was preserved after TLR7/8 (CL097) stimulation, mainly in the neonatal cells. Furthermore, only CL097 activation was able to induce IL-10 and IFN-α secretion in both maternal and CB cells in the infected group. An increase in IFN-α secretion was observed in CL097-treated CB from HIV-infected mothers compared with control mothers. The effectiveness of CL097 stimulation was confirmed by observation of similar mRNA levels of interferon regulatory factor-7 (IRF-7), IFN-α and TNF-α in PBMCs of both groups. The function of both mDCs and pDCs was markedly compromised in the HIV-infected group, and although TLR7/TLR8 activation overcame the impairment in TNF-α secretion by mDCs, such stimulation was unable to reverse the dysfunctional type I IFN response by pDCs in the HIV-infected samples. Our findings highlight the dysfunction of innate immunity in HIV-infected mother-newborn pairs. The activation of the TLR7/8 pathway

  5. Retention in care of HIV-infected pregnant and lactating women starting ART under Option B+ in rural Mozambique.

    Science.gov (United States)

    Llenas-García, Jara; Wikman-Jorgensen, Philip; Hobbins, Michael; Mussa, Manuel Aly; Ehmer, Jochen; Keiser, Olivia; Mbofana, Francisco; Wandeler, Gilles

    2016-08-01

    In 2013, Mozambique adopted Option B+, universal lifelong antiretroviral therapy (ART) for all pregnant and lactating women, as national strategy for prevention of mother-to-child transmission of HIV. We analysed retention in care of pregnant and lactating women starting Option B+ in rural northern Mozambique. We compared ART outcomes in pregnant ('B+ pregnant'), lactating ('B+ lactating') and non-pregnant non-lactating women of childbearing age starting ART according to clinical and/or immunological criteria ('own health') between July 2013 and June 2014. Lost to follow-up was defined as no contact >180 days after the last visit. Multivariable competing risk models were adjusted for type of facility (type 1 vs. peripheral type 2 health centre), age, WHO stage and time from HIV diagnosis to ART. Over 333 person-years of follow-up (243 'B+ pregnant', 65'B+ lactating' and 317 'own health' women), 3.7% of women died and 48.5% were lost to follow-up. 'B+ pregnant' and 'B+ lactating' women were more likely to be lost in the first year (57% vs. 56.9% vs. 31.6%; P < 0.001) and to have no follow-up after the first visit (42.4% vs. 29.2% vs. 16.4%; P < 0.001) than 'own health' women. In adjusted analyses, risk of being lost to follow-up was higher in 'B+ pregnant' (adjusted subhazard ratio [asHR]: 2.77; 95% CI: 2.18-3.50; P < 0.001) and 'B+ lactating' (asHR: 1.94; 95% CI: 1.37-2.74; P < 0.001). Type 2 health centre was the only additional significant risk factor for loss to follow-up. Retention among PLW starting option B+ ART was poor and mainly driven by early losses. The success of Option B+ for prevention of mother-to-child transmission of HIV in rural settings with weak health systems will depend on specific improvements in counselling and retention measures, especially at the beginning of treatment. © 2016 John Wiley & Sons Ltd.

  6. Study on the effectiveness of blocking of maternal - neonatal transmission for HIV -infected pregnant women%HIV感染孕妇母婴阻断效果研究

    Institute of Scientific and Technical Information of China (English)

    桂秀芝; 邱慧; 覃婷

    2012-01-01

    目的:评估HIV母婴阻断效果,为预防艾滋病母婴传播工作提供借鉴.方法:在围生期门诊为初次建卡产前检查的孕妇检测抗- HIV,为HIV感染孕妇提供综合性母婴阻断措施,临产前采血检测HIV病毒载量,对婴儿HIV感染状况进行随访,即产后4月内2次为婴儿采血检测HIV - DNA,12、18月龄时再次检测抗- HIV.结果:近4年来该院孕妇HIV感染率为0.28%,经采取综合性母婴阻断措施,孕期进行规范三联抗病毒治疗,82.71%的孕妇临产时病毒载量低于最低检测限,婴儿HIV感染率0.75%,明显低于未治疗者之婴儿(感染率25.00%),差异有统计学意义(P<0.05).结论:为HIV感染孕妇实施综合性母婴阻断措施安全有效,不失为预防艾滋病母婴传播的有利措施.%Objective; To evaluate the effectiveness of blocking of HIV maternal - neonatal transmission, and provide reference for preventing maternal - neonatal transmission of HIV. Methods; HIV antibodies were detected in the pregnant women who registered and received prenatal examination for the first time in perinatal outpatient department, then comprehensive blocking measures of maternal - neonatal transmission of HIV were provided to HIV -infected pregnant women, HIV load was detected in labor, the HIV infection status of infants was followed up: HIV DNA of infants were detected twice within four months after birth, HIV antibodies were detected at 12 and 18 months. Results; In recent four years, the infection rate of HIV in pregnant women from the hospital was 0. 28%. After comprehensive blocking measures of maternal - neonatal transmission of HIV and regular triple antiviral therapy during pregnancy period, the viral load of 82. 7% of the pregnant women in labor was lower than the lowest detection limit; the infection rate of HIV in infants was 0. 75% , which was statistically significantly lower than that in infants without treatment (25.00% ) (P <0. 05 ) . Conclusion; Comprehensive

  7. Factors associated with alcohol use prior to and during pregnancy among HIV-infected pregnant women in Cape Town, South Africa.

    Science.gov (United States)

    Brittain, Kirsty; Remien, Robert H; Phillips, Tamsin; Zerbe, Allison; Abrams, Elaine J; Myer, Landon; Mellins, Claude A

    2017-04-01

    Alcohol use during pregnancy is prevalent in South Africa, but there are few prospectively-collected data exploring patterns of consumption among HIV-infected women, which may be important to improve maternal and child health outcomes. We examined patterns of and factors associated with alcohol use prior to and during pregnancy among HIV-infected pregnant women in Cape Town, South Africa. Participants were enrolled when entering antenatal care at a large primary care clinic, and alcohol use was assessed using the AUDIT (Alcohol Use Disorders Identification Test). In analysis, the AUDIT-C scoring was used as a measure of hazardous drinking, and we examined factors associated with patterns of alcohol use in logistic regression models. Among 580 women (median age: 28.1 years), 40% reported alcohol use during the 12 months prior to pregnancy, with alcohol use characterised by binge drinking and associated with single relationship status, experience of intimate partner violence (IPV), and lower levels of HIV-related stigma. Of this group, 65% had AUDIT-C scores suggesting hazardous alcohol use, with hazardous alcohol users more likely to report having experienced IPV and having higher levels of education. Among hazardous alcohol users, 70% subsequently reported reduced levels of consumption during pregnancy. Factors independently associated with reduced consumption included earlier gestation when entering antenatal care and report of a better patient-healthcare provider relationship. These unique data provide important insights into alcohol use trajectories in this context, and highlight the urgent need for an increased focus on screening and intervention at primary care level. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. 艾滋病病毒感染孕产妇的护理%Nursing care on pregnant women with HIV infection

    Institute of Scientific and Technical Information of China (English)

    孙蓉晖

    2015-01-01

    目的:探讨艾滋病病毒感染孕妇剖宫产护理方法。方法:2010年5月-2014年8月收治经HIV确认阳性孕妇18例,均给予产前与产后的护理干预。结果:18例HIV阳性孕产妇皆行剖宫产,所产婴儿无一例感染HIV,无一例医护工作者感染。结论:加强HIV孕产妇及婴儿合适的护理,是有效保障母婴健康及控制新生儿艾滋病流行的重要保证。%Objective:To explore the nursing methods of cesarean section in pregnancy with HIV infection.Methods:18 pregnant women confirmed as HIV positive were selected from May 2010 to August 2014.They were given nursing intervention in antenatal and postpartum.Results:All of those 18 pregnant women with HIV positive were treated by caesarean births,no infants infected HIV,and none of the medical workers infected.Conclusion:Strengthening the appropriate nursing on HIV maternal and their infants is very important to guarantee maternal and child health and control of neonatal AIDS epidemic.

  9. Dysregulation of CD4+CD25+CD127lowFOXP3+ regulatory T cells in HIV-infected pregnant women

    DEFF Research Database (Denmark)

    Kolte, Lilian; Gaardbo, Julie C; Karlsson, Ingrid

    2010-01-01

    Pregnancy represents a major challenge to immunologic tolerance. How the fetal "semiallograft" evades maternal immune attack is unknown. Pregnancy success may involve alteration of both central (thymic) and peripheral tolerance mechanisms. HIV infection is characterized by CD4(+) T-cell depletion......, chronic immune activation, and altered lymphocyte subsets. We studied immunologic consequences of pregnancy in 20 HIV-infected women receiving highly active antiretroviral therapy (HAART), and for comparison in 16 HIV-negative women. Lymphocyte subsets, thymic output, and cytokine profiles were measured...... prospectively during pregnancy and postpartum. A significant expansion of CD4(+)CD25(+)CD127(low)FoxP3(+) regulatory T cells indicating alteration of peripheral tolerance was seen during second trimester, but only in HIV-negative women. HIV-infected women had lower CD4 counts, lower thymic output and Th-2...

  10. Determinants of vaccine immunogenicity in HIV-infected pregnant women: analysis of B and T cell responses to pandemic H1N1 monovalent vaccine.

    Directory of Open Access Journals (Sweden)

    Adriana Weinberg

    Full Text Available Influenza infections have high frequency and morbidity in HIV-infected pregnant women, underscoring the importance of vaccine-conferred protection. To identify the factors that determine vaccine immunogenicity in this group, we characterized the relationship of B- and T-cell responses to pandemic H1N1 (pH1N1 vaccine with HIV-associated immunologic and virologic characteristics. pH1N1 and seasonal-H1N1 (sH1N1 antibodies were measured in 119 HIV-infected pregnant women after two double-strength pH1N1 vaccine doses. pH1N1-IgG and IgA B-cell FluoroSpot, pH1N1- and sH1N1-interferon γ (IFNγ and granzyme B (GrB T-cell FluoroSpot, and flow cytometric characterization of B- and T-cell subsets were performed in 57 subjects. pH1N1-antibodies increased after vaccination, but less than previously described in healthy adults. pH1N1-IgG memory B cells (Bmem increased, IFNγ-effector T-cells (Teff decreased, and IgA Bmem and GrB Teff did not change. pH1N1-antibodies and Teff were significantly correlated with each other and with sH1N1-HAI and Teff, respectively, before and after vaccination. pH1N1-antibody responses to the vaccine significantly increased with high proportions of CD4+, low CD8+ and low CD8+HLADR+CD38+ activated (Tact cells. pH1N1-IgG Bmem responses increased with high proportions of CD19+CD27+CD21- activated B cells (Bact, high CD8+CD39+ regulatory T cells (Treg, and low CD19+CD27-CD21- exhausted B cells (Bexhaust. IFNγ-Teff responses increased with low HIV plasma RNA, CD8+HLADR+CD38+ Tact, CD4+FoxP3+ Treg and CD19+IL10+ Breg. In conclusion, pre-existing antibody and Teff responses to sH1N1 were associated with increased responses to pH1N1 vaccination in HIV-infected pregnant women suggesting an important role for heterosubtypic immunologic memory. High CD4+% T cells were associated with increased, whereas high HIV replication, Tact and Bexhaust were associated with decreased vaccine immunogenicity. High Treg increased antibody responses but

  11. Helminthic Infections Rates and Malaria in HIV-Infected Pregnant Women on Anti-Retroviral Therapy in Rwanda

    Science.gov (United States)

    Ivan, Emil; Crowther, Nigel J.; Mutimura, Eugene; Osuwat, Lawrence Obado; Janssen, Saskia; Grobusch, Martin P.

    2013-01-01

    Background Within sub-Saharan Africa, helminth and malaria infections cause considerable morbidity in HIV-positive pregnant women and their offspring. Helminth infections are also associated with a higher risk of mother-to-child HIV transmission. The aim of this study was to determine the prevalence of, and the protective and risk factors for helminth and malaria infections in pregnant HIV-positive Rwandan women receiving anti-retroviral therapy (ART). Methodology and principle findings Pregnant females (n = 980) were recruited from health centres in rural and peri-urban locations in the central and eastern provinces of Rwanda. Helminth infection was diagnosed using the Kato Katz method whilst the presence of Plasmodium falciparum was identified from blood smears. The prevalence of helminth infections was 34.3%; of malaria 13.3%, and of co-infections 6.6%. Helminth infections were more common in rural (43.1%) than peri-urban (18.0%; p<0.0005) sites. A CD4 count ≤350 cells/mm3 was associated with a higher risk of helminth infections (odds ratio, 3.39; 95% CIs, 2.16–5.33; p<0.0005) and malaria (3.37 [2.11–5.38]; p<0.0005) whilst helminth infection was a risk factor for malaria infection and vice versa. Education and employment reduced the risk of all types of infection whilst hand washing protected against helminth infection (0.29 [0.19–0.46]; p<0.0005);). The TDF-3TC-NVP (3.47 [2.21–5.45]; p<0.0005), D4T-3TC-NVP (2.47 [1.27–4.80]; p<0.05) and AZT-NVP (2.60 [1.33–5.08]; p<0.05) regimens each yielded higher helminth infection rates than the AZT-3TC-NVP regimen. Anti-retroviral therapy had no effect on the risk of malaria. Conclusion/significance HIV-positive pregnant women would benefit from the scaling up of de-worming programs alongside health education and hygiene interventions. The differential effect of certain ART combinations (as observed here most strongly with AZT-3TC-NVP) possibly protecting against helminth infection warrants further

  12. IL-10-secreting T cells from HIV-infected pregnant women downregulate HIV-1 replication: effect enhanced by antiretroviral treatment.

    Science.gov (United States)

    Bento, Cleonice A M; Hygino, Joana; Andrade, Regis M; Saramago, Carmen S M; Silva, Renato G; Silva, Agostinho A L; Linhares, Ulisses C; Brindeiro, Rodrigo; Tanuri, Amilcar; Rosenzwajg, Michelle; Klatzmann, David; Andrade, Arnaldo F B

    2009-01-02

    This study aimed to evaluate the impact of pregnancy-related immune events on the HIV-1 replication and to analyze their relationship with the risk of vertical transmission. The peripheral blood from HIV-1-infected pregnant women who controlled (G1) or not controlled (G2) their plasma viral load was drawn, and the plasma and the T cells were obtained. The T-cell cultures were activated in vitro with anti-CD3 and anti-CD28, and the proliferation and cytokine production profile were evaluated after 3 days of incubation. The in-vitro HIV-1 replication was measured in culture supernatants in the seventh day following stimulation. The cytokines were also analyzed in the plasma. Our results demonstrated a lower T-cell proliferation and a lower interleukin-1beta, tumor necrosis factor-alpha and interferon-gamma production in polyclonally activated T-cell cultures from G1 patients, when compared with G2. Furthermore, high levels of interleukin-10 were produced both systemically and by activated T-cell cultures from G1 patients. Interestingly, the neutralization of endogenous interleukin-10 by anti-interleukin-10 monoclonal antibody elevated both the inflammatory cytokines' release and the HIV-1 replication in the polyclonally activated T-cell cultures from G1 patients. Additionally, the maternal antiretroviral treatment significantly enhanced the systemic interleukin-10 production. Finally, the higher systemic interleukin-10 levels were inversely correlated with vertical virus transmission risk. These results indicate that a high tendency of pregnant women to produce interleukin-10 can help them control the HIV-1 replication, and this can reduce the risk of vertical transmission. Furthermore, our data suggest a role for maternal antiretroviral treatment in enhancing this phenomenon.

  13. Obstetrics risk of HIV infection among antenatal women in a rural Nigerian hospital

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    E A Etukumana

    2011-01-01

    Full Text Available Background: Obstetrics risk and practices can lead to the spread of HIV/AIDS. Identification of such obstetrics risk of HIV infection is a useful step in the prevention of transmission of the virus. Objective: We sought to determine obstetrics risk of HIV infection in pregnant women attending antenatal clinic in a rural Northern Nigerian hospital. Methods: We conducted a cross-sectional descriptive study of pregnant women attending antenatal clinic of a rural mission hospital in northern Nigeria between June and October 2005. Data were collected using structured questionnaire. HIV screening and confirmation was carried out on pregnant women after voluntary counseling. Results: 350 pregnant women were enrolled with a mean age (±SD of 26.8± 6.4years. The highest number of HIV infected women was observed in those who had their first coitus between 16 and 20 years. The age at first coitus was not significantly related to the HIV infection (P=0.41. Neither parity (P=0.13 nor past history of abortion (P=0.42 was associated with HIV infection. None of the 41 women who had their last delivery at home had HIV infection compared with 9.8% of the 194 women who delivered in the hospital or clinic (P=0.008. Forty percent of those who had their last delivery in primary health centre had HIV infection while 22.2% of those who delivered under the care of traditional birth had HIV infection. Conclusion: Obstetrics practices may encourage transmission of HIV infection. This calls for re-examination of the obstetrics practices especially in our primary health centers in order to prevent transmission of HIV infection.

  14. Leukocyte counts and lymphocyte subsets in relation to pregnancy and HIV infection in Malawian women.

    Science.gov (United States)

    Mandala, Wilson L; Gondwe, Esther N; Molyneux, Malcolm E; MacLennan, Jenny M; MacLennan, Calman A

    2017-09-01

    We investigated leukocyte and lymphocyte subsets in HIV-infected or HIV-uninfected, pregnant or non-pregnant Malawian women to explore whether HIV infection and pregnancy may act synergistically to impair cellular immunity. We recruited 54 pregnant and 48 non-pregnant HIV-uninfected women and 24 pregnant and 20 non-pregnant HIV-infected Malawian women. We compared peripheral blood leukocyte and lymphocyte subsets between women in the four groups. Parturient HIV-infected and HIV-uninfected women had more neutrophils (each P<.0001), but fewer lymphocytes (P<.0001; P=.0014) than non-pregnant women. Both groups had fewer total T cells (P<.0001; P=.002) and CD8(+) T cells (P<.0001; P=.014) than non-pregnant women. HIV-uninfected parturient women had fewer CD4(+) and γδ T cells, B and NK cells (each P<.0001) than non-pregnant women. Lymphocyte subset percentages were not affected by pregnancy. Malawian women at parturition have an increased total white cell count due to neutrophilia and an HIV-unrelated pan-lymphopenia. © 2017 The Author. American Journal of Reproductive Immunology Published by John Wiley & Sons Ltd.

  15. HIV-Infected Adolescent, Young Adult and Pregnant Smokers: Important Targets for Effective Tobacco Control Programs

    Directory of Open Access Journals (Sweden)

    Gerome Escota

    2013-06-01

    Full Text Available Tobacco use is inextricably linked to a number of health risks both in the general and HIV-infected populations. There is, however, a dearth of research on effective tobacco control programs among people living with HIV, and especially among adolescents, young adults and pregnant women, groups with heightened or increased vulnerability secondary to tobacco use. Adolescents and young adults constitute a growing population of persons living with HIV infection. Early and continued tobacco use in this population living with a disease characterized by premature onset multimorbidity and chronic inflammation is of concern. Additionally, there is an increased acuity for tobacco control among HIV-infected pregnant women to reduce pregnancy morbidity and improve fetal outcome. This review will provide an important summary of current knowledge of tobacco use among HIV-infected adolescents, young adults and pregnant women. The effects of tobacco use in these specific populations will be presented and the current state of tobacco control within these populations, assessed.

  16. HIV-infected women delivering without antenatal care in a large Bangkok hospital, 1997.

    Science.gov (United States)

    Bennetts, A; Inneam, B; Krajangthong, R; Bhengsri, S; Jetsawang, B; Siriwasin, W; Simond, R J; Shaffer, N

    2000-03-01

    The aim was to estimate the proportion of HIV-infected women giving birth at a large Bangkok hospital who had not received antenatal care (ANC) and to identify predictors of not receiving ANC. At Rajavithi Hospital, Bangkok, women with ANC are routinely tested for HIV at their first antenatal visit; women without ANC are routinely tested at delivery. Hospital staff interview all HIV-infected women and record sociodemographic and HIV risk factor information in a delivery room log book. We abstracted and analyzed data recorded in this log book for all HIV-infected women who gave birth at Rajavithi Hospital in 1997. Of 303 HIV-infected women who gave birth, 75% had received ANC at Rajavithi Hospital, 10% had received ANC at other locations, and 15% had not received ANC. On multivariate analysis, HIV-infected women who had received ANC were more likely to work or have partners who worked in construction (25% vs 11%; adjusted odds ratio [AOR]; 2.6; p = 0.03) or have a history of injection drug use (4% vs 0.4%; AOR = 20.8; p = 0.02) than those who had not received ANC, but were less likely to report their current partner as a risk factor for acquiring HIV infection (22% vs. 40%; AOR = 0.4; p = 0.05). Because a substantial number of HIV-infected women give birth in this large Bangkok hospital without receiving ANC, interventions are needed to increase the number of HIV-infected women who receive ANC and to prevent perinatal HIV transmission from HIV-infected pregnant women who have not received ANC.

  17. Pregnancy outcomes and risk factors for low birth weight and preterm delivery among HIV-infected pregnant women in Guangxi, China

    Institute of Scientific and Technical Information of China (English)

    YU Lan; LI Wen-ying; Ray Y. Chen; TANG Zhi-rong; PANG Jun; GUI Xiu-zhi; MENG Xiu-ning; ZHANG Fu-jie

    2012-01-01

    Background Six provinces in China accounted for 70%-80% of all reported HIV/AIDS cases in the country in 2009 and five provinces accounted for 78% of all reported mother-to-child transmission (MTCT) of HIV cases.Because Guangxi belonged to both groups,the Prevention of Mother-to-Child Transmission (PMTCT) Plus program was established there to understand better low birth weight (LBW) and preterm delivery (PD) birth outcomes and their associated risk factors better.Methods Pregnancy outcomes were examined among HIV-infected pregnant women who enrolled in the PMTCT Plus program from June 2006 to February 2009 in Guangxi,China.Multivariate Logistic regression analysis was used to explore the risk factors associated with LBW (<2500 g) and PD (gestational age <37 weeks).Results The prevalence of LBW and PD among 194 HIV-positive mothers was 19.6% (38/194) and 9.8% (19/194),respectively.Multivariate Logistic regression analysis showed that CD4 cell count <100 cell/μI (multivariate-adjusted odds ratio (AOR) 5.52; 95% CI 1.11-25.55) and CD4 cell count 100-199 cells/μl (AOR 3.40; 95% Cl 1.03-11.25,compared to CD4 cell count ≥350 cells/μl),gestational age <37 weeks (AOR 4.38; 95% CI 1.29-14.82,compared to ≥37 weeks),maternal weight <45 kg (AOR 5.64; 95% Cl 1.09-29.07) and maternal weight 45-54 kg (AOR 3.55; 95% Cl 1.31-9.60,compared to ≥55 kg) at enrollment,and HIV RNA ≥100 000 copies/ml at enrollment (AOR 4.22; 95% Cl 1.24-14.32) and 20 000-99 999 (AOR 2.77; 95% CI 1.01-7.77,compared to <20 000 copies/ml) were associated with a higher risk of LBW.For PD,only maternal injection drug use as the route of HIV transmission (AOR 5.30; 95% CI 1.33-21.14,compared to those infected with HIV through sexual transmission) was significantly associated with a higher risk of PD.Conclusions Lower CD4 cell count and higher HIV RNA viral load at enrollment were associated with LBW.Optimal antenatal care,including earlier antenatal screening and

  18. [Pregnancy and postpartum control in HIV infected women].

    Science.gov (United States)

    Warley, Eduardo M; Tavella, Silvina; Rosas, Alejandra

    2017-01-01

    Pregnancy and postpartum control in HIV infected women. We present data from a retrospective observational descriptive study with the objective of evaluating characteristics of HIV-infected pregnant women, analyze the level of control of pregnancy and assess adherence to treatment and loss of follow up after delivery. We analyzed reported data of 104 pregnancies, 32.7% of them under 25 years old. The diagnosis was performed as part of pregnancy control in 36.5% of women. TARV started before 24 weeks of pregnancy in 70% of them and a regimen with 2 nucleos(t)ides and 1 ritonavir potenciated protease inhibitor (PIr) was prescribed in 84.5%. Elective c-section was the most frequent mode of delivery. The viral load after 32 weeks of pregnancy was available in 82.7%, being less than 1000 cop/ml in 78 (75%), less than 200 cop/ml in 70 (67.3%) and not available in 18 (17.3%) of cases. We observed a considered high rate of adherence failure and loss of follow up after delivery. Reported data should alert programs on the need to implement strategies to promote early pregnancy control and increase adherence and retention in care, especially in the postpartum period.

  19. Pregnancy and postpartum control in HIV infected women

    Directory of Open Access Journals (Sweden)

    Eduardo M. Warley

    2017-04-01

    Full Text Available Pregnancy and postpartum control in HIV infected women. We present data from a retrospective observational descriptive study with the objective of evaluating characteristics of HIV-infected pregnant women, analyze the level of control of pregnancy and assess adherence to treatment and loss of follow up after delivery. We analyzed reported data of 104 pregnancies, 32.7% of them under 25 years old. The diagnosis was performed as part of pregnancy control in 36.5% of women. TARV started before 24 weeks of pregnancy in 70% of them and a regimen with 2 nucleos(tides and 1 ritonavir potenciated protease inhibitor (PIr was prescribed in 84.5%. Elective c-section was the most frequent mode of delivery. The viral load after 32 weeks of pregnancy was available in 82.7%, being less than 1000 cop/ml in 78 (75%, less than 200 cop/ml in 70 (67.3% and not available in 18 (17.3% of cases. We observed a considered high rate of adherence failure and loss of follow up after delivery. Reported data should alert programs on the need to implement strategies to promote early pregnancy control and increase adherence and retention in care, especially in the postpartum period

  20. Translating Technical Support Into Country Action: The Role of the Interagency Task Team on the Prevention and Treatment of HIV Infection in Pregnant Women, Mothers, and Children in the Global Plan Era.

    Science.gov (United States)

    Luo, Chewe; Hirnschall, Gottfried; Rodrigues, Jessica; Romano, Sostena; Essajee, Shaffiq; Rogers, Braeden; McCarthy, Elizabeth; Mwango, Albert; Sangrujee, Nalinee; Adler, Michelle R; Houston, James C; Langa, Judite O; Urso, Marilena; Bolu, Omotayo; Tene, Gilbert; Elat Nfetam, Jean B; Kembou, Etienne; Phelps, Benjamin R

    2017-05-01

    While the Interagency Task Team on the Prevention and Treatment of HIV Infection in Pregnant Women, Mothers, and Children (IATT) partnership existed before the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (Global Plan), its reconfiguration was critical to coordinating provision of technical assistance that positively influenced country decision-making and program performance. This article describes how the Global Plan anchored the work of the IATT and, in turn, how the IATT's technical assistance helped to accelerate achievement of the Global Plan targets and milestones. The technical assistance that will be discussed addressed a broad range of priority actions and milestones described in the Global Plan: (1) planning for and implementing Option B+; (2) strengthening monitoring and evaluation systems; (3) translating evidence into action and advocacy; and (4) promoting community engagement. This article also reviews the ongoing challenges and opportunities of providing technical assistance in a rapidly evolving environment that calls for ever more flexible and contextualized responses. The effectiveness of technical assistance facilitated by the IATT was defined by its timeliness, evidence base, and unique global perspective that built on the competencies of its partners and promoted synergies across program areas. Reaching the final goal of eliminating vertical transmission of HIV infection and achieving an AIDS-free generation in countries with the highest HIV burden requires that the IATT partnership and technical assistance remain responsive to country-specific needs while aligning with the current programmatic reality and new global goals such as the Sustainable Development Goals and 90-90-90 targets.

  1. Pregnancy incidence and outcomes in women with perinatal HIV infection.

    Science.gov (United States)

    Byrne, Laura; Sconza, Rebecca; Foster, Caroline; Tookey, Pat A; Cortina-Borja, Mario; Thorne, Claire

    2017-07-31

    To estimate the incidence of first pregnancy in women living with perinatally acquired HIV (PHIV) in the United Kingdom and to compare pregnancy management and outcomes with age-matched women with behaviourally acquired HIV (BHIV). The National Study of HIV in Pregnancy and Childhood is a comprehensive, population-based surveillance study that collects demographic and clinical data on all pregnant women living with HIV, their children, and all HIV-infected children in the United Kingdom and Ireland. The incident rate ratio of first pregnancy was calculated for all women of reproductive age who had been reported to the National Study of HIV in Pregnancy and Childhood as vertically infected children. These women and their pregnancies were compared to age-matched pregnant women with BHIV. Of the 630 women with PHIV reported in the United Kingdom as children, 7% (45) went on to have at least one pregnancy, with 70 pregnancies reported. The incident rate ratio of first pregnancy was 13/1000 woman-years. The BHIV comparison group comprised 118 women (184 pregnancies). Women with PHIV were more likely to be on combined antiretroviral therapy at conception and have a lower baseline CD4 cell count (P < 0.01 for both). In adjusted analysis, PHIV and a low baseline CD4 cell count were risk factors for detectable viral load near delivery; older age at conception and being on combined antiretroviral therapy at conception reduced this risk. Women with PHIV in the United Kingdom have a low pregnancy incidence, but those who become pregnant are at risk of detectable viral load near delivery, reflecting their often complex clinical history, adherence, and drug resistance issues.

  2. Postpartum Sterilization Choices Made by HIV-Infected Women

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    Gretchen S. Stuart

    2005-01-01

    Full Text Available Objective. To assess if HIV-infected women made different choices for postpartum sterilization after implementation of the Pediatric AIDS Clinical Trials Group protocol 076 (November 1, 1994 compared to before implementation.

  3. Placental pathology in HIV infection at term: a comparison with HIV-uninfected women.

    Science.gov (United States)

    Kalk, Emma; Schubert, Pawel; Bettinger, Julie A; Cotton, Mark F; Esser, Monika; Slogrove, Amy; Wright, Colleen A

    2017-05-01

    To describe and correlate placental characteristics from pregnancies in HIV-infected and HIV-negative women with maternal and infant clinical and immunological data. Prospective descriptive study of placentas from term, uncomplicated vaginal births in a cohort of HIV-infected (n = 120) and HIV-negative (n = 103) women in Cape Town, South Africa. Microscopic and macroscopic features were used to determine pathological cluster diagnoses. The majority of HIV-infected women received some form of drug treatment for the prevention of vertical transmission of HIV. Data were analysed using logistic regression. HIV-infected women were older (median [IQR] 27.4 years [24-31] vs. 25.8 [23-30]), more likely to be multiparous (81.7% vs. 71.8%) and had lower CD4 counts (median [IQR] 323.5 cells/ml [235-442] vs. 467 [370-656]). There were no differences in gestational age at first antenatal visit or at delivery. The proportion of specimens with placental lesions was similar in both groups (39.2% vs. 44.7%). Half of all samples were below the tenth percentile expected-weight-for-gestation regardless of HIV status. This was unaffected by adjustment for confounding variables. Maternal vascular malperfusion (MVM) was more frequent in HIV infection (24.2% vs. 12.6%; P = 0.028), an association which strengthened after adjustment (aOR 2.90 [95% confidence interval 1.11-7.57]). Otherwise the frequency of individual diagnoses did not differ between the groups on multivariate analysis. In this cohort of term, uncomplicated pregnant women, few differences were observed between the HIV-infected and uninfected groups apart from MVM. This lesion may underlie the development of hypertensive disorders of pregnancy, which have been observed at higher rates in some HIV-infected women on ART. © 2017 John Wiley & Sons Ltd.

  4. Vitamin A deficiency during pregnancy of HIV infected and non-infected women in tropical settings of Northwest Ethiopia

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    Bekele Assegedech

    2011-07-01

    Full Text Available Abstract Background Vitamin A deficiency (VAD is known to be a major public health problem among women of reproductive age in South East Asia and Africa. In Ethiopia, there are no studies conducted on serum vitamin A status of HIV-infected pregnant women. Therefore, the present study was aimed at determining the level of serum vitamin A and VAD among pregnant women with and without HIV infection in tropical settings of Northwest Ethiopia. Methods In this cross-sectional study, blood samples were collected from 423 pregnant women and from 55 healthy volunteers who visited the University of Gondar Hospital. Serum concentration of vitamin A was measured by high performance liquid chromatography. Results After controlling for total serum protein, albumin and demographic variables, the mean ± SD serum vitamin A in HIV seropositive pregnant women (0.96 ± 0.42 μmol/L was significantly lower than that in pregnant women without HIV infection (1.10 ± 0.45 μmol/L, P Conclusion The present study shows that VAD is a major public health problem among pregnant women in the tropical settings of Northwest Ethiopia. Considering the possible implications of VAD during pregnancy, we recommend multivitamin (which has a lower level of vitamin A supplementation in the care and management of pregnant women with or without HIV infection.

  5. Violence During Pregnancy Among Women With or at Risk for HIV Infection

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    Koenig, Linda J.; Whitaker, Daniel J.; Royce, Rachel A.; Wilson, Tracey E.; Callahan, Michelle R.; Fernandez, M. Isabel

    2002-01-01

    Objectives. This study estimated the prevalence of violence during pregnancy in relation to HIV infection. Methods. Violence, current partnerships, and HIV risk behaviors were assessed among 336 HIV-seropositive and 298 HIV-seronegative at-risk pregnant women. Results. Overall, 8.9% of women experienced recent violence; 21.5% currently had abusive partners. Violence was experienced by women in all partnership categories (range = 3.8% with nonabusive partners to 53.6% with physically abusive partners). Neither experiencing violence nor having an abusive partner differed by serostatus. Receiving an HIV diagnosis prenatally did not increase risk. Disclosure-related violence occurred, but was rare. Conclusions. Many HIV-infected pregnant women experience violence, but it is not typically attributable to their serostatus. Prenatal services should incorporate screening and counseling for all women at risk for violence. (Am J Public Health. 2002;92:367–370) PMID:11867312

  6. High mobile phone ownership, but low Internet and email usage among pregnant, HIV-infected women attending antenatal care in Johannesburg.

    Science.gov (United States)

    Clouse, Kate; Schwartz, Sheree R; Van Rie, Annelies; Bassett, Jean; Vermund, Sten H; Pettifor, Audrey E

    2015-03-01

    We investigated mobile phone usage amongst HIV-positive pregnant women attending antenatal services in a primary care clinic in Johannesburg (n = 50). We conducted a semi-structured interview and asked them about their mobile phone, Internet and email use. The median age of the women was 28 years, 36% had moved one or more times in the past year, and most were employed or recently employed, albeit earning low wages. Nearly all women (94%) reported that they did not share their phone and 76% of the SIM cards were registered to the woman herself. The median time with the current phone was one year (range 1 month-6 years) and the median time with the current phone number was three years (range 1 month-13 years). Even though 42% of the participants were from outside South Africa, they all had mobile phone numbers local to South Africa. About one-third of respondents reported Internet use (30%) and about one-fifth reported using email (18%). Overall, 20% accessed the Internet and 10% accessed email on their mobile phone. Mobile phone interventions are feasible amongst HIV-positive pregnant women and may be useful in prevention of mother-to-child transmission of HIV (PMTCT). Email and Internet-based interventions may not yet be appropriate. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  7. Perfil das gestantes infectadas pelo HIV atendidas em pré-natal de alto risco de referência de Belo Horizonte Profile of HIV-infected pregnant women at a reference prenatal care service in Belo Horizonte

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    Roberta Maia de Castro Romanelli

    2006-09-01

    Full Text Available OBJETIVOS: identificar gestantes infectadas pelo HIV em centro de referência e investigar características refe-rentes à infecção e paridade. MÉTODOS: estudo transversal, que abrangeu toda a população de gestantes infectadas pelo HIV assistidas no Pré-Natal de Alto Risco do Hospital das Clínicas da Universidade Federal de Minas Gerais, em 2004. Foram coletados dados demográficos, epidemiologia da infecção pelo HIV e história obstétrica. Para análise estatística foi utilizado o SPSS 12.0. RESULTADOS: foram identificadas 85 mulheres com média de idade de 29,1 anos e 90 gestações. Em 55 gestações (61,1%, as mulheres tinham conhecimento prévio da infecção. Sessenta e quatro (71,1% informavam união estável. Provavelmente, todas adquiriram o HIV em relações heterossexuais. Cinqüenta e quatro (60% tiveram o diagnóstico durante alguma gravidez. A média global de gestações foi 3,5, sendo 1,71 após o diagnóstico. Pacientes com diagnóstico prévio apresentaram maior média de gestações, em relação àquelas com diagnóstico na gestação estudada (p = 0,002. Oitenta e seis gestantes usaram anti-retroviral, sendo 56,7% por indicação terapêutica. Não foram verificados casos de transmissão vertical. CONCLUSÕES: novas gestações em mulheres infectadas pelo HIV não são raras, apesar dos recursos de contracepção oferecidos. Assim, outras investigações são necessárias para a identificar suas dificuldades não abordadas durante a assistência médica de rotina.OBJECTIVES: identify HIV infected pregnant women in a referral center and investigate characteristics related to infection and parity. METHODS: a cross-sectional study comprising all HIV infected women treated at the High Risk Prenatal Care in the Hospital das Clínicas da Universidade Federal de Minas Gerais, in 2004. Demographic data, HIV epidemiology infection and obstetrical history were collected. For statistical analysis SPSS 12.0 was used. RESULTS

  8. Pregnancy loss and role of infant HIV status on perinatal mortality among HIV-infected women

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    Kim Hae-Young

    2012-08-01

    Full Text Available Abstract Background HIV-infected women, particularly those with advanced disease, may have higher rates of pregnancy loss (miscarriage and stillbirth and neonatal mortality than uninfected women. Here we examine risk factors for these adverse pregnancy outcomes in a cohort of HIV-infected women in Zambia considering the impact of infant HIV status. Methods A total of 1229 HIV-infected pregnant women were enrolled (2001–2004 in Lusaka, Zambia and followed to pregnancy outcome. Live-born infants were tested for HIV by PCR at birth, 1 week and 5 weeks. Obstetric and neonatal data were collected after delivery and the rates of neonatal ( Results The ratio of miscarriage and stillbirth per 100 live-births were 3.1 and 2.6, respectively. Higher maternal plasma viral load (adjusted odds ratio [AOR] for each log10 increase in HIV RNA copies/ml = 1.90; 95% confidence interval [CI] 1.10–3.27 and being symptomatic were associated with an increased risk of stillbirth (AOR = 3.19; 95% CI 1.46–6.97, and decreasing maternal CD4 count by 100 cells/mm3 with an increased risk of miscarriage (OR = 1.25; 95% CI 1.02–1.54. The neonatal mortality rate was 4.3 per 100 increasing to 6.3 by 70 days. Intrauterine HIV infection was not associated with neonatal morality but became associated with mortality through 70 days (adjusted hazard ratio = 2.76; 95% CI 1.25–6.08. Low birth weight and cessation of breastfeeding were significant risk factors for both neonatal and early mortality independent of infant HIV infection. Conclusions More advanced maternal HIV disease was associated with adverse pregnancy outcomes. Excess neonatal mortality in HIV-infected women was not primarily explained by infant HIV infection but was strongly associated with low birth weight and prematurity. Intrauterine HIV infection contributed to mortality as early as 70 days of infant age. Interventions to improve pregnancy outcomes for HIV-infected women are needed to

  9. Population Approach To Analyze the Pharmacokinetics of Free and Total Lopinavir in HIV-Infected Pregnant Women and Consequences for Dose Adjustment

    Science.gov (United States)

    Treluyer, Jean-Marc; Illamola, Silvia M.; Pressiat, Claire; Lui, Gabrielle; Valade, Elodie; Mandelbrot, Laurent; Lechedanec, Jerome; Delmas, Sandrine; Blanche, Stéphane; Warszawski, Josiane; Urien, Saik; Tubiana, Roland; Hirt, Déborah

    2015-01-01

    The aims of this study were to describe the unbound and total lopinavir (LPV) pharmacokinetics in pregnant women in order to evaluate if a dosing adjustment is necessary during pregnancy. Lopinavir placental transfer is described, and several genetic covariates were tested to explain its variability. A total of 400 maternal, 79 cord blood, and 48 amniotic fluid samples were collected from 208 women for LPV concentration determinations and pharmacokinetics analysis. Among the maternal LPV concentrations, 79 samples were also used to measure the unbound LPV concentrations. Population pharmacokinetics models were developed by using NONMEM software. Two models were developed to describe (i) unbound and total LPV pharmacokinetics and (ii) LPV placental transfer. The pharmacokinetics was best described by a one-compartment model with first-order absorption and elimination. A pregnancy effect was found on maternal clearance (39% increase), whereas the treatment group (monotherapy versus triple therapy) or the genetic polymorphisms did not explain the pharmacokinetics or placental transfer of LPV. Efficient unbound LPV concentrations in nonpregnant women were similar to those measured during the third trimester of pregnancy. Our study showed a 39% increase of maternal total LPV clearance during pregnancy, whereas unbound LPV concentrations were similar to those simulated in nonpregnant women. The genetic polymorphisms selected did not influence the LPV pharmacokinetics or placental transfer. Thus, we suggest that the LPV dosage should not be increased during pregnancy. PMID:26149996

  10. Safety and pharmacokinetics of hyperimmune anti-human immunodeficiency virus (HIV) immunoglobulin administered to HIV-infected pregnant women and their newborns. Pediatric AIDS Clinical Trials Group Protocol 185 Pharmacokinetic Study Group.

    Science.gov (United States)

    Lambert, J S; Mofenson, L M; Fletcher, C V; Moye, J; Stiehm, E R; Meyer, W A; Nemo, G J; Mathieson, B J; Hirsch, G; Sapan, C V; Cummins, L M; Jimenez, E; O'Neill, E; Kovacs, A; Stek, A

    1997-02-01

    The pharmacokinetics and safety of hyperimmune anti-human immunodeficiency virus (HIV) intravenous immunoglobulin (HIVIG) were evaluated in the first 28 maternal-infant pairs enrolled in a randomized, intravenous immunoglobulin (IVIG)-controlled trial of HIVIG maternal-infant HIV transmission prophylaxis. Using 200 mg/kg, mean half-life and volume of distribution (Vd) in women were 15 days and 72 mL/kg, respectively, after one and 32 days and 154 mL/kg after three monthly infusions, with stable 4 mL/kg/day clearance. Transplacental passage occurred. Newborn single-dose half-life, Vd, and clearance were 30 days, 143 mL/kg, and 4 mL/kg/day, respectively. HIVIG rapidly cleared maternal serum immune complex-dissociated p24 antigen, and plasma HIV-1 RNA levels were stable. Mild to moderate adverse clinical effects occurred in 2 of 103 maternal and 2 of 25 infant infusions. No adverse hematologic, blood chemistry, or immunologic effects were seen. HIVIG is well-tolerated in HIV-infected pregnant women and their newborns, clears antigenemia, crosses the placenta, and exhibits pharmacokinetics similar to those of other immunoglobulin preparations.

  11. Anaemia in HIV-infected pregnant women receiving triple antiretroviral combination therapy for prevention of mother-to-child transmission: a secondary analysis of the Kisumu breastfeeding study (KiBS).

    Science.gov (United States)

    Odhiambo, Collins; Zeh, Clement; Angira, Frank; Opollo, Valarie; Akinyi, Brenda; Masaba, Rose; Williamson, John M; Otieno, Juliana; Mills, Lisa A; Lecher, Shirley Lee; Thomas, Timothy K

    2016-03-01

    The prevalence of anaemia during pregnancy is estimated to be 35-75% in sub-Saharan Africa and is associated with an increased risk of maternal mortality. We evaluated the frequency and factors associated with anaemia in HIV-infected women undergoing antiretroviral (ARV) therapy for prevention of mother-to-child transmission (PMTCT) enrolled in The Kisumu Breastfeeding Study 2003-2009. Maternal haematological parameters were monitored from 32 to 34 weeks of gestation to 2 years post-delivery among 522 enrolled women. Clinical and laboratory assessments for causes of anaemia were performed, and appropriate management was initiated. Anaemia was graded using the National Institutes of Health Division of AIDS 1994 Adult Toxicity Tables. Data were analysed using SAS software, v 9.2. The Wilcoxon two-sample rank test was used to compare groups. A logistic regression model was fitted to describe the trend in anaemia over time. At enrolment, the prevalence of any grade anaemia (Hb < 9.4 g/dl) was 61.8%, but fell during ARV therapy, reaching a nadir (7.4%) by 6 months post-partum. A total of 41 women (8%) developed severe anaemia (Hb < 7 g/dl) during follow-up; 2 (4.9%) were hospitalised for blood transfusion, whereas 3 (7.3%) were transfused while hospitalised (for delivery). The greatest proportion of severe anaemia events occurred around delivery (48.8%; n = 20). Anaemia (Hb ≥ 7 and < 9.4 g/dl) at enrolment was associated with severe anaemia at delivery (OR 5.87; 95% CI: 4.48, 7.68, P < 0.01). Few cases of severe anaemia coincided with clinical malaria (24.4%; n = 10) and helminth (7.3%; n = 3) infections. Resolution of anaemia among most participants during study follow-up was likely related to receipt of ARV therapy. Efforts should be geared towards addressing common causes of anaemia in HIV-infected pregnant women, prioritising initiation of ARV therapy and management of peripartum blood loss. © 2016 John Wiley & Sons Ltd.

  12. Pregnancy outcomes in perinatally HIV-infected young women in Madrid, Spain: 2000-2015.

    Science.gov (United States)

    Prieto, Luis M; Fernández McPhee, Carolina; Rojas, Patricia; Mazariegos, Diana; Muñoz, Eloy; Mellado, Maria José; Holguín, África; Navarro, María Luisa; González-Tomé, María Isabel; Ramos, José Tomás

    2017-01-01

    An increasing number of perinatally HIV-infected women (PHIV) are reaching adulthood and becoming pregnant. Most PHIV women have been exposed to a high number of antiretroviral regimens, and they may have difficulties to achieve viral suppression. Psychosocial problems are not uncommon and could be an important barrier for treatment adherence. The effects of chronic HIV infection and long-term exposure to antiretroviral treatment of PHIV women cause concerns on the developing fetus. The aims of this study were to describe the prevention of mother-to-child transmission strategies in PHIV women and the infant outcomes in the Madrid Cohort of HIV-infected mother-infant pairs. All PHIV pregnant women registered in the Cohort that gave birth from 2000 to 2015 were included in the study. Twenty-eight pregnancies in twenty-two perinatally infected women were registered. Most women were Caucasian and heavily treatment-experienced. Nine cases (32.1%) were at high risk of HIV mother-to-child transmission. Maternal HIV-1 viral load was detectable close to delivery in four women (14.3%). The management of these cases was described, and the treatment strategies were discussed. None of the newborns acquired HIV infection. Eight infants (28.6%) were small for gestational age. This study included a large series of pregnancies among PHIV women attended according to a youth-centered care model. The challenges in the management of this population by health-care providers were described. Specific strategies to minimize perinatal transmission risks should be addressed in future collaborative studies.

  13. High HIV-1 Diversity and Prevalence of Transmitted Drug Resistance Among Antiretroviral-Naive HIV-Infected Pregnant Women from Rio de Janeiro, Brazil.

    Science.gov (United States)

    Delatorre, Edson; Silva-de-Jesus, Carlos; Couto-Fernandez, José Carlos; Pilotto, Jose H; Morgado, Mariza G

    2017-01-01

    Antiretroviral (ARV) resistance mutations in human immunodeficiency virus type 1 (HIV-1) infection may reduce the efficacy of prophylactic therapy to prevent mother-to-child transmission (PMTCT) and future treatment options. This study evaluated the diversity and the prevalence of transmitted drug resistance (TDR) in protease (PR) and reverse transcriptase (RT) regions of HIV-1 pol gene among 87 ARV-naive HIV-1-infected pregnant women from Rio de Janeiro, Brazil, between 2012 and 2015. The viral diversity comprised HIV-1 subtypes B (67.8%), F1 (17.2%), and C (4.6%); the circulating recombinant forms 12_BF (2.3%), 28/29_BF, 39_BF, 02_AG (1.1% each) and unique recombinants forms (4.5%). The overall prevalence of any TDR was 17.2%, of which 5.7% for nucleoside RT inhibitors, 5.7% for non-nucleoside RT inhibitors, and 8% for PR inhibitors. The TDR prevalence found in this population may affect the virological outcome of the standard PMTCT ARV-regimens, reinforcing the importance of continuous monitoring.

  14. Maraviroc Pharmacokinetics in HIV-1-Infected Pregnant Women

    NARCIS (Netherlands)

    Colbers, A.; Best, B.; Schalkwijk, S.J.; Wang, J; Stek, A.; Tenorio, C.H.; Hawkins, D.; Taylor, G.; Kreitchmann, R.; Burchett, S.; Haberl, A.; Kabeya, K.; Kasteren, M.E.E. van; Smith, E.; Capparelli, E.; Burger, D.M.; Mirochnick, M.; Ven, A. van der

    2015-01-01

    OBJECTIVE: To describe the pharmacokinetics of maraviroc in human immunodeficiency virus (HIV)-infected women during pregnancy and post partum. METHODS: HIV-infected pregnant women receiving maraviroc as part of clinical care had intensive steady-state 12-hour pharmacokinetic profiles performed

  15. Impact of the Menstrual Cycle on Immunologic Markers in HIV-Infected Taiwanese Women

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    Kuang-Han Chao

    2006-03-01

    Conclusions: The CD8+ T cells were increased and activated in women with HIV infection but these alterations were not affected by the menstrual cycle. Therefore, sex hormones seem not to affect the course of HIV infection.

  16. Infecção pelo HIV entre gestantes atendidas nos centros de testagem e aconselhamento em Aids HIV infection among pregnant women attended in testing and counseling centers for AIDS

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    Antônio José Costa Cardoso

    2007-12-01

    counseling center that performed prenatal assistance. Sociodemographic and behavioral data were gathered, as well as syphilis and HIV test results, during the individual counseling sessions registered in the data bank of the Sistema de Informações dos Centros de Testagem e Aconselhamento (Information System on Testing and Counseling Centers. Women who sought the centers for confirmation of previous serology or were referred to this service due to the presence of AIDS symptoms were excluded from the data base. RESULTS: A total of 0.5% of all the pregnant women analyzed (CI 95%=0.3;0.6 were HIV positive. The only variable associated with HIV seropositivity was schooling. The majority of them were basically exposed through unprotected sexual intercourse with the only partner they had a steady relationship with. Younger pregnant women who were single, unemployed and had lower level of education constituted the group with highest exposure. CONCLUSIONS: The Sistema de Informações dos Centros de Testagem e Aconselhamento turned out to be useful for the epidemiological surveillance of HIV infection and high-risk behavior among pregnant women and could also be useful as regards other populations.

  17. Preexposure prophylaxis for HIV infection among African women.

    Science.gov (United States)

    Van Damme, Lut; Corneli, Amy; Ahmed, Khatija; Agot, Kawango; Lombaard, Johan; Kapiga, Saidi; Malahleha, Mookho; Owino, Fredrick; Manongi, Rachel; Onyango, Jacob; Temu, Lucky; Monedi, Modie Constance; Mak'Oketch, Paul; Makanda, Mankalimeng; Reblin, Ilse; Makatu, Shumani Elsie; Saylor, Lisa; Kiernan, Haddie; Kirkendale, Stella; Wong, Christina; Grant, Robert; Kashuba, Angela; Nanda, Kavita; Mandala, Justin; Fransen, Katrien; Deese, Jennifer; Crucitti, Tania; Mastro, Timothy D; Taylor, Douglas

    2012-08-02

    Preexposure prophylaxis with antiretroviral drugs has been effective in the prevention of human immunodeficiency virus (HIV) infection in some trials but not in others. In this randomized, double-blind, placebo-controlled trial, we assigned 2120 HIV-negative women in Kenya, South Africa, and Tanzania to receive either a combination of tenofovir disoproxil fumarate and emtricitabine (TDF-FTC) or placebo once daily. The primary objective was to assess the effectiveness of TDF-FTC in preventing HIV acquisition and to evaluate safety. HIV infections occurred in 33 women in the TDF-FTC group (incidence rate, 4.7 per 100 person-years) and in 35 in the placebo group (incidence rate, 5.0 per 100 person-years), for an estimated hazard ratio in the TDF-FTC group of 0.94 (95% confidence interval, 0.59 to 1.52; P=0.81). The proportions of women with nausea, vomiting, or elevated alanine aminotransferase levels were significantly higher in the TDF-FTC group (P=0.04, P<0.001, and P=0.03, respectively). Rates of drug discontinuation because of hepatic or renal abnormalities were higher in the TDF-FTC group (4.7%) than in the placebo group (3.0%, P=0.051). Less than 40% of the HIV-uninfected women in the TDF-FTC group had evidence of recent pill use at visits that were matched to the HIV-infection window for women with seroconversion. The study was stopped early, on April 18, 2011, because of lack of efficacy. Prophylaxis with TDF-FTC did not significantly reduce the rate of HIV infection and was associated with increased rates of side effects, as compared with placebo. Despite substantial counseling efforts, drug adherence appeared to be low. (Supported by the U.S. Agency for International Development and others; FEM-PrEP ClinicalTrials.gov number, NCT00625404.).

  18. Population pharmacokinetics of abacavir in pregnant women.

    Science.gov (United States)

    Fauchet, Floris; Treluyer, Jean-Marc; Préta, Laure-Helene; Valade, Elodie; Pannier, Emmanuelle; Urien, Saik; Hirt, Déborah

    2014-10-01

    For the first time, a population approach was used to describe abacavir (ABC) pharmacokinetics in HIV-infected pregnant and nonpregnant women. A total of 266 samples from 150 women were obtained. No covariate effect (from age, body weight, pregnancy, or gestational age) on ABC pharmacokinetics was found. Thus, it seems unnecessary to adapt the ABC dosing regimen during pregnancy.

  19. Prevalence of sexually transmitted infections among HIV-infected women in Brazil

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    Ana Gabriela Álvares Travassos

    Full Text Available This study aimed to evaluate the prevalence of sexually transmitted infections (STIs and associated risk factors in HIV-infected pregnant women followed for prenatal care in Salvador, Bahia. This was a cross-sectional study of 63 women seeking prenatal care at a reference center. Participants were interviewed regarding socio-epidemiological and clinical history, and were tested for HBsAg, anti-HCV, anti HTLV I/II, VDRL, Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma hominis, Ureaplasma urealyticum, CD4 count, and HIV plasma viral load. The main outcome variable was the presence of any STI. The mean age of patients was 28.2 years (16-40 years. 23 (36.5% were diagnosed with at least one STI. The frequency of diagnoses was: HBV, 3.2%; HCV, 8.1%; HTLV I/II, 3.4%; syphilis, 9.5%; Chlamydia trachomatis, 11.1%; HPV, 15.0%; Mycoplasma hominis, 2.1%, and Ureaplasma urealyticum, 2.1%. No case of Neisseria gonorrhoeae was identified. No association was found between socio-epidemiological variables and the presence of an STI. CD4 T lymphocyte 1,000 copies (p = 0.027 were associated with the presence of sti. stis are frequent in pregnant women infected with hiv, and all hiv-infected pregnant women should be screened to decrease transmission of these pathogens and to protect their own health.

  20. Trends in a Cohort of HIV-infected pregnant women in Rio de Janeiro, 1996-2004 Tendências temporais observadas em uma coorte de gestantes infectadas pelo HIV acompanhadas no Rio de Janeiro de 1996 a 2004

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    Guilherme Amaral Calvet

    2007-09-01

    Full Text Available OBJECTIVE: To describe trends in sociodemographic, immunological and virological profiles and interventions to decrease the risk of mother-to-child HIV transmission. METHODS: Retrospective cohort study conducted at a tertiary institution in Rio de Janeiro, Brazil from January 1996 to December 2004. Analysis was performed by stratification in three time periods: 1996-1998 (P1, 1999-2001 (P2 and 2002-2004 (P3. RESULTS: In 9 years, 622 pregnancies occurred. Complications included: maternal mortality 0.3%, stillbirths 2.5%, miscarriages 0.6%, neonatal mortality 1.1%, prematurity 9.9%, low birth weight (LBW 16.5%, congenital malformations 2.2%. The number of HIV-infected pregnant patients grew threefold over time reflecting increased prevalence of disease and patient identification. HIV diagnosis before pregnancy increased from 30% in P1 to 45% in P3. The proportion of pregnant women receiving highly active antiretroviral therapy increased from none (P1 to 88% (P3 with a significant trend towards women delivering at undetectable viral loads in later years despite a higher frequency of advanced disease. Scheduled cesarean deliveries increased from 35% in P1 to 48% in P3. Perinatal transmission rates were 2.4% with a decline from 3.5% in P1 to 1.6% in P3. Neonatal outcomes tended to remain constant or improve with time. A slight rise in LBW and congenital malformations were observed. CONCLUSIONS: During the observational period, HIV+ pregnant women presented with more advanced disease and lower socio-economic status. However, improved management of HIV-infected patients (associated with increased identification and increased availability of treatment resulted into very low transmission rates similar to those of developed countries with overall improvement of patient outcomes.OBJETIVOS: Descrever as tendências temporais nas características sociodemográficas, imunológicas e virológicas e as das condutas utilizadas para reduzir o risco da transmiss

  1. Medical eligibility, contraceptive choice, and intrauterine device acceptance among HIV-infected women receiving antiretroviral therapy in Lilongwe, Malawi.

    Science.gov (United States)

    Haddad, Lisa B; Feldacker, Caryl; Jamieson, Denise J; Tweya, Hannock; Cwiak, Carrie; Bryant, Amy G; Hosseinipour, Mina C; Chaweza, Thomas; Mlundira, Linly; Kachale, Fanny; Stuart, Gretchen S; Hoffman, Irving; Phiri, Sam

    2014-09-01

    To determine medical eligibility for contraceptive use, contraceptive preference, and acceptance of a copper intrauterine device (IUD) among a cohort of HIV-infected women receiving antiretroviral therapy (ART). All HIV-infected women who received ART and sought contraceptive services at the Lighthouse clinic, an integrated HIV/ART clinic in Lilongwe, Malawi, between August and December 2010 were invited to participate in a structured interview. Eligibility and preference for the following contraceptive methods were assessed: combined hormonal contraceptives, progestogen-only pills, copper IUD, injectable depot medroxyprogesterone acetate (DMPA), and contraceptive implants. The final sample included 281 women; five were pregnant. The remaining 276 women were eligible for at least three contraceptive methods, with 242 (87.7%) eligible for all five methods evaluated. After counseling, 163 (58.0%) selected DMPA and 98 (34.9%) selected an IUD as their preferred contraceptive method. Regardless of their method of choice, 222 (79.0%) women agreed to have an IUD placed on the same day. Most methods of contraception are safe for use by HIV-infected women. Approximately 80% of the women were willing to receive an IUD. Efforts must be made to increase education about, and access to, long-acting reversible methods that may be acceptable and appropriate contraceptive options for HIV-infected women. Copyright © 2014 International Federation of Gynecology and Obstetrics. All rights reserved.

  2. Rate, correlates and outcomes of repeat pregnancy in HIV-infected women.

    Science.gov (United States)

    Floridia, M; Tamburrini, E; Masuelli, G; Martinelli, P; Spinillo, A; Liuzzi, G; Vimercati, A; Alberico, S; Maccabruni, A; Pinnetti, C; Frisina, V; Dalzero, S; Ravizza, M

    2017-07-01

    The aim of the study was to assess the rate, determinants, and outcomes of repeat pregnancies in women with HIV infection. Data from a national study of pregnant women with HIV infection were used. Main outcomes were preterm delivery, low birth weight, CD4 cell count and HIV plasma viral load. The rate of repeat pregnancy among 3007 women was 16.2%. Women with a repeat pregnancy were on average younger than those with a single pregnancy (median age 30 vs. 33 years, respectively), more recently diagnosed with HIV infection (median time since diagnosis 25 vs. 51 months, respectively), and more frequently of foreign origin [odds ratio (OR) 1.36; 95% confidence interval (CI) 1.10-1.68], diagnosed with HIV infection in the current pregnancy (OR: 1.69; 95% CI: 1.35-2.11), and at their first pregnancy (OR: 1.33; 95% CI: 1.06-1.66). In women with sequential pregnancies, compared with the first pregnancy, several outcomes showed a significant improvement in the second pregnancy, with a higher rate of antiretroviral treatment at conception (39.0 vs. 65.4%, respectively), better median maternal weight at the start of pregnancy (60 vs. 61 kg, respectively), a higher rate of end-of-pregnancy undetectable HIV RNA (60.7 vs. 71.6%, respectively), a higher median birth weight (2815 vs. 2885 g, respectively), lower rates of preterm delivery (23.0 vs. 17.7%, respectively) and of low birth weight (23.4 vs. 15.4%, respectively), and a higher median CD4 cell count (+47 cells/μL), with almost no clinical progression to Centers for Disease Control and Prevention stage C (CDC-C) HIV disease (0.3%). The second pregnancy was significantly more likely to end in voluntary termination than the first pregnancy (11.4 vs. 6.1%, respectively). Younger and foreign women were more likely to have a repeat pregnancy; in women with sequential pregnancies, the second pregnancy was characterized by a significant improvement in several outcomes, suggesting that women with HIV infection who desire multiple

  3. 孕产妇艾滋病感染状况及母婴阻断的干预效果研究%Study on HIV Infection Prevalence of Pregnant and Lying - in Women and the Interventional Effects of Maternal - infant Transmission Blocking

    Institute of Scientific and Technical Information of China (English)

    肖丽华; 金海菊

    2011-01-01

    Objective To study the HIV infection prevalence in pregnant and lying - in women and the effects of prevention of mother-to-child transmission (PMTCT) in Lishui city, so as to provide proper intervention strategy. Methods HIV antibody test was performed in pregnant and lying - in women in Iishui city, and positive cases accepted further confirmatory testing. Results During 4 years of 2006 to 2010, 0.229‰ of those tested pregnant and lying - in women were detected and confirmed as HIV positive. The early detection of HIV during pregnancy can facilitate and strengthen the implementation of PMTCT. There were 7 infants over 18 months among all the 12 surviving infants bom by those HIV positive mothers. Among the 7 infants, 6 were detected as HIV negative and 1 declined the test. Conclusion The prevalence of HIV infection in pregnant and lying - in women in Iishui city is relatively low. Propaganda of HIV PMTCT should be strengthened, and integrated effectively with pre - marital, pre - conception and pregnancy health care. The detection rate of HIV infection before or during pregnancy should be improved to promote the health condition of pregnant and lying - in women and their infants.%目的 为了解丽水市孕产妇HIV感染状况及母婴阻断的干预效果,指导艾滋病母婴阻断工作.方法 对孕产妇进行HIV抗体检测,抗- HIV初筛阳性标本经艾滋病确认试验.结果 2006年10月1日—2010年9月30日4年间,孕产妇HIV感染率为2.29/万.孕期检出的HIV感染孕妇,更能配合母婴传播阻断措施的落实.目前存活的12名儿童有7名已满18个月,其中有6名抗- HIV抗体阴性,1名拒绝检测.结论 丽水市孕产妇HIV感染处于较低水平.今后应加强艾滋病母要阻断相关知识宣传,并将预防母婴传播服务与婚前、孕前、孕期保健有机结合,提高孕前和孕期HIV的检测率和HIV感染孕妇孕早期检出率.

  4. Evaluation of safety and tolerability of antiretroviral therapy in pregnant and non-pregnant women

    OpenAIRE

    Kamini Tyagi; Veena Gupta

    2015-01-01

    Background: The study was conducted to evaluate safety and tolerability of different components of combined antiretroviral therapy (CART) in pregnant and non-pregnant women and to find out substitute of the drug causing intolerance. Methods: An observational study on 75 pregnant and 125 non pregnant, HIV infected women receiving CART, over a period of 1 year (Jan 2013-Jan 20140 in SRN Hospital affiliated to MLN Medical college, Allahabad. All women were examined clinically and investigated...

  5. Maternal nutritional status predicts adverse birth outcomes among HIV-infected rural Ugandan women receiving combination antiretroviral therapy.

    Directory of Open Access Journals (Sweden)

    Sera Young

    Full Text Available Maternal nutritional status is an important predictor of birth outcomes, yet little is known about the nutritional status of HIV-infected pregnant women treated with combination antiretroviral therapy (cART. We therefore examined the relationship between maternal BMI at study enrollment, gestational weight gain (GWG, and hemoglobin concentration (Hb among 166 women initiating cART in rural Uganda.Prospective cohort.HIV-infected, ART-naïve pregnant women were enrolled between 12 and 28 weeks gestation and treated with a protease inhibitor or non-nucleoside reverse transcriptase inhibitor-based combination regimen. Nutritional status was assessed monthly. Neonatal anthropometry was examined at birth. Outcomes were evaluated using multivariate analysis.Mean GWG was 0.17 kg/week, 14.6% of women experienced weight loss during pregnancy, and 44.9% were anemic. Adverse fetal outcomes included low birth weight (LBW (19.6%, preterm delivery (17.7%, fetal death (3.9%, stunting (21.1%, small-for-gestational age (15.1%, and head-sparing growth restriction (26%. No infants were HIV-infected. Gaining <0.1 kg/week was associated with LBW, preterm delivery, and a composite adverse obstetric/fetal outcome. Maternal weight at 7 months gestation predicted LBW. For each g/dL higher mean Hb, the odds of small-for-gestational age decreased by 52%.In our cohort of HIV-infected women initiating cART during pregnancy, grossly inadequate GWG was common. Infants whose mothers gained <0.1 kg/week were at increased risk for LBW, preterm delivery, and composite adverse birth outcomes. cART by itself may not be sufficient for decreasing the burden of adverse birth outcomes among HIV-infected women.Clinicaltrials.gov NCT00993031.

  6. Analysis of partner attitude toward HIV infected pregnant women and its influencing factors in western China during 2005-2011%2005-2011年中国西部HIV感染孕产妇配偶对其态度及影响因素分析

    Institute of Scientific and Technical Information of China (English)

    王前; 方利文; 王芳; 张志慧; 王爱玲; 王潇滟; 乔亚萍; 王临虹

    2013-01-01

    Objective To analyze partner attitude change and influencing factors on HIV infected pregnant women HIV disclosure.Method A multi-stage cross sectional method was used to collect information by questionnaires on 1164 HIV infected pregnant women in 6 counties including Ruili and Longchuan in Yunnan,Hezhou,Lingshan and Pingxiang in Guangxi and Yining in Xinjiang.Information on demographic characteristics and sexual behavior of the subjects and partner attitude toward HIV infected pregnant women were obtained.The influencing factors of partner's discrimination against HIV infected pregnant women were analyzed.Result A total of 991 (85.1%) HIV infected pregnant women have disclosed HIV status to partners among 1164 respondents and 39 (3.9%) reported they were discriminated against partners.Multivariate analysis showed that the 6.5% (15/231) of HIV infected pregnant women in urban had discrimination from their husbands while the ratio among rural preguant women was lower(3.2% (24/760),OR =0.40,95 % CI:0.12-0.77).Compared with the ratio of discrimination among the women of first marriage(2.9%,21/731),the discrimination ratio among women with remarriage and other status was higher (6.5 % (15/232),OR =2.45,95% CI:1.61-5.25 and 10.7% (3/28),OR =3.77,95% CI:1.46-9.88) respectively.The discrimination ratio among pregnant women with multiple sexual partners was 5.9% (23/389),higher than women with single partner (2.6%,15/580) (OR =2.21,95% CI:1.80-6.23).Conclusion The discrimination toward HIV infected pregnant women from husbands was related to demographic characteristics and sexual behaviors.%目的 调查HIV感染孕产妇配偶知晓孕产妇HIV感染状态后对其态度变化情况及影响因素.方法 采用多阶段横断面调查方法,于2005年至201 1年对新疆的伊宁市,云南的瑞丽市和陇川县,广西的贺州市、灵山县和凭祥市等6个研究地区医疗保健机构所发现的1164例HIV感染孕产妇进行问卷调

  7. Health care experiences of HIV-infected women with fertility desires in Mexico: a qualitative study.

    Science.gov (United States)

    van Dijk, Marieke G; Wilson, Kate S; Silva, Martha; Contreras, Xipatl; Fukuda, H Dawn; García, Sandra G

    2014-01-01

    Increased access to antiretroviral therapy has enabled Mexican HIV-infected women to resume healthy sexual and reproductive lives and reduce the risk of mother-to-child transmission of HIV infection. However, little information is available on the experiences of HIV-infected women desiring children. In this qualitative study, we conducted in-depth interviews with 31 HIV-infected women in four Mexican cities. The findings indicated that most of the women were given limited information on their pregnancy options. With some exceptions, the women felt they were denied the option to have (or to have more) children and advised to undergo tubal ligations or abortions. The findings of this study indicate that ongoing efforts are needed to promote the reproductive rights of HIV-infected women in Mexico and to ensure that they receive options aligned with their fertility desires.

  8. Occurrence of Pregnancies among HIV Infected Indian Women : Does Knowledge about HIV Status Make a Difference?

    NARCIS (Netherlands)

    S. Darak (Shrinivas); I. Hutter (Inge); S. Kulkarni (Sanjeevani); V. Kulkarni (Vinay); F. Janssen (Fanny)

    2015-01-01

    textabstractThis is the first study to examine the behavioural effect of HIV on fertility among HIV infected women in India. Retrospective calendar data from ever-married HIV infected women between 15 and 45 years of age, attending a specialized HIV clinic in Pune, Western India (N = 560), were anal

  9. Occurrence of pregnancies among HIV infected Indian women: Does knowledge about HIV status make a difference?

    NARCIS (Netherlands)

    Darak, S.; Hutter, I.; Kulkarni, S.; Kulkarni, V.; Janssen, F.

    2015-01-01

    This is the first study to examine the behavioural effect of HIV on fertility among HIV infected women in India. Retrospective calendar data from ever-married HIV infected women between 15 and 45 years of age, attending a specialized HIV clinic in Pune, Western India , were analysed. Directly standa

  10. Occurence of pregnancies among HIV infected Indian women : Does knowledge about HIV status make a difference?

    NARCIS (Netherlands)

    Darak, Shrinivas; Hutter, Inge; Kulkarni, Sanjeevani; Kulkarni, Vinay; Janssen, Fanny

    2015-01-01

    This is the first study to examine the behavioural effect of HIV on fertility among HIV infected women in India. Retrospective calendar data from ever-married HIV infected women between 15 and 45 years of age, attending a specialized HIV clinic in Pune, Western India (N = 560), were analysed. Direct

  11. Occurence of pregnancies among HIV infected Indian women : Does knowledge about HIV status make a difference?

    NARCIS (Netherlands)

    Darak, Shrinivas; Hutter, Inge; Kulkarni, Sanjeevani; Kulkarni, Vinay; Janssen, Fanny

    2015-01-01

    This is the first study to examine the behavioural effect of HIV on fertility among HIV infected women in India. Retrospective calendar data from ever-married HIV infected women between 15 and 45 years of age, attending a specialized HIV clinic in Pune, Western India (N = 560), were analysed.

  12. Occurrence of pregnancies among HIV infected Indian women: Does knowledge about HIV status make a difference?

    NARCIS (Netherlands)

    Darak, S.; Hutter, I.; Kulkarni, S.; Kulkarni, V.; Janssen, F.

    2015-01-01

    This is the first study to examine the behavioural effect of HIV on fertility among HIV infected women in India. Retrospective calendar data from ever-married HIV infected women between 15 and 45 years of age, attending a specialized HIV clinic in Pune, Western India , were analysed. Directly

  13. Occurrence of Pregnancies among HIV Infected Indian Women : Does Knowledge about HIV Status Make a Difference?

    NARCIS (Netherlands)

    S. Darak (Shrinivas); I. Hutter (Inge); S. Kulkarni (Sanjeevani); V. Kulkarni (Vinay); F. Janssen (Fanny)

    2015-01-01

    textabstractThis is the first study to examine the behavioural effect of HIV on fertility among HIV infected women in India. Retrospective calendar data from ever-married HIV infected women between 15 and 45 years of age, attending a specialized HIV clinic in Pune, Western India (N = 560), were

  14. Occurrence of pregnancies among HIV infected Indian women: Does knowledge about HIV status make a difference?

    NARCIS (Netherlands)

    Darak, S.; Hutter, I.; Kulkarni, S.; Kulkarni, V.; Janssen, F.

    2015-01-01

    This is the first study to examine the behavioural effect of HIV on fertility among HIV infected women in India. Retrospective calendar data from ever-married HIV infected women between 15 and 45 years of age, attending a specialized HIV clinic in Pune, Western India , were analysed. Directly standa

  15. Occurrence of Pregnancies among HIV Infected Indian Women : Does Knowledge about HIV Status Make a Difference?

    NARCIS (Netherlands)

    S. Darak (Shrinivas); I. Hutter (Inge); S. Kulkarni (Sanjeevani); V. Kulkarni (Vinay); F. Janssen (Fanny)

    2015-01-01

    textabstractThis is the first study to examine the behavioural effect of HIV on fertility among HIV infected women in India. Retrospective calendar data from ever-married HIV infected women between 15 and 45 years of age, attending a specialized HIV clinic in Pune, Western India (N = 560), were anal

  16. Occurence of pregnancies among HIV infected Indian women : Does knowledge about HIV status make a difference?

    NARCIS (Netherlands)

    Darak, Shrinivas; Hutter, Inge; Kulkarni, Sanjeevani; Kulkarni, Vinay; Janssen, Fanny

    2015-01-01

    This is the first study to examine the behavioural effect of HIV on fertility among HIV infected women in India. Retrospective calendar data from ever-married HIV infected women between 15 and 45 years of age, attending a specialized HIV clinic in Pune, Western India (N = 560), were analysed. Direct

  17. Pregnancy Outcomes in HIV-Infected Women: Experience from a Tertiary Care Center in India.

    Science.gov (United States)

    Dadhwal, Vatsla; Sharma, Aparna; Khoiwal, Kavita; Deka, Dipika; Sarkar, Plaboni; Vanamail, P

    2017-01-01

    There is conflicting data on the effect of HIV infection as well as antiretroviral therapy (ART) on pregnancy outcome. The objectives of this study were to compare pregnancy outcomes in women with and without HIV infection, and to evaluate the effect of HAART on pregnancy in HIV-infected women. This is a prospective case record analysis of 212 HIV-infected women delivering between 2002 and 2015, in a tertiary health care center in India. The pregnancy outcome in HIV-infected women was compared to 238 HIV-uninfected controls. Women received ART for prevention of mother to child transmission as per protocol which varied during the period of study. Effect of use of ART on preterm birth (PTB) and intrauterine growth restriction (IUGR) was analyzed. HIV-infected women were more likely to have PTB, IUGR, and anemia (9.4%, 9.9%, 5.2%) compared to uninfected women (7.6%, 5%, 3.8%), this did not reach statistical significance (P-value = >0.05). The incidence of PIH, diabetes mellitus and intrahepatic cholestasis of pregnancy was similar in both groups. Mean birth weight was significantly lower in neonates of HIV-infected women (2593.60±499g) than HIV-uninfected women (2919±459g) [P-value=0.001]. neonatal intensive care unit admissions were also significantly higher in infants born to HIV-infected women (P-value=0.002). HIV-infected women on ART had decreased incidence of PTB and IUGR. Good antenatal care and multidisciplinary team approach can optimize pregnancy outcomes in HIV-infected women.

  18. Is pregnancy associated with biochemical and haematological changes in HIV-infected Nigerian women?

    Directory of Open Access Journals (Sweden)

    L O Omo-Aghoja

    2010-04-01

    Full Text Available Background.\tWhile there is evidence that HIV affects the course and outcome of pregnancy, reports on the effects of pregnancy on HIV infection remain conflicting, especially in low-resource settings. Methodology. A prospective study of two demographically similar cohorts of HIV-seropositive women, 154 pregnant and 151 non-pregnant, was conducted in a hospital setting in Nigeria. Results. Cases and controls were matched for age, but parity in controls was significantly higher than in cases (p<0.0001. The time between diagnosis and treatment commencement was greater in controls compared with cases (p<0.0001. Electrolyte, urea and creatinine levels were within normal limits, with mean serum urea and potassium higher in controls compared with cases (p=0.002 and p=0.023. Aspartate aminotransferase (AAT/serum glutamic oxaloacetic acid transaminase (SGOT, alanine aminotransferase (ALT/serum glutamic-pyruvic transaminase (SGPT and amylase levels were higher in controls compared with cases (p=0.001, p=0.0001 and p=0.05, but the mean CD4 count was higher in cases compared with controls (p=0.001. The haematological parameters were within normal limits and comparable in cases and controls. A comparison of CD4 count, total white blood cell count and packed cell volume across the three trimesters in the cases did not reveal any statistically significant differences in these parameters. Conclusion. Pregnancy did not affect biochemical and haematological parameters in HIV-infected Nigerian women.

  19. Depression During Pregnancy and the Postpartum Among HIV-Infected Women on Antiretroviral Therapy in Uganda

    Science.gov (United States)

    Matthews, Lynn T.; Ashaba, Scholastic; Tsai, Alexander C.; Kanters, Steve; Robak, Magdalena; Psaros, Christina; Kabakyenga, Jerome; Boum, Yap; Haberer, Jessica E.; Martin, Jeffrey N.; Hunt, Peter W.; Bangsberg, David R.

    2014-01-01

    Background: Among HIV-infected women, perinatal depression compromises clinical, maternal, and child health outcomes. Antiretroviral therapy (ART) is associated with lower depression symptom severity but the uniformity of effect through pregnancy and postpartum periods is unknown. Methods: We analyzed prospective data from 447 HIV-infected women (18–49 years) initiating ART in rural Uganda (2005–2012). Participants completed blood work and comprehensive questionnaires quarterly. Pregnancy status was assessed by self-report. Analysis time periods were defined as currently pregnant, postpartum (0–12 months post-pregnancy outcome), or non–pregnancy-related. Depression symptom severity was measured using a modified Hopkins Symptom Checklist 15, with scores ranging from 1 to 4. Probable depression was defined as >1.75. Linear regression with generalized estimating equations was used to compare mean depression scores over the 3 periods. Results: At enrollment, median age was 32 years (interquartile range: 27–37), median CD4 count was 160 cells per cubic millimeter (interquartile range: 95–245), and mean depression score was 1.75 (s = 0.58) (39% with probable depression). Over 4.1 median years of follow-up, 104 women experienced 151 pregnancies. Mean depression scores did not differ across the time periods (P = 0.75). Multivariable models yielded similar findings. Increasing time on ART, viral suppression, better physical health, and “never married” were independently associated with lower mean depression scores. Findings were consistent when assessing probable depression. Conclusions: Although the lack of association between depression and perinatal periods is reassuring, high depression prevalence at treatment initiation and continued incidence across pregnancy and non–pregnancy-related periods of follow-up highlight the critical need for mental health services for HIV-infected women to optimize both maternal and perinatal health. PMID:25436816

  20. Candida species isolated from the vaginal mucosa of HIV-infected women in Salvador, Bahia, Brazil

    Directory of Open Access Journals (Sweden)

    Paula Matos Oliveira

    2011-06-01

    Full Text Available BACKGROUND: Vulvovaginal candidiasis (VVC is the second most common vaginal infection. HIV-infection is a risk factor for this infection. OBJECTIVE: To determine the frequency of VVC and to describe the main Candida species isolated and their susceptibility to antifungal drugs in HIV-infected patients, compared to HIV-uninfected women in Salvador, Brazil. METHODS: Cross-sectional study including a group of 64 HIV-infected women and 76 uninfected women, followed up at the AIDS reference center and at the Gynecological Clinic of Escola Bahiana de Medicina e Saúde Pública (Salvador, Bahia, Brazil. RESULTS: Frequency of Candida spp. was higher in HIV-infected women (29.7% than in HIV-uninfected controls (14.5% (p = 0.02. The odds ratio value for vulvovaginal candidiasis in HIV-infected patients was 2.6 (95% CI: 1.07 - 6.32 p = 0.03. Candida albicans was the most commonly isolated species in both HIV-infected (52.3% and uninfected women (85.7%, followed by C. parapsolis in 17.6% and 14.3%, respectively. In HIV-infected women, C. glabrata, C. parapsilosis, and a coinfection of C. albicans and C. glabrata were also identified. There was no significant difference between Candida species isolated from the vaginal mucosa of women with VVC and colonization of the vaginal mucosa of HIV-infected and HIV-uninfected women. One C. glabrata isolate from an HIV-infected patient was resistant to fluconazole and other two isolates exhibited a dose-dependent susceptibility. CONCLUSION: Our results confirm a higher frequency of Candida spp. isolated from the vaginal mucosa of HIV-infected women and a broader spectrum of species involved. Only Candida glabrata isolates showed decreased susceptibility to fluconazole.

  1. Candida species isolated from the vaginal mucosa of HIV-infected women in Salvador, Bahia, Brazil

    Directory of Open Access Journals (Sweden)

    Paula Matos Oliveira

    Full Text Available BACKGROUND: Vulvovaginal candidiasis (VVC is the second most common vaginal infection. HIV-infection is a risk factor for this infection. OBJECTIVE: To determine the frequency of VVC and to describe the main Candida species isolated and their susceptibility to antifungal drugs in HIV-infected patients, compared to HIV-uninfected women in Salvador, Brazil. METHODS: Cross-sectional study including a group of 64 HIV-infected women and 76 uninfected women, followed up at the AIDS reference center and at the Gynecological Clinic of Escola Bahiana de Medicina e Saúde Pública (Salvador, Bahia, Brazil. RESULTS: Frequency of Candida spp. was higher in HIV-infected women (29.7% than in HIV-uninfected controls (14.5% (p = 0.02. The odds ratio value for vulvovaginal candidiasis in HIV-infected patients was 2.6 (95% CI: 1.07 - 6.32 p = 0.03. Candida albicans was the most commonly isolated species in both HIV-infected (52.3% and uninfected women (85.7%, followed by C. parapsolis in 17.6% and 14.3%, respectively. In HIV-infected women, C. glabrata, C. parapsilosis, and a coinfection of C. albicans and C. glabrata were also identified. There was no significant difference between Candida species isolated from the vaginal mucosa of women with VVC and colonization of the vaginal mucosa of HIV-infected and HIV-uninfected women. One C. glabrata isolate from an HIV-infected patient was resistant to fluconazole and other two isolates exhibited a dose-dependent susceptibility. CONCLUSION: Our results confirm a higher frequency of Candida spp. isolated from the vaginal mucosa of HIV-infected women and a broader spectrum of species involved. Only Candida glabrata isolates showed decreased susceptibility to fluconazole.

  2. Fertility among HIV-infected Indian women Indian women : the biological effect and its implications

    NARCIS (Netherlands)

    Darak, Shrinivas; Janssen, Fanny; Hutter, Inge

    In India, nearly one million women of childbearing age are infected with HIV. This study sought to examine the biological effect of HIV on the fertility of HIV-infected Indian women. This is relevant for the provision of pregnancy-related counselling and care to the infected women, and for

  3. Fertility among HIV-infected Indian women Indian women : the biological effect and its implications

    NARCIS (Netherlands)

    Darak, Shrinivas; Janssen, Fanny; Hutter, Inge

    2011-01-01

    In India, nearly one million women of childbearing age are infected with HIV. This study sought to examine the biological effect of HIV on the fertility of HIV-infected Indian women. This is relevant for the provision of pregnancy-related counselling and care to the infected women, and for estimatin

  4. Pregnancy and linkage to care among women diagnosed with HIV infection in 61 CDC-funded health departments in the United States, 2013.

    Science.gov (United States)

    FitzHarris, Lauren F; Hollis, Natasha D; Nesheim, Steven R; Greenspan, Julia L; Dunbar, Erica K

    2017-07-01

    Timely linkage to HIV care (LTC) following an HIV diagnosis is especially important for pregnant women with HIV to prevent perinatal transmission and improve maternal health. However, limited data are available on LTC among U.S. pregnant women. Our analysis aimed to identify HIV diagnoses among childbearing age (CBA) women (15-44 years old) by pregnancy status and to compare LTC of HIV-infected pregnant women to HIV-infected non-pregnant women. We analyzed 2013 CDC-funded HIV testing data from 61 health departments and 151 directly funded community-based organizations among CBA women. LTC includes linkage at any time after an HIV diagnosis and within 90 days after HIV diagnosis. Pearson's chi-square was used to compare LTC of pregnant and non-pregnant women. Data were analyzed using SAS v9.3. Among the 1,379,860 HIV testing events among CBA women in 2013, 0.3% (n = 3690) were HIV-positive. Among all HIV-positive diagnoses with an available pregnancy status (n = 1987), 7%, (n = 138) were pregnant. Among women with pregnancy status data, LTC any time after an HIV-positive diagnosis was 73.2% for pregnant women and 60.7% for non-pregnant women. LTC within 90 days was 71.7% for pregnant women and 56.2% for non-pregnant women. Pregnancy was associated with LTC any time (p < 0.01) and within 90 days of diagnosis (p < 0.01). Compared with non-pregnant women, a higher proportion of pregnant women with HIV were linked to care overall, and linked within 90 days. Pregnancy appears to facilitate better LTC, but improvements are needed for women overall and pregnant women specifically.

  5. Tuberculosis Disease during Pregnancy and Treatment Outcomes in HIV-Infected and Uninfected Women at a Referral Hospital in Cape Town.

    Science.gov (United States)

    Bekker, Adrie; Schaaf, Hendrik S; Draper, Heather R; Kriel, Magdalena; Hesseling, Anneke C

    2016-01-01

    Tuberculosis during pregnancy and treatment outcomes are poorly defined in high prevalence tuberculosis and HIV settings. A prospective cohort study of pregnant and postpartum women identified to be routinely on antituberculosis treatment was conducted at Tygerberg Hospital, Cape Town, South Africa, from January 2011 through December 2011. Maternal tuberculosis disease spectrum and tuberculosis-exposed newborns were characterized by maternal HIV status. Maternal tuberculosis treatment outcomes were documented and a multivariable regression model identified predictors of unfavourable tuberculosis treatment outcomes. Infant outcomes were also described. Seventy-four women with tuberculosis, 53 (72%) HIV-infected, were consecutively enrolled; 35 (47%) were diagnosed at delivery or postpartum and 22 (30%) of women reported previous antituberculosis treatment. HIV-infected women were 5.67 times more likely to have extrapulmonary tuberculosis (95% CI 1.18-27.25, p = 0.03). All 5 maternal deaths were amongst HIV-infected women. Birth outcomes were available for 75 newborns (2 sets of twins, missing data for 1 stillbirth). Of the 75 newborns, 49 (65%) were premature and 44 (59%) were low birth weight (LBW; tuberculosis treatment outcomes were documented in 33/74 (45%) women. Unfavourable maternal tuberculosis outcome was associated with delivery of LBW infants (OR 3.83; 95% CI 1.40-10.53, p = 0.009). A large number of pregnant women with tuberculosis presented at a provincial referral hospital. All maternal and infant deaths occurred in HIV-infected women and their newborns. Maternal tuberculosis treatment outcomes were poor.

  6. Reproductive Counseling by Clinic Healthcare Workers in Durban, South Africa: Perspectives from HIV-Infected Men and Women Reporting Serodiscordant Partners

    Directory of Open Access Journals (Sweden)

    L. T. Matthews

    2012-01-01

    Full Text Available Background. Understanding HIV-infected patient experiences and perceptions of reproductive counseling in the health care context is critical to inform design of effective pharmaco-behavioral interventions that minimize periconception HIV risk and support HIV-affected couples to realize their fertility goals. Methods. We conducted semistructured, in-depth interviews with 30 HIV-infected women (with pregnancy in prior year and 20 HIV-infected men, all reporting serodiscordant partners and accessing care in Durban, South Africa. We investigated patient-reported experiences with safer conception counseling from health care workers (HCWs. Interview transcripts were reviewed and coded using content analysis for conceptual categories and emergent themes. Results. The study findings indicate that HIV-infected patients recognize HCWs as a resource for periconception-related information and are receptive to speaking to a HCW prior to becoming pregnant, but seldom seek or receive conception advice in the clinic setting. HIV nondisclosure and unplanned pregnancy are important intervening factors. When advice is shared, patients reported receiving a range of information. Male participants showed particular interest in accessing safer conception information. Conclusions. HIV-infected men and women with serodiscordant partners are receptive to the idea of safer conception counseling. HCWs need to be supported to routinely initiate accurate safer conception counseling with HIV-infected patients of reproductive age.

  7. [Coping and perception of women with HIV infection].

    Science.gov (United States)

    Renesto, Helana Maria Ferreira; Falbo, Ana Rodrigues; Souza, Edvaldo; Vasconcelos, Maria Gorete

    2014-02-01

    OBJECTIVE To analyze women's perceptions and coping regarding the discovery of an HIV infection. METHODS A qualitative study in an HIV/AIDS Specialist Helpdesk in Recife, PE, Northeastern Brazil, from January to September 2010, involving eight women living with asymptomatic HIV aged between 27 and 37 years, without criteria for diagnosis of AIDS infected through intercourse and monitored by the service for at least one year. Forms were used to characterize the clinical situation and semi-structured interviews to understand perceptions and feelings related to personal trajectory after diagnosis and different ways of facing the diagnosis in family and social life. Content analysis was performed as suggested by Bardin. RESULTS The thematic category that emerged was stigma and discrimination. The women had life trajectories marked by stigma, which was perceived as discrimination after the diagnosis and in the experiences of everyday life. The revelation of the infection was perceived as limiting to a normal life, leading to the need to conceal the diagnosis. The discriminatory attitudes of some health care professionals, non-specialist in HIV/AIDS, had a negative impact on future experiences in other health services. Besides the effects of institutional stigma, the perception of women was that the service did not include dedicated space for the expression of other needs beyond the disease, which could help in fighting the infection. CONCLUSIONS Living with HIV was strongly linked to stigma. The results show the importance of strengthening educational approaches and emotional support at the time of diagnosis in order to facilitate coping with the condition of seropositivity.

  8. Antiretroviral Resistance and Pregnancy Characteristics of Women with Perinatal and Nonperinatal HIV Infection

    Directory of Open Access Journals (Sweden)

    Gweneth B. Lazenby

    2016-01-01

    Full Text Available Objective. To compare HIV drug resistance in pregnant women with perinatal HIV (PHIV and those with nonperinatal HIV (NPHIV infection. Methods. We conducted a multisite cohort study of PHIV and NPHIV women from 2000 to 2014. Sample size was calculated to identify a fourfold increase in antiretroviral (ARV drug resistance in PHIV women. Continuous variables were compared using Student’s t-test and Wilcoxon rank-sum tests. Categorical variables were compared using χ2 and Fisher’s exact tests. Univariate analysis was used to determine factors associated with antiretroviral drug resistance. Results. Forty-one PHIV and 41 NPHIV participants were included. Women with PHIV were more likely to have drug resistance than those with NPHIV ((55% versus 17%, p=0.03, OR 6.0 (95% CI 1.0–34.8, p=0.05, including multiclass resistance (15% versus 0, p=0.03, and they were more likely to receive nonstandard ARVs during pregnancy (27% versus 5%, p=0.01. PHIV and NPHIV women had similar rates of preterm birth (11% versus 28%, p=0.08 and cesarean delivery (47% versus 46%, p=0.9. Two infants born to a single NPHIV woman acquired HIV infection. Conclusions. PHIV women have a high frequency of HIV drug resistance mutations, leading to nonstandard ARVs use during pregnancy. Despite nonstandard ARV use during pregnancy, PHIV women did not experience increased rates of adverse pregnancy outcomes.

  9. Coping and perception of women with HIV infection

    Science.gov (United States)

    Renesto, Helana Maria Ferreira; Falbo, Ana Rodrigues; Souza, Edvaldo; Vasconcelos, Maria Gorete

    2014-01-01

    OBJECTIVE To analyze women’s perceptions and coping regarding the discovery of an HIV infection. METHODS A qualitative study in an HIV/AIDS Specialist Helpdesk in Recife, PE, Northeastern Brazil, from January to September 2010, involving eight women living with asymptomatic HIV aged between 27 and 37 years, without criteria for diagnosis of AIDS infected through intercourse and monitored by the service for at least one year. Forms were used to characterize the clinical situation and semi-structured interviews to understand perceptions and feelings related to personal trajectory after diagnosis and different ways of facing the diagnosis in family and social life. Content analysis was performed as suggested by Bardin. RESULTS The thematic category that emerged was stigma and discrimination. The women had life trajectories marked by stigma, which was perceived as discrimination after the diagnosis and in the experiences of everyday life. The revelation of the infection was perceived as limiting to a normal life, leading to the need to conceal the diagnosis. The discriminatory attitudes of some health care professionals, non-specialist in HIV/AIDS, had a negative impact on future experiences in other health services. Besides the effects of institutional stigma, the perception of women was that the service did not include dedicated space for the expression of other needs beyond the disease, which could help in fighting the infection. CONCLUSIONS Living with HIV was strongly linked to stigma. The results show the importance of strengthening educational approaches and emotional support at the time of diagnosis in order to facilitate coping with the condition of seropositivity. PMID:24789635

  10. Associations between plasma tenofovir concentration and renal function markers in HIV-infected women

    Directory of Open Access Journals (Sweden)

    Mwila Mulubwa

    2016-02-01

    Full Text Available Background: Tenofovir disoproxil fumarate (TDF has been associated with kidney tubulardys function and reduced renal function. Limited studies were performed in Europe and Asia that related plasma tenofovir (TFV concentration with renal function; no such studies to date have been performed on Africans.Objective: To investigate the correlation between plasma tenofovir (TFV concentration and certain renal function markers in HIV-infected women on TDF antiretroviral therapy (ART.These markers were also compared to a HIV-uninfected control group.Methods: HIV-infected women (n = 30 on TDF-based ART were matched with 30 controls forage and body mass index. Renal markers analysed were estimated glomerular filtration rate (eGFR, creatinine clearance (CrCl, serum creatinine, albuminuria, glucosuria, serum urea, serum uric acid, urine sodium and maximum tubular reabsorption of phosphate. Baseline eGFR and CrCl data were obtained retrospectively for the HIV-infected women. Plasma TFV was assayed using a validated HPLC-MS/MS method. Step wise regression, Mann–Whitney test, unpaired and paired t-tests were applied in the statistical analyses.Results: TFV concentration was independently associated with albuminuria (adjusted r2 = 0.339; p = 0.001 in HIV-infected women. In the adjusted (weight analysis, eGFR (p = 0.038,CrCl (p = 0.032 and albuminuria (p = 0.048 were significantly higher in HIV-infected compared to the uninfected women, but eGFR was abnormally high in HIV-infected women. Both eGFR (p < 0.001 and CrCl (p = 0.008 increased from baseline to follow-up in HIV-infected women.Conclusion: Plasma TFV concentration was associated with increased albuminuria in HIV infected women in this sub-study. Both eGFR and CrCl were increased in HIV-infected women from baseline. These findings should be confirmed in larger studies, and hyperfiltration in HIV-infected women warrants further investigation.

  11. Study on Fertility willing of HIV-infected pregnant women and the influencing factors%HIV 感染孕产妇生育意愿及影响因素研究

    Institute of Scientific and Technical Information of China (English)

    牟鸿江; 杨梅; 张玉锦; 何蕾; 金真菊; 王伟人

    2015-01-01

    Objective To understand the fertility willing of HIV positive pregnant women and its influence factors.Method A questionnaire survey analysis of HIV positive pregnant women diagnosed who were from twentysix countries in nine cities of whole province.Result Among 162 cases HIV positive pregnant women ,21cases (12.96 percent) people chose to terminate the pregnancies.Because of worry about children infected ,discriminated against and unable to care for children by themselves.141cases chose to continue the pregnancy.Main reasons were they worried cannot pregnant on later ,want to be a mother ,etc.Will of terminating the pregnancies was about pregnant women's career ,but nothing on pregnant women's and their husband's age ,household ,living conditions ,literacy , monthly income ,etc.Conclusion There is a large difference of HIV positive pregnant women's fertility willing in different district.Medical personnel should respect and understand the fertility willing of HIV positive pregnant women ,and their choice ,on the basis of fully informed.%目的了解 H IV阳性孕产妇生育意愿及影响因素.方法对全省9个市(州)26个县2011至2013年确诊的H IV阳性孕产妇进行问卷调查.结果 162例H IV阳性孕产妇中 ,21例(12 .96% )选择终止妊娠 ,原因主要是担心小孩被感染、受歧视或自己不能照顾小孩 ;141例(87 .04% )选择继续妊娠 ,主要原因是担心以后怀不上、迫切想当母亲等 ;终止妊娠意愿与 H IV感染孕产妇的职业有关( P=0 .017 ) ,与孕产妇及其配偶的年龄、民族、户籍、居住情况、文化程度、月收入等无关( P>0 .05 );2011至2013年选择终止妊娠的 H IV阳性孕产妇比例呈逐年上升趋势.结论不同地区影响妊娠结局选择意愿的因素差异较大 ,医务人员应该在充分告知的基础上 ,尊重、理解H IV感染孕产妇的生育意愿和妊娠结局选择.

  12. Reproductive health and family planning needs among HIV-infected women in Sub-Saharan Africa.

    Science.gov (United States)

    Sarnquist, Clea C; Rahangdale, Lisa; Maldonado, Yvonne

    2013-03-01

    Review key topics and recent literature regarding reproductive health and family planning needs for HIV-infected women in Sub-Saharan Africa. Electronic searches performed in PubMed, JSTOR, and Web of Science; identified articles reviewed for inclusion. Most HIV-infected women in Sub-Saharan Africa bear children, and access to antiretroviral therapy may increase childbearing desires and/or fertility, resulting in greater need for contraception. Most contraceptive options can be safely and effectively used by HIV-infected women. Unmet need for contraception is high in this population, with 66- 92% of women reporting not wanting another child (now or ever), but only 20-43% using contraception. During pregnancy and delivery, HIV-infected women need access to prevention of mother-to-child transmission (PMTCT) services, a skilled birth attendant, and quality post-partum care to prevent HIV infection in the infant and maximize maternal health. Providers may lack resources as well as appropriate training and support to provide such services to women with HIV. Innovations in biomedical and behavioral interventions may improve reproductive healthcare for HIV-infected women, but in Sub-Saharan Africa, models of integrating HIV and PMTCT services with family planning and reproductive health services will be important to improve reproductive outcomes. HIV-infected women in Sub-Saharan Africa have myriad needs related to reproductive health, including access to high-quality family planning information and options, high-quality pregnancy care, and trained providers. Integrated services that help prevent unintended pregnancy and optimize maternal and infant health before, during and after pregnancy will both maximize limited resources as well as provide improved reproductive outcomes.

  13. Pregnancy Outcomes in HIV-Infected Women Receiving Long-Term Isoniazid Prophylaxis for Tuberculosis and Antiretroviral Therapy

    Directory of Open Access Journals (Sweden)

    Allan W. Taylor

    2013-01-01

    Full Text Available Objective. While 6- to 12-month courses of isoniazid for tuberculosis prevention are considered safe in pregnant women, the effects of longer-term isoniazid prophylaxis or isoniazid in combination with antiretroviral therapy (ART are not established in human-immunodeficiency-virus-(HIV- infected women who experience pregnancy during the course of therapy. Design. Nested study of pregnancy outcomes among HIV-infected women participating in a placebo-controlled, TB-prevention trial using 36 months daily isoniazid. Pregnancy outcomes were collected by interview and record review. Results. Among 196 pregnant women, 103 (52.6% were exposed to isoniazid during pregnancy; all were exposed to antiretroviral drugs. Prior to pregnancy they had received a median of 341 days (range 1–1095 of isoniazid. We observed no isoniazid-associated hepatitis or other severe isoniazid-associated adverse events in the 103 women. Pregnancy outcomes were 132 term live births, 42 premature births, 11 stillbirths, 8 low birth weight, 6 spontaneous abortions, 4 neonatal deaths, and 1 congenital abnormality. In a multivariable model, neither isoniazid nor ART exposure during pregnancy was significantly associated with adverse pregnancy outcome (adjusted odds ratios 0.6, 95% CI: 0.3–1.1 and 1.8, 95% CI 0.9–3.6, resp.. Conclusions. Long-term isoniazid prophylaxis was not associated with adverse pregnancy outcomes, such as preterm delivery, even in the context of ART exposure.

  14. NEUROCOGNITIVE DEFICITS IN HIV-INFECTED WOMEN AND VICTIMS OF CHILDHOOD TRAUMA

    Science.gov (United States)

    Spies, G; Fennema-Notestine, C; Archibald, SL; Cherner, M; Seedat, S

    2015-01-01

    Objectives The study investigated the behavioral and brain effects of childhood trauma and HIV-infection, both separately and in combination, and assessed potential interactions in women who were dually affected. Methods 83 HIV-positive and 47 matched HIV-negative South African women underwent neuromedical, neuropsychiatric and neurocognitive assessments. Univariate tests of significance assessed if either HIV infection or childhood trauma, or the combination, had a significant effect on neurocognitive performance. Results The majority of women were Black (96%) and had an average age of 30. An analysis of covariance revealed significant HIV effects for the Hopkins Verbal Learning Test (HVLT) learning and delay trials (p < .01) and the Halstead Category test (p < .05). A significant trauma effect was seen on the HVLT delay trial (p < .05). Conclusion The results provide evidence for neurocognitive dysfunction in memory and executive functions in HIV-infected women and memory disturbances in trauma exposed women. PMID:22672200

  15. HIV感染孕妇母婴阻断的16例临床效果分析%Clinical Effect Analysis of 16 Cases of Maternal and Child Blocking of HIV Infection in Pregnant Women

    Institute of Scientific and Technical Information of China (English)

    吴爱萍

    2015-01-01

    目的:分析研讨感染 HIV 病毒的孕妇母婴阻断抗病毒治疗的临床效果。方法选取我院2011~2014年内发现的16例 HIV 阳性孕妇的临床资料,针对 HIV 阳性孕妇采用抗病毒治疗,辅助其他治疗,联合应用拉米夫定及克力芝、齐多夫定,新生儿出生后给予应用齐多夫定糖浆至产后42天,新生儿出生后,1、3、6、12、18月龄进行HIV-RNA 检测。结果出生后的新生儿未发现感染 HIV 病毒,均为正常儿童,成功阻断病毒的侵入。结论采用母婴抗病毒治疗能够有效阻止 HIV 病毒母婴传播。%Objective To study the clinical effect of anti viral therapy for pregnant women with infected HIV virus. Methods The clinical data of 16 cases of HIV positive pregnant women were selected in our hospital from 2011 to 2014, according to Yang HIV positive pregnant women received antiviral treatment, other adjuvant therapies, lamivudine and kriton Shiba, Zidorf, after the birth to the application of Zidovudine Syrup to 42 days postpartum, after birth, 1, 3, 6, 12, 18 months were detected by HIV-RNA. Results After birth were found infected with HIV, were normal children, successfully blocked the invasion of the virus. Conclusion The maternal antiviral therapy can effectively prevent HIV virus transmission.

  16. The influence of partnership on contraceptive use among HIV-infected women accessing antiretroviral therapy in rural Uganda

    Science.gov (United States)

    Nieves, Christina I.; Kaida, Angela; Seage, George R.; Kabakyenga, Jerome; Muyindike, Winnie; Boum, Yap; Mocello, A. Rain; Martin, Jeffrey N.; Hunt, Peter W.; Haberer, Jessica E.; Bangsberg, David R.; Matthews, Lynn T

    2016-01-01

    Objective To determine individual and dyadic factors associated with effective contraceptive use among HIV-infected women accessing antiretroviral therapy (ART) in rural Uganda. Study Design HIV-infected women enrolled in the Uganda AIDS Rural Treatment Outcomes cohort completed questionnaires (detailing socio-behavioral characteristics, sexual and reproductive history, contraceptive use, fertility desires), and phlebotomy (October 2011–March 2013). We describe prevalence of effective contraceptive use (i.e., consistent condom use, and/or oral contraceptives, injectable hormonal contraception, intrauterine device, female sterilization) in the previous six months among sexually active, non-pregnant women (18–40 years). We assessed covariates of contraceptive use using multivariable logistic regression. Results 362 women (median values: age 30 years, CD4 count 397 cells/mm3, 4.0 years since ART initiation) were included. Among 284 sexually active women, 50% did not desire a(nother) child and 51% had a sero-concordant partner. 45% (n=127) reported effective contraceptive use of whom, 57% (n=72) used condoms, 42% (n=53) injectables, 12% (n=15) oral contraceptives, and 11% (n=14) other effective methods. Dual contraception was reported by 6% (n=8). Only ‘partnership fertility desire’ was independently associated with contraceptive use; women who reported neither partner desired a child had significantly increased odds of contraceptive use (aOR: 2.40, 95% CI: 1.07–5.35) compared with women in partnerships where at least one partner desired a child. Conclusions Less than half of sexually active HIV-infected women accessing ART used effective contraception, of which 44% (n=56) relied exclusively on male condoms, highlighting a continued need to expand access to a wider range of longer acting female-controlled contraceptive methods. Association with partnership fertility desire underscores the need to include men in reproductive health programming. PMID:25983013

  17. PREGNANT WOMEN

    African Journals Online (AJOL)

    women attending an antenatal clinic and gynaeco- logical clinic ... Other observa- tions are less specific and may be part of the gen- .... be due to the high levels of corticosteroids though there is no direct proof ... Scully C, Cawson RA. Medical ...

  18. Complications of cesarean deliveries among HIV-infected women in the United States

    Science.gov (United States)

    Kourtis, Athena P.; Ellington, Sascha; Pazol, Karen; Flowers, Lisa; Haddad, Lisa; Jamieson, Denise J.

    2015-01-01

    Objective To compare rates of complications associated with cesarean delivery in HIV-infected and HIV-uninfected women in the United States and to investigate trends in such complications across four study cycles spanning the implementation of HAART in the United States (1995–1996, 2000–2001, 2005–2006, 2010–2011). Design The Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project is the largest all-payer hospital inpatient care database in the United States; when weighted to account for the complex sampling design, nationally representative estimates are derived. After restricting the study sample to women aged 15–49 years, our study sample consisted of approximately 1 090 000 cesarean delivery hospitalizations annually. Methods Complications associated with cesarean deliveries were categorized as infection, hemorrhage, or surgical trauma, based on groups of specific International Classification of Diseases 9th revision codes. Length of hospitalization, hospital charges, and in-hospital deaths were also examined. Results The rate of complications significantly decreased during the study periods for HIV-infected and HIV-uninfected women. However, rates of infectious complications and surgical trauma associated with cesarean deliveries remained higher among HIV-infected, compared with HIV-uninfected women in 2010–2011, as did prolonged hospital stay and in-hospital deaths. Length of hospitalization decreased over time for cesarean deliveries of HIV-infected women to a greater extent compared with HIV-uninfected women. Conclusion In the United States, rates of cesarean delivery complications decreased from 1995 to 2011. However, rates of infection, surgical trauma, hospital deaths, and prolonged hospitalization are still higher among HIV-infected women. Clinicians should remain alert to this persistently increased risk of cesarean delivery complications among HIV-infected women. PMID:25574961

  19. Risk Factors for Preterm Birth among HIV-Infected Tanzanian Women: A Prospective Study

    Directory of Open Access Journals (Sweden)

    Rachel M. Zack

    2014-01-01

    Full Text Available Premature delivery, a significant cause of child mortality and morbidity worldwide, is particularly prevalent in the developing world. As HIV is highly prevalent in much of sub-Saharan Africa, it is important to determine risk factors for prematurity among HIV-positive pregnancies. The aims of this study were to identify risk factors of preterm (<37 weeks and very preterm (<34 weeks birth among a cohort of 927 HIV positive women living in Dar es Salaam, Tanzania, who enrolled in the Tanzania Vitamin and HIV Infection Trial between 1995 and 1997. Multivariable relative risk regression models were used to determine the association of potential maternal risk factors with premature and very premature delivery. High rates of preterm (24% and very preterm birth (9% were found. Risk factors (adjusted RR (95% CI for preterm birth were mother <20 years (1.46 (1.10, 1.95, maternal illiteracy (1.54 (1.10, 2.16, malaria (1.42 (1.11, 1.81, Entamoeba coli (1.49 (1.04, 2.15, no or low pregnancy weight gain, and HIV disease stage ≥2 (1.41 (1.12, 1.50. Interventions to reduce pregnancies in women under 20, prevent and treat malaria, reduce Entamoeba coli infection, and promote weight gain in pregnant women may have a protective effect on prematurity.

  20. Bayesian mapping of HIV infection among women of reproductive age in Rwanda.

    Directory of Open Access Journals (Sweden)

    François Niragire

    Full Text Available HIV prevalence is rising and has been consistently higher among women in Rwanda whereas a decreasing national HIV prevalence rate in the adult population has stabilised since 2005. Factors explaining the increased vulnerability of women to HIV infection are not currently well understood. A statistical mapping at smaller geographic units and the identification of key HIV risk factors are crucial for pragmatic and more efficient interventions. The data used in this study were extracted from the 2010 Rwanda Demographic and Health Survey data for 6952 women. A full Bayesian geo-additive logistic regression model was fitted to data in order to assess the effect of key risk factors and map district-level spatial effects on the risk of HIV infection. The results showed that women who had STIs, concurrent sexual partners in the 12 months prior to the survey, a sex debut at earlier age than 19 years, were living in a woman-headed or high-economic status household were significantly associated with a higher risk of HIV infection. There was a protective effect of high HIV knowledge and perception. Women occupied in agriculture, and those residing in rural areas were also associated with lower risk of being infected. This study provides district-level maps of the variation of HIV infection among women of child-bearing age in Rwanda. The maps highlight areas where women are at a higher risk of infection; the aspect that proximate and distal factors alone could not uncover. There are distinctive geographic patterns, although statistically insignificant, of the risk of HIV infection suggesting potential effectiveness of district specific interventions. The results also suggest that changes in sexual behaviour can yield significant results in controlling HIV infection in Rwanda.

  1. Crack cocaine use and adherence to antiretroviral treatment among HIV-infected black women.

    Science.gov (United States)

    Sharpe, Tanya Telfair; Lee, Lisa M; Nakashima, Allyn K; Elam-Evans, Laurie D; Fleming, Patricia L

    2004-04-01

    Since the appearance of crack cocaine in the 1980s, unprecedented numbers of women have become addicted. A disproportionate number of female crack users are Black and poor. We analyzed interview data of HIV-infected women > or = 18 years of age reported to 12 health departments between July 1997 and December 2000 to ascertain if Black women reported crack use more than other HIV-infected women and to examine the relationship between crack use and antiretroviral treatment (ART) adherence among Black women. Of 1655 HIV-infected women, 585 (35%) were nonusers of drugs, 694 (42%) were users of other drugs and 376 (23%) were crack users. Of the 1196 (72%) Black women, 306 (26%) were crack users. We used logistic regression to examine the effect of crack use on adherence to ART, controlling for age and education among Black women. In multivariate analysis, crack users and users of other drugs were less likely than non-users to take their ART medicines exactly as prescribed (odds ratio [OR] = 0.37; 95% confidence interval [CI] = 0.24-0.56), OR = 0.47; 95% CI = 0.36-0.68), respectively. HIV-infected Black women substance users, especially crack cocaine users, may require sustained treatment and counseling to help them reduce substance use and adhere to ART.

  2. Lights and Shadows about the Effectiveness of IVF in HIV Infected Women: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Catarina Marques

    2015-01-01

    Full Text Available Background. HIV infected women have higher rates of infertility. Objective. The purpose of this literature review is to evaluate the effectiveness of fresh IVF/ICSI cycles in HIV infected women. Materials and Methods. A search of the PubMed database was performed to identify studies assessing fresh nondonor oocyte IVF/ICSI cycle outcomes of serodiscordant couples with an HIV infected female partner. Results and Discussion. Ten studies met the inclusion criteria. Whenever a comparison with a control group was available, with the exception of one case, ovarian stimulation cancelation rate was higher and pregnancy rate (PR was lower in HIV infected women. However, statistically significant differences in both rates were only seen in one and two studies, respectively. A number of noncontrolled sources of bias for IVF outcome were identified. This fact, added to the small size of samples studied and heterogeneity in study design and methodology, still hampers the performance of a meta-analysis on the issue. Conclusion. Prospective matched case-control studies are necessary for the understanding of the specific effects of HIV infection on ovarian response and ART outcome.

  3. Relative risk of HIV infection among young men and women in a South African township

    CSIR Research Space (South Africa)

    MacPhail, C

    2002-05-01

    Full Text Available as other sexually transmitted infections (STIs), and answered a behavioural questionnaire. The age-prevalence of HIV infection differs between men and women with considerably higher rates of increase with age among young women. The age of sexual debut did...

  4. 2004-2012年我国4省(自治区)HIV 感染孕产妇检测前后咨询状况及咨询满意度调查%Satisfaction survey on HIV infected pregnant women utilization of HIV Voluntary Counseling and Testing, 2004-2012

    Institute of Scientific and Technical Information of China (English)

    王前; 方利文; 王临虹; 张志慧; 王爱玲; 王芳; 王潇滟

    2013-01-01

    目的了解我国 HIV 感染孕产妇对艾滋病病毒自愿咨询检测(VCT)服务的满意度。方法采用多阶段横断面调查,对2004-2012年我国河南、云南、新疆和广西4省(自治区)7个艾滋病高发地区确诊的所有 HIV 感染孕产妇1367例进行问卷调查,数据采用趋势χ2检验分析不同年度变化趋势。结果HIV 感染孕产妇中,49.31%接受过检测前咨询,95.68%的孕产妇接受过检测后咨询。2004-2012年检测前咨询比例由35.16%升至72.09%,检测后咨询比例由89.01%升至100%。调查对象对检测前、后咨询“非常满意”比例分别为24.04%和34.25%。其中2004年检测前咨询“非常满意”度为0,2012年比例为48.39%;检测后咨询“非常满意或满意”度从2004年的87.65%上升至2012年的100%,检测前、后满意度均呈逐年上升趋势,差异有统计学意义(P <0.01)。结论HIV 感染孕产妇对艾滋病检测前咨询服务的利用仍然较低,医务人员提供咨询服务的技巧和质量有待提高。%Objective To learn the satisfaction degree of HIV pregnant women utilization of HIV Voluntary Coun-seling and Testing (VCT).Methods The multi-staged cross sectional study design was used to collect information.1367 pregnant women in 7 counties from Henan,Yunnan,Xinjiang and Guangxi provinces were recruited in the survey.The HIV pregnant women were investigated by the questionnaire which included social characters,HIV testing,pre-test counseling, post-test counseling and related satisfaction degree,etc.CMHχ2was applied to analysis the trend of pre-or post-test counse-ling rate and change of HIV infected pregnant women satisfaction on counseling.Results Only 49.31% of HIV infected pregnant women received pre-test counseling,and 95.69% of them received post-test counseling.In 2004 -2012,the rates of pre-test and post-test counseling were raised from 35.16%,89.01% to 72.09% and 100% respectively

  5. Association of Kidney Function and Early Kidney Injury With Incident Hypertension in HIV-Infected Women.

    Science.gov (United States)

    Ascher, Simon B; Scherzer, Rebecca; Peralta, Carmen A; Tien, Phyllis C; Grunfeld, Carl; Estrella, Michelle M; Abraham, Alison; Gustafson, Deborah R; Nowicki, Marek; Sharma, Anjali; Cohen, Mardge H; Butch, Anthony W; Young, Mary A; Bennett, Michael R; Shlipak, Michael G

    2017-02-01

    Subclinical kidney disease is associated with developing hypertension in the general population, but data are lacking among HIV-infected people. We examined associations of kidney function and injury with incident hypertension in 823 HIV-infected and 267 HIV-uninfected women in the Women's Interagency HIV Study, a multicenter, prospective cohort of HIV-infected and uninfected women in the United States. Baseline kidney biomarkers included estimated glomerular filtration rate using cystatin C, urine albumin-to-creatinine ratio, and 7 urine biomarkers of tubular injury: α-1-microglobulin, interleukin-18, kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, liver fatty acid-binding protein, N-acetyl-β-d-glucosaminidase, and α1-acid-glycoprotein. We used multivariable Poisson regression to evaluate associations of kidney biomarkers with incident hypertension, defined as 2 consecutive visits of antihypertensive medication use. During a median follow-up of 9.6 years, 288 HIV-infected women (35%) developed hypertension. Among the HIV-infected women, higher urine albumin-to-creatinine ratio was independently associated with incident hypertension (relative risk =1.13 per urine albumin-to-creatinine ratio doubling, 95% confidence interval, 1.07-1.20), as was lower estimated glomerular filtration rate (relative risk =1.10 per 10 mL/min/1.73 m(2) lower estimated glomerular filtration rate; 95% confidence interval, 1.04-1.17). No tubular injury and dysfunction biomarkers were independently associated with incident hypertension in HIV-infected women. In contrast, among the HIV-uninfected women, urine albumin-to-creatinine ratio was not associated with incident hypertension, whereas higher urine interleukin-18, α1-acid-glycoprotein, and N-acetyl-β-d-glucosaminidase levels were significantly associated with incident hypertension. These findings suggest that early glomerular injury and kidney dysfunction may be involved in the pathogenesis of hypertension in

  6. Intimate partner violence and HIV infection among women: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Ying Li

    2014-02-01

    Full Text Available Introduction: To assess evidence of an association between intimate partner violence (IPV and HIV infection among women. Methods: Medline/PubMed, Embase, Web of Science, EBSCO, Ovid, Cochrane HIV/AIDS Group's Specialized Register and Cochrane Central Register of Controlled Trials were searched up to 20 May 2013 to identify studies that examined the association between IPV and HIV infection in women. We included studies on women aged ≥15 years, in any form of sexually intimate relationship with a male partner. Results: Twenty-eight studies [(19 cross-sectional, 5 cohorts and 4 case-control studies involving 331,468 individuals in 16 countries – the US (eight studies, South Africa (four studies, East Africa (10 studies, India (three studies, Brazil (one study and multiple low-income countries (two studies] were included. Results were pooled using RevMan 5.0. To moderate effect estimates, we analyzed all data using the random effects model, irrespective of heterogeneity level. Pooled results of cohort studies indicated that physical IPV [pooled RR (95% CI: 1.22 (1.01, 1.46] and any type of IPV [pooled RR (95% CI: 1.28 (1.00, 1.64] were significantly associated with HIV infection among women. Results of cross-sectional studies demonstrated significant associations of physical IPV with HIV infection among women [pooled OR (95% CI: 1.44 (1.10, 1.87]. Similarly, results of cross-sectional studies indicated that combination of physical and sexual IPV [pooled OR (95% CI: 2.00 (1.24, 3.22 and any type of IPV [pooled OR (95% CI: 1.41 (1.16, 1.73] were significantly associated with HIV infection among women. Conclusions: Available evidence suggests a moderate statistically significant association between IPV and HIV infection among women. To further elucidate the strength of the association between IPV and HIV infection among women, there is a need for high-quality follow-up studies conducted in different geographical regions of the world, and among

  7. Levamisole-Contaminated Cocaine Use in HIV-Infected and Uninfected Unstably Housed Women.

    Science.gov (United States)

    Riley, Elise D; Kral, Alex H; Cohen, Jennifer; Dilworth, Samantha E; Shumway, Martha; Lynch, Kara L

    2016-09-01

    A growing number of case reports cite serious health complications linked to the cocaine adulterant, levamisole and women are disproportionately affected; however, the clinical effects are not well established. Between April and October of 2010, we conducted a cross-sectional study among 222 homeless and unstably housed women (116 human immunodeficiency virus [HIV]-infected and 106 HIV-uninfected). Immune markers and behavioral factors were compared in separate models by cocaine and levamisole exposure. Overall, 63% of participants were toxicology positive for cocaine/benzoylecgonine, 85% of whom also tested positive for levamisole. Differences in immune markers did not reach levels of significance among HIV-uninfected persons. Compared to HIV-infected persons who were negative for both cocaine and levamisole, the adjusted odds of low white blood cell count were significantly higher among HIV-infected persons positive for both (p = 0.03), but not for those positive for cocaine only. Neutrophil count and HIV viral load did not differ by cocaine and levamisole status among HIV-infected persons. In a separate model, the adjusted odds of testing positive for levamisole were higher among African American women compared to Caucasian and Asian women (p = 0.02). In the context of high levamisole prevalence, results suggest that decreased immune function as a result of levamisole exposure occurs mainly in individuals who are already immune compromised (e.g., HIV-positive), and race/ethnicity appears to be an important factor in understanding levamisole exposure among cocaine-using women. While larger and geographically diverse studies are needed to elucidate these initial findings, results suggest that levamisole may be one mechanism of immune dysfunction in HIV-infected cocaine-using women.

  8. Uptake and performance of prevention of mother-to-child transmission and early infant diagnosis in pregnant HIV-infected women and their exposed infants at seven health centres in Addis Ababa, Ethiopia.

    Science.gov (United States)

    Girma, Marshet; Wendaferash, Rahel; Shibru, Hailu; Berhane, Yemane; Hoelscher, Michael; Kroidl, Arne

    2017-06-01

    To assess the uptake of WHO-recommended PMTCT procedures in Ethiopia's health services. Prospective observational study of HIV-positive pregnant mothers and their newborns attending PMTCT services at seven health centres in Addis Ababa. Women were recruited during antenatal care and followed up with their newborns at delivery, Day 6 and Week 6 post-partum. Retention to PMCTC procedures, self-reported antiretroviral treatment (ART) adherence and HIV infant outcome were assessed. Turnaround times of HIV early infant diagnosis (EID) procedures were extracted from health registers. Of 494 women enrolled, 4.9% did not complete PMTCT procedures due to active denial or loss to follow-up. HIV was first diagnosed in 223 (45.1%) and ART initiated in 321 (65.0%) women during pregnancy. ART was initiated in a median of 1.3 weeks (IQR 0-4.3) after HIV diagnosis. Poor self-reported treatment adherence was higher post-partum than during pregnancy (12.5% vs. 7.0%, P = 0.002) and significantly associated with divorced/separated marital status (RR 2.2, 95% CI 1.3-3.8), low family income (RR 2.1, 95% CI 1.1-4.1), low CD4 count (RR 1.7, 95% CI 1.0-3.0) and ART initiation during delivery (RR 2.5, 95% CI 1.1-5.6). Of 435 infants born alive, 98.6% received nevirapine prophylaxis. The mother-to-child HIV transmission rate was 0.7% after a median of 6.7 weeks (IQR 6.4-10.4), but EID results were received for only 46.6% within 3 months of birth. High retention in PMTCT services, triple maternal ART and high infant nevirapine prophylaxis coverage were associated with low mother-to-child HIV transmission. Declining post-partum ART adherence and challenges of EID linkage require attention. © 2017 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  9. Access to gynecological services and Papanicolau tests in HIV-infected Italian women: a questionnaire survey.

    Science.gov (United States)

    Murri, R; Franceschi, S; Ravizza, M; Fiore, S; Bini, T; Mussini, C; Fasolo, M; Liuzzi, G; Ippolito, G; D'Arminio Monforte, A

    2006-05-01

    The objective of the study was to evaluate the access to Papanicolau (Pap) tests of HIV-infected women in Italy. A cross-sectional survey on a cohort of HIV-infected women seen at 27 HIV clinics was performed. At each clinic a female physician involved in the care of HIV-infected women was asked questions on clinic and patients' characteristics and on access to Pap tests. The outcome of the study was to find the percentage of women who had not had a Pap test before coming to the HIV clinic and the percentage having had a Pap test in 2001. In the survey, 7,600 HIV-infected women were represented. Women who came to the clinic without having ever had a Pap test were 62+/-22%, while women who had had a Pap test in 2001 were 43+/-36%. Women who reported never having had a Pap test before coming to the HIV clinic were more often from the south than the north of Italy (17.9+/-49% from the north, 18+/-53% from the center and 9.3+/-83.9% from the south; p<0.001). This a difference disappeared when comparing the women who had had a Pap test in 2001 (28+/-39.6% from the north, 31.6+/-44.2% from the center and 25.6+/-45.7% from the south; p=0.88). Despite the published guidelines in Italy, only 38% of women had ever had a Pap test before coming to the HIV clinic and only 43% had had a Pap test in 2001. Strategies aimed to improve these proportions should be rapidly implemented at all levels of care organization.

  10. Association Between Smoking and Size of Anal Warts in HIV-infected Women

    Science.gov (United States)

    Luu, HN; Amirian, ES; Beasley, RP; Piller, L; Chan, W; Scheurer, ME

    2015-01-01

    While the association between smoking and HPV infection, cervical cancer, and anal cancer has been well studied, evidence on the association between cigarette smoking and anal warts is limited. The purpose of this study was to investigate if cigarette smoking status influences the size of anal warts over time in HIV-infected women in a sample of 976 HIV-infected women from the Women’s Interagency HIV Study (WIHS). A linear mixed model was used to determine the effect of smoking on anal wart size. Even though women who were currently smokers had larger anal warts at baseline and slower growth rate of anal wart size after each visit than women who were not current smokers, there was no association between size of anal wart and current smoking status over time. Further studies on the role of smoking and interaction between smoking and other risk factors, however, should be explored. PMID:23155099

  11. Effect of Pregnancy on Response to Antiretroviral Therapy in HIV-Infected African Women.

    Science.gov (United States)

    Kourtis, Athena P; Wiener, Jeffrey; King, Caroline C; Heffron, Renee; Mugo, Nelly R; Nanda, Kavita; Pyra, Maria; Donnell, Deborah; Celum, Connie; Lingappa, Jairam R; Baeten, Jared M

    2017-01-01

    While most recent evidence does not support a role for pregnancy in accelerating HIV disease progression, very little information is available on the effects of incident pregnancy in response to antiretroviral therapy (ART). Hormonal, immune, and behavioral changes during pregnancy may influence response to ART. We sought to explore the effects of incident pregnancy (after ART initiation) on virologic, immunologic, and clinical response to ART. Data were collected from HIV-infected women participating in 3 prospective studies (Partners in Prevention Herpes simplex virus/HIV Transmission Study, Couples Observational Study, and Partners Preexposure Prophylaxis Study) from 7 countries in Africa from 2004 to 2012. Women were included in this analysis if they were ≤45 years of age, were started on ART during the study and were not pregnant at ART initiation. Pregnancy was treated as a time-dependent exposure variable covering the duration of pregnancy, including all pregnancies occurring after ART initiation. Virologic failure was defined as a viral load (VL) greater than 400 copies per milliliter ≥6 months after ART initiation and viral suppression was defined as VL ≤400 copies per milliliter. Multivariable Cox proportional hazards models were used to assess the association between pregnancy and time to viral suppression, virologic failure, World Health Organization clinical stage III/IV, and death. Linear mixed-effects models were used to assess the association between pregnancy and CD4 count and VL. All analyses were adjusted for confounders, including pre-ART CD4 count and plasma VL. A total of 1041 women were followed, contributing 1196.1 person-years of follow-up. Median CD4 count before ART initiation was 276 cells per cubic millimeter (interquartile range, 209-375); median pre-ART VL was 17,511 copies per milliliter (interquartile range, 2480-69,286). One hundred ten women became pregnant after ART initiation. Pregnancy was not associated with time to

  12. Effect of Pregnancy on Response to Antiretroviral Therapy in HIV-Infected African Women

    Science.gov (United States)

    Wiener, Jeffrey; King, Caroline C.; Heffron, Renee; Mugo, Nelly R.; Nanda, Kavita; Pyra, Maria; Donnell, Deborah; Celum, Connie; Lingappa, Jairam R.; Baeten, Jared M.

    2017-01-01

    Background: While most recent evidence does not support a role for pregnancy in accelerating HIV disease progression, very little information is available on the effects of incident pregnancy in response to antiretroviral therapy (ART). Hormonal, immune, and behavioral changes during pregnancy may influence response to ART. We sought to explore the effects of incident pregnancy (after ART initiation) on virologic, immunologic, and clinical response to ART. Methods: Data were collected from HIV-infected women participating in 3 prospective studies (Partners in Prevention Herpes simplex virus/HIV Transmission Study, Couples Observational Study, and Partners Preexposure Prophylaxis Study) from 7 countries in Africa from 2004 to 2012. Women were included in this analysis if they were ≤45 years of age, were started on ART during the study and were not pregnant at ART initiation. Pregnancy was treated as a time-dependent exposure variable covering the duration of pregnancy, including all pregnancies occurring after ART initiation. Virologic failure was defined as a viral load (VL) greater than 400 copies per milliliter ≥6 months after ART initiation and viral suppression was defined as VL ≤400 copies per milliliter. Multivariable Cox proportional hazards models were used to assess the association between pregnancy and time to viral suppression, virologic failure, World Health Organization clinical stage III/IV, and death. Linear mixed-effects models were used to assess the association between pregnancy and CD4+ count and VL. All analyses were adjusted for confounders, including pre-ART CD4+ count and plasma VL. Results: A total of 1041 women were followed, contributing 1196.1 person-years of follow-up. Median CD4+ count before ART initiation was 276 cells per cubic millimeter (interquartile range, 209–375); median pre-ART VL was 17,511 copies per milliliter (interquartile range, 2480–69,286). One hundred ten women became pregnant after ART initiation. Pregnancy

  13. Antiretroviral therapy and pregnancy: effect on cortical bone status of HIV-infected women

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    V Giacomet

    2012-11-01

    Full Text Available Purpose of the study: Vertical transmission of HIV can be almost eliminated by an appropriate combination of preventative measures, which include the use of combination antiretroviral therapy (ARV during pregnancy, elective cesarean delivery, and avoidance of breastfeeding. Although current ARV demonstrated to be very effective to control virus infection, it has numerous side effects, including negative repercussions on bone mass. Currently there are no data regarding the bone status of HIV-infected women who received ARV during pregnancy. The aim of this study was to evaluate cortical bone status at delivery in a group of HIV-infected women who received ARV during pregnancy, to monitor the changes occurring during the first year post-partum and to compare the results with those obtained in healthy mothers. Methods: We studied 17 HIV-infected and 55 HIV-uninfected healthy women within 3 days from delivery, at 4 and 12 months postpartum (median age 36.4 years. The majority (68% of the HIV-infected mothers was on ARV containing two nucleoside reverse transcriptase inhibitors (NRTI and a protease inhibitor (PI, and 16% was on a regimen containing two NRTIs and two PIs. Other ARV regimens included the use of two NRTIs and one non-NRTI (10%, one NRTI plus one PI (3%, or two NRTIs and three PIs (3%. The median (range exposure to ARV during gestation was 14 (5-35 weeks. The great majority (91% of the women showed an undetectable viral load (<50 cp/mL at delivery. Median CD4 number at delivery was 610 (128 to 1415. Cortical bone status was evaluated by quantitative ultrasonography at the mid-tibia, and bone measurements were expressed as the speed-of-sound (SOS. Summary of results: HIV-infected women after delivery had a median SOS of 3985 (3567–4242 m/s, while the median SOS of healthy women was 4025 (3643–4250. The difference was not significant (t=0.39; P=0.69. SOS measurements at baseline, at 4, and at 12 months are shown in Table 1. SOS values

  14. Invasive cervical cancer risk among HIV-infected women: A North American multi-cohort collaboration prospective study

    Science.gov (United States)

    Abraham, Alison G; Strickler, Howard D; Jing, Yuezhou; Gange, Stephen J; Sterling, Timothy R; Silverberg, Michael; Saag, Michael; Rourke, Sean; Rachlis, Anita; Napravnik, Sonia; Moore, Richard D; Klein, Marina; Kitahata, Mari; Kirk, Greg; Hogg, Robert; Hessol, Nancy A; Goedert, James J; Gill, M John; Gebo, Kelly; Eron, Joseph J; Engels, Eric A; Dubrow, Robert; Crane, Heidi M; Brooks, John T; Bosch, Ronald; D’Souza, Gypsyamber

    2013-01-01

    Objective HIV infection and low CD4+ T-cell count are associated with an increased risk of persistent oncogenic HPV infection – the major risk factor for cervical cancer. Few reported prospective cohort studies have characterized the incidence of invasive cervical cancer (ICC) in HIV-infected women. Methods Data were obtained from HIV-infected and -uninfected female participants in the NA-ACCORD with no history of ICC at enrollment. Participants were followed from study entry or January, 1996 through ICC, loss-to follow-up or December, 2010. The relationship of HIV infection and CD4+ T-cell count with risk of ICC was assessed using age-adjusted Poisson regression models and standardized incidence ratios (SIR). All cases were confirmed by cancer registry records and/or pathology reports. Cervical cytology screening history was assessed through medical record abstraction. Results A total of 13,690 HIV-infected and 12,021 HIV-uninfected women contributed 66,249 and 70,815 person-years (pys) of observation, respectively. Incident ICC was diagnosed in 17 HIV-infected and 4 HIV-uninfected women (incidence rate of 26 and 6 per 100,000 pys, respectively). HIV-infected women with baseline CD4+ T-cells of ≥ 350, 200–349 and <200 cells/uL had a 2.3-times, 3.0-times and 7.7-times increase in ICC incidence, respectively, compared with HIV-uninfected women (Ptrend =0.001). Of the 17 HIV-infected cases, medical records for the 5 years prior to diagnosis showed that 6 had no documented screening, 5 had screening with low grade or normal results, and 6 had high-grade results. Conclusions This study found elevated incidence of ICC in HIV-infected compared to -uninfected women, and these rates increased with immunosuppression. PMID:23254153

  15. Prevalence of Anal HPV and Anal Dysplasia in HIV-Infected Women From Johannesburg, South Africa.

    Science.gov (United States)

    Goeieman, Bridgette J; Firnhaber, Cynthia S; Jong, Eefje; Michelow, Pam; Kegorilwe, Patricia; Swarts, Avril; Williamson, Anna-Lise; Allan, Bruce; Smith, Jennifer S; Wilkin, Timothy J

    2017-07-01

    Anal cancer is a relatively common cancer among HIV-infected populations. There are limited data on the prevalence of anal high-risk human papillomavirus (HR-HPV) infection and anal dysplasia in HIV-infected women from resource-constrained settings. A cross-sectional study of HIV-infected women aged 25-65 years recruited from an HIV clinic in Johannesburg, South Africa. Cervical and anal swabs were taken for conventional cytology and HR-HPV testing. Women with abnormal anal cytology and 20% of women with negative cytology were seen for high-resolution anoscopy with biopsy of visible lesions. Two hundred women were enrolled. Anal HR-HPV was found in 43%. The anal cytology results were negative in 51 (26%); 97 (49%) had low-grade squamous intraepithelial lesions (SIL), 32 (16%) had atypical squamous cells of unknown significance, and 19 (9.5%) had high-grade SIL or atypical squamous cells suggestive of high-grade SIL. On high-resolution anoscopy, 71 (36%) had atypia or low-grade SIL on anal histology and 17 (8.5%) had high-grade SIL. Overall, 31 (17.5%) had high-grade SIL present on anal cytology or histology. Abnormal cervical cytology was found in 70% and cervical HR-HPV in 41%. We found a significant burden of anal HR-HPV infection, abnormal anal cytology, and high-grade SIL in our cohort. This is the first study of the prevalence of anal dysplasia in HIV-infected women from sub-Saharan Africa. Additional studies are needed to define the epidemiology of these conditions, as well as the incidence of anal cancer, in this population.

  16. Perfil clínico e epidemiológico de gestantes infectadas pelo HIV em um serviço do sul do Brasil Clinical and epidemiological profile of HIV-infected pregnant women in a service in south Brazil

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    Cristine Kolling Konopka

    2010-04-01

    ão importantes para prover a apropriada adesão ao tratamento e a redução das taxas de transmissão vertical.PURPOSE: to analyze the clinical and epidemiological profile, the outcome of pregnancy and the vertical transmission of human immunodeficiency virus (HIV-infected pregnant women receiving prenatal care at the University Hospital of Santa Maria (HUSM. METHODS: A prospective study was conducted on 139 HIV-infected pregnant women attended at the High-Risk Prenatal Care Outpatient Clinic of HUSM, during the period from August 2002 to August 2007, with at least two prenatal visits in this service. Data were collected by an interview and by filling out a research protocol during a prenatal visit. The protocol was attached to the medical records of the patient and kept until the outcome of gestation. Descriptive analysis of quantitative variables was performed using the SPSS software, version 15.0. RESULTS: The mean age of the 139 pregnant women studied was 25.6 years (±5.8, 79 (56.8% were white, 81 (58.5% were married or lived in a stable union, and 90 (65.0% had less than eight years of schooling. Fifty-one percent of the pregnant women already had two or more children, with a number of children higher than the mean for the state. The infection was diagnosed during the present or a previous pregnancy in more than 70.0% cases. Sexual exposure occurred in 97.0%, and in 59.6% of cases the partner was known to be infected. During the study period, among the cases properly monitored, only one newborn (0.7% was infected with HIV. CONCLUSIONS: Young women in a socioeconomic situation of vulnerability, with low schooling and multiparous represent the majority of HIV-positive pregnant women attended at the service. Evaluations performed during the prenatal period were relevant for the diagnosis of infection in most cases. An early diagnosis associated with proper clinical, obstetrical and psychological monitoring and with nursing care is important to provide appropriate treatment

  17. Survival and health benefits of breastfeeding versus artificial feeding in infants of HIV-infected women: developing versus developed world.

    Science.gov (United States)

    Kuhn, Louise; Aldrovandi, Grace

    2010-12-01

    Infant feeding policies for HIV-infected women in developing countries differ from policies in developed countries. This article summarizes the epidemiologic data on the risks and benefits of various infant feeding practices for HIV-infected women living in different contexts. Artificial feeding can prevent a large proportion of mother-to-child HIV transmission but also is associated with increases in morbidity and mortality among exposed-uninfected and HIV-infected children. Antiretroviral drugs can be used during lactation and reduce risks of transmission. For most of the developing world, the health and survival benefits of breastfeeding exceed the risks of HIV transmission, especially when antiretroviral interventions are provided.

  18. Psychosocial burden of abnormal pap smears among HIV-infected women at Chon Buri hospital, Thailand.

    Science.gov (United States)

    Jayathunge, Mangala P H; Bowanwatanuwong, Chureeratana; Maek-A-nantawat, Wirach; Pitisuttithum, Benjaluck Phonratland Punnee

    2010-01-01

    This retrospective case-control study assessed the psychological burden of abnormal Pap smears, and their prevalence and characteristics among HIV-infected women attending an HIV clinic. Women with positive (n = 73) and negative Pap-smear results (n = 317) were assessed for psychosocial burden using 4 questionnaires: Psycho-Social Impact of Abnormal Pap Smears (PEAPS-Q), Hospital Anxiety and Depression Scale (HADS), Work Productivity and Impairment (WPAI) and the EURO-Qol Thermometer. The prevalence of pre-cervical cancer lesions in HIV infected woman was 17.5% (ASCUS 2.9%, LSIL 3.8%, HSIL 7.4%, SCC 1.7%, and atypical glandular cells including adenocarcinoma 1.7%). HIV infected women with abnormal Pap smears showed higher anxiety levels on the HADS questionnaire (p = 0.015); this had a significant effect on regular daily activities (p = 0.009) per the WPAI questionnaire compared to HIV positive women with normal Pap smear. Ever married HIV infected woman with an abnormal Pap smear had a significantly lower psychosocial burden using the PEAPS-Q questionnaire (p < 0.001). After adjusting for age and duration since last Pap smear, the education level of the patient was a strong predictor for anxiety. Patients, with a college education had significantly lower anxiety (p = 0.001, 95% CI -5.74 to -1.37) than those with lower or higher education. Women with HSIL were more anxious (p = 0.014, 95% CI 0.49 -4.39) than those with low grade or normal lesions.

  19. Avaliação dos efeitos colaterais da nevirapina em gestantes HIV positivo em Hospital Universitário do sul do Brasil Evaluation of the adverse effects of nevirapine in HIV-infected pregnant women in a South Brazilian University Hospital

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    William Kondo

    2008-01-01

    Full Text Available OBJETIVO: avaliar a freqüência de efeitos advesos com o uso da nevirapina e suas correlações em gestantes infectadas pelo vírus da imunodeficiência humana (HIV. MÉTODOS: estudo retrospectivo foi realizado entre janeiro de 2003 e dezembro de 2006, incluindo todas as mulheres que utilizaram nevirapina durante a gestação. Os critérios de exclusão foram: início da nevirapina antes da gestação; presença de enzimas hepáticas basais aumentadas e dados incompletos de bioquímica hepática no prontuário. Os parâmetros avaliados foram idade, duração de exposição à nevirapina, idade gestacional no início da medicação, semanas de seguimento, carga viral, contagem de CD4 e dosagens de transaminases. A incidência de efeitos adversos hepáticos e/ou cutâneos foi determinada e correlacionada com a contagem de CD4. As análises estatísticas foram realizadas utilizando o teste exato de Fisher e o teste t de Student quando apropriado. A significância estatística foi estabelecida quando p 250 células/µL.PURPOSE: The aim of this article is to evaluate the use of nevirapine HIV-infected pregnant women in our service. METHODS: a retrospective study was performed between January 2003 and December 2006 analysing all women prescribed nevirapine in pregnancy. Exclusion criteria included: (1 women who started nevirapine before pregnancy, (2 patients with abnormal baseline liver enzymes, and (3 women with incomplete liver biochemistry data. Evaluated parameters included age, weeks of exposure to nevirapine, gestational age in the begginning of medication, weeks of follow-up, viral load, CD4 cells count and serum aminotransferase levels. The incidence of adverse hepatic and/or cutaneous effects was determined and correlated to the CD4 cells count. Statistical analysis were performed using Fisher’s exact test and t-Student test when appropriate, with a statistical significance level of p250 cells/µL.

  20. Prevalence and risk factors for cervical intraepithelial neoplasia among HIV-infected women

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    Nara Chartuni Pereira Teixeira

    2012-04-01

    Full Text Available OBJECTIVES: To evaluate the prevalence and the risk factors for cervical intraepithelial neoplasia (CIN among HIV-infected women. METHODS: Cross-sectional study of 494 HIV-infected women in Brazil, between 1998 and 2008. Gynecologic exam was performed, and samples were collected for cervical cytology and for HPV DNA detection. Cervical biopsy was carried out when indicated. HPV infection, CD4 T-lymphocyte count and HIV viral load were compared with cervical histopathology. Univariate and multivariate statistical analyses were performed to evaluate the statistical association of several risk factors. RESULTS: CIN prevalence detected by histopathology was 23.4% (6% of CIN2/3 and 17.4% cases of CIN1. Multivariate analysis confirmed an independent association of CIN with CD4 T-lymphocyte count below 200 cells/mm³ (OR 5.0, 95% CI 2.5-10.1, with a positive detection of HPV DNA (OR 2.0, 95% CI 1.2-3.5, and with age < 34 years old (OR 1.5, 95% CI 1.0-2.4. HIV viral load and antiretroviral use were not independent risk factors for CIN. CONCLUSIONS: Severity of immunosupression, presence of HPV infection and younger age are strong predictors of CIN among HIV-infected women.

  1. Sexual relationship power and depression among HIV-infected women in Rural Uganda.

    Science.gov (United States)

    Hatcher, Abigail M; Tsai, Alexander C; Kumbakumba, Elias; Dworkin, Shari L; Hunt, Peter W; Martin, Jeffrey N; Clark, Gina; Bangsberg, David R; Weiser, Sheri D

    2012-01-01

    Depression is associated with increased HIV transmission risk, increased morbidity, and higher risk of HIV-related death among HIV-infected women. Low sexual relationship power also contributes to HIV risk, but there is limited understanding of how it relates to mental health among HIV-infected women. Participants were 270 HIV-infected women from the Uganda AIDS Rural Treatment Outcomes study, a prospective cohort of individuals initiating antiretroviral therapy (ART) in Mbarara, Uganda. Our primary predictor was baseline sexual relationship power as measured by the Sexual Relationship Power Scale (SRPS). The primary outcome was depression severity, measured with the Hopkins Symptom Checklist (HSCL), and a secondary outcome was a functional scale for mental health status (MHS). Adjusted models controlled for socio-demographic factors, CD4 count, alcohol and tobacco use, baseline WHO stage 4 disease, social support, and duration of ART. The mean HSCL score was 1.34 and 23.7% of participants had HSCL scores consistent with probable depression (HSCL>1.75). Compared to participants with low SRPS scores, individuals with both moderate (coefficient b = -0.21; 95%CI, -0.36 to -0.07) and high power (b = -0.21; 95%CI, -0.36 to -0.06) reported decreased depressive symptomology. High SRPS scores halved the likelihood of women meeting criteria for probable depression (adjusted odds ratio = 0.44; 95%CI, 0.20 to 0.93). In lagged models, low SRPS predicted subsequent depression severity, but depression did not predict subsequent changes in SPRS. Results were similar for MHS, with lagged models showing SRPS predicts subsequent mental health, but not visa versa. Both Decision-Making Dominance and Relationship Control subscales of SRPS were associated with depression symptom severity. HIV-infected women with high sexual relationship power had lower depression and higher mental health status than women with low power. Interventions to improve equity in decision-making and control

  2. Sexual relationship power and depression among HIV-infected women in Rural Uganda.

    Directory of Open Access Journals (Sweden)

    Abigail M Hatcher

    Full Text Available Depression is associated with increased HIV transmission risk, increased morbidity, and higher risk of HIV-related death among HIV-infected women. Low sexual relationship power also contributes to HIV risk, but there is limited understanding of how it relates to mental health among HIV-infected women.Participants were 270 HIV-infected women from the Uganda AIDS Rural Treatment Outcomes study, a prospective cohort of individuals initiating antiretroviral therapy (ART in Mbarara, Uganda. Our primary predictor was baseline sexual relationship power as measured by the Sexual Relationship Power Scale (SRPS. The primary outcome was depression severity, measured with the Hopkins Symptom Checklist (HSCL, and a secondary outcome was a functional scale for mental health status (MHS. Adjusted models controlled for socio-demographic factors, CD4 count, alcohol and tobacco use, baseline WHO stage 4 disease, social support, and duration of ART.The mean HSCL score was 1.34 and 23.7% of participants had HSCL scores consistent with probable depression (HSCL>1.75. Compared to participants with low SRPS scores, individuals with both moderate (coefficient b = -0.21; 95%CI, -0.36 to -0.07 and high power (b = -0.21; 95%CI, -0.36 to -0.06 reported decreased depressive symptomology. High SRPS scores halved the likelihood of women meeting criteria for probable depression (adjusted odds ratio = 0.44; 95%CI, 0.20 to 0.93. In lagged models, low SRPS predicted subsequent depression severity, but depression did not predict subsequent changes in SPRS. Results were similar for MHS, with lagged models showing SRPS predicts subsequent mental health, but not visa versa. Both Decision-Making Dominance and Relationship Control subscales of SRPS were associated with depression symptom severity.HIV-infected women with high sexual relationship power had lower depression and higher mental health status than women with low power. Interventions to improve equity in decision

  3. Cervical Precancer Risk in HIV-Infected Women Who Test Positive for Oncogenic Human Papillomavirus Despite a Normal Pap Test

    Science.gov (United States)

    Keller, Marla J.; Burk, Robert D.; Massad, L. Stewart; Eltoum, Isam-Eldin; Hessol, Nancy A.; Castle, Philip E.; Anastos, Kathryn; Xie, Xianhong; Minkoff, Howard; Xue, Xiaonan; D'Souza, Gypsyamber; Flowers, Lisa; Levine, Alexandra M.; Colie, Christine; Rahangdale, Lisa; Fischl, Margaret A.; Palefsky, Joel M.; Strickler, Howard D.

    2015-01-01

    Background. Determining cervical precancer risk among human immunodeficiency virus (HIV)–infected women who despite a normal Pap test are positive for oncogenic human papillomavirus (oncHPV) types is important for setting screening practices. Methods. A total of 2791 HIV-infected and 975 HIV-uninfected women in the Women's Interagency HIV Study were followed semiannually with Pap tests and colposcopy. Cumulative risks of cervical intraepithelial neoplasia grade 2 or greater (CIN-2+; threshold used for CIN treatment) and grade 3 or greater (CIN-3+; threshold to set screening practices) were measured in HIV-infected and HIV-uninfected women with normal Pap tests, stratified by baseline HPV results, and also in HIV-infected women with a low-grade squamous intraepithelial lesion (LSIL; benchmark indication for colposcopy). Results. At baseline, 1021 HIV-infected and 518 HIV-uninfected women had normal Pap tests, of whom 154 (15%) and 27 (5%), respectively, tested oncHPV positive. The 5-year CIN-2+ cumulative risk in the HIV-infected oncHPV-positive women was 22% (95% confidence interval [CI], 9%–34%), 12% (95% CI, 0%–22%), and 14% (95% CI, 2%–25%) among those with CD4 counts CIN-3+, the cumulative risk averaged 4% (95% CI, 1%–8%) in HIV-infected oncHPV-positive women, and 10% (95% CI, 0%–23%) among those positive for HPV type 16. In HIV-infected women with LSIL, CIN-3+ risk was 7% (95% CI, 3%–11%). In multivariate analysis, HIV-infected HPV16-positive women had 13-fold (P = .001) greater CIN-3+ risk than oncHPV-negative women (referent), and HIV-infected women with LSIL had 9-fold (P < .0001) greater risk. Conclusions. HIV-infected women with a normal Pap result who test HPV16 positive have high precancer risk (similar to those with LSIL), possibly warranting immediate colposcopy. Repeat screening in 1 year may be appropriate if non-16 oncHPV is detected. PMID:26187020

  4. The association of perceived stress and verbal memory is greater in HIV-infected versus HIV-uninfected women.

    Science.gov (United States)

    Rubin, Leah H; Cook, Judith A; Weber, Kathleen M; Cohen, Mardge H; Martin, Eileen; Valcour, Victor; Milam, Joel; Anastos, Kathryn; Young, Mary A; Alden, Christine; Gustafson, Deborah R; Maki, Pauline M

    2015-08-01

    In contrast to findings from cohorts comprised primarily of HIV-infected men, verbal memory deficits are the largest cognitive deficit found in HIV-infected women from the Women's Interagency HIV Study (WIHS), and this deficit is not explained by depressive symptoms or substance abuse. HIV-infected women may be at greater risk for verbal memory deficits due to a higher prevalence of cognitive risk factors such as high psychosocial stress and lower socioeconomic status. Here, we investigate the association between perceived stress using the Perceived Stress Scale (PSS-10) and verbal memory performance using the Hopkins Verbal Learning Test (HVLT) in 1009 HIV-infected and 496 at-risk HIV-uninfected WIHS participants. Participants completed a comprehensive neuropsychological test battery which yielded seven cognitive domain scores, including a primary outcome of verbal memory. HIV infection was not associated with a higher prevalence of high perceived stress (i.e., PSS-10 score in the top tertile) but was associated with worse performance on verbal learning (p memory (p stress was associated with poorer performance in those cognitive domains (p's stress interaction was found only for the verbal memory domain (p = 0.02); among HIV-infected women only, high stress was associated with lower performance (p's memory measure in particular. These findings suggest that high levels of perceived stress contribute to the deficits in verbal memory observed in WIHS women.

  5. The incidence of complications after cesarean section in HIV-infected women with advanced WHO stages of HIV disease

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    S Shevchenko

    2012-11-01

    Full Text Available Prevalence of HIV infection in Ukraine is 1.6% overall, with antenatal prevalence of 0.52%, the highest in Europe. According to national protocol, cesarean section has been recommended for women with viral load above 50 copies/mL to further prevent vertical transmission of HIV. The aim of our study was to compare the infectious complication rates after cesarean delivery in HIV-infected women with advanced WHO stages of HIV disease who received HAART, and HIV-infected women with I or II WHO stages. Materials and methods: A retrospective analysis was performed on data derived from 150 HIV-infected women with advanced WHO stages of HIV disease (group I and 150 HIV-infected women with I or II WHO stages (group II, who underwent cesarean delivery. Postoperative infectious morbidity in both groups was analyzed according to whether the cesarean section was an elective or emergent delivery. Descriptive, comparison analyses were performed. Results: There was no significant difference between the both groups in terms of gravidity, parity, number of previous cesarean sections, estimated gestational age at time of delivery. It has been shown that HIV-infected women from the group I have 2 times more factors for the appearance of postpartum infectious complications, such as anemia, the urinary tract infection, sexually transmitted infections. Both groups of women were statistically more likely to experience postpartum endometritis when being delivered by emergent cesarean section than by elective cesarean section (14.6% versus 4.6%, respectively in the group I and 5.3% versus 0.5%, respectively, in the group II, superficial or deep wound breakdown (22.6% versus 4.6%, respectively, in the first group and 5.3% versus 2.6%, respectively, in the second group. Septic pelvic thrombophlebitis was only in 2% of HIV-infected women from the group I. Urinary tract infection had 25% HIV-infected women in the both groups. Overall, the rate of postpartum infectious

  6. Safety and acceptability of vaginal disinfection with benzalkonium chloride in HIV infected pregnant women in west Africa: ANRS 049b phase II randomized, double blinded placebo controlled trial. DITRAME Study Group

    Science.gov (United States)

    Msellati, P.; Meda, N.; Leroy, V.; Likikouet, R.; Van de Perre, P.; Cartoux, M.; Bonard, D.; Ouangre, A.; Combe, P.; Gautier-Charpenti..., L.; Sylla-Koko, F.; Lassalle, R.; Dosso, M.; Welffens-Ekra, C.; Dabis, F.; Mandelbrot, L.

    1999-01-01

    OBJECTIVES: To study the tolerance and acceptability in Africa of a perinatal intervention to prevent vertical HIV transmission using benzalkonium chloride disinfection. DESIGN: A randomized, double blinded phase II trial. SETTING: Prenatal care units in Abidjan (Cote d'Ivoire) and Bobo-Dioulasso (Burkina Faso). PATIENTS: Women accepting testing and counselling who were seropositive for HIV-1 and under 37 weeks of pregnancy were eligible. A total of 108 women (54 in each group) enrolled from November 1996 to April 1997, with their informed consent. INTERVENTION: Women self administered daily a vaginal suppository of 1% benzalkonium chloride or matched placebo from 36 weeks of pregnancy, and a single intrapartum dose. The neonate was bathed with 1% benzalkonium chloride solution or placebo within 30 minutes after birth. MAIN OUTCOME MEASURES: Adverse events were recorded weekly, with a questionnaire and speculum examination in women through delivery, and examination of the neonate through day 30. The incidence of genital signs and symptoms in the women and cutaneous or ophthalmological events in newborns were compared between groups on an intent to treat basis. RESULTS: The median duration of prepartum treatment was 21 days (range 0-87 days). Compliance was 87% for prepartum and 69% for intrapartum treatment, and 88% for the neonatal bath, without differences between the two groups. In women, the most frequent event was leucorrhoea; the incidence of adverse events did not differ between treatment groups. In children, the incidence of dermatitis and conjunctivitis did not differ between the benzalkonium chloride and placebo groups (p = 0.16 and p = 0.29, respectively). CONCLUSION: Vaginal disinfection with benzalkonium chloride is a feasible and well tolerated intervention in west Africa. Its efficacy in preventing vertical HIV transmission remains to be demonstrated. 


 PMID:10754950

  7. Vitamin Supplementation Increases Risk of Subclinical Mastitis in HIV-Infected Women123

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    Arsenault, Joanne E.; Aboud, Said; Manji, Karim P.; Fawzi, Wafaie W.; Villamor, Eduardo

    2010-01-01

    Subclinical mastitis is common in HIV-infected women and is a risk factor for mother-to-child transmission of HIV. The purpose of this study was to examine the effect of vitamin supplementation [vitamin A + β-carotene, multivitamins (B complex, C, and E), or multivitamins, including vitamin A + β-carotene] on the risk of subclinical mastitis during the first 2 y postpartum among HIV-infected women. The study was a randomized, placebo-controlled, clinical trial including 674 HIV-infected, antiretroviral naïve Tanzanian women who were recruited during pregnancy and followed-up after delivery. Breast milk samples were obtained approximately every 3 mo. Any subclinical mastitis was defined as a ratio of the sodium to potassium (Na:K) breast milk concentrations > 0.6 and further classified as either moderate (Na:K ≥ 0.6 and ≤ 1) or severe (Na:K > 1.0). Fifty-eight percent of women had at least 1 episode of any subclinical mastitis. Women assigned to multivitamins (B complex, C, and E) had a 33% greater risk of any subclinical mastitis (P = 0.005) and a 75% greater risk of severe subclinical mastitis (P = 0.0006) than women who received the placebo. Vitamin A + β-carotene also increased the risk of severe subclinical mastitis by 45% (P = 0.03). Among women with CD4+ T-cell counts ≥ 350 cells/μL, multivitamin intake resulted in a 49% increased risk of any subclinical mastitis (P = 0.006); by contrast, there were no treatment effects among women with CD4+ T-cell counts mastitis. PMID:20739447

  8. The reproductive health behaviors of HIV-infected young women in the United States: A literature review.

    Science.gov (United States)

    Carter, Marion W; Kraft, Joan M; Hatfield-Timajchy, Kendra; Snead, Margaret C; Ozeryansky, Larisa; Fasula, Amy M; Koenig, Linda J; Kourtis, Athena P

    2013-12-01

    HIV-infected young women in the United States have important reproductive health needs that are made more complex by their HIV status. We searched Pubmed and relevant bibliographies to identify 32 articles published from 2001 to July 2012 that described the prevalence, correlates, and characteristics of the sexual activity, relationships, pregnancy intentions, HIV status disclosure, and contraceptive and condom use among US HIV-infected adolescents and young women. Our synthesis of those articles found that, like youth not infected with HIV, substantial proportions of HIV-infected youth were sexually active, and most sought romantic or sexual relationships, though their serostatus may have affected the pace of physical and emotional intimacy. Disclosure was difficult, and large proportions of HIV-infected youth had not disclosed their serostatus to recent partners. A few studies suggest that most HIV-infected young women hoped to have children in the future, but many wanted to avoid pregnancy until later. Only one study described contraceptive use among this population in detail and found that condoms were a primary method of contraception. The results point to substantial gaps in published research, particularly in the areas of pregnancy intentions and contraceptive use. Much more needs to be done in research and health services to better understand and meet the complex health needs of HIV-infected young women.

  9. Evaluation of bone alterations in the jaws of HIV-infected menopausal women

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    Bruno Vieira Caputo

    2013-06-01

    Full Text Available The advent of highly active antiretroviral therapy (HAART has caused a reduction in mortality, thus contributing to an increase in the number of women with HIVࢧAIDS who reach the climacteric period, experience decline in ovarian function, and develop complications of viral infection and HAART, which can accelerate bone loss. The aim of this study was to detect possible alterations in the jaws of HIV-infected women by panoramic radiography. The study comprised a total of 120 women above 40 years of age who were divided into the following two groups: women who are HIV positive (Group I and women with no known HIV infection (Group II. Measurement of the following three radiomorphometric indexes was performed by panoramic radiography: Mental Index (MI, Panoramic Mandibular Index (PMI and Antegonial Depth (AD. A total of 70% of women in the control group and 50% of women in the HIV group were in the postmenopausal period, and the average values of both MI (p = 0.0054 and AD (p < 0.0001 for this period were lower in the HIV group than in the control group. For patients who were in the premenopausal period, the average AD was lower in the HIV group than in the control group (p = 0.0003. Despite the difference in the average age between groups, greater bone resorption in the mandible was found in the group of HIV-positive women.

  10. Relationship of vitamin D, HIV, HIV treatment, and lipid levels in the Women's Interagency HIV Study of HIV-infected and uninfected women in the United States.

    Science.gov (United States)

    Schwartz, Janice B; Moore, Kelly L; Yin, Michael; Sharma, Anjali; Merenstein, Dan; Islam, Talat; Golub, Elizabeth T; Tien, Phyllis C; Adeyemi, Oluwatoyin M

    2014-01-01

    Relationships between vitamin D, lipids, HIV infection, and HIV treatment (±antiretroviral therapy [ART]) were investigated with Women's Interagency HIV Study data (n = 1758 middle-aged women) using multivariable regression. Sixty-three percent of women had vitamin D deficiency. Median 25-hydroxyvitamin D (25-OH vitamin D) was highest in HIV-infected + ART-treated women (17 ng/mL; P HIV treatment. Similarly, vitamin D levels were positively related to triglycerides only in ART-treated HIV-infected women and unrelated to cholesterol.

  11. Transactional sex among young women in rural South Africa: prevalence, mediators and association with HIV infection

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    Meghna Ranganathan

    2016-07-01

    Full Text Available Introduction: Young adolescent women in sub-Saharan Africa are three to four times more likely to be HIV-positive than boys or men. One of the relationship dynamics that is likely to be associated with young women's increased vulnerability to HIV is transactional sex. There are a range of HIV-related risk behaviours that may drive this vulnerability. However, to date, limited epidemiological data exist on the role of transactional sex in increasing HIV acquisition, especially among young women in sub-Saharan Africa. Our paper presents data on the prevalence of self-reported engagement in transactional sex and explores whether transactional sex is associated with increased risk of HIV infection among a cohort of young, rural, sexually active South African women. We also explore whether this relationship is mediated through certain HIV-related risk behaviours. Methods: We analyzed baseline data from a phase III trial of conditional cash transfers for HIV prevention of 693 sexually active, school-going young women aged 13–20 years in rural South Africa. We examined the association between young women's engagement in transactional sex and HIV infection. Transactional sex is defined as a non-commercial, non-marital sexual relationship whereby sex is exchanged for money and/or gifts. We explored whether this relationship is mediated by certain HIV-related risk behaviours. We used logistic and multinomial regression and report unadjusted and adjusted odds ratios with 95% CI. Results: Overall, 14% (n=97 of sexually active young women reported engaging in transactional sex. Engagement in transactional sex was associated with an increased risk of being HIV-positive (aOR: 2.5, CI: 95% 1.19–5.25, p=0.01. The effect size of this association remained nearly unchanged when adjusted for certain other dimensions of HIV risk that might help explain the underlying pathways for this relationship. Conclusions: This study provides quantitative support

  12. Toxoplasmic encephalitis in an HIV infected pregnant woman: successful outcome for both mother and child

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    Susie Andries Nogueira

    Full Text Available This report describes a case of Toxoplasma encephalitis during pregnancy of an HIV infected woman who was severely immunosuppressed (CD4: 17 cells/mm3, had a high viral load (RNA PCR:230,000 copies/ml, was treated with sulfadiazine, pyrimethamine and folinic acid for toxoplasmosis and was being treated with highly potent antiretroviral drugs (AZT, 3TC and nelfinavir for HIV infection. The newborn was born through an elective C-section, received six weeks of AZT according to the 076 protocol and was clinically normal at birth. Subsequently he had two RNA PCR negatives for HIV, seroreverted and had no clinical or laboratory evidence of congenital toxoplasmosis. Despite the concerns of the use of these combined therapies on the foetus during pregnancy, their efficacy illustrates that keeping the mother alive and in good health is an important strategy to protect the unborn child from acquiring these two infections.

  13. Toxoplasmic encephalitis in an HIV infected pregnant woman: successful outcome for both mother and child

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    Susie Andries Nogueira

    2002-08-01

    Full Text Available This report describes a case of Toxoplasma encephalitis during pregnancy of an HIV infected woman who was severely immunosuppressed (CD4: 17 cells/mm3, had a high viral load (RNA PCR:230,000 copies/ml, was treated with sulfadiazine, pyrimethamine and folinic acid for toxoplasmosis and was being treated with highly potent antiretroviral drugs (AZT, 3TC and nelfinavir for HIV infection. The newborn was born through an elective C-section, received six weeks of AZT according to the 076 protocol and was clinically normal at birth. Subsequently he had two RNA PCR negatives for HIV, seroreverted and had no clinical or laboratory evidence of congenital toxoplasmosis. Despite the concerns of the use of these combined therapies on the foetus during pregnancy, their efficacy illustrates that keeping the mother alive and in good health is an important strategy to protect the unborn child from acquiring these two infections.

  14. Relationship between heterosexual anal sex, injection drug use and HIV infection among black men and women.

    Science.gov (United States)

    Risser, J M H; Padgett, P; Wolverton, M; Risser, W L

    2009-05-01

    US blacks carry a disproportionate risk of heterosexually transmitted HIV. This study aimed to evaluate the association between self-reported heterosexual anal intercourse and HIV. Using respondent-driven sampling (RDS), we recruited and interviewed 909 blacks from areas of high poverty and HIV prevalence in Houston, Texas, and who reported heterosexual sex in the last year. All individuals were tested for HIV. Weighted prevalence values were calculated to account for non-random recruitment associated with RDS. The weighted population prevalence of HIV infection was 2.4% and 2.5% among men and women, respectively. Education, employment status, income and crack cocaine use were not associated with HIV infection. Lifetime injection drug use (odds ratio [OR] 3.31, 95% confidence interval [CI] 1.31-8.33%) and heterosexual anal intercourse (OR 2.41, 95% CI 1.02-5.73%) were associated with HIV infection. Individuals who reported both injection drug use and heterosexual anal intercourse had 6.21 increased odds of HIV (95% CI 2.47-15.61%). Our results suggest that heterosexual anal sex may be a vector for HIV transmission, especially in the context of injection drug use. Prevention strategies directed at curbing the HIV epidemic among black heterosexuals require that we correctly identify the risks so that appropriate interventions can be developed.

  15. Knowledge of HPV among HIV-Infected and HIV-Uninfected Adolescent Women in South Africa.

    Science.gov (United States)

    Griffith, David C; Adler, David; Wallace, Melissa; Bennie, Thola; Abar, Beau; Bekker, Linda-Gail

    The aim of this study is to examine the knowledge of human papillomavirus (HPV) and cervical cancer among HIV-infected and HIV-uninfected female adolescents in South Africa. Subjects were recruited from a parent study of HPV infection comprised of females ages 16-21 in Masiphumelele, Cape Town, South Africa. A total of 30 subjects, 15 HIV-infected and 15 HIV-uninfected, were selected via randomization and completed a measure of HPV knowledge, based on a previously validated instrument. The study took place in May 2013. The overall mean score on the measure for all subjects was 43.3% (S.D. 10.9). There was no significant difference in HPV knowledge between the HIV-infected and HIV-uninfected groups. Based on results from a previous large-scale study using the same validated measure, this sample scored significantly worse on general HPV knowledge than samples from the US, UK, and Australia. Given the limited knowledge of HPV in this sample, there is greater need for education about the prevention of cervical cancer, specifically among high-risk adolescent women.

  16. Central nervous system manifestations of HIV infection in children

    Energy Technology Data Exchange (ETDEWEB)

    George, Reena; Andronikou, Savvas; Plessis, Jaco du; Plessis, Anne-Marie du; Maydell, Arthur [University of Stellenbosch, Department of Radiology, Tygerberg Academic Hospital, Cape Town (South Africa); Toorn, Ronald van [University of Stellenbosch, Department of Paediatrics and Child Health, Tygerberg Academic Hospital, Cape Town (South Africa)

    2009-06-15

    Vertically transmitted HIV infection is a major problem in the developing world due to the poor availability of antiretroviral agents to pregnant women. HIV is a neurotrophic virus and causes devastating neurological insults to the immature brain. The effects of the virus are further compounded by the opportunistic infections and neoplasms that occur as a result of the associated immune suppression. This review focuses on the imaging features of HIV infection and its complications in the central nervous system. (orig.)

  17. Pursuing Treatment and Moral Worth: HIV-Infected Women in a Northern Province of Vietnam Living With Antiretroviral Therapy

    DEFF Research Database (Denmark)

    Nguyen, Nam Thi Thu; Rasch, Vibeke; Bygbjerg, Ib Christian;

    2012-01-01

    There is a need to understand how social and cultural expectations of being a woman shape the challenges women face when trying to access antiretroviral therapy (ART) and to continue the treatment over time. Based on a 7-month prospective study of 15 HIV-infected women, the particular challenges...... met by these women in northern Vietnam are discussed in this article. We argued that, by taking ART to maintain their health and to fulfill their responsibilities to family and community, the women managed to reclaim the "moral worth" they had lost as a result of having HIV infection. At the same time...

  18. Structural and sociocultural factors associated with cervical cancer screening among HIV-infected African American women in Alabama.

    Science.gov (United States)

    Williams, Michelle; Moneyham, Linda; Kempf, Mirjam-Colette; Chamot, Eric; Scarinci, Isabel

    2015-01-01

    African American women have disproportionately high prevalence rates of HIV and cervical cancer. HIV-infected women are significantly less likely to obtain recommended cervical cancer screenings than HIV-uninfected women. The purpose of this study was to examine sociocultural and structural factors associated with cervical cancer screening among HIV-infected African American in Alabama. The PEN-3 Model and the Health Belief Model were used as theoretical frameworks. In-depth interviews were conducted with twenty HIV-infected African American women to identify perceptions, enablers, and nurturers, perceived susceptibility, perceived severity, and perceived benefits related to cervical cancer and screening. The most common positive perceptions, enablers, and nurturers that contributed to cervical cancer screening included internal motivation and awareness of the importance of HIV-infected women getting Pap tests due to their weakened immune system. Negative perceptions, enablers, and nurturers included lack of knowledge about cervical cancer and screening, and lack of perceived susceptibility to cervical cancer. The results of this study can be used to guide the development of culturally relevant cervical cancer and screening education interventions aimed at increasing cervical cancer screening adherence among HIV-infected African American women.

  19. Detection of Fastidious Vaginal Bacteria in Women with HIV Infection and Bacterial Vaginosis

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    Caroline Mitchell

    2009-01-01

    Full Text Available Background. Fastidious bacteria have been associated with bacterial vaginosis (BV using PCR methods. We assessed the prevalence of these bacteria in HIV-1 infected women and their relationship with vaginal pH and shedding of HIV-1 RNA. Methods. 64 cervicovaginal lavage (CVL samples were collected from 51 women. Vaginal microbiota were characterized using 8 bacterium-specific quantitative PCR assays. Results. Women with the fastidious bacteria Bacterial Vaginosis Associated Bacterium (BVAB 1, 2, and 3 showed a trend to increased HIV-1 shedding (OR 2.59–3.07, P=.14–.17. Absence of Lactobacillus crispatus (P<.005 and presence of BVAB2 (P<.001 were associated with elevated vaginal pH. BVAB1, 2, and 3 were highly specific indicators of BV in HIV-infected women, with specificities of 89%–93%. Conclusions. Fastidious bacteria (BVAB 1, 2, and 3 remain specific indicators of BV in HIV-infected women, and BVAB2 may contribute to the elevated vaginal pH that is a hallmark of this syndrome.

  20. Poverty, food insufficiency and HIV infection and sexual behaviour among young rural Zimbabwean women.

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    Sophie J S Pascoe

    Full Text Available Despite a recent decline, Zimbabwe still has the fifth highest adult HIV prevalence in the world at 14.7%; 56% of the population are currently living in extreme poverty.Cross-sectional population-based survey of 18-22 year olds, conducted in 30 communities in south-eastern Zimbabwe in 2007.To examine whether the risk of HIV infection among young rural Zimbabwean women is associated with socio-economic position and whether different socio-economic domains, including food sufficiency, might be associated with HIV risk in different ways.Eligible participants completed a structured questionnaire and provided a finger-prick blood sample tested for antibodies to HIV and HSV-2. The relationship between poverty and HIV was explored for three socio-economic domains: ability to afford essential items; asset wealth; food sufficiency. Analyses were performed to examine whether these domains were associated with HIV infection or risk factors for infection among young women, and to explore which factors might mediate the relationship between poverty and HIV.2593 eligible females participated in the survey and were included in the analyses. Overall HIV prevalence among these young females was 7.7% (95% CI: 6.7-8.7; HSV-2 prevalence was 11.2% (95% CI: 9.9-12.4. Lower socio-economic position was associated with lower educational attainment, earlier marriage, increased risk of depression and anxiety disorders and increased reporting of higher risk sexual behaviours such as earlier sexual debut, more and older sexual partners and transactional sex. Young women reporting insufficient food were at increased risk of HIV infection and HSV-2.This study provides evidence from Zimbabwe that among young poor women, economic need and food insufficiency are associated with the adoption of unsafe behaviours. Targeted structural interventions that aim to tackle social and economic constraints including insufficient food should be developed and evaluated alongside behaviour

  1. The prevalence of precancerous cervical cancer lesion among HIV-infected women in southern Ethiopia: a cross-sectional study.

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    Abel Gedefaw

    Full Text Available INTRODUCTION: The magnitude of precancerous cervical cancer lesions as well as invasive cervical cancer is higher in HIV-infected women than non HIV-infected women. Thus, screening targeting HIV-infected women is being undertaken in developing countries, including Ethiopia. However, data on the prevalence and determinants of precancerous cervical cancer lesion among HIV-infected women in southern Ethiopia is lacking. Thus, this study aimed to assess the prevalence of and factors associated with precancerous cervical cancer lesion among HIV- infected women in southern Ethiopia. METHODS: A hospital-based cross-sectional study was conducted from October 2012 to February 2013 among HIV-infected women in Southern Ethiopia. Four hundred forty eight HIV-infected women who had been screened and treated for precancerous cervical cancer lesion were included in the study. Data were collected by using structured and pretested questionnaire. Visual inspection with acetic acid was applied for screening and treatment. SPSS version 16.0 was used for data entry and analysis. Logistic regression analysis was fitted and odds ratios with 95% Confidence intervals and p-values were computed to identify factors associated with precancerous cervical cancer lesion. RESULTS: Out of 448 study participants, 99 (22.1% were found to be positive for precancerous cervical cancer. Being currently on highly active antiretroviral treatment (AOR=0.52, 95%CI: 0.35, 0.92, history of sexually transmitted disease (AOR=2.30, 95%CI: 1.23, 4.29 and having only one lifetime sexual partner (AOR=0.33, 95%CI: 0.20, 0.56 were factors associated with precancerous cervical cancer lesion. CONCLUSIONS: The prevalence of precancerous cervical cancer lesion among HIV-infected women in southern Ethiopia was found to be high. Intervention to access all HIV-infected women like scaling up the limited services and awareness creation should be undertaken. Measures aimed at preventing the acquisition and

  2. Poverty, unstable housing, and HIV infection among women living in the United States.

    Science.gov (United States)

    Riley, Elise D; Gandhi, Monica; Hare, C; Cohen, Jennifer; Hwang, Stephen

    2007-12-01

    Women who are HIV positive incur a higher risk of mortality than men who are HIV positive, a difference which is primarily based in the social context of poverty. Economic crises that lead to homelessness, unmet subsistence needs, and sex exchange often reorder priorities among women with HIV infection, de-emphasizing consistent medical care or the use of antiretroviral therapy. High rates of mental illness, drug use, and victimization further increase health and safety risks. HIV prevention messages highlighting education and behavior change insufficiently address the predicament of indigent women where constrained survival choices in the context of poverty may take precedence over safe behaviors. In this article, we highlight the risks of poor and unstably housed women to clarify the context in which risks occur. Suggestions for service provision are offered with the understanding that providers may have limited time and expertise to meet the entire array of needs for impoverished women.

  3. Gynaecological morbidity among HIV positive pregnant women in Cameroon

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    Nana Philip N

    2008-07-01

    Full Text Available Abstract Objective To compare the prevalence of gynaecological conditions among HIV infected and non-infected pregnant women. Methods Two thousand and eight (2008 pregnant women were screened for HIV, lower genital tract infections and lower genital tract neoplasia at booking antenatal visit. Results About 10% (198/2008 were HIV positive. All lower genital tract infections except candidiasis were more prevalent among HIV positive compared to HIV negative women: vaginal candidiasis (36.9% vs 35.4%; p = 0.678, Trichomoniasis (21.2% vs 10.6%; p p p = 0.026, syphilis (35.9% vs 10.6%; p Chlamydia trachomatis (38.4% vs 7.1%; p p p Conclusion We conclude that (i sexually transmitted infections (STIs are common in both HIV positive and HIV negative pregnant women in Cameroon, and (ii STIs and preinvasive cervical lesions are more prevalent in HIV-infected pregnant women compared to their non-infected compatriots. We recommend routine screening and treatment of STIs during antenatal care in Cameroon and other countries with similar social profiles.

  4. Predictors of early breastfeeding cessation among HIV-infected women in Botswana.

    Science.gov (United States)

    Ogwu, Anthony; Moyo, Sikhulile; Powis, Kathleen; Asmelash, Aida; Lockman, Shahin; Moffat, Claire; Leidner, Jean; Makhema, Joseph; Essex, Max; Shapiro, Roger

    2016-08-01

    Infants born to HIV-infected women receiving antiretroviral treatment (ART) can be breastfed through at least 6 months with very low risk of HIV acquisition. We aimed to identify demographic and cultural factors that may influence mothers' willingness to breastfeed for the recommended duration. We evaluated factors associated with early cessation of breastfeeding (i.e. before 5 months post-partum) in a randomized clinical trial evaluating different ART regimens used for prevention of mother-to-child transmission during breastfeeding in Botswana. Univariate and multivariable Cox regressions were used to describe predictors of early exclusive BF cessation. Among 677 women who started breastfeeding, the median time to breastfeeding cessation was 178 days (IQR 150-181) and 25.1% weaned early. In multivariable analysis, urban location (aHR = 1.86 95%CI 1.27-2.73; P = 0.002), salaried employment or being a student (aHR = 2.78 95% CI 1.63-4.75; P < 0.001) and infant hospitalisation before weaning (aHR = 2.04 95% CI 1.21-3.45; P = 0.008) were independently and significantly associated with early BF cessation. Improved support for breastfeeding among employed mothers, especially in urban settings, may allow HIV-infected women who are receiving ART prophylaxis to breastfeed longer. © 2016 John Wiley & Sons Ltd.

  5. Growth Patterns in the First Year of Life Differ in Infants Born to Perinatally vs. Non-Perinatally HIV-infected Women

    Science.gov (United States)

    Jao, Jennifer; Agwu, Allison; Mhango, Grace; Kim, Annie; Park, Kaye; Posada, Roberto; Abrams, Elaine J.; Hutton, Nancy; Sperling, Rhoda S.

    2015-01-01

    Objective To compare growth patterns in the first year of life between children born to perinatally HIV-infected (PHIV) vs. non-perinatally HIV-infected (NPHIV) women in the U.S. Design Retrospective cohort study of HIV-infected pregnant women who received care and delivered a liveborn at two urban tertiary centers from January 2004 - March 2012. Methods We collected data via chart review on demographics, behavioral risk factors, HIV clinical markers, combination antiretroviral therapy (cART), mode of HIV acquisition, pregnancy outcomes, and infant anthropometrics on study subjects. Mixed effects models were used to assess the association between maternal mode of HIV acquisition and weight-for-age (WAZ), length-for-age (LAZ), and weight-for-length (WLZ) z-scores. Results Of 152 pregnancies evaluated, 32 and 120 infants were born to 25 PHIV and 99 NPHIV women respectively. Infants of PHIV women exhibited lower mean WAZ and LAZ throughout the first year of life in unadjusted analyses. After adjusting for potential confounders, the relationship between PHIV & LAZ persisted (β=−0.54, p=0.026). Small for gestational age for each birth anthropometric parameter [birth length, birth weight, and both birth length and weight] was associated with decreased LAZ (β=−0.48, p=0.007), WAZ (β=−0.99, p<0.001) and WLZ (β=−0.36, p=0.027) respectively. A delivery HIV RNA level <400 copies/mL was associated with increased WAZ & WLZ (β=0.43, p=0.015; β=0.38, p=0.021). Conclusions Infants of PHIV women may remain at persistently decreased lengths throughout the first year of life. Further studies aimed at understanding intrauterine and environmental factors in PHIV women are warranted. PMID:25562495

  6. Implications of Post-LLETZ “Treatment Failure” for Further Management of HIV-Infected Women

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    Louis-Jacques van Bogaert

    2014-01-01

    Full Text Available Background. Since the preconisation presence of high-risk human papillomavirus (HR-HPV is the main determinant of the risk of progression of preinvasive lesions; the state of the excision margins could be of less importance. Relatively little is known about the effect of human immunodeficiency virus (HIV infection on the relation between the states of the excision margins. Methods. We compared 120 HIV-infected and 139 HIV-uninfected women who underwent a hysterectomy after large loop excision of the transformation zone (LLETZ for abnormal Pap smear. Results. The excision margins had been reported negative in 21.7% of infected and 7.8% of uninfected cases (P=0.03. Three (11.5% of 26 negative margins in HIV-infected and 2 (18.2 out of HIV-uninfected cases were falsely negative as evidenced on hysterectomy specimens (P=0.73. The persistence rate of the initial lesion was similar in both groups (P=0.20. The persistence rate with highly active antiretroviral treatment (HAART was similar to untreated patients (P=0.20. The progression rate from low-grade to high-grade preinvasive lesions was higher in HIV-infected than HIV-uninfected women (P=0.027. Conclusion. HIV-infected women with incomplete excision margins after LLETZ are at higher risk of progression of residual preneoplastic lesions.

  7. Prevalence of HIV and anemia among pregnant women

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    Bankole Henry Oladeinde

    2011-01-01

    Full Text Available Background: Human immunodeficiency virus (HIV prevalence is high among rural dwellers and pregnant women. Aims: This study aims to determine the prevalence of HIV and anemia among pregnant women attending antenatal clinic in rural community of Okada, Edo State, Nigeria. Patients and Methods: Anticoagulated blood and sera samples were obtained from 480 women consisting of 292 pregnant and 188 non-pregnant women. Antibodies to HIV were detected in the sera samples and hemoglobin concentration of the anticoagulated blood specimens were determined using standard techniques. Anemia was defined as hemoglobin concentration <11g/dl for pregnant women and <12g/dl for non-pregnant women. Results: Pregnancy was not a risk factor for acquiring HIV infection (pregnant vs. non-pregnant: 10.2% vs. 13.8%; OR=0.713, 95% CI=0.407, 1.259, P = 0.247. The prevalence of HIV was significantly (P = 0.005 and P = 0.025 higher in the age group 10-20 years and 21 - 30 years among pregnant and non-pregnant women respectively. Pregnancy was a risk factor for acquiring anemia (OR=1.717, 95% CI=1.179, 2.500, P = 0.006. Only the age of pregnant women significantly (P = 0.004 affected the prevalence of anemia inversely. Conclusion: The prevalence of HIV and anemia among pregnant women were 10.2% and 49.3% respectively. Pregnancy was associated with anemia. Interventions by appropriate agencies are advocated to reduce associated sequelae.

  8. Risk factors for HIV infection among women in Carletonville, South Africa: migration, clemography and sexually transmitted diseases

    CSIR Research Space (South Africa)

    Zuma, K

    2003-12-01

    Full Text Available The authors investigate the prevalence of, and risk factors for, HIV infection among women in an urban South African setting. A random sample of 834 women was recruited into a community-based cross-sectional study. HIV prevalence was 37...

  9. Epidemiology of HIV infection in women and children: a global perspective.

    Science.gov (United States)

    Shetty, Avinash K

    2013-03-01

    The global epidemiology of HIV/AIDS is rapidly evolving in low and middle income countries. Women and adolescent females in Sub-Saharan Africa are at risk of HIV acquisition due to a myriad of complex biological, behavioral and structural factors. Primary HIV infection among women primarily drives the pediatric HIV epidemic. Postnatal transmission of HIV during breastfeeding is a major concern in LMIC, particularly in Sub-Saharan Africa where breastfeeding remains the only feasible, safe and culturally acceptable infant feeding choice. Given the remarkable discoveries in biomedical interventions to prevent sexual transmission of HIV and MTCT during breastfeeding, there is now a unique opportunity to rapidly implement combination HIV prevention packages, provide quality prevention of mother-to-child HIV transmission services, and improve maternal and infant survival. Although rapid scale-up of PMTCT interventions has occurred in Sub-Saharan Africa in the past five years, significant challenges remain towards reaching the ambitious goal of virtual elimination of new HIV infections among children on a global scale by 2015 and keeping their mothers alive. Rapid translation of scientific discoveries into policy and practice in conjunction with strong commitment from national leadership and global partners is crucial to end the pediatric AIDS and achieve a HIV-free generation.

  10. Pregnancy and neonatal outcomes among a cohort of HIV-infected women in a large Italian teaching hospital: a 30-year retrospective study.

    Science.gov (United States)

    Grignolo, S; Agnello, R; Gerbaldo, D; Gotta, C; Alicino, C; Del Puente, F; Taramasso, L; Bruzzone, B; Gustavino, C; Trasino, S; DE Maria, A; Icardi, G; Viscoli, C; DI Biagio, A

    2017-06-01

    The primary study objective was to investigate three decades from 1985 to 2014 of changes in pregnancies among HIV-infected women. The secondary objective was to assess risk factors associated with preterm delivery and severe small-for-gestational-age (SGA) infants in HIV-infected women. A retrospective review of deliveries among pregnant HIV-infected women at the University of Genoa and IRCCS San Martino-IST in Genoa between 1985 and 2014 was performed. Univariate and multivariable analyses were used to study the variables associated with neonatal outcomes. Overall, 262 deliveries were included in the study. An increase in median age (26 years in 1985-1994 vs. 34 years in 2005-2014), in the proportion of foreigners (none in 1985-1994 vs. 27/70 (38·6%) in 2005-2014), and a decrease in intravenous drug use (75·2% (91/121) in 1985-1994 vs. 12·9% (9/70) in 2005-2014) among pregnant HIV-infected women was observed. Progressively, HIV infections were diagnosed sooner (prior to pregnancy in 80% (56/70) of women in the last decade). An increase in combined antiretroviral therapy (cART) prescription during pregnancy (50% (27/54) in 1995-2004 vs. 92·2% (59/64) in 2005-2014) and in HIV-RNA <50 copies/ml at delivery (19·2% (5/26) in 1995-2004 vs. 82·3% (53/64) in 2005-2014) was observed. The rate of elective caesarean section from 1985 to 1994 was 9·1%, which increased to 92·3% from 2004 to 2015. Twelve (10·1%) mother-to-child transmissions (MTCT) occurred in the first decade, and six (8·3%) cases occurred in the second decade, the last of which was in 2000. Preterm delivery (<37 weeks gestation) was 5% (6/121) from 1985 to 1994 and increased to 17·1% (12/70) from 2005 to 2014. In univariate and multivariable logistic regression analyses, advancing maternal age and previous pregnancies were associated with preterm delivery (odds ratio (OR) 2·7; 95% confidence intervals (CI) 1-7·8 and OR 2·6; 95% CI 1·1-6·7, respectively). In the logistic regression analysis

  11. Universal HIV screening of pregnant women in England : cost effectiveness analysis

    NARCIS (Netherlands)

    Postma, Maarten; Beck, E J; Mandalia, S; Sherr, L; Walters, M D; Houweling, H; Jager, Johannes C

    1999-01-01

    OBJECTIVE: To estimate the cost effectiveness of universal, voluntary HIV screening of pregnant women in England. DESIGN: Cost effectiveness analysis. Cost estimates of caring for HIV positive children were based on the stage of HIV infection and calculated using data obtained from a London hospital

  12. Universal HIV screening of pregnant women in England : cost effectiveness analysis

    NARCIS (Netherlands)

    Postma, Maarten; Beck, E J; Mandalia, S; Sherr, L; Walters, M D; Houweling, H; Jager, Johannes C

    1999-01-01

    OBJECTIVE: To estimate the cost effectiveness of universal, voluntary HIV screening of pregnant women in England. DESIGN: Cost effectiveness analysis. Cost estimates of caring for HIV positive children were based on the stage of HIV infection and calculated using data obtained from a London hospital

  13. Selection of women at risk for cervical cancer in an HIV-infected South African population.

    Science.gov (United States)

    Van Zummeren, Marjolein; Kremer, Wieke W; Van Aardt, Matthys C; Breytenbach, Erika; Richter, Karin L; Rozendaal, Lawrence; Witte, Birgit I; De Strooper, Lise M A; Hesselink, Albertus T; Heideman, Daniëlle A M; Snijders, Peter J F; Steenbergen, Renske D M; Dreyer, Greta; Meijer, Chris J L M

    2017-09-10

    Cervical cancer is the leading cause of cancer-related death in women in South Africa. This study evaluates DNA methylation levels in cervical (pre)cancer and aims to assess the value of high-risk human papillomavirus (hrHPV) testing and methylation analysis, alone or in combination, on physician-taken cervical scrapes to detect cervical cancer, and cervical intraepithelial neoplasia grade 3 (CIN3) in an HIV-infected South African population. Prospective observational multicentre cohort study. Women from a cohort of women living with HIV (n = 355) and a referral cohort (n = 109, 60% HIV seropositive) were included. Cervical scrapes were collected for hrHPV testing and methylation analysis of cell adhesion molecule 1, T-lymphocyte maturation-associated protein, and microRNA124-2 genes. Histologic endpoints were available for all participants. Performance for detection of CIN3 or worse (CIN3+) was determined in the cohort of women living with HIV and different testing strategies were compared. HrHPV and methylation positivity rates increased with severity of cervical disease in the two study cohorts, each reaching 100% in samples of women with carcinoma. HrHPV testing showed a sensitivity for CIN3+ of 83.6%, at a specificity of 67.7%. Methylation analysis showed a comparable CIN3+ sensitivity of 85.2%, but a significantly lower specificity of 49.6%. HrHPV testing with reflex methylation analysis showed a CIN3+ sensitivity of 73.8%, at a specificity of 81.5%. In this HIV-infected South African population, stratifying hrHPV-positive women with reflex methylation analysis detects all cervical carcinomas and yields an acceptable sensitivity and specificity for CIN3+.

  14. Subtype distribution of human papillomavirus in HIV-infected women with cervical intraepithelial neoplasia stages 2 and 3 in Botswana.

    Science.gov (United States)

    Ramogola-Masire, Doreen; McGrath, Cindy M; Barnhart, Kurt T; Friedman, Harvey M; Zetola, Nicola M

    2011-11-01

    Human papillomavirus (HPV) vaccines containing types 16 and 18 are likely to be effective in preventing cervical cancer associated with these HPV types. No information currently exists in Botswana concerning the HPV types causing precancerous or cancerous lesions. Our goal was to determine the prevalence of HPV types associated with precancerous cervical intraepithelial neoplasia (CIN) stages 2 and 3 in HIV-infected women in Gaborone, Botswana. HIV-infected women referred to our clinic with high-grade intraepithelial lesion on the Pap smear were enrolled in the study. HPV typing was only performed if the histopathology results showed CIN stage 2 or 3 disease using linear array genotyping (CE-IVD, Roche Diagnostics). One hundred HIV-infected women were identified with CIN stages 2 or 3 between August 11, 2009 and September 29, 2010. Eighty-two of 100 women enrolled had coinfection by multiple HPV subtypes (range, 2 to 12). Of the remaining 18 women, 14 were infected with a single high-risk subtype and 4 had no HPV detected. Overall, 92 (92%) women were infected with at least 1 high-risk HPV subtype, and 56 were coinfected with more than 1 high-risk HPV type (range, 2 to 5). Fifty-one (51%) women had HPV subtypes 16, 18, or both. HPV 16 and 18 are the most common types in HIV-infected women with CIN 2 or 3 in Gaborone, Botswana, suggesting that the implementation of HPV vaccination programs could have a significant impact on the reduction of cervical cancer incidence. However, given the relative lack of knowledge on the natural history of cervical cancer in HIV-infected women and the significant prevalence of infection and coinfection with other high-risk HPV types in our sample, the true impact and cost-effectiveness of such vaccination programs need to be evaluated.

  15. Household food insecurity, maternal nutritional status, and infant feeding practices among HIV-infected Ugandan women receiving combination antiretroviral therapy.

    Science.gov (United States)

    Young, Sera L; Plenty, Albert H J; Luwedde, Flavia A; Natamba, Barnabas K; Natureeba, Paul; Achan, Jane; Mwesigwa, Julia; Ruel, Theodore D; Ades, Veronica; Osterbauer, Beth; Clark, Tamara D; Dorsey, Grant; Charlebois, Edwin D; Kamya, Moses; Havlir, Diane V; Cohan, Deborah L

    2014-11-01

    Household food insecurity (HHFI) may be a barrier to both optimal maternal nutritional status and infant feeding practices, but few studies have tested this relationship quantitatively, and never among HIV-infected individuals. We therefore described the prevalence of HHFI and explored if it was associated with poorer maternal nutritional status, shorter duration of exclusive breastfeeding (EBF) and fewer animal-source complementary foods. We assessed these outcomes using bivariate and multivariate analyses among 178 HIV-infected pregnant and breastfeeding (BF) women receiving combination antiretroviral therapy in the PROMOTE trial (NCT00993031), a prospective, longitudinal cohort study in Tororo, Uganda. HHFI was common; the prevalence of severe, moderate, and little to no household hunger was 7.3, 39.9, and 52.8 %, respectively. Poor maternal nutritional status was common and women in households experiencing moderate to severe household hunger (MSHH) had statistically significantly lower body mass index (BMIs) at enrollment (21.3 vs. 22.5, p < 0.01) and prior to delivery (22.6 vs. 23.8, p < 0.01). BMI across time during pregnancy, but not gestational weight gain, was significantly lower for MSHH [adjusted beta (95 % CI) -0.79 (-1.56, -0.02), p = 0.04; -2.06 (-4.31, 0.19), p = 0.07], respectively. The prevalence (95 % CI) of EBF at 6 months was 67.2 % (59.7-73.5 %), and the proportion of women BF at 12 months was 80.4 % (73.3-85.7 %). MSHH was not associated with prevalence of EBF at 6 months or BF at 12 months. However, among those women still EBF at 4 months (81.4 % of population), those experiencing MSHH were significantly more likely to cease EBF between 4 and 6 months (aHR 2.38, 95 % CI 1.02-5.58). The prevalence of HHFI, maternal malnutrition, and suboptimal infant feeding practices are high and the causal relationships among these phenomena must be further explored.

  16. Pregnancy may be followed by an inflexion of the immune reconstitution in HIV-infected women who receive antiretroviral drugs before conception

    Science.gov (United States)

    Le-Moing, Vincent; Taieb, Audrey; Longuet, Pascale; Lewden, Charlotte; Delcey, Véronique; Drobacheff, Marie Christine; Chêne, Geneviève; Leport, Catherine; the ANRS CO8 (APROCO-COPILOTE) study-group

    2008-01-01

    Summary Background Whether pregnancy has an impact on evolution of CD4+ cell counts in women treated with highly potent antiretrovirals before conception remains largely unknown. Methods Among patients enrolled in the ANRS CO8 (APROCO/COPILOTE) cohort, we selected all women aged between 18 and 50 years at initiation of combination antiretroviral therapy (cART). Slopes of CD4+ cell counts during follow-up were estimated using mixed longitudinal models with time-dependent indicators for pregnancy and delivery. Results Among the 260 selected HIV-infected women, a pregnancy occurred among 39 during a median follow-up of 66 months. Women who became pregnant had higher CD4+ cell count at baseline but this difference was progressively blurred during follow-up because they had a slower increase than women who did not become pregnant. The estimated slope of CD4+ cell count decreased significantly from +2.3 cells/mm3/month before pregnancy and in women who did not become pregnant to − 0.04 cells/mm3/month after delivery (p = 0.0003). Conclusion A significant increase in CD4+ cell count may be preferable before pregnancy in women treated with cART, in order to overcome the evolution observed after pregnancy. PMID:18795961

  17. Factors associated with HIV infection among delivered women in Sergipe, Brazil

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    Lemos Lígia

    2009-08-01

    Full Text Available Abstract Background In Brazil, the number of HIV cases has increased mostly amongst poor less educated women in the northeast region. This combination increased the risk for vertical transmission. This study aims to identify risk factors associated with HIV infection at delivery in Sergipe-NE Brazil. Findings This was a case-control study, with 39 cases and 117 controls that gave birth at the official health system hospitals. All patients were tested for HIV at hospital admission, using a rapid test and were interviewed about socioeconomic conditions and health attitudes and practices. Univariate and multivariate logistic analysis were performed to evaluate the factors associated with HIV infection. In the univariate analysis, association with HIV positivity was found for the variables "antenatal HIV test" (OR: 4.44; CI: 1.93 – 10.29 and "intravenous drug use" (OR = 12.08; 95% CI 1.28 – 8. Three patients were intravenous drug users, all HIV+. After logistic multivariate regression, not being tested for HIV during antenatal care (OR = 4.98; 95% CI: 2.13–12.22; p Conclusion Drug use, limited knowledge about how to prevent AIDS, and lack of HIV testing during pregnancy were risk factors for infection with HIV. Although it was not conceived to evaluate effectiveness of procedures to prevent vertical transmission, the risk factors here detected may corroborate official recommendation for rapid HIV testing at delivery as an effective procedure to prevent vertical transmission.

  18. Effect of Efavirenz on Endogenous Progesterone Concentrations and Contraceptive Outcomes among Ugandan HIV Infected Women Coadministering Ethinylestradiol/Levonorgestrel.

    Science.gov (United States)

    Munkwase, Grant; Bisaso, Kuteesa R; Kakaire, Othman; Nanzigu, Sarah

    2017-01-01

    This study assessed the effect of efavirenz mid-dose plasma concentrations on mid-luteal endogenous progesterone concentrations and contraceptive outcomes among 49 HIV infected women coadministering ethinylestradiol/levonorgestrel, including 34 HIV positive women on Highly Active Antiretroviral Therapy (HAART) and 15 HAART naïve HIV infected women, purposively selected from Mulago Hospital, Uganda. A blood sample was collected once between days 20 and 22 of each woman's menstrual cycle for measuring endogenous progesterone and efavirenz concentrations by electrochemiluminescence technology and High Performance Liquid Chromatography (HPLC), respectively. Descriptive statistical analysis and correlation and logistic regression analysis were done using SPSS v.21 and R3.1. Efavirenz showed a weak positive linear relationship with endogenous progesterone at efavirenz concentrations below 12 μg/ml. Based on serum endogenous progesterone, the observed hormonal contraceptives failure rate (24.5%) was higher than expected (maximum 8%). A higher proportion of HIV positive women on efavirenz based HAART (26.5%) was at risk of contraceptive failure than their HIV infected HAART naïve counterparts (20%) though it was not statistically significant (p = 0.63). Efavirenz mid-dose plasma concentrations seem to have no significant effect on mid-luteal endogenous progesterone concentrations and contraceptive outcomes among HIV infected Ugandan women coadministering ethinylestradiol/levonorgestrel oral pills.

  19. Effect of Efavirenz on Endogenous Progesterone Concentrations and Contraceptive Outcomes among Ugandan HIV Infected Women Coadministering Ethinylestradiol/Levonorgestrel

    Directory of Open Access Journals (Sweden)

    Grant Munkwase

    2017-01-01

    Full Text Available This study assessed the effect of efavirenz mid-dose plasma concentrations on mid-luteal endogenous progesterone concentrations and contraceptive outcomes among 49 HIV infected women coadministering ethinylestradiol/levonorgestrel, including 34 HIV positive women on Highly Active Antiretroviral Therapy (HAART and 15 HAART naïve HIV infected women, purposively selected from Mulago Hospital, Uganda. A blood sample was collected once between days 20 and 22 of each woman’s menstrual cycle for measuring endogenous progesterone and efavirenz concentrations by electrochemiluminescence technology and High Performance Liquid Chromatography (HPLC, respectively. Descriptive statistical analysis and correlation and logistic regression analysis were done using SPSS v.21 and R3.1. Efavirenz showed a weak positive linear relationship with endogenous progesterone at efavirenz concentrations below 12 μg/ml. Based on serum endogenous progesterone, the observed hormonal contraceptives failure rate (24.5% was higher than expected (maximum 8%. A higher proportion of HIV positive women on efavirenz based HAART (26.5% was at risk of contraceptive failure than their HIV infected HAART naïve counterparts (20% though it was not statistically significant (p=0.63. Efavirenz mid-dose plasma concentrations seem to have no significant effect on mid-luteal endogenous progesterone concentrations and contraceptive outcomes among HIV infected Ugandan women coadministering ethinylestradiol/levonorgestrel oral pills.

  20. Intravaginal practices, bacterial vaginosis, and HIV infection in women: individual participant data meta-analysis.

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    Nicola Low

    2011-02-01

    Full Text Available Identifying modifiable factors that increase women's vulnerability to HIV is a critical step in developing effective female-initiated prevention interventions. The primary objective of this study was to pool individual participant data from prospective longitudinal studies to investigate the association between intravaginal practices and acquisition of HIV infection among women in sub-Saharan Africa. Secondary objectives were to investigate associations between intravaginal practices and disrupted vaginal flora; and between disrupted vaginal flora and HIV acquisition.We conducted a meta-analysis of individual participant data from 13 prospective cohort studies involving 14,874 women, of whom 791 acquired HIV infection during 21,218 woman years of follow-up. Data were pooled using random-effects meta-analysis. The level of between-study heterogeneity was low in all analyses (I(2 values 0.0%-16.1%. Intravaginal use of cloth or paper (pooled adjusted hazard ratio [aHR] 1.47, 95% confidence interval [CI] 1.18-1.83, insertion of products to dry or tighten the vagina (aHR 1.31, 95% CI 1.00-1.71, and intravaginal cleaning with soap (aHR 1.24, 95% CI 1.01-1.53 remained associated with HIV acquisition after controlling for age, marital status, and number of sex partners in the past 3 months. Intravaginal cleaning with soap was also associated with the development of intermediate vaginal flora and bacterial vaginosis in women with normal vaginal flora at baseline (pooled adjusted odds ratio [OR] 1.24, 95% CI 1.04-1.47. Use of cloth or paper was not associated with the development of disrupted vaginal flora. Intermediate vaginal flora and bacterial vaginosis were each associated with HIV acquisition in multivariable models when measured at baseline (aHR 1.54 and 1.69, p<0.001 or at the visit before the estimated date of HIV infection (aHR 1.41 and 1.53, p<0.001, respectively.This study provides evidence to suggest that some intravaginal practices increase

  1. Intravaginal Practices, Bacterial Vaginosis, and HIV Infection in Women: Individual Participant Data Meta-analysis

    Science.gov (United States)

    Low, Nicola; Chersich, Matthew F.; Schmidlin, Kurt; Egger, Matthias; Francis, Suzanna C.; H. H. M. van de Wijgert, Janneke; Hayes, Richard J.; Baeten, Jared M.; Brown, Joelle; Delany-Moretlwe, Sinead; Kaul, Rupert; McGrath, Nuala; Morrison, Charles; Myer, Landon; Temmerman, Marleen; van der Straten, Ariane; Watson-Jones, Deborah; Zwahlen, Marcel; Martin Hilber, Adriane

    2011-01-01

    Background Identifying modifiable factors that increase women's vulnerability to HIV is a critical step in developing effective female-initiated prevention interventions. The primary objective of this study was to pool individual participant data from prospective longitudinal studies to investigate the association between intravaginal practices and acquisition of HIV infection among women in sub-Saharan Africa. Secondary objectives were to investigate associations between intravaginal practices and disrupted vaginal flora; and between disrupted vaginal flora and HIV acquisition. Methods and Findings We conducted a meta-analysis of individual participant data from 13 prospective cohort studies involving 14,874 women, of whom 791 acquired HIV infection during 21,218 woman years of follow-up. Data were pooled using random-effects meta-analysis. The level of between-study heterogeneity was low in all analyses (I 2 values 0.0%–16.1%). Intravaginal use of cloth or paper (pooled adjusted hazard ratio [aHR] 1.47, 95% confidence interval [CI] 1.18–1.83), insertion of products to dry or tighten the vagina (aHR 1.31, 95% CI 1.00–1.71), and intravaginal cleaning with soap (aHR 1.24, 95% CI 1.01–1.53) remained associated with HIV acquisition after controlling for age, marital status, and number of sex partners in the past 3 months. Intravaginal cleaning with soap was also associated with the development of intermediate vaginal flora and bacterial vaginosis in women with normal vaginal flora at baseline (pooled adjusted odds ratio [OR] 1.24, 95% CI 1.04–1.47). Use of cloth or paper was not associated with the development of disrupted vaginal flora. Intermediate vaginal flora and bacterial vaginosis were each associated with HIV acquisition in multivariable models when measured at baseline (aHR 1.54 and 1.69, p<0.001) or at the visit before the estimated date of HIV infection (aHR 1.41 and 1.53, p<0.001), respectively. Conclusions This study provides evidence to suggest

  2. Monocyte bioenergetic function is associated with body composition in virologically suppressed HIV-infected women

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    Amanda L. Willig

    2017-08-01

    Full Text Available Women living with HIV may present with high levels of body fat that are associated with altered bioenergetic function. Excess body fat may therefore exacerbate the bioenergetic dysfunction observed with HIV infection. To determine if body fat is associated with bioenergetic function in HIV, we conducted a cross-sectional study of 42 women with HIV who were virologically suppressed on antiretroviral therapy. Body composition was determined via dual-energy x-ray absorptiometry. Oxygen consumption rate (OCR of monocytes was sorted from peripheral blood mononuclear cells obtained from participants in the fasting state. Differences in bioenergetic function, as measured by OCR, was assessed using Kruskal-Wallis tests and Spearman correlations adjusted for age, race, and smoking status. Participants were 86% Black, 45.5 years old, 48% current smokers, and 57% were obese (body mass index ≥30. Nearly all women (93% had >30% total fat mass, while 12% had >50% total fat mass. Elevated levels of total fat mass, trunk fat, and leg fat were inversely correlated with measures of bioenergetic health as evidenced by lower maximal and reserve capacity OCR, and Bioenergetic Health Index. Measures of extracellular acidification (ECAR in the absence (basal or maximal (with oligomycin were positively correlated with measures of bioenergetics, except proton leak, and were negatively correlated with fat mass. Despite virological suppression, women with HIV present with extremely high levels of adiposity that correlate with impaired bioenergetic health. Without effective interventions, this syndemic of HIV infection and obesity will likely have devastating consequences for our patients, potentially mediated through altered mitochondrial and glycolytic function.

  3. Risk factors for HIV infection among women in Dodoma region, Tanzania

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    Objective To investigate the risk factors of HIV infection among women in the Dodoma region, Tanzania. Methods The protocol were assessed through a population-based cross sec-tional study. The participants were obtained by randomly selecting clusters of 10-households from Unga imited, Babati town and Matufa roadside village which are urban, semi-urban and rural communi-ties respectively. Informed verbal consent for participation in an interview and in HIV testing was sought from each respondent. Blood samples were collected from each consenting individual for HIV antibody testing using enzyme linked immunosorbent assay(ELISA) and all positive sera were con-firmed using repeated ELISA tests. Information on risk factors was obtained through the interview process using a structured questionnaire. Results Of 567 women who gave blood samples, 48 (8.5 % ) were HIV positive. The HIV seroprevalence rates among women in the urban area, the semi-ur-ban area and in the rural village were 14.4%, 6.9% and 2.3% respectively. Factors associated with significantly higher HIV seroprevalence were urban residence,history of having travelled out of Dodoma region within Tanzania, as well as having travelled abroad, having multiple sexual partners and having sexual intercourse under the influence of alcohol. Women who reported ever having used condoms had significantly higher probability of being infected with HIV than those who had never used condoms, suggesting that condom use may be a marker of high risk sexual behavior and that condom use was probably not adhered to in a way that consistently protects against HIV infection.Conclusions The results suggest the need for health education interventions aimed at increasing ap-propriate and consistent condom use and reduction of the number of sexual partners.

  4. HIV-Infected Ugandan Women on Antiretroviral Therapy Maintain HIV-1 RNA Suppression Across Periconception, Pregnancy, and Postpartum Periods.

    Science.gov (United States)

    Matthews, Lynn T; Ribaudo, Heather B; Kaida, Angela; Bennett, Kara; Musinguzi, Nicholas; Siedner, Mark J; Kabakyenga, Jerome; Hunt, Peter W; Martin, Jeffrey N; Boum, Yap; Haberer, Jessica E; Bangsberg, David R

    2016-04-01

    HIV-infected women risk sexual and perinatal HIV transmission during conception, pregnancy, childbirth, and breastfeeding. We compared HIV-1 RNA suppression and medication adherence across periconception, pregnancy, and postpartum periods, among women on antiretroviral therapy (ART) in Uganda. We analyzed data from women in a prospective cohort study, aged 18-49 years, enrolled at ART initiation and with ≥1 pregnancy between 2005 and 2011. Participants were seen quarterly. The primary exposure of interest was pregnancy period, including periconception (3 quarters before pregnancy), pregnancy, postpartum (6 months after pregnancy outcome), or nonpregnancy related. Regression models using generalized estimating equations compared the likelihood of HIV-1 RNA ≤400 copies per milliliter, <80% average adherence based on electronic pill caps (medication event monitoring system), and likelihood of 72-hour medication gaps across each period. One hundred eleven women contributed 486 person-years of follow-up. Viral suppression was present at 89% of nonpregnancy, 97% of periconception, 93% of pregnancy, and 89% of postpartum visits, and was more likely during periconception (adjusted odds ratio, 2.15) compared with nonpregnant periods. Average ART adherence was 90% [interquartile range (IQR), 70%-98%], 93% (IQR, 82%-98%), 92% (IQR, 72%-98%), and 88% (IQR, 63%-97%) during nonpregnant, periconception, pregnant, and postpartum periods, respectively. Average adherence <80% was less likely during periconception (adjusted odds ratio, 0.68), and 72-hour gaps per 90 days were less frequent during periconception (adjusted relative risk, 0.72) and more frequent during postpartum (adjusted relative risk, 1.40). Women with pregnancy were virologically suppressed at most visits, with an increased likelihood of suppression and high adherence during periconception follow-up. Increased frequency of 72-hour gaps suggests a need for increased adherence support during postpartum periods.

  5. Pregnancy and HIV infection

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    Mete Sucu

    2016-12-01

    Full Text Available The management of Human Immunodeficiency Virus (HIV infection is progressing rapidly. In developed countries, the perinatal transmission rates have decreased from 20-30% to 1-2% with the use of antiretroviral therapy and cesarean section. Interventions for the prevention of prenatal transmission has made the prenatal care of pregnant patients with HIV infection more complex. Rapid development of standard care and continuing increase in the distribution of HIV infection has required clinicians taking care of pregnants to have current information. Therefore, in our review we aimed to summarize the prenatal course, treatment and preventive methods for perinatal transmission of HIV. [Archives Medical Review Journal 2016; 25(4.000: 522-535

  6. Vaccinations for pregnant women.

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    Swamy, Geeta K; Heine, R Phillips

    2015-01-01

    In the United States, eradication and reduction of vaccine-preventable diseases through immunization has directly increased life expectancy by reducing mortality. Although immunization is a public priority, vaccine coverage among adult Americans is inadequate. The Institute of Medicine, the Community Preventive Services Task Force, and other public health entities have called for the development of innovative programs to incorporate adult vaccination into routine clinical practice. Obstetrician-gynecologists are well suited to serve as vaccinators of women in general and more specifically pregnant women. Pregnant women are at risk for vaccine-preventable disease-related morbidity and mortality and adverse pregnancy outcomes, including congenital anomalies, spontaneous abortion, preterm birth, and low birth weight. In addition to providing direct maternal benefit, vaccination during pregnancy likely provides direct fetal and neonatal benefit through passive immunity (transplacental transfer of maternal vaccine-induced antibodies). This article reviews: 1) types of vaccines; 2) vaccines specifically recommended during pregnancy and postpartum; 3) vaccines recommended during pregnancy and postpartum based on risk factors and special circumstances; 4) vaccines currently under research and development for licensure for maternal-fetal immunization; and 5) barriers to maternal immunization and available patient and health care provider resources.

  7. Comparison of lower genital tract microbiota in HIV-infected and uninfected women from Rwanda and the US.

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    Lorie Benning

    Full Text Available INTRODUCTION: Previous studies have shown that alterations of the bacterial microbiota in the lower female genital tract influence susceptibility to HIV infection and shedding. We assessed geographic differences in types of genital microbiota between HIV-infected and uninfected women from Rwanda and the United States. METHODS: Genera of lower genital tract bacterial microbiota were identified by high-throughput pyrosequencing of the 16S rRNA gene from 46 US women (36 HIV-infected, 10 HIV-uninfected and 40 Rwandan women (18 HIV-infected, 22 HIV-uninfected with similar proportions of low (0-3 Nugent scores. Species of Lactobacillus were identified by assembling sequences along with reference sequences into phylogenetic trees. Prevalence of genera and Lactobacillus species were compared using Fisher's exact tests. RESULTS: Overall the seven most prevalent genera were Lactobacillus (74%, Prevotella (56%, Gardnerella (55%, Atopobium (42%, Sneathia (37%, Megasphaera (30%, and Parvimonas (26%, observed at similar prevalences comparing Rwandan to US women, except for Megasphaera (20% vs. 39%, p = 0.06. Additionally, Rwandan women had higher frequencies of Mycoplasma (23% vs. 7%, p = 0.06 and Eggerthella (13% vs. 0%, p = 0.02, and lower frequencies of Lachnobacterium (8% vs. 35%, p<0.01 and Allisonella (5% vs. 30%, p<0.01, compared with US women. The prevalence of Mycoplasma was highest (p<0.05 in HIV-infected Rwandan women (39%, compared to HIV-infected US women (6%, HIV-uninfected Rwandan (9% and US (10% women. The most prevalent lactobacillus species in both Rwandan and US women was L. iners (58% vs. 76%, p = 0.11, followed by L. crispatus (28% vs. 30%, p = 0.82, L. jensenii (20% vs. 24%, p = 0.80, L. gasseri (20% vs. 11%, p = 0.37 and L. vaginalis (20% vs. 7%, p = 0.10. DISCUSSION: We found similar prevalence of most major bacterial genera and Lactobacillus species in Rwandan and US women. Further work will be needed

  8. Unmet need for family planning, contraceptive failure, and unintended pregnancy among HIV-infected and HIV-uninfected women in Zimbabwe.

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    Sandra I McCoy

    Full Text Available BACKGROUND: Prevention of unintended pregnancies among women living with HIV infection is a strategy recommended by the World Health Organization for prevention of mother-to-child transmission of HIV (PMTCT. We assessed pregnancy intentions and contraceptive use among HIV-positive and HIV-negative women with a recent pregnancy in Zimbabwe. METHODS: We analyzed baseline data from the evaluation of Zimbabwe's Accelerated National PMTCT Program. Eligible women were randomly sampled from the catchment areas of 157 health facilities offering PMTCT services in five provinces. Eligible women were ≥16 years old and mothers of infants (alive or deceased born 9 to 18 months prior to the interview. Participants were interviewed about their HIV status, intendedness of the birth, and contraceptive use. RESULTS: Of 8,797 women, the mean age was 26.7 years, 92.8% were married or had a regular sexual partner, and they had an average of 2.7 lifetime births. Overall, 3,090 (35.1% reported that their births were unintended; of these women, 1,477 (47.8% and 1,613 (52.2% were and were not using a contraceptive method prior to learning that they were pregnant, respectively. Twelve percent of women reported that they were HIV-positive at the time of the survey; women who reported that they were HIV-infected were significantly more likely to report that their pregnancy was unintended compared to women who reported that they were HIV-uninfected (44.9% vs. 33.8%, p<0.01. After adjustment for covariates, among women with unintended births, there was no association between self-reported HIV status and lack of contraception use prior to pregnancy. CONCLUSIONS: Unmet need for family planning and contraceptive failure contribute to unintended pregnancies among women in Zimbabwe. Both HIV-infected and HIV-uninfected women reported unintended pregnancies despite intending to avoid or delay pregnancy, highlighting the need for effective contraceptive methods that align with

  9. Immune activation in HIV-infected aging women on antiretrovirals--implications for age-associated comorbidities: a cross-sectional pilot study.

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    Maria L Alcaide

    Full Text Available Persistent immune activation and microbial translocation associated with HIV infection likely place HIV-infected aging women at high risk of developing chronic age-related diseases. We investigated immune activation and microbial translocation in HIV-infected aging women in the post-menopausal ages.Twenty-seven post-menopausal women with HIV infection receiving antiretroviral treatment with documented viral suppression and 15 HIV-negative age-matched controls were enrolled. Levels of immune activation markers (T cell immune phenotype, sCD25, sCD14, sCD163, microbial translocation (LPS and biomarkers of cardiovascular disease and impaired cognitive function (sVCAM-1, sICAM-1 and CXCL10 were evaluated.T cell activation and exhaustion, monocyte/macrophage activation, and microbial translocation were significantly higher in HIV-infected women when compared to uninfected controls. Microbial translocation correlated with T cell and monocyte/macrophage activation. Biomarkers of cardiovascular disease and impaired cognition were elevated in women with HIV infection and correlated with immune activation.HIV-infected antiretroviral-treated aging women who achieved viral suppression are in a generalized status of immune activation and therefore are at an increased risk of age-associated end-organ diseases compared to uninfected age-matched controls.

  10. EFFECT OF HIGHLY ACTIVE ANTIRETROVIRAL THERAPY ON VAGINAL Candida spp. ISOLATION IN HIV-INFECTED COMPARED TO HIV-UNINFECTED WOMEN

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    Silvia de Souza Dantas ALCZUK

    2015-04-01

    Full Text Available Vulvovaginal candidiasis (VVC in HIV-infected women contributed to the impairment of their quality of life. The aim of this study was to evaluate the effect of highly active antiretroviral therapy (HAART use on the vaginal Candida spp. isolation in HIV-infected compared to HIV-uninfected women. This cross-sectional study included 178 HIV-infected (HIV group and 200 HIV-uninfected women (control that were studied at the Specialized Assistance Service (SAE for sexually transmitted diseases (STD/AIDS of the city of Maringá, Brazil, from April 1 to October 30, 2011. The yeasts were isolated and identified by phenotypic and molecular methods. The in vitro antifungal susceptibility to fluconazole, itraconazole, nystatin and amphotericin B was tested by the reference microdilution method. Higher frequencies of total vaginal Candida spp. isolation were found in the HIV-infected group than in the control group. However, both groups showed a similar frequency of colonization and VVC. Although C. albicans was the most frequent and sensitive to azolics and polyenes in both HIV-infected and uninfected women, the emerging resistance of C. glabrata to amphotericin B in the HIV-infected women was observed. Although higher frequency of vaginal Candida spp. isolation had been observed in the HIV-infected than in HIV-uninfected women, colonization and VVC showed similar frequency in both groups, indicating that HAART appears to protect against vaginal colonization and VVC.

  11. Food insecurity with hunger is associated with obesity among HIV-infected and at risk women in Bronx, NY.

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    Nicole Sirotin

    Full Text Available Food insecurity, insufficient quality and quantity of nutritionally adequate food, affects millions of people in the United States (US yearly, with over 18 million Americans reporting hunger. Food insecurity is associated with obesity in the general population. Due to the increasing prevalence of obesity and risk factors for cardiovascular disease among HIV-infected women, we sought to determine the relationship between food insecurity and obesity in this cohort of urban, HIV-infected and -uninfected but at risk women.Using a cross-sectional design, we collected data on food insecurity, body mass index and demographic and clinical data from 231 HIV-infected and 119 HIV-negative women enrolled in Bronx site of the Women's Interagency HIV Study (WIHS. We used multivariate logistic regression to identify factors associated with obesity.Food insecurity was highly prevalent, with almost one third of women (110/350, 31% reporting food insecurity over the previous six months and over 13% of women reported food insecurity with hunger. Over half the women were obese with a Body Mass Index (BMI of ≥ 30. In multivariate analyses, women who were food insecure with hunger had higher odds of obesity (Adjusted odds ratio [aOR] =  2.56, 95% Confidence Interval [CI]  =  1.27, 5.20 after adjusting for HIV status, age, race, household status, income, drug and alcohol use.Food insecurity with hunger was associated with obesity in this population of HIV-infected and -uninfected, urban women. Both food insecurity and obesity are independent markers for increased mortality; further research is needed to understand this relationship and their role in adverse health outcomes.

  12. Intermittent preventive treatment of malaria in pregnancy with mefloquine in HIV-infected women receiving cotrimoxazole prophylaxis: a multicenter randomized placebo-controlled trial.

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    Raquel González

    2014-09-01

    Full Text Available BACKGROUND: Intermittent preventive treatment in pregnancy (IPTp with sulfadoxine-pyrimethamine (SP is recommended for malaria prevention in HIV-negative pregnant women, but it is contraindicated in HIV-infected women taking daily cotrimoxazole prophylaxis (CTXp because of potential added risk of adverse effects associated with taking two antifolate drugs simultaneously. We studied the safety and efficacy of mefloquine (MQ in women receiving CTXp and long-lasting insecticide treated nets (LLITNs. METHODS AND FINDINGS: A total of 1,071 HIV-infected women from Kenya, Mozambique, and Tanzania were randomized to receive either three doses of IPTp-MQ (15 mg/kg or placebo given at least one month apart; all received CTXp and a LLITN. IPTp-MQ was associated with reduced rates of maternal parasitemia (risk ratio [RR], 0.47 [95% CI 0.27-0.82]; p=0.008, placental malaria (RR, 0.52 [95% CI 0.29-0.90]; p=0.021, and reduced incidence of non-obstetric hospital admissions (RR, 0.59 [95% CI 0.37-0.95]; p=0.031 in the intention to treat (ITT analysis. There were no differences in the prevalence of adverse pregnancy outcomes between groups. Drug tolerability was poorer in the MQ group compared to the control group (29.6% referred dizziness and 23.9% vomiting after the first IPTp-MQ administration. HIV viral load at delivery was higher in the MQ group compared to the control group (p=0.048 in the ATP analysis. The frequency of perinatal mother to child transmission of HIV was increased in women who received MQ (RR, 1.95 [95% CI 1.14-3.33]; p=0.015. The main limitation of the latter finding relates to the exploratory nature of this part of the analysis. CONCLUSIONS: An effective antimalarial added to CTXp and LLITNs in HIV-infected pregnant women can improve malaria prevention, as well as maternal health through reduction in hospital admissions. However, MQ was not well tolerated, limiting its potential for IPTp and indicating the need to find alternatives with

  13. Сost assessment of HIV prophylaxis of mother to child transmission and family planning program among HIV infected women

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    A. V. Samarina

    2014-01-01

    Full Text Available The manuscript provides comparative cost assessment of HIV PMTCT and family planning program among HIV infected women.Materials and Methods: calculation is based on the state healthcare system costs of complex/combined 3-stage perinatal HIV prophylaxis, follow up antiretroviral therapy and social costs related to rehabilitation and education HIV infected children. Cost benefit analysis is conducted on utility per 1 RUB of budget investment.Results and discussion: HIV PMTCT cost benefit is 3,33 per 1 RUB of investment in long-term perspective. Analysis stated average family planning expenditure will be 3,69 K RUB despite 21,72 K RUB per patient without family planning service. As result cost benefit family planning program among HIV infected women is 4,89 RUB per 1 RUB of investment.Conclusion. Broad access to reproductive health service is key milestone of quality of life among HIV infected patients and it would be positioning as economically reasonable HIV prevention and cost containment measure.

  14. Post-operative complications after caesarean section in HIV-infected women.

    Science.gov (United States)

    Ferrero, Simone; Bentivoglio, Giorgio

    2003-10-01

    This retrospective study evaluated complications associated with caesarean section in HIV-infected women. For each HIV-positive patient ( n=45) a control group of ten seronegative women ( n=450) was matched for age, number of foetuses, gestational age, indication for caesarean section, status of the membranes and kind of anaesthesia. All women delivered in the same hospital using a uniform protocol. We evaluated the duration of stay in hospital after operation, the need for antibiotics after caesarean section, the incidence of minor postoperative complications (mild anaemia, mild temperature or fever 24 h after surgery, wound haematoma or infection, urinary tract infection, endometritis) and major postoperative complications (severe anaemia, pneumonia, pleural effusion, peritonitis, sepsis, disseminated intravascular coagulation, thromboembolism). Most HIV-positive women (64.5%) had a complicated recovery after surgery. A higher incidence of major and minor postoperative complications were observed in the HIV-positive group than in the control group. There was a statistically significant greater incidence of mild anaemia, mild temperature or fever, urinary tract infection and pneumonia in the HIV-positive group. HIV-positive women with less than 500x10(6) CD4(+) lymphocytest/l had higher post-caesarean section morbidity than HIV-positive women with more than 500x10(6) CD4(+) lymphocytest/l. The median duration of hospital stay was significantly higher in the HIV-positive group (median 7 days) than in the HIV-negative group (median 4 days). The rate of HIV vertical transmission was 8.8%. Higher post-caesarean section morbidity was found in HIV-positive women than in controls. Unfortunately, the HIV-positive women (with low CD4 lymphocytes counts), whose infants theoretically will benefit most from caesarean delivery, are also the women who are most likely to experience post-operative complications.

  15. Antibody Maturation in Women Who Acquire HIV Infection While Using Antiretroviral Preexposure Prophylaxis.

    Science.gov (United States)

    Laeyendecker, Oliver; Redd, Andrew D; Nason, Martha; Longosz, Andrew F; Karim, Quarraisha Abdool; Naranbhai, Vivek; Garrett, Nigel; Eshleman, Susan H; Abdool Karim, Salim S; Quinn, Thomas C

    2015-09-01

    The CAPRISA 004 preexposure prophylaxis (PrEP) randomized trial demonstrated that women who used a vaginal gel containing the antiretroviral drug tenofovir (TFV) had a 39% lower risk of acquiring human immunodeficiency virus (HIV). It is not known whether topical TFV alters the antibody response to breakthrough HIV infection. In this study, antibody maturation was evaluated using 3 serologic assays: the BED capture enzyme immunoassay (CEIA), the Bio-Plex (Luminex) assay, and the Bio-Rad avidity assay. Tests were performed using serum samples collected 3, 6, 9, 12, 24, 36, 48, and >48 months after seroconversion from 95 women in the CAPRISA 004 trial (35 in the TFV gel arm and 60 in the placebo arm). For the BED CEIA and Luminex assay, linear mixed effects models were used to examine test results by study arm. Cox proportional hazard analysis was used to examine time to avidity cutoff. Anti-HIV antibody titers did not differ between study arms. Women assigned to TFV gel demonstrated slower antibody avidity maturation, as determined by the Bio-Rad (P = .04) and gp120 Bio-Plex (P = .028) assays. Women who were assigned to receive topical TFV but became infected had slower antibody avidity maturation, with potential implications for diagnosis and antibody-based incidence assays as access to antiretroviral therapy-based PrEP is increased.

  16. Determinants of intravaginal practices among HIV-infected women in Zambia using conjoint analysis.

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    Alcaide, Maria L; Cook, Ryan; Chisembele, Maureen; Malupande, Emeria; Jones, Deborah L

    2016-05-01

    Intravaginal practices (IVPs) are associated with an increased risk of bacterial vaginosis and may play a role in HIV transmission. The objective of this study was to identify the importance of factors underlying the decision to engage in IVP using conjoint analysis; a novel statistical technique used to quantify health-related decisions. This study was a cross-sectional study. HIV-infected women in Zambia completed audio computer-administered self-interview questionnaires assessing demographic, risk factors and IVPs. Reasons for engaging in IVPs were explored using conjoint questionnaires. Conjoint analysis was used to identify the relative importance of factors for engaging in IVPs. Results of the conjoint analysis demonstrated that hygiene was the most important reason for engaging in IVPs (mean importance score = 61, SD = 24.3) followed by partner's preference (mean importance score = 20, SD = 14.4) and health (mean importance score = 17, SD = 13.5). When making the decision to engage in IVPs, women rank the importance of hygiene, partner preference and health differently, according to their personal characteristics. The use of conjoint analysis to define the characteristics of women more likely to engage in specific practices should be used to develop tailored rather than standardised IVP interventions, and such interventions should be incorporated into clinical practice and women's health programmes.

  17. Pregnancy outcomes in HIV-infected women in a German cohort

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    N Hanhoff

    2012-11-01

    Full Text Available Background: To describe the findings of a German HIV-pregnancy cohort. To investigate factors associated with pregnancy complications and outcomes in HIV-infected women. Methods: Retrospective analysis of HIV pregnancies from 2008 to 2010 in six German outpatient clinics specialized in HIV care. Results: 230 mother-child pairs were included in the evaluation. In 25 cases, HIV infection was diagnosed during pregnancy (mean gestational age 17.5 weeks with a mean CD4 cell count of 364 cells/µl and a median viral load (VL of 6,660 copies/ml. 150 (65.2% women were antiretroviral therapy (ART-experienced prior to pregnancy; 112 (48.7% received ART at conception; a further 97 (42.2% started ART during pregnancy at an average gestational age of 25 weeks. Anemia was documented in 36.5% of the women with an average hemoglobin of 9.5 g/dl. Mean gestational age at delivery was 38±2.41 weeks; range 24–42 weeks. 17 births (7.4% were preterm. Average CD4 cell count at time of delivery was 447 cells/µl; in 162 (70.4% cases, VL was <50 copies/ml. Mode of delivery was as follows: 70 (30.4% vaginal, 131 (57% primary and 29 (12.6% secondary Caesarian (C-section. Vaginal delivery was associated with a higher gestational age at delivery (39.1 vs 37.5 weeks, p<0.001. Maternal CDC disease stage was found to be correlated with premature contractions (p=0.025, shortened cervix (p=0.044 and gestational age at delivery (p=0.042. Further, healthier women, according to CDC classification, were more likely to deliver vaginally (p<0.001. No vertical HIV transmission was documented. Mean birth weight was 2922±580 g. Conclusions: In this cohort, lower CD4 counts were associated with preterm contractions, shortened cervix, and a lower gestational age at delivery. In addition, women with less advanced disease were more likely to deliver vaginally.

  18. Addressing intravaginal practices in women with HIV and at-risk for HIV infection, a mixed methods pilot study

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    Alcaide, Maria L; Rodriguez, Violeta J; Fischl, Margaret A; Jones, Deborah L; Weiss, Stephen M

    2017-01-01

    Intravaginal practices (IVPs), include intravaginal cleansing (cleansing the inside of the vagina) or intravaginal insertion of products for hygiene, health or sexuality reasons. IVPs are associated with adverse female health outcomes, development of bacterial vaginosis, HIV acquisition and transmission. A mixed methods approach was used in this study to examine the prevalence of IVP, assess reasons for engagement, and perceptions of IVP among a sample of minority (African-American and Hispanic) women infected, or at-risk, for HIV in Miami, USA, a city with increasing numbers of sexually transmitted infections (STIs) and HIV. Three focus groups (total n=20) and quantitative assessments (n=72) were conducted with women infected or uninfected with HIV. In the qualitative assessments, most women reported engaging in both intravaginal cleansing and intravaginal insertion, and stated the main motivation for IVP was hygiene. The quantitative assessments confirmed that cleansing with water alone, soap with water or using commercial douches was common, as well as intravaginal insertion using a cloth or a rag in both HIV-infected and uninfected women. Women with HIV infection reported less use of water and water and soap for IVPs, and reported learning about the potential harm of IVP from their HIV health care providers. Despite their health risks, IVP appeared common in both HIV-infected and at-risk minority women, and interventions to decrease IVP could have important health implications among populations with high rates of IVP, STIs and HIV. PMID:28280394

  19. Abacavir alters the transcription of inflammatory cytokines in virologically suppressed, HIV-infected women

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    Roger L Shapiro

    2012-07-01

    Full Text Available Background: Abacavir (ABC may be associated with a small, increased risk of myocardial infarction in HIV-infected adults, possibly related to cytokine-mediated inflammation. Methods: To evaluate the induction of inflammatory cytokine transcription by ABC, we used samples from women randomized to receive zidovudine/lamivudine/ABC (Trizivir or lopinavir/ritonavir and zidovudine/lamividine (Kaletra/Combivir from the third trimester through six-months postpartum for the prevention of mother-to-child transmission (PMTCT. Women were matched by CD4 count and baseline HIV RNA. All women attained viral suppression (<50 copies/ml by the time of sampling. Results: Four cytokines showed a difference in expression between the treatment arms, all in a proinflammatory direction for the ABC arm: CD40LG 1.82-fold, (p=.027; IL-8 3.16-fold (p=.020; LTA 2.82-fold, (p=.008; and CCL5 −1.67-fold, (p=.035. At 12-months postpartum, 6-months after antiretroviral discontinuation, cytokine expression was similar by treatment arm. Conclusions: We conclude that ABC may upregulate proinflammatory cytokines at the transcriptional level in this population.

  20. The Role of Mental Health Services in Addressing HIV Infection Among Women With Serious Mental Illness.

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    Seeman, Mary V

    2015-09-01

    This article reviews how mental health services can best prevent and treat HIV infection among women with serious mental illness. This is a selective narrative review of the recent literature on mental health services and HIV. The author used the terms "HIV," "serious mental illness," and "women" to search Google Scholar. Out of 500 relevant papers retrieved, 82 were included, based on their state-of-the-art findings. Women with serious mental illness at risk of HIV were found to be an especially vulnerable group. The evidence suggests that discussion of the modes of viral transmission reduces the risk of infection in this population, as do psychoeducation; long-term antipsychotic medication; adherence therapy; community treatment orders; prevention of domestic violence and homelessness; disbursement of financial entitlements; provision of psychotherapy and social support; cognitive rehabilitation; promotion of abstinence, monogamy, or reduction in the number of sexual partners; access to and training in the use of condoms; prophylaxis with vaginal microbicides and oral antiretroviral drugs; prompt diagnosis and treatment of sexually transmitted diseases; across-the-board offers of HIV testing; and preservation and monitoring of reproductive health. For HIV-positive individuals, comprehensive treatment measures have included prompt HIV treatment; long-term retention in care; supervision of medication adherence and drug interactions; rapid management of substance use disorders and all other comorbidities as well as drug side effects; and preclusion of professional stigmatization. There is now sufficient evidence to recommend effective combinations of strategies to prevent and treat HIV within mental health services.

  1. Safety and tolerability of depot medroxyprogesterone acetate among HIV-infected women on antiretroviral therapy: ACTG A5093

    Science.gov (United States)

    Watts, D Heather; Park, Jeong-Gun; Cohn, Susan E; Yu, Song; Hitti, Jane; Stek, Alice; Clax, Pamela A.; Muderspach, Laila; Lertora, Juan JL

    2008-01-01

    Background Concomitant use of antiretrovirals (ARV) and hormonal contraceptives may change the metabolism of each and the resulting safety profiles. We evaluated the safety and tolerability of depot medroxyprogesterone acetate (DMPA) among women on ARV. Study Design HIV-infected women on selected ARV regimens or no ARV were administered DMPA 150 mg intramuscularly and evaluated for 12 weeks for adverse events, changes in CD4+ count and HIV RNA levels, and ovulation. Results Seventy evaluable subjects were included, 16 on nucleoside only or no ARV, 21 on nelfinavir-containing regimens, 17 on efavirenz-containing regimens, and 16 on nevirapine-containing regimens. Nine grade 3 or 4 adverse events occurred in 7 subjects; none were judged related to DMPA. The most common findings possibly related to DMPA were abnormal vaginal bleeding (9, 12.7%), headache (3, 4.2%), abdominal pain, mood changes, insomnia, anorexia, and fatigue, each occurring in 2 (2.9%) subjects. No significant changes in CD4+ count or HIV RNA levels occurred with DMPA. No evidence of ovulation was detected, and no pregnancies occurred. Conclusions The clinical profile associated with DMPA administration in HIV-infected women, most on ARV, appears similar to that seen in HIV-uninfected women. DMPA prevented ovulation and did not affect CD4+ counts or HIV RNA levels. In concert with previously published DMPA/ARV interaction data, these data suggest that DMPA can be used safely by HIV-infected women on the ARV studied. PMID:18226670

  2. Prefrontal cortical volume loss is associated with stress-related deficits in verbal learning and memory in HIV-infected women.

    Science.gov (United States)

    Rubin, Leah H; Meyer, Vanessa J; J Conant, Rhoda; Sundermann, Erin E; Wu, Minjie; Weber, Kathleen M; Cohen, Mardge H; Little, Deborah M; Maki, Pauline M

    2016-08-01

    Deficits in verbal learning and memory are a prominent feature of neurocognitive function in HIV-infected women, and are associated with high levels of perceived stress. To understand the neurobiological factors contributing to this stress-related memory impairment, we examined the association between stress, verbal memory, and brain volumes in HIV-infected women. Participants included 38 HIV-infected women (Mean age=43.9years) from the Chicago Consortium of the Women's Interagency HIV Study (WIHS). Participants underwent structural magnetic resonance imaging (MRI) and completed standardized measures of verbal learning and memory and stress (Perceived Stress Scale-10; PSS-10). Brain volumes were evaluated in a priori regions of interest, including the medial temporal lobe (MTL) and prefrontal cortex (PFC). Compared to HIV-infected women with lower stress (PSS-10 scores in lower two tertiles), HIV-infected women with higher stress (scores in the top tertile), performed worse on measures of verbal learning and memory and showed smaller volumes bilaterally in the parahippocampal gyrus, superior frontal gyrus, middle frontal gyrus, and inferior frontal gyrus (p'slearning and memory performance. Prefrontal cortical atrophy is associated with stress-related deficits in verbal learning and memory in HIV-infected women. The time course of these volume losses in relation to memory deficits has yet to be elucidated, but the magnitude of the volumetric differences between women with higher versus lower stress suggests a prolonged vulnerability due to chronic stress and/or early life trauma.

  3. Amniocentesis in HIV pregnant women: 16 years of experience.

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    Simões, Mafalda; Marques, Catarina; Gonçalves, Ana; Pereira, Ana Paula; Correia, Joaquim; Castela, João; Guerreiro, Cristina

    2013-01-01

    The iatrogenic risk of HIV vertical transmission, calculated in initial epidemiologic studies, seemed to counterindicate invasive prenatal diagnosis (PND) procedures. The implementation of highly active antiretroviral therapy (HAART) represented a turning point in PND management, owing to a rapid and effective reduction of maternal viral load (VL). In the present study, we identified cases of vertical transmission in HIV-infected pregnant women who did amniocentesis in the second trimester of pregnancy (n = 27), from 1996 to 2011. We divided our sample into Group A--women under HAART when submitted to amniocentesis (n = 20) and Group B--women without antiretroviral therapy before amniocentesis (n = 7). We had 1 case of vertical transmission in Group B. Preconceptional or early first trimester HIV serology is essential to avoid performing an amniocentesis without antiretroviral therapy or viral suppression. When there is an indication for amniocentesis in an HIV-infected pregnant woman, it should be done if the patient is on HAART and, if possible, when VL is undetectable. Nowadays, with combined first trimester screening test to select pregnancies with high risk of aneuploidies, advanced maternal age is a less frequent indication to perform PND invasive procedures, representing an outstanding gain in prenatal diagnosis of this population.

  4. High prevalence of unwanted pregnancies and induced abortions among HIV-infected women from Western India : need to emphasize dual method use?

    NARCIS (Netherlands)

    Darak, Shrinivas; Hutter, Inge; Kulkarni, Vinay; Kulkarni, Sanjeevani; Janssen, Fanny

    2016-01-01

    This study examines the prevalence, reasons, and predictors of unwanted pregnancies and induced abortions among ever married HIV-infected women attending a care facility in Maharashtra, Western India, and discusses its programmatic and policy implications. Retrospectively collected data of

  5. Prevalence and risk factors of cervical squamous intraepithelial lesions among HIV-infected women in Dar es Salaam, Tanzania.

    Science.gov (United States)

    Liu, Enju; McCree, Renicha; Mtisi, Expeditho; Fawzi, Wafaie W; Aris, Eric; Lema, Irene A; Hertzmark, Ellen; Chalamilla, Guerino; Li, Nan; Vermund, Sten H; Spiegelman, Donna

    2016-03-01

    To determine the prevalence and predictors of cervical squamous intraepithelial lesions (SIL) among HIV-infected women in Tanzania, a cross-sectional study was conducted among HIV-infected women at HIV care and treatment clinics. A Papanicolaou (Pap) smear was used as a screening tool for detection of cervical SIL. From December 2006 to August 2009, 1365 HIV-infected women received cervical screening. The median age was 35 (interquartile range [IQR]: 30-42) years, and the median CD4 + cell count was 164 (IQR: 80-257) cells/mm(3). The prevalence of cervical SIL was 8.7% (119/1365). In multivariate analysis, older age (≥50 versus 30-<40 years: prevalence ratio [PR], 2.36; 95% confidence interval [CI], 1.45-3.84, p for trend = 0.001), lower CD4 + cell counts (<100 versus ≥200 cells/mm(3): PR, 1.55; 95% CI, 1.01-2.36, p for trend = 0.03) and cervical inflammation (PR, 1.73; 95% CI, 1.16-2.60, p = 0.008) were associated with an increased risk of cervical SIL. Women with advanced WHO HIV disease stage (IV versus I/II: PR, 3.45; 95% CI, 1.35-8.85, p for trend = 0.01) had an increased risk for high-grade SIL. In resource-limited settings where it is not feasible to provide cervical cancer prevention services to all HIV-infected women, greater efforts should focus on scaling-up services among those who are older than 50 years, with lower CD4 cell counts and advanced HIV disease stage. © The Author(s) 2015.

  6. Prevalence and Risk Factors Associated with Precancerous Cervical Cancer Lesions among HIV-Infected Women in Resource-Limited Settings

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    Peter Memiah

    2012-01-01

    Full Text Available Objective. To assess the prevalence and identified associated risk factors for precancerous cervical cancer lesions among HIV-infected women in resource-limited settings in Kenya. Methods. HIV-infected women attending the ART clinic at the Nazareth Hospital ART clinic between June 2009 and September 2010. Multivariate logistic regression model with odds ratios and 95% confidence intervals (CI were estimated after controlling for important covariates. Result. A total of 715 women were screened for cervical cancer. The median age of the participants was 40 years (range 18–69 years. The prevalence of precancerous lesions (CINI, CINII, CIN III, ICC was 191 (26.7%. After controlling for other variables in logistic regression analysis, cervical precancerous lesions were associated with not being on ART therapy; whereby non-ART were 2.21 times more likely to have precancerous lesions than ART patients [(aOR=2.21, 95% CI (1.28–3.83]. Conclusion. The prevalence of precancerous cervical lesions was lower than other similar settings. It is recommended that cancer screening of HIV-infected women should be an established practice. Availability and accessibility of these services can be done through their integration into HIV. Prompt initiation of HAART through an early enrollment into care has an impact on reducing the prevalence and progression of cervical precancerous lesions.

  7. Impact of childhood trauma on functionality and quality of life in HIV-infected women

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    Spottiswoode Bruce

    2011-09-01

    Full Text Available Abstract Background While there are many published studies on HIV and functional limitations, there are few in the context of early abuse and its impact on functionality and Quality of Life (QoL in HIV. Methods The present study focused on HIV in the context of childhood trauma and its impact on functionality and Quality of Life (QoL by evaluating 85 HIV-positive (48 with childhood trauma and 37 without and 52 HIV-negative (21 with childhood trauma and 31 without South African women infected with Clade C HIV. QoL was assessed using the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q, the Patient's Assessment of Own Functioning Inventory (PAOFI, the Activities of Daily Living (ADL scale and the Sheehan Disability Scale (SDS. Furthermore, participants were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D and the Childhood Trauma Questionnaire (CTQ. Results Subjects had a mean age of 30.1 years. After controlling for age, level of education and CES-D scores, analysis of covariance (ANCOVA demonstrated significant individual effects of HIV status and childhood trauma on self-reported QoL. No significant interactional effects were evident. Functional limitation was, however, negatively correlated with CD4 lymphocyte count. Conclusions In assessing QoL in HIV-infected women, we were able to demonstrate the impact of childhood trauma on functional limitations in HIV.

  8. The metabolic profiles of HIV-infected and non-infected women in ...

    African Journals Online (AJOL)

    Human Immunodeficiency Virus (HIV) infection has reached epidemic proportions in ... Care, Management and Treatment for South Africa”, antiretroviral therapy (ART) ..... Racial differences in serum immunoglobulin levels: Relationship to ...

  9. Comparison of Ankle Proprioception Between Pregnant and Non Pregnant Women

    OpenAIRE

    Preetha R; John Solomon M

    2011-01-01

    Pregnant women report falls especially during their third trimester. Physiological changes along with ligament laxity can affect the joint proprioception in this population. This study was conducted to compare the ankle proprioception between pregnant and non pregnant women. Thirty pregnant and 30 non pregnant women were included in the study and the position of ankles were recorded by a digital camera placed 60 cms away from the feet of the subject. UTHSCSA Image tool software version 3.0. w...

  10. The quality of life of HIV-infected women is associated with psychiatric morbidity.

    Science.gov (United States)

    Tostes, M A; Chalub, M; Botega, N J

    2004-02-01

    This study evaluated the effect of clinical, demographic and psychiatric factors on the health-related quality of life of 76 women with HIV infection seen in two HIV reference centres in Brazil. The generic questionnaire for evaluation of Health-Related Quality of Life (SF-36), the Hospital Anxiety and Depression Scale (HAD) and the Clinical Interview Schedule (CIS-R) were used. The statistical tests included the covariance analysis. The patients' mean age was 37.4 years; 44.7% had less than 8 years of schooling. A total of 44.8% were asymptomatic, 28.9% symptomatic non-AIDS and 26.3% had AIDS. Most (77.6%) used two or three kinds of antiretrovirals; 36.8 and 30.3% achieved scores for anxiety and depression, respectively (HAD); and 48.7% for conspicuous psychiatric morbidity (CIS-R). The sub-group of the non-AIDS symptoms (clinical stage B) showed the worst quality of life. The variables which better explained the scoring variation on both the mental and physical components of the SF-36 were related to mental health. The more mental symptoms present, the worse the health-related quality of life. We must rethink care strategies in the area of mental health which are directed toward HIV+ patients, by virtue of the levels of mental symptoms found and the request for care which the research revealed.

  11. Socioeconomic status as a risk factor for HIV infection in women in East, Central and Southern Africa: a systematic review.

    Science.gov (United States)

    Wojcicki, Janet Maia

    2005-01-01

    This is a critical, systematic review of the relationship between socioeconomic status (SES) and HIV infection in women in Southern, Central and Eastern Africa. In light of the interest in micro-credit programmes and other HIV prevention interventions structured to empower women through increasing women's access to funds and education, this review examines the epidemiological and public health literature, which ascertains the association between low SES using different measurements of SES and risk of HIV infection in women. Also, given the focus on structural violence and poverty as factors driving the HIV epidemic at a structural/ecological level, as advocated by Paul Farmer and others, this study examines the extent to which differences in SES between individuals in areas with generalized poverty affect risk for SES. Out of 71 studies retrieved, 36 studies met the inclusion criteria including 30 cross-sectional, one case-control and five prospective cohort or nested case-control studies. Thirty-five studies used at least one measurement of female's SES and fourteen also included a measurement of partner's SES. Studies used variables measuring educational level, household income and occupation or employment status at the individual and neighbourhood level to ascertain SES. Of the 36 studies, fifteen found no association between SES and HIV infection, twelve found an association between high SES and HIV infection, eight found an association between low SES and HIV infection and one was mixed. In interpreting these results, this review examines the role of potential confounders and effect modifiers such as history of STDs, number of partners, living in urban or rural areas and time and location of study in sub-Saharan Africa. It is argued that STDs and number of partners are on the causal pathway under investigation between HIV and SES and should not be adjusted as confounders in any analysis. In conclusion, it is argued that in low-income sub-Saharan Africans

  12. Evolución de los embarazos de mujeres infectadas por el virus de la inmunodeficiencia humana Pregnancy outcome in HIV-infected women

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    Ricardo Figueroa-Damián

    1999-10-01

    Full Text Available OBJETIVO: Identificar las complicaciones médicas de las embarazadas infectadas por el virus de la inmunodeficiencia humana (VIH y asintomáticas, y determinar el riesgo que el virus representa para el desarrollo de las mismas. MATERIAL Y MÉTODOS: Se comparó la evolución del embarazo y el resultado perinatal de 44 embarazadas seropositivas al VIH, asintomáticas y que presentaron más de 200 linfocitos CD4/mm³, con embarazadas control no infectadas; las pacientes se parearon por edad y nivel socioeconómico. RESULTADOS: En 42 (95.4% pacientes la vía de contagio fue sexual; 35 (79.5% tenían menos de un año de saber que estaban infectadas y 15 (34% recibieron tratamiento antiviral durante la gestación. Las mujeres infectadas por el VIH presentaron un riesgo mayor de complicaciones infecciosas (RR3.1, IC95% 1.9-52, cervicovaginitis (RR2.2, IC95% 1- 48 y enfermedades de transmisión sexual (RR18, IC95% 2.3-137. El promedio de peso y talla de los recién nacidos y el número de complicaciones neonatales fueron similares entre los grupos comparados. El análisis estratificado mostró que la ausencia de tratamiento antirretroviral y el antecedente de tres o más parejas sexuales incrementaron el riesgo de complicaciones infecciosas. CONCLUSIONES: Las embarazadas seropositivas al VIH y asintomáticas no tuvieron un riesgo mayor de complicaciones médicas del embarazo, con excepción de problemas infecciosos.OBJECTIVE: To identify the medical complications in a cohort of HIV-infected, pregnant women and to determine the risk of having the virus in the development of these complications. MATERIAL AND METHODS: A cohort study of 44 HIV-infected and 88 seronegative pregnant women was performed. Pregnancy was followed and perinatal results were compared. HIV-infected women were asymptomatic with CD4 count > 200 mm³. Patients were matched for age and socioeconomic status. RESULTS: In 42 (95.4% of HIV patients the disease had been transmitted sexually

  13. Trichomonas vaginalis Incidence Associated with Hormonal Contraceptive Use and HIV Infection among Women in Rakai, Uganda

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    Heena Brahmbhatt

    2014-01-01

    Full Text Available Background. Data on the incidence of Trichomonas vaginalis and use of hormonal contraception (HC are limited. Methods. 2,374 sexually active women aged 15–49 years from cohort surveys in Rakai, Uganda, were included. Incidence of T. vaginalis was estimated per 100 person years (py and association between HC (DMPA, Norplant, and oral contraceptives and T. vaginalis infection was assessed by incidence rate ratios (IRR, using Poisson regression models. Results. At baseline, 34.9% had used HC in the last 12 months, 12.8% HIV+, 39.7% with high BV-scores (7–10, and 3.1% syphilis positive. The 12-month incidence of T. vaginalis was 2.4/100 py; CI (1.90, 3.25. When stratified by type of HC used, compared to women who did not use HC or condoms, incidence of T. vaginalis was significantly higher among users of Norplant (adj.IRR = 3.01, CI: 1.07–8.49 and significantly lower among DMPA users (adj.IRR = 0.55, CI: 0.30, 0.98 and women who discontinued HC use at follow-up (adj.IRR = 0.30, CI: 0.09, 0.99. HIV infection was associated with an increase in incidence of T. vaginalis (adj.IRR = 2.34, CI: 1.44, 3.78. Conclusions. Use of Norplant and being HIV+ significantly increased the risk of T. vaginalis, while use of DMPA and discontinuation of overall HC use were associated with a decreased incidence of T. vaginalis.

  14. Dynamics of regulatory T-cells during pregnancy: effect of HIV infection and correlations with other immune parameters.

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    Kelly Richardson

    Full Text Available OBJECTIVES: Regulatory T cells (Treg increase in the context of HIV infection and pregnancy. We studied Treg subpopulations in HIV-infected and uninfected women during pregnancy and their relationship with inflammation, activation and cell-mediated immunity (CMI. DESIGN AND METHODS: Blood obtained from 20 HIV-infected and 18 uninfected women during early and late gestation was used to measure Treg and activated T cells (Tact by flow cytometry; plasma cytokines and inflammatory markers by ELISA and chemoluminescence; and CMI against varicella-zoster virus (VZV by lymphocyte proliferation. RESULTS AND CONCLUSIONS: Compared with uninfected women, HIV-infected participants had higher frequencies of Treg subpopulations in early pregnancy, including CD4+CD25+FoxP3+%, CD8+CD25+FoxP3+%, CD4+TGFβ+% and CD4+IL10+%. In contrast, Treg frequencies were lower during late pregnancy in HIV-infected compared with uninfected women, including CD8+TGFβ+%, CD4+CTLA4+% and CD8+CTLA4+%. VZV-CMI, which was lower in HIV-infected compared with uninfected pregnant women, was inversely correlated with CD4+FoxP3+%, CD8+FoxP3+% and CD8+TGFβ+% in HIV-infected, but not in uninfected pregnant women. β₂-microglobulin, neopterin, IL1, IL4, IL8, IL10, IFNγ and TNFα plasma concentrations as well as Tact were higher in HIV-infected compared with uninfected women throughout pregnancy. In HIV-infected, but not in uninfected women, inflammatory, Th1, Th2 and regulatory cytokines increased with higher Treg%, suggesting that inflammation and regulation have a common pathophysiologic origin in the context of HIV infection. In HIV-infected and more commonly in uninfected pregnant women, higher Treg% correlated with lower Tact%. We conclude that Treg have different dynamics during pregnancy in HIV-infected and uninfected women. Higher levels of inflammatory cytokines and lower Treg% during late pregnancy in HIV-infected women may contribute to their increased incidence of maternal

  15. Hepatitis C viremia is associated with cytomegalovirus IgG antibody levels in HIV-infected women.

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    Mark H Kuniholm

    Full Text Available BACKGROUND: Individuals with HIV infection exhibit high cytomegalovirus (CMV IgG levels, but there are few data regarding the association of hepatitis C virus (HCV with the immune response against CMV. METHODS: Associations of HCV with CMV seropositivity and CMV IgG levels were studied in 635 HIV-infected women, 187 of whom were HCV-seropositive, with adjustment in multivariable models for age, race/ethnicity, and HIV disease characteristics. Eighty one percent of the women reported receipt of highly active antiretroviral therapy (HAART prior to or at CMV testing. RESULTS: In adjusted models women with chronic HCV had higher CMV IgG levels than those without HCV RNA (β = 2.86, 95% CI:0.89 - 4.83; P = 0.004. The association of HCV RNA with CMV IgG differed by age (P(interaction = 0.0007, with a strong association observed among women in the low and middle age tertiles (≤ 45.3 years of age; β = 6.21, 95% CI:3.30 - 9.11, P<0.0001 but not among women in the high age tertile. CMV IgG levels were not associated with non-invasive measures of liver disease, APRI and FIB-4, or with HCV RNA level and adjustment for Epstein-Barr virus (EBV IgG levels did not affect the association between HCV and CMV. CONCLUSIONS: CMV IgG levels are higher in HCV/HIV co-infected women than in HIV mono-infected women. Further research on the association of HCV with CMV IgG is indicated because prior studies have found CMV IgG to be associated with morbidity and mortality in the general population and subclinical carotid artery disease in HIV-infected patients.

  16. Distribution of HIV among pregnant women visiting a tertiary care hospital in Kathmandu, Nepal

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    Manish Rijal

    2014-09-01

    Full Text Available Objective: To explore the distribution of HIV among the pregnant women visiting a tertiary care hospital in Kathmandu. Methods: A total of 1 440 blood samples from pregnant women were collected and tested for antiHIV antibodies using rapid screening assay kits and ELISA in Paropakar Maternity and Women ’s Hospital during May to November, 2011. Results: The overall sero-prevalence of HIV among pregnant women was 0.62%, the prevalence being highest (1.4% in age group 35-39 years old, and during second trimester of gestation (0.75%. Similarly, it was found to be highest among the illiterates (1.92%, commercial sex worker (10.00% and those having multiple sexual partners (30.00%. Conclusions: Sero-prevalence of HIV infection was higher among the pregnant women of Kathmandu.

  17. High-risk human papillomavirus in HIV-infected women undergoing cervical cancer screening in Lilongwe, Malawi: a pilot study.

    Science.gov (United States)

    Reddy, Deepa; Njala, Joseph; Stocker, Penny; Schooley, Alan; Flores, Martiniano; Tseng, Chi-Hong; Pfaff, Colin; Jansen, Perry; Mitsuyasu, Ronald T; Hoffman, Risa M

    2015-05-01

    Rates of abnormal visual inspection with acetic acid and prevalence of high-risk human papillomavirus (HPV) subtypes have not been well characterized in HIV-infected women in Malawi. We performed a prospective cohort study of visual inspection with acetic acid (N = 440) in HIV-infected women aged 25--59 years, with a nested study of HPV subtypes in first 300 women enrolled. Of 440 women screened, 9.5% (N = 42) had abnormal visual inspection with acetic acid with 69.0% (N = 29) having advanced disease not amenable to cryotherapy. Of 294 women with HPV results, 39% (N = 114) of women were positive for high-risk HPV infection. Only lower CD4 count (287 cells/mm(3) versus 339 cells/mm(3), p = 0.03) and high-risk HPV (66.7% versus 35.6%, p < 0.01) were associated with abnormal visual inspection with acetic acid. The most common high-risk HPV subtypes in women with abnormal visual inspection with acetic acid were 35 (33.3%), 16 (26.7%), and 58 (23.3%). Low CD4 cell count was associated with abnormal visual inspection with acetic acid and raises the importance of early antiretroviral therapy and expanded availability of visual inspection with acetic acid. HPV vaccines targeting additional non-16/18 high-risk HPV subtypes may have greater protective advantages in countries such as Malawi.

  18. Male out-migration: a factor for the spread of HIV infection among married men and women in rural India.

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    Niranjan Saggurti

    Full Text Available INTRODUCTION: Thus far, the reasons for increasing HIV prevalence in northern and eastern Indian states are unknown. We investigated the role of male out-migration in the spread of human immunodeficiency virus (HIV infection through a case-control study in rural India. METHODS: Currently married men and women were recruited from HIV testing and treatment centers across seven selected districts with high rates of male out-migration in eastern and northern India in 2010 using a case-control study design. Case subjects (men: 595, women: 609 were people who tested HIV seropositive and control subjects (men: 611, women: 600 were those tested HIV seronegative. For each gender, we obtained adjusted odds ratios (AORs and population attributable risks (PARs for migration, and behavioral factors. RESULTS: For men, the prevalence of HIV was significantly higher among those with a migration history (AOR, 4.4; for women, the prevalence of HIV was higher among those with migrant husbands (AOR, 2·3. For both genders, the returned male migration (men: AOR, 3·7; women: AOR, 28 was significantly associated with higher prevalence of HIV infection. The PAR associated with male migration was higher for men (54.5%-68.6% than for women (32·7%-56·9% across the study areas. DISCUSSION: Male out-migration is the most important risk factor influencing the spread of HIV infection in rural areas with high out-migration rates, thereby emphasizing the need for interventions, particularly, for returned migrants and spouses of those migrants.

  19. Body image is a major determinant of sexual dysfunction in stable HIV-infected women.

    Science.gov (United States)

    Luzi, Kety; Guaraldi, Giovanni; Murri, Rita; De Paola, Maria; Orlando, Gabriella; Squillace, Nicola; Esposito, Roberto; Rochira, Vincenzo; Vincenzo, Rochira; Zirilli, Lucia; Martinez, Esteban

    2009-01-01

    Prevalence and factors associated with sexual dysfunction in HIV-positive women are poorly known. This was a cross-sectional study in a cohort of HIV-infected women. Clinically stable women were invited to participate in a female sexual dysfunction (FSD) evaluation with Female Sexual Function Index (FSFI) exploring desire, arousal, lubrication, orgasm, pain and satisfaction. An FSFI score body appearance satisfaction, interference of body changes with habits, social life and attitudinal aspects of body image, health-related quality of life, hormonal assessment, menopause, cumulative exposure to antiretroviral drug classes and immune-virological parameters. Lipodystrophy was defined according to the HIV Outpatient Study definition. A total of 185 women completed the FSFI. The mean (+/-SD) age was 42 years (+/-5), 27% had CDC stage C, the mean (+/-SD) CD4+ T-cell count was 508 cells/microl (+/-251) and median HIV RNA was 1.7 log10 copies/ml (interquartile range 1.7-2.6). Among 161 evaluable patients, 59 (32%) reported FSD. In a multiple linear regression analysis, desire, arousal and satisfaction domains were associated with interference of body changes with habits, social life and attitudinal aspects of body image (beta = 0.22, 95% confidence interval [CI] 0.06-0.37; beta = 0.29, 95% CI 0.10-0.48; and beta = 0.20, 95% CI 0.02-0.38, respectively). Lubrication and orgasm domains were associated with body image satisfaction (beta = -0.49, 95% CI -0.88 - -0.10 and beta = -0.58, 95% CI -1.00 - -0.16, respectively). No significant associations with sex hormones, CDC stage, CD4+ T-cell count, HIV RNA viral load and cumulative exposure to antiretroviral drug classes were found. In women with FSD, severity of self-perceived abdominal fat accumulation showed a trend towards lower FSFI scores (ANOVA P = 0.02). FSD was highly prevalent in this cohort. Self-perceived body changes was identified as its major determinant.

  20. Post-natal anaemia and iron deficiency in HIV-infected women and the health and survival of their children.

    Science.gov (United States)

    Isanaka, Sheila; Spiegelman, Donna; Aboud, Said; Manji, Karim P; Msamanga, Gernard I; Willet, Walter C; Duggan, Christopher; Fawzi, Wafaie W

    2012-07-01

    Prenatal iron supplementation may improve pregnancy outcomes and decrease the risk of child mortality. However, little is known about the importance of post-natal maternal iron status for child health and survival, particularly in the context of HIV infection. We examined the association of maternal anaemia and hypochromic microcytosis, an erythrocyte morphology consistent with iron deficiency, with child health and survival in the first two to five years of life. Repeated measures of maternal anaemia and hypochromic microcytosis from 840 HIV-positive women enrolled in a clinical trial of vitamin supplementation were prospectively related to child mortality, HIV infection and CD4 T-cell count. Median duration of follow-up for the endpoints of child mortality, HIV infection and CD4 cell count was 58, 17 and 23 months, respectively. Maternal anaemia and hypochromic microcytosis were associated with greater risk of child mortality [hazard ratio (HR) for severe anaemia = 2.58, 95% confidence interval (CI): 1.66-4.01, P trend children (difference in CD4 T-cell count/µL for severe anaemia: -93, 95% CI: -204-17, P trend = 0.02). The potential child health risks associated with maternal anaemia and iron deficiency may not be limited to the prenatal period. Efforts to reduce maternal anaemia and iron deficiency during pregnancy may need to be expanded to include the post-partum period. © 2012 Blackwell Publishing Ltd.

  1. Postnatal anemia and iron deficiency in HIV-infected women and the health and survival of their children

    Science.gov (United States)

    Isanaka, Sheila; Spiegelman, Donna; Aboud, Said; Manji, Karim P.; Msamanga, Gernard I.; Willet, Walter C.; Duggan, Christopher; Fawzi, Wafaie W.

    2011-01-01

    Prenatal iron supplementation may improve pregnancy outcomes and decrease the risk of child mortality. However, little is known about the importance of postnatal maternal iron status for child health and survival, particularly in the context of HIV infection. We examined the association of maternal anemia and hypochromic microcytosis, an erythrocyte morphology consistent with iron deficiency, with child health and survival in the first two to five years of life. Repeated measures of maternal anemia and hypochromic microcytosis from 840 HIV-positive women enrolled in a clinical trial of vitamin supplementation were prospectively related to child mortality, HIV infection, and CD4 T-cell count. Median duration of follow-up for the endpoints of child mortality, HIV infection and CD4 cell count was 58, 17 and 23 months, respectively. Maternal anemia and hypochromic microcytosis were associated with greater risk of child mortality (HR for severe anemia=2.58, 95% CI: 1.66-4.01, P trendchildren (difference in CD4 T-cell count/μL for severe anemia:-93, 95% CI: -204-17, P trend=0.02). The potential child health risks associated with maternal anemia and iron deficiency may not be limited to the prenatal period. Efforts to reduce maternal anemia and iron deficiency during pregnancy may need to be expanded to include the postpartum period. PMID:22236211

  2. The accessibility of HIV-infected Poor Women to the Prevention of Mother to Child Transmission Service in Surakarta Indonesia

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    Argyo Demartoto

    2016-12-01

    Full Text Available Background: HIV transmission from HIV-infected mother to child can occur through pregnancy, birth and lactation process; therefore, there should be Prevention of Mother to Child Transmission or PMTCT. Aims & Objectives: This research aimed to study the HIV-infected poor women’s accessibility to the Prevention of Mother to Child Transmission Service in Surakarta Indonesia. Material & Methods: This study was a qualitative research with explorative approach conducted in October-December 2015 and HIV-infected poor women as the unit of analysis. The sampling technique used was maximum variation sampling. Techniques of collecting data used were observation, in-depth interview and documentation, while data analysis was conducted using an Interactive Model of analysis with materialist theory. Results: Structural, financial and personal or cultural constraints were found: less target-appropriate health insurance policy, expensive cost of delivery with section caesarian surgery and breastfeed-substituting formula milk, and limited knowledge, experience and negotiation with the service provider leading to the HIV-infected Poor Women’s limited accessibility to comprehensive and sustainable PMTCT. PMTCT socialization, the giving-birth insurance and Food Supplementation program activation by Empowerment Work Group in AIDS Coping Commission in Surakarta City was the opportunity to access PMTCT service. Conclusion: Although PMTCT resulted in some problems, particularly formula milk administration and delivery process with section caesarian surgery, this attempt should be taken to make the baby born healthy. For that reasons, PMTCT service and health insurance should be improved from beneficiary data to accessible and sustainable procedure.

  3. Prevalence and concordance of human papillomavirus infection at multiple anatomic sites among HIV-infected women from Chennai, India.

    Science.gov (United States)

    Menezes, Lynette J; Poongulali, Selvamuthu; Tommasino, Massimo; Lin, Hui-Yi; Kumarasamy, Nagalingeswaran; Fisher, Kate J; Saravanan, Shanmugam; Gheit, Tarik; Ezhilarasi, Chandrasekaran; Jeeva, Arumugham; Lu, Beibei; Giuliano, Anna R

    2016-06-01

    Human papillomavirus (HPV) infection at the cervix, anus and oropharynx has been rarely concurrently estimated among HIV-infected women. Using multiplex polymerase chain reaction testing, we prospectively evaluated HPV genotype distribution across three anatomic sites among 50 eligible HIV-infected women from Chennai, India, who provided biological specimens and answered a sexual behaviour questionnaire. We also assessed clinical and behavioural factors related to HPV prevalence. Oncogenic HPV prevalence was comparable between the anus and cervix at 52.2% and 52.0% and lower at the oropharynx at 13.2%; 78% of women with a cervical HPV infection had the same type in the anus. Newly acquired oncogenic HPV infections were lower at cervix (24%) than anus (35%) at three months. 'Any type' cervical HPV prevalence was higher among women with low education and less than five years since HIV diagnosis. CD4+ count and antiretroviral therapy status were not associated with HPV prevalence at the three anatomic sites; however, enrolment cervical HPV16 prevalence was elevated among women with nadir CD4+ infected Indian women irrespective of CD4+ count and antiretroviral therapy status. Additional research clarifying the natural history of anal HPV infection is also needed in this population. © The Author(s) 2015.

  4. Insulin resistance change and antiretroviral therapy exposure in HIV-infected and uninfected Rwandan women: a longitudinal analysis.

    Science.gov (United States)

    Mutimura, Eugene; Hoover, Donald R; Shi, Qiuhu; Dusingize, Jean Claude; Sinayobye, Jean D'Amour; Cohen, Mardge; Anastos, Kathryn

    2015-01-01

    We longitudinally assessed predictors of insulin resistance (IR) change among HIV-uninfected and HIV-infected (ART-initiators and ART-non-initiators) Rwandan women. HIV-infected (HIV+) and uninfected (HIV-) women provided demographic and clinical measures: age, body mass index (BMI) in Kg/(height in meters)2, Fat-Mass (FMI) and Fat-Free-Mass (FFMI) index, fasting serum glucose and insulin. Homeostasis Model Assessment (HOMA) was calculated to estimate IR change over time in log10 transformed HOMA measured at study enrollment or prior to ART initiation in 3 groups: HIV- (n = 194), HIV+ ART-non-initiators (n=95) and HIV+ ART-initiators (n=371). ANCOVA linear regression models of change in log10-HOMA were fit with all models included the first log10 HOMA as a predictor. Mean±SD log10-HOMA was -0.18±0.39 at the 1st and -0.21±0.41 at the 2nd measure, with mean change of 0.03±0.44. In the final model (all women) BMI at 1st HOMA measure (0.014; 95% CI=0.006-0.021 per kg/m2; pchange in BMI from 1st to 2nd measure (0.024; 95% CI=0.013-0.035 per kg/m2; pchange. When restricted to subjects with FMI measures, FMI at 1st HOMA measure (0.020; 95% CI=0.010-0.030 per kg/m2; pchange in FMI from 1st to 2nd measure (0.032; 95% CI=0.020-0.043 per kg/m2; pchange in HOMA. While ART use did not predict change in log10-HOMA, untreated HIV+ women had a significant decline in IR over time. Use or duration of AZT, d4T and EFV was not associated with HOMA change in HIV+ women. Baseline BMI and change in BMI, and in particular fat mass and change in fat mass predicted insulin resistance change over ~3 years in HIV-infected and uninfected Rwandan women. Exposure to specific ART (d4T, AZT, EFV) did not predict insulin resistance change in ART-treated HIV-infected Rwandan women.

  5. A risk score to identify HIV-infected women most likely to become lost to follow-up in the postpartum period.

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    Bengtson, Angela M; Chibwesha, Carla J; Westreich, Daniel; Mubiana-Mbewe, Mwangelwa; Chi, Benjamin H; Miller, William C; Mapani, Muntanga; Pence, Brian W; Musonda, Patrick; Stringer, Jeffrey Sa; Pettifor, Audrey

    2016-08-01

    Access to lifelong combination antiretroviral therapy (cART) is expanding among HIV-infected pregnant and breastfeeding women throughout sub-Saharan Africa (SSA). For this strategy to meaningfully improve maternal HIV outcomes, retention in HIV care is essential. We developed a risk score to identify women with high likelihood of loss to follow-up (LTFU) at 6 months postpartum from HIV care, using data from public health facilities in Lusaka, Zambia. LTFU was defined as not presenting for HIV care within 60 days of the last scheduled appointment. We used logistic regression to assess demographic, obstetric and HIV predictors of LTFU and to develop a simple risk score. Sensitivity and specificity were assessed at each risk score cut-point. Among 2029 pregnant women initiating cART between 2009 and 2011, 507 (25%) were LTFU by 6 months postpartum. Parity, education, employment status, WHO clinical stage, duration of cART during pregnancy and number of antenatal care visits were associated with LTFU (p-value risk score cut-point of 11 (42nd percentile) had 85% sensitivity (95% CI 82%, 88%) and 22% specificity (95% CI 20%, 24%) to detect women LTFU and would exclude 20% of women from a retention intervention. A risk score cut-point of 18 (69th percentile) identified the 23% of women with the highest probability of LTFU and had sensitivity 32% (95% CI 28%, 36%) and specificity 80% (95% CI 78%, 82%). A risk score approach may be useful to triage a subset of women most likely to be LTFU for targeted retention interventions.

  6. Birth defects among a cohort of infants born to HIV-infected women on antiretroviral medication

    Science.gov (United States)

    Watts, D. Heather; Huang, Sharon; Culnane, Mary; Kaiser, Kathleen A.; Scheuerle, Angela; Mofenson, Lynne; Stanley, Kenneth; Newell, Marie-Louise; Mandelbrot, Laurent; Delfraissy, Jean-Francois; Cunningham, Coleen K.

    2011-01-01

    Objective To determine rate of and risk factors for birth defects in infants born to HIV-infected women receiving nucleoside and protease inhibitor antiretroviral (ARV) therapy. Methods Birth defects were evaluated among infants on the Pediatric AIDS Clinical Trials Group 316 trial that studied addition of peripartum nevirapine to established ARV regimen for prevention of mother-to-child transmission. Maternal therapy was categorized by trimester of earliest exposure. Birth defects were coded using conventions of the Antiretroviral Pregnancy Registry. Results Birth defects were detected in 60/1414 (4.2%; 95% CI 3.3–5.4%) infants including 30/636 (4.7%; 95% CI 3.2–6.7%) with first trimester ARV exposure and 30/778 (3.9%; 95% CI 2.6–5.5%) with exposure only after the first trimester (P=0.51). Rates of classes of defects were similar between first trimester compared to later exposure groups except heart defects which occurred in 16 (2.5%; 95% CI 1.4–4.1%) with first trimester ARV exposure and in six (0.8%; 95% CI 0.3–1.7%) infants with later exposure (P=0.02). Exposure to ARV was not associated with specific types of heart defects. Two cases of cardiomyopathy were noted. Conclusion ARV use in early pregnancy was not associated with an increased risk of birth defects overall. The possible association of ARV exposure with heart defects requires further surveillance. PMID:21142844

  7. Epidemiology of Cervical Squamous Intraepithelial Lesions in HIV Infected Women in Kenya: a cross-Sectional Study.

    Science.gov (United States)

    Memiah, Peter; Makokha, Violet; Mbuthia, Wangeci; Kiiru, Grace Wanjiku; Agbor, Solomon; Odhiambo, Francesca; Ojoo, Sylvia; Mbizo, Justice; Muhula, Samuel; Mahasi, Gabriel; Biadgilign, Sibhatu

    2015-03-01

    Cervical cancer is the second most common cancer among women worldwide. Infection with the human immunodeficiency virus (HIV) and its related immunosuppression are associated with an increased risk of prevalent, incident, and persistent squamous intraepithelial lesions (SILs) of the cervix. The objective of the study was to describe the prevalence and predictors of high-risk HPV and cervical cancer to support the need for strengthening cervical cancer screening programs for HIV infected women in Kenya. A cross sectional study was conducted in a hospital in Central Kenya, Kiambu district. The study population constituted of HIV positive women attending the ART treatment clinic. A total of 715 HIV positive women initiated on Antiretroviral Therapy (ART) were enrolled in this study. About 359 (52.1%) were less than 40 years of age and 644 (90.3%) of the patients were widowed. About 642 (92.6%) of the HIV infected women were in follow-up period of ≥ 1 year. The outcome/prognosis of the patients undergoing ICC was 3 cured, 5 good and 4 poor respectively. In a multivariable ordinal logistic regression analysis showed that for a one-unit decrease of CD4, we expect 1.23 log odds of increasing the severity of cervical cancer (B = 1.23, P treatment, enrolling patients on HAART with higher CD4 counts is recommended to see the net effect of HAART response.

  8. Dyslipidaemia in HIV-infected women on antiretroviral therapy. Analysis of 922 patients from the Spanish VACH cohort

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    Estrada Vicente

    2011-08-01

    Full Text Available Abstract Background Information concerning lipid disturbances in HIV-infected women on antiretroviral therapy (ART is scarce. The objective of the study is to describe the lipid profile in a large cohort of HIV-infected women on contemporary ART and analyse differences between regimes and patient's characteristics. Methods Observational, multicentre, cross-sectional study from the Spanish VACH Cohort. 922 women on stable ART without lipid-lowering treatment were included. Results Median age was 42 years, median CD4 lymphocyte count was 544 cells/mm3, and 85.6% presented undetectable HIV-1 viral load. Median total cholesterol (TC was 189 mg/dL (interquartile range, IQR, 165-221, HDL cholesterol 53 mg/dL (IQR, 44-64, LDL cholesterol 108 mg/dL (IQR, 86-134, and triglycerides 116 mg/dL (IQR, 85-163. Mean accumulated time on ART was 116 months; 47.4% were on NNRTI-based regimes, 44.7% on PI, and 6.7% on only-NRTI therapy. 43.8% were also hepatitis C (HCV coinfected. Patients on PI treatment presented higher TC/HDL ratio than those on NNRTI (p Conclusions In HIV-infected women, the NNRTI-based ART is associated with a better lipid profile than the PI-based. Factors unrelated to ART selection may also exert an independent, significant influence on lipids; in particular, age, and triglyceride levels are associated with an increased TC/HDL ratio while HCV co-infection is associated with a reduced TC/HDL ratio.

  9. Trajectories of childbearing among HIV infected Indian women: A sequence analysis approach

    NARCIS (Netherlands)

    Darak, S.; Mills, M.; Kulkarni, V.; Kulkarni, S.; Hutter, I.; Janssen, F.

    2015-01-01

    Background HIV infection closely relates to and deeply affects the reproductive career of those infected. However, little is known about the reproductive career trajectories, specifically the interaction of the timing of HIV diagnosis with the timing and sequencing of reproductive events among HIV i

  10. Trajectories of Childbearing among HIV Infected Indian Women : A Sequence Analysis Approach

    NARCIS (Netherlands)

    Darak, Shrinivas; Mills, Melinda; Kulkarni, Vinay; Kulkarni, Sanjeevani; Hutter, Inge; Janssen, Fanny

    2015-01-01

    Background HIV infection closely relates to and deeply affects the reproductive career of those infected. However, little is known about the reproductive career trajectories, specifically the interaction of the timing of HIV diagnosis with the timing and sequencing of reproductive events among HIV i

  11. Pregnancy and delivery outcomes of HIV infected women in Switzerland 2003-2008.

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    Aebi-Popp, Karoline; Lapaire, Olav; Glass, Tracy R; Vilén, Louise; Rudin, Christoph; Elzi, Luigia; Battegay, Mannel; Keiser, Olivia; de Tejada, Begona Martinez; Hoesli, Irene M

    2010-07-01

    Rates of vertical HIV transmission between mother and child are low, allowing many HIV positive women to have children with near impunity. In this study, data from the Swiss Mother and Child HIV Cohort Study were used to describe maternal characteristics and their association with pregnancy outcomes in HIV positive women. HIV positive women were followed prospectively during their pregnancies and deliveries by anonymous questionnaires between January 2003 and October 2008. Adverse pregnancy outcomes included preterm delivery, preeclampsia and gestational diabetes mellitus. This study included 266 HIV positive women, of which 67 (25.2%) were first diagnosed with HIV during pregnancy. Thirty percent (n=80) of the women had pregnancy complications after 24 weeks of gestation. Preterm delivery was noted in 72 (27%) patients. Other complications included preeclampsia (n=7; 2.6%) and gestational diabetes (n=7; 2.6%). Older maternal age was the only risk factor associated with adverse pregnancy outcomes (adjusted odds ratio: 1.06, 95% confidence interval 1.01-1.12, P=0.02). HIV positive women, especially with advanced maternal age, have high-risk pregnancies and should be monitored as in an interdisciplinary setting. The preponderance of initial HIV diagnosis during pregnancy confirms the importance of HIV screening in pregnant women.

  12. Safety of Tenofovir Disoproxil Fumarate-Based Antiretroviral Therapy Regimens in Pregnancy for HIV-Infected Women and Their Infants: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Nachega, Jean B; Uthman, Olalekan A; Mofenson, Lynne M; Anderson, Jean R; Kanters, Steve; Renaud, Francoise; Ford, Nathan; Essajee, Shaffiq; Doherty, Meg C; Mills, Edward J

    2017-09-01

    There are limited data on adverse effects of tenofovir disoproxil fumarate (TDF)-based antiretroviral therapy (ART) on pregnant women and their infants. We conducted a systematic review of studies published between January 1980 and January 2017 that compared adverse outcomes in HIV-infected women receiving TDF- vs. non-TDF-based ART during pregnancy. The risk ratio (RR) for associations was pooled using a fixed-effects model. Seventeen studies met the study inclusion criteria. We found that the rate of preterm (14 days) (RR = 0.65; 95% CI: 0.23 to 1.85), but increased neonatal mortality (age <14 days) risk (RR = 5.64, 95% CI: 1.70 to 18.79) with TDR-based ART exposure. No differences were found for anthropomorphic parameters at birth; one study reported minor differences in z-scores for length and head circumference at age 1 year. TDF-based ART in pregnancy seems generally safe for women and their infants. However, data remain limited and further studies are needed, particularly to assess neonatal mortality and infant growth/bone effects.

  13. Perinatal Outcomes in HIV Positive Pregnant Women with Concomitant Sexually Transmitted Infections

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    Erin Burnett

    2015-01-01

    Full Text Available Objective. To evaluate whether HIV infected pregnant women with concomitant sexually transmitted infection (STIs are at increased risk of adverse perinatal and neonatal outcomes. Methods. We conducted a cohort study of HIV positive women who delivered at an inner-city hospital in Atlanta, Georgia, from 2003 to 2013. Demographics, presence of concomitant STIs, prenatal care information, and maternal and neonatal outcomes were collected. The outcomes examined were the association of the presence of concomitant STIs on the risk of preterm birth (PTB, postpartum hemorrhage, chorioamnionitis, preeclampsia, intrauterine growth restriction, small for gestational age, low Apgar scores, and neonatal intensive care admission. Multiple logistic regression was performed to adjust for potential confounders. Results. HIV positive pregnant women with concomitant STIs had an increased risk of spontaneous PTB (odds ratio (OR 2.11, 95% confidence interval [CI] 1.12–3.97. After adjusting for a history of preterm birth, maternal age, and low CD4+ count at prenatal care entry the association between concomitant STIs and spontaneous PTB persisted (adjusted OR 1.96, 95% CI 1.01–3.78. Conclusions. HIV infected pregnant women with concomitant STIs relative to HIV positive pregnant women without a concomitant STI are at increased risk of spontaneous PTB.

  14. The breast-feeding dilemma and its impact on HIV-infected women and their children.

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    Heymann, S J; Vo, P

    1999-07-01

    The rate of HIV transmission via breast-feeding ranges from 14% to 26%, depending on the timing of maternal infection. In settings where infant mortality rates from infectious diseases and malnutrition are low and relatively safe alternatives to breast-feeding are available, HIV-infected mothers should be advised not to breast-feed. Where breast-feeding by HIV-infected mothers and bottle-feeding both present serious risks of mortality, changing the conditions in which families live so that safe feeding alternatives become available must be a top priority. At the same time, these mothers need information about the relative risks and benefits of breast-feeding, early weaning, wet-nursing, and formula feeding. This article reviews the available research data and discusses critical gaps in current knowledge.

  15. Asymptomatic bacteriuria in pregnant women.

    Science.gov (United States)

    Thakur, Achala; Baral, Ratna; Basnet, Pritha; Rai, Rubina; Agrawal, Ajay; Regmi, Mohan Chandra; Uprety, Dhruba Kumar

    2013-01-01

    Asymptomatic bacteriuria is the significant presence of bacteria in urine of an individual without symptoms. The aim of the study is to determine the prevalence of asymptomatic bacteriuria in pregnant women. This study was a prospective study conducted in the department of Obstetrics and Gynaecology at B. P. Koirala Institute of Health Sciences. The duration of the study was six months from January to June 2012. A total of 600 pregnant women were enrolled. All women were clinically identified to have no signs and symptoms of UTI. Clean catch midstream urine sample was collected from each patient into a sterile vial. The urine samples were examined for microscopic and culture sensitivity test. Out of 600 pregnant women, 52 were positive for significant bacteriuria with a prevalence rate of 8.7%. There was a significant difference in prevalence of asymptomatic bacteriuria with respect to trimester (p=0.005). Age did not show any significant difference in the prevalence of asymptomatic bacteriuria (p=0.807). There was not any significant difference in the prevalence of asymptomatic bacteriuria with respect to parity (p=0.864) and booking status (p=0.397). Escherichia coli (35%), Acinetobacter species (15%), Enterococcus species (12%) and Klebsiella pneumoniae (10%) were the common isolates. Most of the isolates were sensitive either to Nitrofurantoin, Norfloxacin or Amikacin. Asymptomatic bacteriuria is common in pregnancy. Urine culture sensitivity should be carried out routinely on all pregnant patients in order to prevent the dangerous complications associated with it.

  16. Attitudes Toward Restricting the Sexual and Reproductive Rights of Women Living With HIV Infection in Yemen.

    Science.gov (United States)

    Badahdah, Abdallah M

    2016-01-01

    A considerable amount of research has demonstrated the pervasive and destructive power of discrimination against people living with HIV, which limits their full and equal participation in society. This study surveyed 613 young adults from Yemen about their attitudes toward the sexual and reproductive rights of women living with HIV (WLWH). Among survey respondents, 80% believed that WLWH should be sterilized and not allowed to get married. Furthermore, 62% thought that WLWH should be forced to have abortions if they became pregnant. Men were more likely than women to impose restrictions on the sexual and reproductive rights of WLWH. HIV stigma predicted respondent attitudes toward WLWH, but religiosity and knowledge about HIV did not. The results of the study have implications for developing programs to protect and promote the rights of WLWH in Yemen.

  17. Fibrinolytic changes in pregnant women on highly active antiretroviral therapy.

    Science.gov (United States)

    Osime, Odaburhine E; Ese-Onakewhor, Joseph U; Kolade, Samson O

    2015-02-01

    To report on the changes in fibrinolytic activity in human immunodeficiency virus (HIV) infected pregnant women who are undergoing highly active antiretroviral therapy (HAART). Blood was collected from 50 HIV positive women on HAART (test subjects), and 50 HIV positive women not on HAART (controls). These women were attending the prevention of mother to child clinic (PMTCT) of the University of Benin Teaching Hospital, Benin City, Nigeria from January to June 2014. Standard manual techniques were used to estimate plasma fibrinogen concentration (PFC), euglobulin lysis time (ELT), packed cell volume (PCV), and plasma viscosity (PV). The mean ± standard error of mean (SEM) of PFC was 4.02±0.13 g/l and ELT from the test subjects was 378±15 mins was significantly higher (p0.05). There were differences in the various parameters investigated when the various trimesters were compared. These differences did not, however, follow a particular pattern. Highly active antiretroviral therapy can cause changes in fibrinolytic activity that may predispose pregnant women to hyperfibrinogenemia and anemia.

  18. Substance Use Patterns of HIV-Infected Russian Women with and Without Hepatitis C Virus Co-infection.

    Science.gov (United States)

    Brown, Jennifer L; DiClemente, Ralph J; Sales, Jessica M; Rose, Eve S; Safonova, Polina; Levina, Olga S; Belyakov, Nikolay; Rassokhin, Vadim V

    2016-10-01

    Individuals with HIV and hepatitis C virus (HCV) co-infection may experience substance use related health complications. This study characterized substance use patterns between HIV/HCV co-infected and HIV mono-infected Russian women. HIV-infected women (N = 247; M age = 30.0) in St. Petersburg, Russia, completed a survey assessing substance use, problematic substance use, and the co-occurrence of substance use and sexual behaviors. Covariate adjusted logistic and linear regression analyses indicated that HIV/HCV co-infected participants (57.1 %) reported more lifetime drug use (e.g., heroin: AOR: 13.2, 95 % CI 4.9, 35.3, p Russian women.

  19. Behavior change interventions to prevent HIV infection among women living in low and middle income countries: a systematic review.

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    McCoy, Sandra I; Kangwende, Rugare A; Padian, Nancy S

    2010-06-01

    We conducted a systematic review of behavioral change interventions to prevent the sexual transmission of HIV among women and girls living in low- and middle-income countries. PubMed/MEDLINE, Web of Science, the Cochrane Library, and other databases and bibliographies were systematically searched for trials using randomized or quasi-experimental designs to evaluate behavioral interventions with HIV infection as an outcome. We identified 11 analyses for inclusion reporting on eight unique interventions. Interventions varied widely in intensity, duration, and delivery as well as by target population. Only two analyses showed a significant protective effect on HIV incidence among women and only three of ten analyses that measured behavioral outcomes reduced any measure of HIV-related risk behavior. Ongoing research is needed to determine whether behavior change interventions can be incorporated as independent efficacious components in HIV prevention packages for women or simply as complements to biomedical prevention strategies.

  20. High uptake of HIV testing in pregnant women in Ontario, Canada.

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    Robert S Remis

    Full Text Available In 1999, Ontario implemented a policy to offer HIV counseling and testing to all pregnant women and undertook measures to increase HIV testing. We evaluated the effectiveness of the new policy by examining HIV test uptake, the number of HIV-infected women identified and, in 2002, the HIV rate in women not tested during prenatal care. We analyzed test uptake among women receiving prenatal care from 1999 to 2010. We examined HIV test uptake and HIV rate by year, age and health region. In an anonymous, unlinked study, we determined the HIV rate in pregnant women not tested. Prenatal HIV test uptake in Ontario increased dramatically, from 33% in the first quarter of 1999 to 96% in 2010. Test uptake was highest in younger women but increased in all age groups. All health regions improved and experienced similar test uptake in recent years. The HIV rate among pregnant women tested in 2010 was 0.13/1,000; in Toronto, the rate was 0.28 per 1,000. In the 2002 unlinked study, the HIV rate was 0.62/1,000 among women not tested in pregnancy compared to 0.31/1,000 among tested women. HIV incidence among women who tested more than once was 0.05/1,000 person-years. In response to the new policy in Ontario, prenatal HIV testing uptake improved dramatically among women in all age groups and health regions. A reminder to physicians who had not ordered a prenatal HIV test appeared to be very effective. In 2002, the HIV rate in women who were not tested was twice that of tested women: though 77% of pregnant women had been tested, only 63% of HIV-infected women were tested. HIV testing uptake was estimated at 98% in 2010.

  1. High Rates of Anal High-Grade Squamous Intraepithelial Lesions in HIV-Infected Women Who Do Not Meet Screening Guidelines.

    Science.gov (United States)

    Gaisa, Michael; Ita-Nagy, Fanny; Sigel, Keith; Arens, Yotam; Hennessy, Mary Ann; Rodriguez-Caprio, Gabriela; Mullen, Michael; Aberg, Judith A; Cespedes, Michelle

    2017-02-01

    Human immunodeficiency virus (HIV)-infected women have a higher burden of anal high-grade squamous intraepithelial lesions (HSIL) and anal cancer (AC) compared with HIV-uninfected women. Guidelines for AC screening in this population are heterogeneous. Here we report outcomes and risk factors for anal HSIL following implementation of universal AC screening offered to all HIV-infected women. Data from women who underwent AC screening with anal cytology from April 2009 to July 2014 were analyzed. Routine clinical data included anal and cervical cytology, demographic/behavioral data, and high-resolution anoscopy (HRA) results. We evaluated the association of cytology with HRA results, and predictors of HSIL pathology, and compared rates of HSIL pathology among women meeting screening guidelines to those who did not. Seven hundred forty-five HIV-infected women were screened with anal cytology. Thirty-nine percent had abnormal anal cytology on initial screen and 15% on secondary screen; 208 women underwent HRA following abnormal anal cytology. HSIL was found in 26% and 18% of anal biopsies following initial and secondary screening, respectively. One woman had AC. Cigarette smoking more than doubled HSIL risk. Among women who underwent AC screening despite not meeting existing guideline criteria, 21% and 10%, respectively, were found to have HSIL on biopsy. Neither meeting criteria for screening nor history of receptive anal sex was significantly associated with HSIL. Anal HSIL is common in HIV-infected women. Substantial numbers of HSIL would have been missed by strictly adhering to existing AC screening guidelines. These results support routine screening of all HIV-infected women regardless of human papillomavirus history or sexual practices. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  2. Factors associated with colposcopy-histopathology confirmed cervical intraepithelial neoplasia among HIV-infected women from Rio De Janeiro, Brazil.

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    Angela Cristina Vasconcelos de Andrade

    Full Text Available INTRODUCTION: Despite the availability of preventive strategies (screening tests and vaccines, cervical cancer continues to impose a significant health burden in low- and medium-resourced countries. HIV-infected women are at increased risk for infection with human papillomavirus (HPV and thus development of cervical squamous intraepithelial neoplasia (CIN. METHODS: Study participants included HIV-infected women enrolling the prospective open cohort of Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation (IPEC/FIOCRUZ. At cohort entry, women were subjected to conventional Papanicolaou test, HPV-DNA test and colposcopy; lesions suspicious for CIN were biopsied. Histopathology report was based on directed biopsy or on specimens obtained by excision of the transformation zone or cervical conization. Poisson regression modeling was used to assess factors associated with CIN2+ diagnosis. RESULTS: The median age of the 366 HIV-infected women included in the study was 34 years (interquartile range: 28-41 years. The prevalence of CIN1, CIN2 and CIN3 were 20.0%, 3.5%, and 2.2%, respectively. One woman was found to have cervical cancer. The prevalence of CIN2+ was 6.0%. Factors associated with CIN2+ diagnosis in the multivariate model were age < years compared to ≥ 35 years (aPR  =  3.22 95%CI 1.23-8.39, current tobacco use (aPR  =  3.69 95%CI 1.54-8.78, nadir CD4 T-cell count <350 cells/mm3 when compared to ≥ 350 cells/mm3 (aPR  =  6.03 95%CI 1.50-24.3 and concomitant diagnosis of vulvar and/or vaginal intraepithelial lesion (aPR  =  2.68 95%CI 0.99-7.24. DISCUSSION: Increased survival through wide-spread use of highly active antiretroviral therapy might allow for the development of cervical cancer. In Brazil, limited cytology screening and gynecological care adds further complexity to the HIV-HPV co-infection problem. Integrated HIV care and cervical cancer prevention programs are needed for the prevention of cervical

  3. Frequency of Viremic Episodes in HIV-Infected Women Initiating Antiretroviral Therapy During Pregnancy: A Cohort Study.

    Science.gov (United States)

    Myer, Landon; Dunning, Lorna; Lesosky, Maia; Hsiao, Nei-Yuan; Phillips, Tamsin; Petro, Greg; Zerbe, Allison; McIntyre, James A; Abrams, Elaine J

    2017-02-15

    The numbers of human immunodeficiency virus (HIV)-infected women initiating antiretroviral therapy (ART) in pregnancy are increasing rapidly with global policy changes. There are widespread concerns about ART adherence during pregnancy and postpartum but few data on viral suppression (VS) over time in these populations. We followed a cohort of 523 women in Cape Town, South Africa, initiating ART in pregnancy (once-daily tenofovir 300 mg, emtricitabine 200 mg, and efavirenz 600 mg) and achieving VS (1000 copies/mL) and minor (50-1000 copies/mL) viremic episodes (VEs) and factors associated with major VEs. In the cohort (median age, 28 years; median pre-ART VL, 3.99 copies/mL; 3% previously defaulted ART; 24% with previous exposure to short-course antiretrovirals), the median time of follow-up from VS was 322 days. Overall, 70% maintained VS throughout follow-up, 8% experienced minor VEs only, and at least 1 major VE was documented in 22% of women. In women with VEs, peak viremia (median, 3.79 log10 copies/mL) was linearly related to pre-ART VL. The incidence of major VEs after initial VS was independently associated with younger age, ART initiation during the third trimester, previous defaulting on ART, and postpartum follow-up. Viremia appears to occur frequently, particularly postpartum, among HIV-infected women after initial VS in this setting. More intensive VL monitoring is warranted in this population; the immediate causes and long-term implications of VE require investigation.

  4. Marriage as a risk factor for HIV: learning from the experiences of HIV-infected women in Malawi.

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    Mkandawire-Valhmu, Lucy; Wendland, Claire; Stevens, Patricia E; Kako, Peninnah M; Dressel, Anne; Kibicho, Jennifer

    2013-01-01

    The gender inequalities that characterise intimate partner relationships in Malawi, a country with one of the highest HIV prevalence rates in the world, arguably place marriage as an important risk factor for HIV infection among women, yet few studies detail the complex interactions of marriage and risk. In order to develop HIV-prevention interventions that have lasting impacts in such communities, we need a deeper understanding of the intricacies of women's lives, how and why they are involved in marital relationships, and the implications of these relationships for HIV transmission or prevention. This article describes how women understand marriage's effects on their lives and their HIV risks. Drawing from focus group discussions with 72 women attending antiretroviral clinics in Malawi, we explore why women enter marriage, what women's experiences are within marriage and how they leave spouses for other relationships. Based on their narratives, we describe women's lives after separation, abandonment or widowhood, and report their reflections on marriage after being married two or three times. We then review women's narratives in light of published work on HIV, and provide recommendations that would minimise the risks of HIV attendant on marriage.

  5. Asymptomatic bacteriuria among pregnant women

    OpenAIRE

    Sudha Biradar Kerure; Rajeshwari Surpur; Sheela S. Sagarad; Sneha Hegadi

    2013-01-01

    Background: Urinary tract infections (UTIs) are the most common bacterial infections during pregnancy. Asymptomatic bacteriuria (ASB) is a major risk factor for the development of urinary tract infections during pregnancy and with further risk of preterm birth & pyelonephritis if untreated. Aims & Objectives: This study was carried out to determine the prevalence of asymptomatic bacteriuria (ASB) in pregnant women & to isolate, identify and establish antimicrobial susceptibility of pathogens....

  6. HPV infection, cervical abnormalities, and cancer in HIV-infected women in Mumbai, India: 12-month follow-up

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    Isaakidis P

    2013-08-01

    Full Text Available Petros Isaakidis,1,2 Sharmila Pimple,3 Bhanumati Varghese,1 Samsuddin Khan,1 Homa Mansoor,1 Joanna Ladomirska,1 Neelakumari Sharma,1 Esdras Da Silva,1 Carol Metcalf,4 Severine Caluwaerts,4 Petra Alders,4 Evangelia E Ntzani,2 Tony Reid41Médecins Sans Frontières, Mumbai, India; 2Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece; 3Preventive Oncology Department, Tata Memorial Hospital, Mumbai, India; 4Médecins Sans Frontières, Brussels, BelgiumBackground: HIV-infected women are at a higher risk of cervical intraepithelial neoplasia (CIN and cancer than women in the general population, partly due to a high prevalence of persistent human papillomavirus (HPV infection. The aim of the study was to assess the burden of HPV infection, cervical abnormalities, and cervical cancer among a cohort of HIV-infected women as part of a routine screening in an urban overpopulated slum setting in Mumbai, India.Methods: From May 2010 to October 2010, Médecins Sans Frontières and Tata Memorial Hospital Mumbai offered routine annual Pap smears and HPV DNA testing of women attending an antiretroviral therapy (ART clinic and a 12-month follow-up. Women with abnormal test results were offered cervical biopsy and treatment, including treatment for sexually transmitted infections (STIs.Results: Ninety-five women were screened. Median age was 38 years (IQR: 33–41; median nadir CD4-count 143 cells/µL (IQR: 79–270; and median time on ART 23 months (IQR:10–41. HPV DNA was detected in 30/94 women (32%, and 18/94 (19% showed either low-grade or high-grade squamous intraepithelial lesions (LSIL/HSIL on Pap smear. Overall, >50% had cervical inflammatory reactions including STIs. Of the 43 women with a cervical biopsy, eight (8.4% had CIN-1, five (5.3% CIN-2, and two (2.1% carcinoma in situ. All but one had HPV DNA detected (risk ratio: 11, 95% confidence interval: 3.3–34. By

  7. Oral Mucosal Disorders in Pregnant versus Non-Pregnant Women

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    Fahimeh Rezazadeh

    2014-12-01

    Full Text Available The effects of pregnancy on the Oral Mucosa Disorder (OMD have been sporadically documented in some developed countries. Less known is the status of OMD during pregnancy in less developed/developing countries. Iran is no exception. This study assesses the prevalence of OMD in 200 pregnant women and compares the findings with the findings from a 200 non-pregnant woman of similar age distribution in Iran. The participants had been referred to a clinic to receive reproductive age-related services. Participants suffering from systemic chronic diseases, those on medications/drugs, smokers, needing biopsies, and those with urgent Oral Mucosal Lesion (OML treatments were excluded from the study. Oral mucosal of all 400 participants were examined. The participants’ age ranges were from 17 to 47; with the average age of 33.14 for one group; and 30.23 for the other group. Both groups had the same level of formal education. Out of 400 examined women; 62 had lesions, including 47 pregnant (23.5%; and 15 non-pregnant (7.5% women. This result shows that the OMD rate of occurrence was significantly higher among the pregnant women. Higher OML prevalence in pregnant women, as compared to the non-pregnant women, indicates the importance of timely oral examination of pregnant women and subsequent treatment plans for them.

  8. Asymptomatic bacteriuria among pregnant women

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    Sudha Biradar Kerure

    2013-04-01

    Full Text Available Background: Urinary tract infections (UTIs are the most common bacterial infections during pregnancy. Asymptomatic bacteriuria (ASB is a major risk factor for the development of urinary tract infections during pregnancy and with further risk of preterm birth & pyelonephritis if untreated. Aims & Objectives: This study was carried out to determine the prevalence of asymptomatic bacteriuria (ASB in pregnant women & to isolate, identify and establish antimicrobial susceptibility of pathogens. Methods: A total of 500 pregnant women were studied over a period of one year. Clean catch midstream urine sample was collected into a sterile container & then subjected to culture method. Results: Significant bacteriuria was noted in 45 patients (9%. 3% patients had insignificant bacteriuria. Growth of contaminants was noted in 8%. 80% samples were sterile with no growth. E. coli was the most common etiological agent, followed by Staphylococcus aureus. Conclusions: Asymptomatic bacteriuria is not uncommon in antenatal patients. All pregnant women should be screened by urine culture to detect asymptomatic bacteriuria at their first visit to prevent overt UTI & other complications in both mother & fetus. [Int J Reprod Contracept Obstet Gynecol 2013; 2(2.000: 213-216

  9. Asymptomatic bacteriuria among pregnant women

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    Paul Erhunmwunse Imade

    2010-06-01

    Full Text Available Background: Asymptomatic bacteriuria is the significant presence of bacteria in the urine of an individual without symptoms. In pregnancy, the apparent reduction in immunity of pregnant women tends to encourage the growth of pathogens. Aim: This study was carried out to determine the prevalence of asymptomatic bacteriuria in pregnant women attending a primary health centre in Benin City, Nigeria. Materials and Methods: A total of 1,228 pregnant women were recruited for this study. All subjects were clinically identified to have no signs and symptoms of UTI. Clean catch midstream urine sample was collected from each patient into sterile universal container. The urine samples were examined microscopically and by cultural method. Identification of isolates was by standard microbiological technique. Result: A total of 556 (45.3% were positive for significant bacteriuria. There was a significant difference in the prevalence of asymptomatic bacteriuria with respect to age (P < 0.0001. Trimester did not show any significant difference (P = 0.2006 in the prevalence of asymptomatic bacteriuria. Escherichia coli was the most predominant organism followed closely by Staphylococcus aureus. Ciprofloxacin, Ceftriaxone and Augmentin were found to be the most effective antibiotics against the urinary isolates. Conclusion: Asymptomatic bacteriuria is not uncommon among antenatal patients in the population studied. Routine urine cultural test should be carried out on all antenatal patients in order to identify any unsuspecting infection. This measure will go a long way in reducing maternal and obstetric complications associated with pregnancy.

  10. Asymptomatic bacteriuria among pregnant women

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    Paul Erhunmwunse Imade

    2010-01-01

    Full Text Available Background: Asymptomatic bacteriuria is the significant presence of bacteria in the urine of an individual without symptoms. In pregnancy, the apparent reduction in immunity of pregnant women tends to encourage the growth of pathogens. Aim : This study was carried out to determine the prevalence of asymptomatic bacteriuria in pregnant women attending a primary health centre in Benin City, Nigeria. Materials and Methods: A total of 1,228 pregnant women were recruited for this study. All subjects were clinically identified to have no signs and symptoms of UTI. Clean catch midstream urine sample was collected from each patient into sterile universal container. The urine samples were examined microscopically and by cultural method. Identification of isolates was by standard microbiological technique. Result: A total of 556 (45.3% were positive for significant bacteriuria. There was a significant difference in the prevalence of asymptomatic bacteriuria with respect to age (P < 0.0001. Trimester did not show any significant difference (P = 0.2006 in the prevalence of asymptomatic bacteriuria. Escherichia coli was the most predominant organism followed closely by Staphylococcus aureus. Ciprofloxacin, Ceftriaxone and Augmentin were found to be the most effective antibiotics against the urinary isolates. Conclusion : Asymptomatic bacteriuria is not uncommon among antenatal patients in the population studied. Routine urine cultural test should be carried out on all antenatal patients in order to identify any unsuspecting infection. This measure will go a long way in reducing maternal and obstetric complications associated with pregnancy.

  11. High prevalence of unwanted pregnancies and induced abortions among HIV-infected women from Western India : need to emphasize dual method use?

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    Darak, Shrinivas; Hutter, Inge; Kulkarni, Vinay; Kulkarni, Sanjeevani; Janssen, Fanny

    2016-01-01

    This study examines the prevalence, reasons, and predictors of unwanted pregnancies and induced abortions among ever married HIV-infected women attending a care facility in Maharashtra, Western India, and discusses its programmatic and policy implications. Retrospectively collected data of pregnanci

  12. Identification of HIV-Infected 12-to 24-Year-Old Men and Women in 15 US Cities Through Venue-Based Testing

    NARCIS (Netherlands)

    Barnes, William; D'Angelo, Lawrence; Yamazaki, Michiyo; Belzer, Marvin; Schroeder, Sybil; Palmer-Castor, Judith; Futterman, Donna; Kapogiannis, Bill; Muenz, Larry; Harris, D. Robert; Ellen, Jonathan M.

    2010-01-01

    Objective: To test whether "venue-based testing" could identify human immunodeficiency virus (HIV) infection in US youth, 12 to 24 years of age, who were otherwise not aware of their infection. Racial and ethnic minority women and men who have sex with men (WSM and MSM) compose the majority of new H

  13. Socio-demographic factors associated with loss to follow-up of HIV-infected women attending a private sector PMTCT program in Maharashtra, India

    NARCIS (Netherlands)

    Panditrao, Mayuri; Darak, Shrinivas; Kulkarni, Vinay; Kulkarni, Sanjeevani; Parchure, Ritu

    2011-01-01

    Currently, 40% of HIV-infected women enrolled in national prevention of mother-to-child transmission (PMTCT) program in India are loss to follow-up (LTF) before they can receive single dose Nevirapine. To date no study from India has examined the reasons for inadequate utilization of PMTCT services.

  14. High prevalence of unwanted pregnancies and induced abortions among HIV-infected women from Western India : need to emphasize dual method use?

    NARCIS (Netherlands)

    Darak, Shrinivas; Hutter, Inge; Kulkarni, Vinay; Kulkarni, Sanjeevani; Janssen, Fanny

    2016-01-01

    This study examines the prevalence, reasons, and predictors of unwanted pregnancies and induced abortions among ever married HIV-infected women attending a care facility in Maharashtra, Western India, and discusses its programmatic and policy implications. Retrospectively collected data of pregnanci

  15. Prevalence and cumulative incidence of abnormal cervical cytology among HIV-infected Thai women: a 5.5-year retrospective cohort study

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    Thamkhantho Manopchai

    2011-01-01

    Full Text Available Abstract Background Cervical cancer is one of the most common AIDS-related malignancies in Thailand. To prevent cervical cancer, The US Public Health Service and The Infectious Disease Society of America have recommended that all HIV-infected women should obtain 2 Pap smears 6 months apart after the initial HIV diagnosis and, if results of both are normal, should undergo annual cytological screening. However, there has been no evidence in supporting whether this guideline is appropriate in all settings - especially in areas where HIV-infected women are living in resource-constrained condition. Methods To determine the appropriate interval of Pap smear screenings for HIV-infected Thai women and risk factors for subsequent abnormal cervical cytology, we assessed the prevalence, cumulative incidence and associated factors of cervical cell abnormalities (atypical squamous cell of undetermined significance or higher grades, ASCUS+ among this group of patients. Results The prevalence of ASCUS+ was 15.4% at the first visit, and the cumulative incidence of ASCUS+ gradually increased to 37% in the first 3.5 years of follow-up appointments (first 7 times, and tended to plateau in the last 2 years. For multivariate correlation analysis, women with a CD4 count P = 0.043. There were no associations of subsequent ASCUS+ with age, pregnancy, contraceptive method, highly active anti-retroviral treatment, assumed duration of infection, or the CD4 count nadir level. Conclusion There are high prevalence and cumulative incidence of ASCUS+ in HIV-infected Thai women. With a high lost-to-follow-up rate, an appropriate interval of Pap smear screening cannot be concluded from the present study. Nevertheless, the HIV-infected Thai women may require more than two normal semi-annual Pap smears before shifting to routinely annual cytologic screening.

  16. Loss to follow-up of HIV-infected women after delivery: The Swiss HIV Cohort Study and the Swiss Mother and Child HIV Cohort Study

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    Karoline Aebi-Popp

    2014-11-01

    Full Text Available Introduction: HIV-infected pregnant women are very likely to engage in HIV medical care to prevent transmission of HIV to their newborn. After delivery, however, childcare and competing commitments might lead to disengagement from HIV care. The aim of this study was to quantify loss to follow-up (LTFU from HIV care after delivery and to identify risk factors for LTFU. Methods: We used data on 719 pregnancies within the Swiss HIV Cohort Study from 1996 to 2012 and with information on follow-up visits available. Two LTFU events were defined: no clinical visit for >180 days and no visit for >360 days in the year after delivery. Logistic regression analysis was used to identify risk factors for a LTFU event after delivery. Results: Median maternal age at delivery was 32 years (IQR 28–36, 357 (49% women were black, 280 (39% white, 56 (8% Asian and 4% other ethnicities. One hundred and seven (15% women reported any history of IDU. The majority (524, 73% of women received their HIV diagnosis before pregnancy, most of those (413, 79% had lived with diagnosed HIV longer than three years and two-thirds (342, 65% were already on antiretroviral therapy (ART at time of conception. Of the 181 women diagnosed during pregnancy by a screening test, 80 (44% were diagnosed in the first trimester, 67 (37% in the second and 34 (19% in the third trimester. Of 357 (69% women who had been seen in HIV medical care during three months before conception, 93% achieved an undetectable HIV viral load (VL at delivery. Of 62 (12% women with the last medical visit more than six months before conception, only 72% achieved an undetectable VL (p=0.001. Overall, 247 (34% women were LTFU over 180 days in the year after delivery and 86 (12% women were LTFU over 360 days with 43 (50% of those women returning. Being LTFU for 180 days was significantly associated with history of intravenous drug use (aOR 1.73, 95% CI 1.09–2.77, p=0.021 and not achieving an undetectable VL at

  17. Select neurocognitive impairment in HIV-infected women: associations with HIV viral load, hepatitis C virus, and depression, but not leukocyte telomere length.

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    Chantelle J Giesbrecht

    Full Text Available BACKGROUND: Through implementation of combination antiretroviral therapy (cART remarkable gains have been achieved in the management of HIV infection; nonetheless, the neurocognitive consequences of infection remain a pivotal concern in the cART era. Research has often employed norm-referenced neuropsychological scores, derived from healthy populations (excluding many seronegative individuals at high risk for HIV infection, to characterize impairments in predominately male HIV-infected populations. METHODS: Using matched-group methodology, we assessed 81 HIV-seropositive (HIV+ women with established neuropsychological measures validated for detection of HIV-related impairments, as well as additional detailed tests of executive function and decision-making from the Cambridge Neuropsychological Test Automated Battery (CANTAB. RESULTS: On validated tests, the HIV+ women exhibited impairments that were limited to significantly slower information processing speed when compared with 45 HIV-seronegative (HIV- women with very similar demographic backgrounds and illness comorbidities. Additionally, select executive impairments in shifting attention (i.e., reversal learning and in decision-making quality were revealed in HIV+ participants. Modifiers of neurocognition in HIV-infected women included detectable HIV plasma viral load, active hepatitis C virus co-infection, and self-reported depression symptoms. In contrast, leukocyte telomere length (LTL, a marker of cellular aging, did not significantly differ between HIV+ and HIV- women, nor was LTL associated with overall neurocognition in the HIV+ group. CONCLUSIONS: The findings suggest that well-managed HIV infection may entail a more circumscribed neurocognitive deficit pattern than that reported in many norm-referenced studies, and that common comorbidities make a secondary contribution to HIV-related neurocognitive impairments.

  18. Activation of CD8 T cells predicts progression of HIV infection in women coinfected with hepatitis C virus.

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    Kovacs, Andrea; Karim, Roksana; Mack, Wendy J; Xu, Jiaao; Chen, Zhi; Operskalski, Eva; Frederick, Toni; Landay, Alan; Voris, John; Spencer, La Shonda; Young, Mary A; Tien, Phyllis C; Augenbraun, Michael; Strickler, Howard D; Al-Harthi, Lena

    2010-03-15

    Because activation of T cells is associated with human immunodeficiency virus (HIV) pathogenesis, CD4 and CD8 activation levels in patients coinfected with HIV and hepatitis C virus (HCV) may explain conflicting reports regarding effects of HCV on HIV disease progression. Kaplan-Meier and multivariate Cox regression models were used to study the risk of incident clinical AIDS and AIDS-related deaths among 813 HCV-negative women with HIV infection, 87 HCV-positive nonviremic women with HIV coinfection, and 407 HCV-positive viremic women with HIV coinfection (median follow-up time, 5.2 years). For 592 women, the percentages of activated CD4 and CD8 T cells expressing HLA-DR (DR) and/or CD38 were evaluated. HCV-positive viremic women had a statistically significantly higher percentage of activated CD8 T cells (P AIDS compared with HCV-negative women (P AIDS risk was greater among HCV-positive viremic women in the highest tertile compared with the lowest tertile (>43% vs difference was not observed in the HCV-negative women (hazard ratio, 1.87 [95% confidence interval, 0.80-4.35]; P = .16). In contrast, CD4 activation predicted AIDS in both groups similarly. Increased percentages of CD8(+)CD38(-)DR(+), CD4(+)CD38(-)DR(-), and CD8(+)CD38(-)DR(-) T cells were associated with a >60% decreased risk of AIDS for HCV-positive viremic women and HCV-negative women. HCV-positive viremic women with HIV coinfection who have high levels of T cell activation may have increased risk of AIDS. Earlier treatment of HIV and HCV infection may be beneficial.

  19. HIV infection does not prevent the metabolic benefits of diet-induced weight loss in women with obesity.

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    Reeds, Dominic N; Pietka, Terri A; Yarasheski, Kevin E; Cade, W Todd; Patterson, Bruce W; Okunade, Adewole; Abumrad, Nada A; Klein, Samuel

    2017-04-01

    To test the hypothesis that HIV infection impairs the beneficial effects of weight loss on insulin sensitivity, adipose tissue inflammation, and endoplasmic reticulum (ER) stress. A prospective clinical trial evaluated the effects of moderate diet-induced weight loss on body composition, metabolic function, and adipose tissue biology in women with obesity who were HIV-seronegative (HIV-) or HIV-positive (HIV+). Body composition, multiorgan insulin sensitivity (assessed by using a two-stage hyperinsulinemic-euglycemic clamp procedure with stable isotopically labeled tracer infusions), and adipose tissue expression of markers of inflammation, autophagy, and ER stress were evaluated in 8 HIV- and 20 HIV+ women with obesity before and after diet-induced weight loss of 6% to 8%. Although weight loss was not different between groups (∼7.5%), the decrease in fat-free mass was greater in HIV+ than HIV- subjects (-4.4 ± 0.7% vs. -1.7 ± 1.0%, P diet-induced weight loss improves multiorgan insulin sensitivity in HIV+ women to the same extent as women who are HIV-. However, weight loss causes a greater decline in fat-free mass in HIV+ than HIV- women. © 2017 The Obesity Society.

  20. Maternal valacyclovir and infant cytomegalovirus acquisition: a randomized controlled trial among HIV-infected women.

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    Alison C Roxby

    Full Text Available BACKGROUND: Studies in HIV-1-infected infants and HIV-1-exposed, uninfected infants link early cytomegalovirus (CMV acquisition with growth delay and cognitive impairment. We investigated maternal valacyclovir to delay infant acquisition of CMV. METHODS: Pregnant women with HIV-1, HSV-2 and CD4 count >250 cells/µl were randomized at 34 weeks gestation to 500 mg twice-daily valacyclovir or placebo for 12 months. Maternal CMV DNA was measured in plasma at 34 weeks gestation, in cervical secretions at 34 and 38 weeks gestation, and in breast milk at 7 postpartum timepoints; infant CMV DNA was measured in dried blood spots at 8 timepoints including birth. RESULTS: Among 148 women, 141 infants were compared in intent-to-treat analyses. Maternal and infant characteristics were similar between study arms. Infant CMV acquisition did not differ between study arms, with 46/70 infants (66% in placebo arm and 47/71 infants (66% in the valacyclovir arm acquiring CMV; median time to CMV detection did not differ. CMV DNA was detected in 92% of 542 breast milk specimens with no difference in CMV level between study arms. Change in cervical shedding of CMV DNA between baseline and 38 weeks was 0.40-log greater in the placebo arm than the valacyclovir arm (p = 0.05. CONCLUSIONS: In this cohort of HIV-1-seropositive mothers, two-thirds of infants acquired CMV by one year. Maternal valacyclovir had no effect on timing of infant CMV acquisition or breast milk CMV viral loads, although it modestly reduced cervical CMV shedding. Maternal prophylaxis to reduce infant CMV acquisition warrants further evaluation in trials with antiviral agents. TRIALS REGISTRATION: ClinicalTrials.gov NCT00530777.

  1. HIV-related intimate partner violence among pregnant women in Nigeria.

    Science.gov (United States)

    Hyginus, Ezegwui; Chukwuemeka, Iyoke; Lawrence, Ikeako; Sunday, Mbah

    2012-03-01

    To compare the prevalences and patterns of intimate partner violence between HIV-positive and HIV-negative pregnant women receiving prenatal care at a tertiary hospital in South East Nigeria A comparative cross-sectional study of HIV-positive and HIV-negative pregnant women was done. Statistical analysis was by descriptive and inferential statistics at 95% level of confidence A total of 220 pregnant women studied. These were equally divided between HIV-positive women (cases) and HIV-negative women (controls). Cases did not differ significantly from controls with respect to age, parity, tribe, religion, marital status, monthly family income. HIV positive respondents experienced physical violence in the course of the index pregnancy six times more than controls; sexual violence about 4 times more than controls and were 12 times more likely to be denied sex by their partner compared to controls. Threat of being hurt, deprivation of financial support and denial of communication were the commonest forms of intimate partner violence among HIV-positive pregnant women and these also occurred significantly more among HIV positive women than the controls. HIV-positive status predisposes pregnant women to increased intimate partner violence more of emotional nature further underlying the enormity of social rejection suffered as a result of HIV infection. Intimate partner violence screening should form part of their routine antenatal care

  2. Soluble and cell-associated insulin receptor dysfunction correlates with severity of HAND in HIV-infected women.

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    Yamil Gerena

    Full Text Available Blood sugar metabolism abnormalities have been identified in HIV-infected individuals and associated with HIV-associated neurocognitive disorders (HAND. These abnormalities may occur as a result of chronic HIV infection, long-term use of combined antiretroviral treatment (CART, aging, genetic predisposition, or a combination of these factors, and may increase morbidity and mortality in this population.To determine if changes in soluble and cell-associated insulin receptor (IR levels, IR substrate-1 (IRS-1 levels, and IRS-1 tyrosine phosphorylation are associated with the presence and severity of HAND in a cohort of HIV-seropositive women.This is a retrospective cross-sectional study using patient database information and stored samples from 34 HIV-seropositive women and 10 controls without history of diabetes from the Hispanic-Latino Longitudinal Cohort of Women. Soluble IR subunits [sIR, ectodomain (α and full-length or intact (αβ] were assayed in plasma and CSF samples by ELISA. Membrane IR levels, IRS-1 levels, and IRS-1 tyrosine phosphorylation were analyzed in CSF white cell pellets (WCP using flow cytometry. HIV-seropositive women had significantly increased levels of intact or full-length sIR in plasma (p<0.001 and CSF (p<0.005 relative to controls. Stratified by HAND, increased levels of full-length sIR in plasma were associated with the presence (p<0.001 and severity (p<0.005 of HAND. A significant decrease in IRS-1 tyrosine-phosphorylation in the WCP was also associated with the presence (p<0.02 and severity (p<0.02 of HAND.This study provides evidence that IR secretion is increased in HIV-seropositive women, and increased IR secretion is associated with cognitive impairment in these women. Thus, IR dysfunction may have a role in the progression of HAND and could represent a biomarker for the presence and severity of HAND.

  3. Tenofovir accelerates bone mass loss of the lumbar spine in the first years of menopause in HIV-infected women

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    E Garlassi

    2012-11-01

    Full Text Available Background: HIV-infected postmenopausal women have higher rates of bone loss than HIV negative women. We aimed to identify predictors of body mass density (BMD in HIV infected women entering menopause and to evaluate the pre- and post-menopausal BMD change, with regard to tenofovir (TDF use. Methods: Women with at least one DEXA measurement were enrolled. The observation period was divided into: “Reproductive period”, “Menopause transition period”, “Early menopause period”, “Late menopause period”. BMD of the lumbar spine (L1-4 and femur neck were measured by DEXA. Lowess smoothing curves were drawn to analyze impact of menopause and TDF on BMD. Three different longitudinal linear regression models with random effects were built. Longitudinal regression analysis fits cross sectional time series regression models and allows to analyze repeated measures for each patient. Results: Fifty-five women were included. Median age at enrollment was 46 years (IQ range 44–49. Median observation period was 16 months (IQ range 8; 23 and 33 months (IQ range 23; 72 for pre- and post-menopausal respectively. At enrollment mean CD4 cell count was 553 cell/mL (±269.62 and HIV-VL was undetectable in 77.5% of patients: 6 women were not undergoing ART. Most common backbone TDF/FTC (46.9% and ABC/3TC (20.4%. At the time of inclusion in the cohort osteopenia and ostoeporosis were present in 60% and 3.64%, respectively. At the time of last DEXA evaluation osteopenia and osteoporosis were present in 78.18% and 36.36%, respectively. The impact of menopause on lumbar BMD was depicted (fig. 1 using a lowess smoothing analysis according to current TDF exposure (as treated model. Lumbar BMD change predictors were years from menopause and TDF current exposure in the “Early menopause period” and years from menopause, Baseline lumbar BMD, BMI and vitD supplementation in the “Late menopause period”. Discussion: This is the first study analyzing BMD

  4. Medicinal and recreational marijuana use among HIV-infected women in the Women's Interagency HIV Study (WIHS) cohort, 1994-2010.

    Science.gov (United States)

    Dʼsouza, Gypsyamber; Matson, Pamela A; Grady, Cynthia D; Nahvi, Shadi; Merenstein, Dan; Weber, Kathleen M; Greenblatt, Ruth; Burian, Pam; Wilson, Tracey E

    2012-12-15

    Despite the major benefits of effective antiretroviral therapy on HIV-related survival, there is an ongoing need to help alleviate medication side effects related to antiretroviral therapy use. Initial studies suggest that marijuana use may reduce HIV-related symptoms, but medical marijuana use among HIV-infected individuals has not been well described. The authors evaluated trends in marijuana use and reported motivations for use among 2776 HIV-infected women in the Women's Interagency HIV Study between October 1994 and March 2010. Predictors of any and daily marijuana use were explored in multivariate logistic regression models clustered by person using generalized estimating equation. In 2009, participants were asked if their marijuana use was medical, "meaning prescribed by a doctor," or recreational, or both. Over the 16 years of this study, the prevalence of current marijuana use decreased significantly from 21% to 14%. In contrast, daily marijuana use almost doubled from 3.3% to 6.1% of all women and from 18% to 51% of current marijuana users. Relaxation, appetite improvement, reduction of HIV-related symptoms, and social use were reported as common reasons for marijuana use. In 2009, most marijuana users reported either purely medicinal use (26%) or both medicinal and recreational usage (29%). Daily marijuana use was associated with higher CD4 cell count, quality of life, and older age. Demographic characteristics and risk behaviors were associated with current marijuana use overall but were not predictors of daily use. This study suggests that both recreational and medicinal marijuana use are relatively common among HIV-infected women in the United States.

  5. Cost-effectiveness of HIV screening for incarcerated pregnant women.

    Science.gov (United States)

    Resch, Stephen; Altice, Frederick L; Paltiel, A David

    2005-02-01

    Antiretroviral therapy (ART) initiated on a prenatal basis in HIV-infected pregnant women is a highly effective method for preventing mother-to-child HIV transmission. We developed a decision analytic model to project the clinical and economic outcomes of alternative HIV screening strategies (voluntary prenatal screening [VPS], routine prenatal screening [RPS], and mandatory newborn screening [MNS]) for a high-risk population of incarcerated pregnant women. Data for the decision model came from the HIV voluntary counseling and testing program at Connecticut's sole correctional facility for women and a comprehensive anonymously linked serosurvey of all inmates who entered the facility during the 2-year period beginning in October 1994. Based on serosurvey results, in the absence of any HIV screening program, 2.5 cases of pediatric HIV infection would be expected per 1000 pregnancies. Multiplied by the discounted lifetime cost per case of $247,000, this translates to a cost of $624 per testing-eligible prison entrant. Entrants were considered eligible if they were pregnant and their HIV status was unknown. MNS would save money, cost $364 per eligible entrant, and simultaneously reduce the rate of infections to 1.1 per 1000 pregnancies. Doing both MNS and RPS is most effective in reducing the rate of new infections (down to 0.2 per 1000 pregnancies). It would, however, increase costs to $430 per eligible entrant. This would result in an incremental cost of $73,603 per additional pediatric HIV case averted when compared with MNS alone. If mandatory newborn testing was not considered a feasible option, RPS would dominate VPS and would be cost-saving compared with no screening. RPS compares favorably with alternative uses of HIV prevention and treatment resources. In correctional facilities where voluntary newborn screening is already in place, our findings show that there remains a small marginal benefit to be realized from switching to RPS. In settings where HIV

  6. Factors Associated with Hormonal and Intrauterine Contraceptive Use among HIV-Infected Men and Women in Lilongwe, Malawi: A Cross-Sectional Study

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    Jennifer H. Tang

    2016-01-01

    Full Text Available Background. Understanding the factors associated with the use of hormonal and intrauterine contraception among HIV-infected men and women may lead to interventions that can help reduce high unintended pregnancy rates. Materials and Methods. This study is a subanalysis of a cross-sectional survey of 289 women and 241 men who were sexually active and HIV-infected and were attending HIV care visits in Lilongwe, Malawi. We estimated adjusted prevalence ratios (PRs to evaluate factors associated with hormonal and intrauterine contraceptive use for men and women in separate models. Results and Discussion. 39.8% of women and 33.2% of men (p=0.117 reported that they were using hormonal or intrauterine contraception at last intercourse. Having greater than 3 children was the only factor associated with hormonal and intrauterine contraceptive use among men. Among women, younger age, not wanting a pregnancy in 2 years, being with their partner for more than 4 years, and being able to make family planning decisions by themselves were associated with hormonal and intrauterine contraceptive use. Conclusions. The men and women in our study population differed in the factors associated with hormonal and intrauterine contraceptive use. Understanding these differences may help decrease unmet FP needs among HIV-infected men and women.

  7. Intimate partner violence among women with HIV infection in rural Uganda: critical implications for policy and practice

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    Osinde Michael O

    2011-11-01

    Full Text Available Abstract Background Intimate partner violence (IPV is a major public health problem in Africa and worldwide. HIV infected women face increased IPV risk. We assessed the prevalence and factors associated with IPV among HIV infected women attending HIV care in Kabale hospital, Uganda. Methods This cross-sectional study was conducted among 317 HIV infected women attending Kabale regional hospital HIV treatment centre, from March to December 2010. Participants were interviewed using an interviewer-administered questionnaire. Data was collected on socio-demographic variables, social habits, and IPV (using the abuse assessment screen and the Severity of Violence against Women Scale to identify physical, sexual and psychological violence. Characteristics of the participants who reported IPV were compared with those who did not. Multivariate logistic-regression analysis was conducted to analyze factors that were independently associated with IPV. Results The mean age of 317 respondents was 29.7 years. Twenty two (6.9% were adolescents and 233 (73.5% were married or cohabiting. The mean age of the spouse was 33.0 years. One hundred and eleven (35.0% were currently on antiretroviral therapy. Lifetime prevalence of IPV (physical or sexual was 36.6%. In the preceding 12 months, IPV (any type was reported by 93 respondents (29.3%. This was physical for 55 (17.6%, and sexual /psychological for 38 (12.1%. On multivariate multinomial logistic regression analysis, there was a significant but inverse association between education level and physical partner violence (adjusted relative risk (ARR 0.50, confidence limits (95% CI 0.31-0.82, p-value = 0.007. There was a significant but inverse association between education level of respondent and sexual/psychological violence (ARR 0.47 95%CI (0.25-0.87, p-value = 0.017 Likewise, there was a significant inverse association between the education level of the spouse and psychological/sexual violence (ARR 0.57, 95% CI 0

  8. Pregnancy prevention and condom use practices among HIV-infected women on antiretroviral therapy seeking family planning in Lilongwe, Malawi.

    Directory of Open Access Journals (Sweden)

    Lisa B Haddad

    Full Text Available Programs for integration of family planning into HIV care must recognize current practices and desires among clients to appropriately target and tailor interventions. We sought to evaluate fertility intentions, unintended pregnancy, contraceptive and condom use among a cohort of HIV-infected women seeking family planning services within an antiretroviral therapy (ART clinic.200 women completed an interviewer-administered questionnaire during enrollment into a prospective contraceptive study at the Lighthouse Clinic, an HIV/ART clinic in Lilongwe, Malawi, between August and December 2010.Most women (95% did not desire future pregnancy. Prior reported unintended pregnancy rates were high (69% unplanned and 61% unhappy with timing of last pregnancy. Condom use was inconsistent, even among couples with discordant HIV status, with lack of use often attributed to partner's refusal. Higher education, older age, lower parity and having an HIV negative partner were factors associated with consistent condom usage.High rates of unintended pregnancy among these women underscore the need for integ rating family planning, sexually transmitted infection (STI prevention, and HIV services. Contraceptive access and use, including condoms, must be improved with specific efforts to enlist partner support. Messages regarding the importance of condom usage in conjunction with more effective modern contraceptive methods for both infection and pregnancy prevention must continue to be reinforced over the course of ongoing ART treatment.

  9. Sociocultural influences on infant feeding decisions among HIV-infected women in rural Kwa-Zulu Natal, South Africa.

    Science.gov (United States)

    Thairu, Lucy N; Pelto, Gretel H; Rollins, Nigel C; Bland, Ruth M; Ntshangase, Ncamisile

    2005-01-01

    The promotion of exclusive breastfeeding for 6 months, followed by rapid transition to alternative food sources may be an important public health approach to the reduction of mother-to-child transmission of HIV through breastmilk. The basic ethical principle of 'informed choice' requires that HIV positive women are provided with adequate information about their options. However, information is only one factor that affects their decisions. The objective of this ethnographic study was to identify sociocultural influences on infant feeding decisions in the context of a large cohort study designed to assess the impact of a breastfeeding counselling and support strategy to promote exclusive breastfeeding on postnatal transmission of HIV in African women. Following an initial period of exploratory interviewing, ethnographic techniques were used to interview 22 HIV positive women about their views on infant feeding and health. Interviews were tape-recorded, transcribed and analysed with a text analysis program. Five themes of influences on feeding decisions emerged: (1) social stigma of HIV infection; (2) maternal age and family influences on feeding practices; (3) economic circumstances; (4) beliefs about HIV transmission through breastmilk; and (5) beliefs about the quality of breastmilk compared to formula. The study highlights the role of cultural, social, economic and psychological factors that affect HIV positive women's infant feeding decisions and behaviour.

  10. Sedentary behavior patterns in non-pregnant and pregnant women.

    Science.gov (United States)

    Hawkins, Marquis; Kim, Youngdeok; Gabriel, Kelley Pettee; Rockette-Wagner, Bonny Jane; Chasan-Taber, Lisa

    2017-06-01

    Sedentary behavior has been associated with adverse health outcomes among pregnant women; however, few studies have characterized sedentary behavior patterns in this population. We described patterns of accelerometer-determined indicators of sedentary behavior among a national sample of US pregnant (n = 234) women and non-pregnant (n = 1146) women participating in the NHANES 2003-06 cycles. We included women with ≥ 4 days of accelerometer wear of ≥ 10 h/day. A count threshold of sedentary behavior as: 1) total accumulated sedentary time by bout length categories; 2) accumulated sedentary time within discrete bout length categories; 3) mean, median, and usual bout length; and 4) and bout frequency. Both non-pregnant and pregnant women spent up to 60% of their accelerometer wear time in sedentary behavior depending on the minimum bout threshold applied. Sedentary time was higher among pregnant women compared to non-pregnant women when lower bout thresholds (i.e. 10 min or less) were applied. The majority of total sedentary time was accumulated in bouts lasting sedentary bouts (i.e., ≥ 30 min) per day, which accounted for nearly 20% of total accumulated sedentary time. When applying a minimum threshold of at least 15 min, sedentary time increased across pregnancy trimesters, while sedentary time was similar across trimesters when using lower thresholds. These findings provide the first characterization of accelerometer-determined indicators of sedentary behavior in pregnant women. The minimum bout threshold applied influenced estimates of sedentary time and patterns sedentary time accumulation across pregnancy trimesters.

  11. Associations of HIV infection with insulin and glucose levels in antiretroviral-naïve Rwandan women: a cross-sectional analysis

    Science.gov (United States)

    Dusingize, Jean Claude; Hoover, Donald R; Shi, Qiuhu; Mutimura, Eugene; Kiefer, Elizabeth; Anastos, Kathryn

    2013-01-01

    Objectives The purpose of these analyses was to determine the associations of HIV infection and related immune dysfunction with a glucose homeostasis in the population of antiretroviral-naïve HIV-infected and uninfected Rwandan women. We hypothesise that insulin resistance and its consequences in the developing countries may be further elevated with HIV infection itself regardless of antiretroviral therapy. Study design Cross-sectional analysis of a longitudinal cohort. Setting Community-based women's associations. Participants In 2005, 710 HIV-infected (HIV positive) antiretroviral naïve and 226 HIV-uninfected (HIV negative) women were enrolled in the Rwanda Women's Interassociation Study and Assessment (RWISA). Clinical and demographic parameters, CD4 count, fasting insulin and glucose levels, anthropometric measurements and Bioelectrical Impedance Analysis (BIA) were obtained. Linear models were fit to log-transformed Homeostasis Model Assessment (HOMA) with results exponentiated back to a multiplicative effect on the original scale. Primary outcome measures The outcome, insulin resistance, was measured by the HOMA, calculated as fasting insulin (μU/mL)×fasting glucose (mmol/L)⁄22.5. Results In adjusted models, HIV-positive women were less insulin resistant than HIV-negative; an HIV-positive woman tended to have 0.728 times as much (95% CI 0.681 to 0.861) HOMA than a comparable HIV-negative woman. Among the HIV-positive women, those with CD4 350 cells/µL. The older age was independently associated with a lower HOMA insulin resistance. After adjusting for body mass index, fat and fat-free mass were not independently associated with HOMA. Conclusions This study found that HIV infection and more advanced HIV infection (CD4 counts <200 cells/µL) were associated with greater insulin sensitivity in antiretroviral naïve African women. These findings provide baseline information for the interpretation of future studies on the effect of antiretroviral therapy on

  12. Maternal HIV infection alters the immune balance in the mother and fetus; implications for pregnancy outcome and infant health.

    Science.gov (United States)

    Pfeifer, Caroline; Bunders, Madeleine J

    2016-03-01

    With the rapid roll-out of combination antiretroviral therapy to prevent mother-to-child transmission of HIV, there is an annual increase in the number of uninfected infants born to HIV-infected women. Although the introduction of combination antiretroviral therapy has vastly improved pregnancy outcome and the health of infants born to HIV-infected women, concerns remain regarding the impact the maternal HIV infection on the pregnancy outcome and the health of HIV-exposed uninfected infants. Maternal HIV infection is associated with negative pregnancy outcomes such as low birth weight. In addition, an increased susceptibility to infections is reported in HIV-exposed uninfected infants compared with infants born to uninfected women. Studies have shown that HIV-exposure affects the maternal/fetal unit, with increase of proinflammatory cytokine produced by placental cells, as well as altered infant immune responses. These changes could provide the underlying conditions for negative pregnancy outcomes and facilitate mother-to-child transmission of HIV in the infant. Further studies are required to understand the underlying mechanisms and investigate whether these altered infant immune responses persist and have clinical consequences beyond childhood. HIV infection in pregnant women is associated with altered immune responses in HIV-infected women and their offspring with clinical consequences for pregnancy outcome and the HIV-exposed uninfected infant. Further studies are required to address the origin and long-term consequences of prenatal HIV-exposure and subsequent immune activation for infant health.

  13. Why are the benefits of increased resources not impacting the risk of HIV infection for high SES women in Cameroon?

    Directory of Open Access Journals (Sweden)

    Joyce N Mumah

    boosting women's social and economic power may be insufficient to address other drivers of HIV infection among women in SSA.

  14. Urinary Eicosanoid Metabolites in HIV-Infected Women with Central Obesity Switching to Raltegravir: An Analysis from the Women, Integrase, and Fat Accumulation Trial

    Directory of Open Access Journals (Sweden)

    Todd Hulgan

    2014-01-01

    Full Text Available Chronic inflammation is a hallmark of HIV infection. Eicosanoids reflect inflammation, oxidant stress, and vascular health and vary by sex and metabolic parameters. Raltegravir (RAL is an HIV-1 integrase inhibitor that may have limited metabolic effects. We assessed urinary F2-isoprostanes (F2-IsoPs, prostaglandin E2 (PGE-M, prostacyclin (PGI-M, and thromboxane B2 (TxB2 in HIV-infected women switching to RAL-containing antiretroviral therapy (ART. Thirty-seven women (RAL = 17; PI/NNRTI = 20 with a median age of 43 years and BMI 32 kg/m2 completed week 24. TxB2 increased in the RAL versus PI/NNRTI arm (+0.09 versus −0.02; P=0.06. Baseline PGI-M was lower in the RAL arm (P=0.005; no other between-arm cross-sectional differences were observed. In the PI/NNRTI arm, 24-week visceral adipose tissue change correlated with PGI-M (rho=0.45; P=0.04 and TxB2 (rho=0.44; P=0.005 changes, with a trend seen for PGE-M (rho=0.41; P=0.07. In an adjusted model, age ≥ 50 years (N=8 was associated with increased PGE-M (P=0.04. In this randomized trial, a switch to RAL did not significantly affect urinary eicosanoids over 24 weeks. In women continuing PI/NNRTI, increased visceral adipose tissue correlated with increased PGI-M and PGE-M. Older age (≥50 was associated with increased PGE-M. Relationships between aging, adiposity, ART, and eicosanoids during HIV-infection require further study.

  15. Urinary eicosanoid metabolites in HIV-infected women with central obesity switching to raltegravir: an analysis from the women, integrase, and fat accumulation trial.

    Science.gov (United States)

    Hulgan, Todd; Boger, M Sean; Liao, Diana H; McComsey, Grace A; Wanke, Christine A; Mangili, Alexandra; Walmsley, Sharon L; McCreath, Heather; Milne, Ginger L; Sanchez, Stephanie C; Currier, Judith S; Lake, Jordan E

    2014-01-01

    Chronic inflammation is a hallmark of HIV infection. Eicosanoids reflect inflammation, oxidant stress, and vascular health and vary by sex and metabolic parameters. Raltegravir (RAL) is an HIV-1 integrase inhibitor that may have limited metabolic effects. We assessed urinary F2-isoprostanes (F2-IsoPs), prostaglandin E2 (PGE-M), prostacyclin (PGI-M), and thromboxane B2 (TxB2) in HIV-infected women switching to RAL-containing antiretroviral therapy (ART). Thirty-seven women (RAL = 17; PI/NNRTI = 20) with a median age of 43 years and BMI 32 kg/m(2) completed week 24. TxB2 increased in the RAL versus PI/NNRTI arm (+0.09 versus -0.02; P = 0.06). Baseline PGI-M was lower in the RAL arm (P = 0.005); no other between-arm cross-sectional differences were observed. In the PI/NNRTI arm, 24-week visceral adipose tissue change correlated with PGI-M (rho = 0.45; P = 0.04) and TxB2 (rho = 0.44; P = 0.005) changes, with a trend seen for PGE-M (rho = 0.41; P = 0.07). In an adjusted model, age ≥ 50 years (N = 8) was associated with increased PGE-M (P = 0.04). In this randomized trial, a switch to RAL did not significantly affect urinary eicosanoids over 24 weeks. In women continuing PI/NNRTI, increased visceral adipose tissue correlated with increased PGI-M and PGE-M. Older age (≥ 50) was associated with increased PGE-M. Relationships between aging, adiposity, ART, and eicosanoids during HIV-infection require further study.

  16. Effect of Pregnancy on Interferon Gamma Release Assay and Tuberculin Skin Test Detection of Latent TB Infection Among HIV-Infected Women in a High Burden Setting.

    Science.gov (United States)

    LaCourse, Sylvia M; Cranmer, Lisa M; Matemo, Daniel; Kinuthia, John; Richardson, Barbra A; Horne, David J; John-Stewart, Grace

    2017-05-01

    Peripartum immunologic changes may affect latent tuberculosis infection (LTBI) diagnostic performance among HIV-infected women. HIV-infected women were serially tested with tuberculin skin test (TST) and interferon gamma release assay [QuantiFERON TB Gold In-tube (QFT)] in pregnancy and 6 weeks postpartum in Kenya. Prevalence, sensitivity and agreement, and correlates of QFT/TST positivity were assessed. Quantitative QFT mitogen and Mycobacterium tuberculosis antigen (Mtb-Ag) responses were compared by peripartum stage. Incidence of test conversion at 6 weeks postpartum was evaluated in baseline TST-/QFT- women. Among 100 HIV-infected women, median age was 26 years, median CD4 was 555 cells per cubic millimeter, and 88% were on antiretrovirals. More women were QFT+ than TST+ in both pregnancy (35.4% vs. 13.5%, P = 0.001) and postpartum (29.6% vs. 14.8%, P 2-fold more women with LTBI compared with TST in pregnancy and postpartum. Lower QFT Mtb-Ag and mitogen responses in pregnancy compared with postpartum suggest that pregnancy-associated immunologic changes may influence LTBI test performance.

  17. Risk factors for cervical intraepithelial neoplasia in HIV-infected women on antiretroviral treatment in Cote d'Ivoire, West Africa.

    Directory of Open Access Journals (Sweden)

    Antoine Jaquet

    Full Text Available BACKGROUND: Facing the dual burden of invasive cervical cancer and HIV in sub-Saharan Africa, the identification of preventable determinants of Cervical Intraepithelial Neoplasia (CIN in HIV-infected women is of paramount importance. METHODS: A cervical cancer screening based on visual inspection methods was proposed to HIV-infected women in care in Abidjan, Côte d'Ivoire. Positively screened women were referred for a colposcopy to a gynaecologist who performed directed biopsies. RESULTS: Of the 2,998 HIV-infected women enrolled, 132 (4.4% CIN of any grade (CIN+ were identified. Women had been followed-up for a median duration of three years [IQR: 1-5] and 76% were on antiretroviral treatment (ART. Their median most recent CD4 count was 452 [IQR: 301-621] cells/mm3. In multivariate analysis, CIN+ was associated with a most recent CD4 count >350 cells/mm3 (OR: 0.3; 95% CI: 0.2-0.6 or ≥200-350 cells/mm3 (OR 0.6; 95% CI 0.4-1.0 (Ref: <200 cells/mm3 CD4 (p<10-4. CONCLUSIONS: The presence of CIN+ is less common among HIV-infected women with limited or no immune deficiency. Despite the potential impact of immunological recovery on the reduction of premalignant cervical lesions through the use of ART, cervical cancer prevention, including screening and vaccination remains a priority in West Africa while ART is rolled-out.

  18. Depression, Abuse, Relationship Power and Condom Use by Pregnant and Postpartum Women with Substance Abuse History.

    Science.gov (United States)

    Dévieux, Jessy G; Jean-Gilles, Michèle; Rosenberg, Rhonda; Beck-Sagué, Consuelo; Attonito, Jennifer M; Saxena, Anshul; Stein, Judith A

    2016-02-01

    Substance-abusing pregnant and postpartum women are less likely to maintain consistent condom use and drug and alcohol abstinence, which is particularly concerning in high HIV-prevalence areas. Data from 224 pregnant and postpartum women in substance abuse treatment were analyzed to examine effects of history of substance use, child abuse, and mental health problems on current substance use and condom-use barriers. Mediators were depression, relationship power and social support. Most participants (72.9 %) evidenced current depression. Less social support (-0.17, p relationship power (-0.48, p relationship power (0.15, p relationship power limit highest-risk women's ability to negotiate condom use and abstain from substance use, increasing their risk of acute HIV infection and vertical transmission.

  19. Care of Patients With HIV Infection: Diagnosis and Monitoring.

    Science.gov (United States)

    Bolduc, Philip; Roder, Navid; Colgate, Emily; Cheeseman, Sarah H

    2016-04-01

    Appropriate screening for HIV infection is the cornerstone of HIV-related care. There have been several recent changes in testing technology and screening recommendations. The US Preventive Services Task Force recommends universal HIV screening at least once for adolescents and adults ages 15 to 65 years, and additional screening for patients at higher risk, although evidence is insufficient to determine optimum rescreening intervals. All pregnant women should be screened for HIV infection in the first trimester, and pregnant women at high risk should be screened again in the third trimester. The Centers for Disease Control and Prevention recommends use of an algorithm using fourth-generation tests for screening; this decreases the window period between infection and detection to as few as 14 days, thereby reducing the number of false-negative results. Home HIV testing kits, which require follow-up confirmatory testing, also are available. Clinicians should be aware of HIV-specific laws in their states, including those criminalizing HIV exposure and transmission. Thorough medical and laboratory evaluations are essential at initiation of care for patients with HIV infection, along with appropriate follow-up monitoring, as recommended in various guidelines.

  20. Associations of periodontitis and oral manifestations with CD4 counts in HIV-pregnant women in Thailand

    Science.gov (United States)

    Pattrapornnan, Pakkaporn; DeRouen, Timothy A.

    2013-01-01

    Objectives To investigate the associations of CD4 count with chronic periodontitis and HIV-related oral lesions in pregnant HIV-infected Thai women. Study Design 292 HIV-infected pregnant women were interviewed for health information and examined for their periodontal condition and HIV-related oral lesions during weeks 16-34 of gestation. Logistic regression, t-tests and chi-squared tests were used to examine the associations of CD4 count with oral lesions and periodontal conditions. Results 133 women (45.6%) had at least 1 tooth with a periodontal pocket over 4 mm. Thirty-eight (17.76%) subjects had oral candidiasis and 53 subjects (24.77%) had oral hairy leukoplakia (OHL). Low CD4 count was significantly associated with periodontitis at OR=2.06 with 95%CI [1.00-4.27], p-value 0.05. A significant association was found for low CD4 count with oral hairy leukoplakia with OR 3.57, 95%CI [1.34-9.46], p-value 0.01. Conclusions Chronic periodontitis and OHL were associated with CD4 count lower than 200 cells/mm3 in HIV-infected women. PMID:23790956

  1. Frequency and types of human papillomavirus among pregnant and non-pregnant women with human immunodeficiency virus infection in Recife determined by genotyping

    Directory of Open Access Journals (Sweden)

    Vírginia da Conceição Ribes Amorim Bezerra Brandão

    2009-08-01

    Full Text Available Women with human immunodeficiency virus (HIV infection present a higher risk of infection by the human papillomavirus (HPV and cervical cancer. To determine HPV genotypes and frequencies among HIV-positive women, an analytical cross-sectional study was carried out on 147 women (51 were pregnant and HIV-positive, 45 pregnant and HIV-negative and 51 HIV-positive and not pregnant, who were attended at a maternity hospital in Recife between April 2006-May 2007. They answered a questionnaire and underwent a gynaecological examination, with samples collected for HPV investigation by PCR, hybrid capture II, oncotic colpocytology (Papanicolau and colposcopy. The frequency of HPV DNA was 85.3% (122/143, with a high proportion of HPV types that have been identified as high risk for cervical cancer. Among HIV-positive pregnant women, there was an HPV prevalence of 96% (48/50, of whom 60.4% (29/48 were high-risk. HPV 16, 58, 18, 66 and 31 were the most frequent types. Colpocytological abnormalities were observed in 35.3% (18/51 of HIV-positive non-pregnant women, 21.6% (11/51 of HIV-positive pregnant women and 13.3% (6/45 of HIV-negative pregnant women with a predominance of low-level lesions. A high prevalence of HPV infection was identified, especially with the high-risk types 16, 58, 18 and 66. This study identified high-risk HPV types in all three groups examined (HIV-positive pregnant women, HIV-negative pregnant women and HIV-positive not pregnant, characterising its distribution in this setting.

  2. Association of the Fractal Dimension of Retinal Arteries and Veins with Quantitative Brain MRI Measures in HIV-Infected and Uninfected Women.

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    Howard A Crystal

    Full Text Available The fractal dimension of retinal arteries and veins is a measure of the complexity of the vascular tree. We hypothesized that retinal fractal dimension would be associated with brain volume and white matter integrity in HIV-infected women.Nested case-control within longitudinal cohort study.Women were recruited from the Brooklyn site of the Women's Interagency HIV study (WIHS; 34 HIV-infected and 21 HIV-uninfected women with analyzable MRIs and retinal photographs were included. Fractal dimension was determined using the SIVA software program on skeletonized retinal images. The relationship between predictors (retinal vascular measures and outcomes (quantitative MRI measures were analyzed with linear regression models. All models included age, intracranial volume, and both arterial and venous fractal dimension. Some models were adjusted for blood pressure, race/ethnicity, and HIV-infection.The women were 45.6 ± 7.3 years of age. Higher arterial dimension was associated with larger cortical volumes, but higher venous dimension was associated with smaller cortical volumes. In fully adjusted models, venous dimension was significantly associated with fractional anisotropy (standardized β = -0.41, p = 0.009 and total gray matter volume (β = -0.24, p = 0.03, and arterial dimension with mean diffusivity (β = -0.33,.p = 0.04 and fractional anisotropy (β = 0.34, p = 0.03. HIV-infection was not associated with any retinal or MRI measure.Higher venous fractal dimension was associated with smaller cortical volumes and lower fractional anisotropy, whereas higher arterial fractal dimension was associated with the opposite patterns. Longitudinal studies are needed to validate this finding.

  3. Effect of alcohol consumption and psychosocial stressors on preterm and small-for-gestational-age births in HIV-infected women in South Africa: a cohort study

    Science.gov (United States)

    Sania, Ayesha; Brittain, Kirsty; Phillips, Tamsin K; Zerbe, Allison; Ronan, Agnes; Myer, Landon; Abrams, Elaine J

    2017-01-01

    Objectives Psychosocial stressors such as depression and stress, intimate partner violence (IPV) and alcohol use have been linked to preterm and small-for-gestational-age (SGA) births in general populations. The prevalence of psychosocial stressors and alcohol abuse is high in many HIV-infected (HIV+) populations. Our objective was to evaluate the effects of psychosocial stressors and alcohol abuse on birth outcomes in HIV-infected women. Methods Antenatal depression and non-specific psychological distress, periconception IPV and alcohol consumption were measured during the second trimester among HIV+ women initiating antiretroviral treatment with efavirenz + emtricitibine + tenofovir in Cape Town, South Africa. Log binomial regression models were used to estimate the risk ratios (RR) and 95% CIs of the effects of psychosocial stressors and periconception alcohol consumption on birth outcomes: SGA (birth weight child health programmes to improve the long-term health of HIV-exposed children. Trial registration number NCT01933477; Pre-results. PMID:28320796

  4. High-nutrition biscuits to increase animal protein in diets of HIV-infected Kenyan women and their children: a study in progress.

    Science.gov (United States)

    Ernst, Judith; Ettyang, Grace; Neumann, Charlotte G

    2014-12-01

    Preliminary evidence suggests that improved nutrition early in HIV infection may delay progression to AIDS and delay the initiation or improve the effectiveness of antiretroviral drug therapy. There are few studies that evaluate food-based interventions in drug-naïve, HIV-infected women and their children. Meat provides several nutrients identified as important in maintaining immune function and lean body mass. To design supplemental meat and soybean biscuits for use in a randomized trial examining the effect of meat in the diet of drug-naïve, HIV-infected rural Kenyan women on changes in weight, lean body mass, morbidity, nutritional status, and activities of daily living of the women and growth and development of their children. We designed three supplemental biscuits: one with added dried beef another with added soybean flour, and a wheat biscuit to serve as a control biscuit to be used in a randomized feeding intervention in drug-naïve, HIV-infected rural Kenyan women and their children. The nutritional contents of the different types of biscuit were examined and compared. The three biscuits were isocaloric. Meat biscuits provided more lysine, vitamin B12, and bioavailable zinc. Soybean biscuits provided more total and absorbable iron; however, higher fiber and phytate contents may inhibit nutrient absorption. Data analysis for clinical outcomes of the trial is ongoing. The "biscuit model" is useful for nutrition supplementation studies because it can be provided in a blinded and randomized fashion, safely and privately in a home under directly observed consumption by a highly stigmatized population. It is well received by adults and children, and the biscuits can be produced locally with available, simple, affordable technology.

  5. Plasma concentration of atrial natriuretic peptide in normal pregnant women and in pregnant women with preeclampsia

    DEFF Research Database (Denmark)

    Mikkelsen, A L; Schütten, G; Asping, U;

    1991-01-01

    Plasma concentration of atrial natriuretic peptide (ANP) was determined in pregnant women with preeclampsia, in normal pregnant and in nonpregnant women by a specific radioimmunoassay. Results did not show important differences between nonpregnant controls and normal pregnant women, but a signifi......Plasma concentration of atrial natriuretic peptide (ANP) was determined in pregnant women with preeclampsia, in normal pregnant and in nonpregnant women by a specific radioimmunoassay. Results did not show important differences between nonpregnant controls and normal pregnant women......, but a significant rise was seen in women with preeclampsia compared to nonpregnant controls. Marked interindividual variation was found in all three groups. The mechanism of ANP release may differ between those women with normal pregnancy and those with preeclampsia. It is unclear whether the increased level of ANP...... in preeclampsia is an effect or a cause of the disease....

  6. Urinary bisphenol A concentrations in pregnant women.

    Science.gov (United States)

    Callan, Anna Carita; Hinwood, Andrea Lee; Heffernan, Amy; Eaglesham, Geoff; Mueller, Jochen; Odland, Jon Øyvind

    2013-11-01

    Bisphenol A is a chemical that is present in a number of products and types of food packaging. Prenatal exposure to bisphenol A may cause behavioural changes in young children. The aim of this study was to investigate exposure to bisphenol A in pregnant Australian women as a surrogate of neonatal exposure. First morning void urine samples were collected from 26 pregnant women at around week 38 of gestation. Bisphenol A was detectable in 85% of the samples analysed. The median concentration in this group of women was 2.41μg/L with a range of bisphenol A concentrations, as did women with a pre-pregnancy BMI of bisphenol A exposure in Australia and reveals that pregnant women have measured biological concentrations of urinary bisphenol A similar to those reported for pregnant women in other developed countries. Given the potential impacts of prenatal bisphenol A exposure, further research in this area is warranted.

  7. Approaches to the vaccination of pregnant women

    OpenAIRE

    Baxter, David

    2013-01-01

    For the 2010/11 influenza season the prenatal vaccination program was extended to all women in England and Wales irrespective of gestational age—this was a considerable shift in practice for both pregnant women and healthcare providers where the emphasis previously had been only on targeted vaccination for pregnant women with adverse risk factors for influenza infection. This paper will describe the program’s operation in Stockport, UK during this season when uptake was among the highest in t...

  8. Doula birth support for incarcerated pregnant women.

    Science.gov (United States)

    Schroeder, Carole; Bell, Janice

    2005-01-01

    The objective of this study was to provide trained labor support (doulas) to pregnant women in jail. A multiagency intervention project provided doula birth services to pregnant women in urban jails. Program evaluation included interviews with women and written satisfaction surveys of providers and correctional officers. A convenience sample of 18 incarcerated women received doula services. A doula visited each woman in jail antepartum to review expectations for labor and birth; during hospitalization, the doula provided continuous support throughout labor and birth. Doulas visited women postpartum to review birth events. Surveys administered to providers and officers demonstrated high satisfaction with the program. Qualitative interviews with 14 women indicated unanimous support for the services and documented women's major concerns. Findings support offering doula services to all pregnant women in custody and expanding doula services to include early and comprehensive intervention coordinated by nurses.

  9. Post-traumatic stress is associated with verbal learning, memory, and psychomotor speed in HIV-infected and HIV-uninfected women.

    Science.gov (United States)

    Rubin, Leah H; Pyra, Maria; Cook, Judith A; Weber, Kathleen M; Cohen, Mardge H; Martin, Eileen; Valcour, Victor; Milam, Joel; Anastos, Kathryn; Young, Mary A; Alden, Christine; Gustafson, Deborah R; Maki, Pauline M

    2016-04-01

    The prevalence of post-traumatic stress disorder (PTSD) is higher among HIV-infected (HIV+) women compared with HIV-uninfected (HIV-) women, and deficits in episodic memory are a common feature of both PTSD and HIV infection. We investigated the association between a probable PTSD diagnosis using the PTSD Checklist-Civilian (PCL-C) version and verbal learning and memory using the Hopkins Verbal Learning Test in 1004 HIV+ and 496 at-risk HIV- women. HIV infection was not associated with a probable PTSD diagnosis (17% HIV+, 16% HIV-; p = 0.49) but was associated with lower verbal learning (p < 0.01) and memory scores (p < 0.01). Irrespective of HIV status, a probable PTSD diagnosis was associated with poorer performance in verbal learning (p < 0.01) and memory (p < 0.01) and psychomotor speed (p < 0.001). The particular pattern of cognitive correlates of probable PTSD varied depending on exposure to sexual abuse and/or violence, with exposure to either being associated with a greater number of cognitive domains and a worse cognitive profile. A statistical interaction between HIV serostatus and PTSD was observed on the fine motor skills domain (p = 0.03). Among women with probable PTSD, HIV- women performed worse than HIV+ women on fine motor skills (p = 0.01), but among women without probable PTSD, there was no significant difference in performance between the groups (p = 0.59). These findings underscore the importance of considering mental health factors as correlates to cognitive deficits in women with HIV.

  10. Women in community corrections in New York City: HIV infection and risks.

    Science.gov (United States)

    El-Bassel, Nabila; Marotta, Phillip L; Shaw, Stacey A; Chang, Mingway; Ma, Xin; Goddard-Eckrich, Dawn; Hunt, Tim; Johnson, Karen; Goodwin, Sharun; Almonte, Maria; Gilbert, Louisa

    2017-02-01

    Although the incidence of HIV among women on probation, parole and alternatives to incarceration programs is significant to public health, drivers of this concentrated epidemic among women under community corrections remain understudied. This study examined prevalence of HIV and sexually transmitted infections and the associations between substance use, socio-demographic factors and the prevalence of biologically-confirmed HIV and other sexually transmitted infections among a sample of 337 substance-using women recruited from community correction sites in New York City. Prevalence of HIV was 13% and sexually transmitted infections was 26% ( Chlamydia, trachomatis and Neisseria gonorrhea). After adjusting for covariates, HIV-positive women were 1.42 times more likely to use crack/cocaine than HIV-negative women (95% CI = 1.05-1.92). HIV-positive women were 25% less likely than HIV-negative women to report any unprotected vaginal and anal sex with their main partner (95% CI = 0.57-0.99). They were 70% less likely than HIV-negative women to report unprotected vaginal sex with a non-paying casual partner (95% CI = 0.1-0.9) and 22% less likely to report unprotected vaginal sex across all partners (95% CI = 0.61-0.99). Community corrections settings may be optimal venues to launch HIV/sexually transmitted infections prevention that have potential to reach and engage an ever-growing number of substance-using women.

  11. Women in community corrections in New York City: HIV infection and risks

    Science.gov (United States)

    El-Bassel, Nabila; Marotta, Phillip L; Shaw, Stacey A; Chang, Mingway; Ma, Xin; Goddard-Eckrich, Dawn; Hunt, Tim; Johnson, Karen; Goodwin, Sharun; Almonte, Maria; Gilbert, Louisa

    2017-01-01

    Although the incidence of HIV among women on probation, parole and alternatives to incarceration programs is significant to public health, drivers of this concentrated epidemic among women under community corrections remain understudied. This study examined prevalence of HIV and sexually transmitted infections and the associations between substance use, socio-demographic factors and the prevalence of biologically-confirmed HIV and other sexually transmitted infections among a sample of 337 substance-using women recruited from community correction sites in New York City. Prevalence of HIV was 13% and sexually transmitted infections was 26% (Chlamydia, trachomatis and Neisseria gonorrhea). After adjusting for covariates, HIV-positive women were 1.42 times more likely to use crack/ cocaine than HIV-negative women (95% CI = 1.05–1.92). HIV-positive women were 25% less likely than HIV-negative women to report any unprotected vaginal and anal sex with their main partner (95% CI = 0.57–0.99). They were 70% less likely than HIV-negative women to report unprotected vaginal sex with a non-paying casual partner (95% CI = 0.1–0.9) and 22% less likely to report unprotected vaginal sex across all partners (95% CI = 0.61–0.99). Community corrections settings may be optimal venues to launch HIV/sexually transmitted infections prevention that have potential to reach and engage an ever-growing number of substance-using women. PMID:26887890

  12. Nevirapine-induced side effects in pregnant women: experience of a Brazilian university hospital.

    Science.gov (United States)

    Kondo, William; Carraro, Elaine Aparecida; Prandel, Elaine; Dias, Josiane Mourão; Perini, Juliane; Macedo, Rodolfo Lara de; Cornelsen, Taynah Cristina; Sbalquiero, Renato; Sasaki, Maria das Graças

    2007-12-01

    Nevirapine-based therapy is associated with increased frequency of adverse events among HIV-infected pregnant women. The aim of this article was to evaluate the incidence of adverse effects in HIV-infected women who started nevirapine during pregnancy. A retrospective study was performed in our center between January 2003 and December 2006 analyzing all women prescribed nevirapine during pregnancy. Women presenting any risk factor for hepatotoxicity were excluded from the analysis. Patients were divided into two groups according to the presence or absence of adverse effects, and a correlation to CD4 counts was performed. Liver function abnormality was graded according to the Division of AIDS toxicity guidelines. A total of 170 women initiated nevirapine during pregnancy, but only 133 were included in the study. Twenty-seven women (20.3%) presented adverse effects, skin rash accounting for 77.8% (21/27 women) and liver function abnormalities for 22.2% (6/27) of the cases. Baseline CD4 counts, viral loads and transaminases were similar in both groups. All nevirapine side effects were developed in less than seven weeks. Four of 31 women with CD4 counts or = 250 cells/microL (22.5%) developed adverse events. All patients who experienced hepatotoxicity had pretreatment CD4 counts > or =250 cells/microL. The incidence of adverse events with nevirapine in our study was high, but most of them were cutaneous. There was no correlation between high CD4 counts and adverse events when analyzing both cutaneous and hepatic reactions; nevertheless, hepatotoxicity occurred only in pregnant women with CD4 counts > or =250 cells/microL.

  13. Characteristics and management of HIV-1-infected pregnant women enrolled in a randomised trial: differences between Europe and the USA

    Directory of Open Access Journals (Sweden)

    Delke Isaac

    2007-06-01

    Full Text Available Abstract Background Rates of mother-to-child transmission of HIV-1 (MTCT have historically been lower in European than in American cohort studies, possibly due to differences in population characteristics. The Pediatric AIDS Clinical Trials Group Protocol (PACTG 316 trial evaluated the effectiveness of the addition of intrapartum/neonatal nevirapine in reducing MTCT in women already receiving antiretroviral prophylaxis. Participation of large numbers of pregnant HIV-infected women from the US and Western Europe enrolling in the same clinical trial provided the opportunity to identify and explore differences in their characteristics and in the use of non-study interventions to reduce MTCT. Methods In this secondary analysis, 1350 women were categorized according to enrollment in centres in the USA (n = 978 or in Europe (n = 372. Factors associated with receipt of highly active antiretroviral therapy and with elective caesarean delivery were identified with logistic regression. Results In Europe, women enrolled were more likely to be white and those of black race were mainly born in Sub-Saharan Africa. Women in the US were younger and more likely to have previous pregnancies and miscarriages and a history of sexually transmitted infections. More than 90% of women did not report symptoms of their HIV infection; however, more women from the US had symptoms (8%, compared to women from Europe (4%. Women in the US were less likely to have HIV RNA levels Conclusion These findings confirm that there are important historical differences between the HIV-infected pregnant populations in Western Europe and the USA, both in terms of the characteristics of the women and their obstetric and therapeutic management. Although highly active antiretroviral therapy predominates in pregnancy in both settings now, population differences are likely to remain. Trial registration NCT00000869

  14. Intravaginal Practices, Bacterial Vaginosis, and HIV Infection in Women: Individual Participant Data Meta-analysis

    NARCIS (Netherlands)

    Low, N.; Chersich, M.F.; Schmidlin, K.; Egger, M.; Francis, S.C.; van de Wijgert, J.H.H.M.; Hayes, R.J.; Baeten, J.M.; Brown, J.; Delany-Moretlwe, S.; Kaul, R.; McGrath, N.; Morrison, C.; Myer, L.; Temmerman, M.; van Straten, A.; Watson-Jones, D.; Zwahlen, M.; Hilber, A.M.

    2011-01-01

    Background: Identifying modifiable factors that increase women's vulnerability to HIV is a critical step in developing effective female-initiated prevention interventions. The primary objective of this study was to pool individual participant data from prospective longitudinal studies to investigate

  15. Intravaginal Practices, Bacterial Vaginosis, and HIV Infection in Women: Individual Participant Data Meta-analysis

    NARCIS (Netherlands)

    Low, N.; Chersich, M.F.; Schmidlin, K.; Egger, M.; Francis, S.C.; van de Wijgert, J.H.H.M.; Hayes, R.J.; Baeten, J.M.; Brown, J.; Delany-Moretlwe, S.; Kaul, R.; McGrath, N.; Morrison, C.; Myer, L.; Temmerman, M.; van Straten, A.; Watson-Jones, D.; Zwahlen, M.; Hilber, A.M.

    2011-01-01

    Background: Identifying modifiable factors that increase women's vulnerability to HIV is a critical step in developing effective female-initiated prevention interventions. The primary objective of this study was to pool individual participant data from prospective longitudinal studies to investigate

  16. Socio-demographic, Marital, and Psychosocial Factors Associated with Condom Use Negotiation Self-Efficacy Among Mozambican Women at Risk for HIV Infection.

    Science.gov (United States)

    Patrão, Ana Luísa; McIntyre, Teresa M

    2017-08-22

    In Mozambique, women are the most affected by HIV/AIDS. Self-efficacy is one of the main predictors of effective use of a condom. Therefore, it is essential to identify the factors that influence condom-use negotiation self-efficacy in vulnerable women. The aim of this paper is to identify socio-demographic, marital, and psychosocial factors associated with condom-use negotiation self-efficacy among Mozambican women at risk for HIV infection. Participants were women (173) who were patients at the Gynecology Department of the Central Hospital of Beira, Mozambique, and at risk for HIV infection. Women completed measures of condom-use negotiation self-efficacy, HIV prevention knowledge, and perceived barriers against safer sex. The results showed that demographic and marital variables are associated with condom-use negotiation self-efficacy, namely, those having more than 9 years of education, who are younger and not living with a partner, and who talk about AIDS with partners report higher condom-use negotiation self-efficacy. Regarding psychosocial factors, higher HIV prevention knowledge and fewer perceived barriers to safer sex predict higher condom-use negotiation self-efficacy. These results can contribute to sexual health promotion and HIV/AIDS prevention in Mozambican women because they identify at-risk groups and marital and psychosocial malleable factors that can be targeted in AIDS prevention among at-risk Mozambican women.

  17. Prevalence of rhesus negativity among pregnant women

    Directory of Open Access Journals (Sweden)

    Ezhil Arasi Nagamuthu

    2016-08-01

    Conclusions: The prevalence of Rh D negative women is low when compared to Rh D positive women.There is a need for adequate counselling of pregnant women on the importance of Rh D negative factor during the antenatal period in order to prevent hemolytic disease of the newborn. [Int J Res Med Sci 2016; 4(8.000: 3305-3309

  18. A randomized trial comparing the diagnostic accuracy of visual inspection with acetic acid to Visual Inspection with Lugol's Iodine for cervical cancer screening in HIV-infected women.

    Science.gov (United States)

    Huchko, Megan J; Sneden, Jennifer; Zakaras, Jennifer M; Smith-McCune, Karen; Sawaya, George; Maloba, May; Bukusi, Elizabeth Ann; Cohen, Craig R

    2015-01-01

    Visual inspection with Acetic Acid (VIA) and Visual Inspection with Lugol’s Iodine (VILI) are increasingly recommended in various cervical cancer screening protocols in low-resource settings. Although VIA is more widely used, VILI has been advocated as an easier and more specific screening test. VILI has not been well-validated as a stand-alone screening test, compared to VIA or validated for use in HIV-infected women. We carried out a randomized clinical trial to compare the diagnostic accuracy of VIA and VILI among HIV-infected women. Women attending the Family AIDS Care and Education Services (FACES) clinic in western Kenya were enrolled and randomized to undergo either VIA or VILI with colposcopy. Lesions suspicious for cervical intraepithelial neoplasia 2 or greater (CIN2+) were biopsied. Between October 2011 and June 2012, 654 were randomized to undergo VIA or VILI. The test positivity rates were 26.2% for VIA and 30.6% for VILI (p = 0.22). The rate of detection of CIN2+ was 7.7% in the VIA arm and 11.5% in the VILI arm (p = 0.10). There was no significant difference in the diagnostic performance of VIA and VILI for the detection of CIN2+. Sensitivity and specificity were 84.0% and 78.6%, respectively, for VIA and 84.2% and 76.4% for VILI. The positive and negative predictive values were 24.7% and 98.3% for VIA, and 31.7% and 97.4% for VILI. Among women with CD4+ count < 350, VILI had a significantly decreased specificity (66.2%) compared to VIA in the same group (83.9%, p = 0.02) and compared to VILI performed among women with CD4+ count ≥ 350 (79.7%, p = 0.02). VIA and VILI had similar diagnostic accuracy and rates of CIN2+ detection among HIV-infected women.

  19. A randomized trial comparing the diagnostic accuracy of visual inspection with acetic acid to Visual Inspection with Lugol's Iodine for cervical cancer screening in HIV-infected women.

    Directory of Open Access Journals (Sweden)

    Megan J Huchko

    Full Text Available Visual inspection with Acetic Acid (VIA and Visual Inspection with Lugol’s Iodine (VILI are increasingly recommended in various cervical cancer screening protocols in low-resource settings. Although VIA is more widely used, VILI has been advocated as an easier and more specific screening test. VILI has not been well-validated as a stand-alone screening test, compared to VIA or validated for use in HIV-infected women. We carried out a randomized clinical trial to compare the diagnostic accuracy of VIA and VILI among HIV-infected women. Women attending the Family AIDS Care and Education Services (FACES clinic in western Kenya were enrolled and randomized to undergo either VIA or VILI with colposcopy. Lesions suspicious for cervical intraepithelial neoplasia 2 or greater (CIN2+ were biopsied. Between October 2011 and June 2012, 654 were randomized to undergo VIA or VILI. The test positivity rates were 26.2% for VIA and 30.6% for VILI (p = 0.22. The rate of detection of CIN2+ was 7.7% in the VIA arm and 11.5% in the VILI arm (p = 0.10. There was no significant difference in the diagnostic performance of VIA and VILI for the detection of CIN2+. Sensitivity and specificity were 84.0% and 78.6%, respectively, for VIA and 84.2% and 76.4% for VILI. The positive and negative predictive values were 24.7% and 98.3% for VIA, and 31.7% and 97.4% for VILI. Among women with CD4+ count < 350, VILI had a significantly decreased specificity (66.2% compared to VIA in the same group (83.9%, p = 0.02 and compared to VILI performed among women with CD4+ count ≥ 350 (79.7%, p = 0.02. VIA and VILI had similar diagnostic accuracy and rates of CIN2+ detection among HIV-infected women.

  20. Zika Virus: Protecting Pregnant Women and Babies

    Science.gov (United States)

    ... Digital Press Kit Read the MMWR Science Clips Zika Virus Protecting Pregnant Women and Babies Language: English ... Pregnancy Registry (50 US states and DC) Problem Zika infection during pregnancy can cause serious birth defects ...

  1. Uso de condom feminino por mulheres infectadas pelo HIV Female condom use among HIV-infected women

    Directory of Open Access Journals (Sweden)

    Jarbas Magalhães

    2003-07-01

    Full Text Available OBJETIVO: avaliar a aceitabilidade, a adesão e a experiência com o uso de condom feminino (CF entre mulheres infectadas pelo HIV. MÉTODO: estudo descritivo prospectivo com 76 mulheres infectadas pelo HIV atendidas no CAISM/UNICAMP e no Centro Corsini de Campinas. Após entrevista de triagem e concordando em participar, as voluntárias receberam calendário para registro das relações sexuais e uso de condom masculino (CM. Após 30 dias, compareceram à visita de treinamento com colocação do CF em modelo pélvico, trazendo o diário do ciclo anterior, considerado controle. Aplicou-se questionário estruturado após 30, 60 e 90 dias, recolhendo-se sempre o diário de registro das relações sexuais e uso de CF ou CM. Usaram-se os testes de c², exato de Fisher, McNemar e Friedman para amostras emparelhadas na análise estatística. RESULTADOS: predominaram as mulheres jovens, de baixa escolaridade, que moravam com o parceiro. Observou-se taxa de continuidade de uso de 52%, ao longo de 90 dias. O uso de CF, em metade das relações sexuais em cada período de estudo, permaneceu estável nos 90 dias. Houve significativa diminuição da proporção média das relações sexuais desprotegidas (de 14% para 6%, sem uso de CM ou CF, aos 90 dias. As dificuldades iniciais no manuseio do CF foram superadas com o tempo. Os casais sorodiscordantes tiveram maior proporção de relações protegidas que os casais soroconcordantes, porém a diferença não foi significativa. As mulheres que relataram uso prévio consistente de CM apresentaram número significantemente maior de relações protegidas com CF. CONCLUSÕES: a oferta do CF foi capaz de reduzir as relações sexuais desprotegidas entre mulheres infectadas pelo HIV, que se mostraram motivadas e receptivas a este método.PURPOSE: to evaluate acceptability, adhesion and experience with the use of female condom (FC among HIV-infected women. METHODS: prospective descriptive study with 76 HIV-infected

  2. Contraceptive Use and Unintended Pregnancies Among HIV-Infected Women in Mumbai

    Science.gov (United States)

    Joshi, Beena; Velhal, Gajanan; Chauhan, Sanjay; Kulkarni, Ragini; Begum, Shahina; Nandanwar, Y. S.; Fonseca, Michelle; Baweja, Sujata; Turbadkar, Dilip; Ramchandran, Anita; Dalal, Asha; Shastri, Jayanti; Agrawal, Sachee; Panhale, Manisha; More, Vasundhara; Sanap, Pravin; Panchal, Renuka; Kanougiya, Suman

    2015-01-01

    Background: Access to reproductive health services in Human Immunodeficiency Virus (HIV) programs can greatly enhance program's potential to limit the spread of disease, reduce unintended pregnancies and safeguard the health of infected people. Objectives: To assess (i) knowledge, attitude, and use regarding contraceptives; safe sex and dual protection; (ii) fertility desires and unintended pregnancies post HIV and (iii) symptoms of reproductive tract infection/sexually transmitted infection (RTI/STI) among women infected with HIV. Materials and Methods: A cross-sectional study among 300 currently married HIV-positive women who had not undergone permanent sterilization with no immediate desire for pregnancy. Study site was Integrated Counseling and Testing Centers (ICTC) in tertiary hospitals of Mumbai and women were interviewed using a semistructured questionnaire. Results: In spite of good awareness about modern methods, 42.7 felt that contraceptives other than condoms were harmful to use due to their HIV status. Knowledge on dual protection was limited to condom (75%). Condom use increased from 5.7% pre-HIV to 71.7% post-HIV, with 89.6% reporting regular use. Future fertility desire was expressed by 8.7% women. Induced abortions post-HIV was reported by16.6% women, as pregnancies were unintended. About 69% wished to use dual contraceptive methods for effective protection if it was not harmful to be used by people living with HIV (PLHIV). Conclusion: Data reveals a need to promote modern contraceptive methods along with regular condom use to prevent unintended pregnancies and improve health-seeking behavior for contraception. Health system models that converge or link HIV services with other reproductive health services need to be tested to provide comprehensive reproductive healthcare to infected women in India. PMID:26170540

  3. Pregnant women’s knowledge about Mother-to-Child Transmission (MTCT of HIV infection through breast feeding

    Directory of Open Access Journals (Sweden)

    MS Maputle

    2008-09-01

    Full Text Available The HIV and AIDS epidemic in South Africa has reached serious proportions. Over 5, 5 million South Africans are infected with HIV (Department of Health, 2004:10. Mother to Child Transmission (MTCT is a well-established mode of HIV transmission and these infections may occur during pregnancy, labour, delivery and breastfeeding. According to the Department of Health (2000:2, breastfeeding constitutes a significant risk of MTCT HIV transmission. Studies in Africa have also shown that breast-feeding increases the risk of MTCT by 12%-43% (Department of Health, 2000:13; Department of Health, 2000:3. Since breastfeeding is a significant and preventable mode of HIV transmission to infants, there is an urgent need to educate, counsel and support women and families to make informed decisions about how best to feed their infants in the context of HTV. To achieve a reduction in MTCT, there is an urgent need to empower women with information on MTCT for informed decision-making. However, cultural factors and the stigma associated with HIV and AIDS might contribute to limited knowledge about MTCT through breastfeeding.

  4. Feasibility of using an iPod touch device and acceptability of a stigma reduction intervention with HIV-infected women in the Deep South.

    Science.gov (United States)

    Relf, Michael V; Silva, Susan G; Williams, Megan Scull; Moore, Elizabeth; Arscott, Joyell; Caiola, Courtney; Barroso, Julie

    2015-10-01

    As with many infectious diseases throughout history, stigma is a part of the trajectory of the HIV disease process. HIV-related stigma impedes women from being tested for HIV. Once infected, HIV-related stigma hinders women from disclosing their HIV status to sexual partners and health care providers, engaging in medical care, effectively self-managing the disease after infection, and adhering to anti-retroviral therapy. After three decades of the HIV epidemic, no evidenced-based, culturally relevant, gender-specific interventions exist to help women infected with HIV manage the stigma associated with HIV infection. This manuscript reports the feasibility of using an iPod touch device and acceptability of a stigma reduction intervention with HIV-infected women in the Deep South in a mixed-method, randomized clinical trial. Results from the study demonstrate that it is feasible to utilize an iPod touch device to deliver an HIV-related stigma intervention to women. Further, women report that the HIV-related stigma intervention is acceptable and meaningful.

  5. Effectiveness of an SMS-based maternal mHealth intervention to improve clinical outcomes of HIV-positive pregnant women.

    Science.gov (United States)

    Coleman, Jesse; Bohlin, Kate C; Thorson, Anna; Black, Vivian; Mechael, Patricia; Mangxaba, Josie; Eriksen, Jaran

    2017-07-01

    We conducted a retrospective study to investigate the effectiveness of an mHealth messaging intervention aiming to improve maternal health and HIV outcomes. Maternal health SMSs were sent to 235 HIV-infected pregnant women twice per week in pregnancy and continued until the infant's first birthday. The messages were timed to the stage of the pregnancy/infant age and covered maternal health and HIV-support information. Outcomes, measured as antenatal care (ANC) visits, birth outcomes and infant HIV testing, were compared to a control group of 586 HIV-infected pregnant women who received no SMS intervention. Results showed that intervention participants attended more ANC visits (5.16 vs. 3.95, p mHealth interventions can have a positive impact on health outcomes and should be scaled nationally following comprehensive evaluation.

  6. [Cartography of healthcare for pregnant women].

    Science.gov (United States)

    Silva, Raimunda Magalhães da; Costa, Milena Silva; Matsue, Regina Yoshie; Sousa, Girliani Silva de; Catrib, Ana Maria Fontenelle; Vieira, Luiza Jane Eyre de Souza

    2012-03-01

    This work uses cartography as a method for mapping the trajectory of primary healthcare provided to pregnant women. The scope of the study comprises 9 Basic Healthcare Units located in the city of Juazeiro do Norte in the State of Ceará. In all, fifteen women in the 37th to 39th week of pregnancy were selected. Interviews were conducted with these women during the period from January to June 2010. The cartographic findings were depicted in stages in the flowchart, which exposed lacunas in prenatal healthcare, such as the low number of oncotic cytology exams conducted and the lack of educational counseling. Nevertheless, in the interviews, a significant number of pregnant women expressed satisfaction with the prenatal care provided. The good relationships developed between the healthcare professionals and the pregnant women were the main reason that led them to continue the treatment. This fact reinforces the importance of dialogue between these two actors for the success of prenatal healthcare.

  7. Levels and patterns of HIV RNA viral load in untreated pregnant women

    DEFF Research Database (Denmark)

    NN, NN; Patel, Deven; Thorne, Claire;

    2008-01-01

    OBJECTIVE: To assess pregnancy levels and patterns of HIV RNA in the absence of antiretroviral therapy, while appropriately adjusting for potential confounders, including maternal immune status and race. METHODS: Data on > or = 1 antenatal HIV RNA measurements were available for 333 untreated HIV......-infected pregnant women enrolled in the European Collaborative Study. CD4 counts and HIV RNA measurements were routinely collected from 1992 and 1998, respectively. Linear mixed effects models based on 246 women for whom complete data were available examined changes in HIV RNA levels over pregnancy, with a nested...... random effects term accounting for measurement variability within women and period of sample collection. RESULTS: The change in HIV RNA over pregnancy varied significantly by race (p=0.005): from the second trimester until delivery, HIV RNA decreased significantly by an estimated 0.019 log(10) copies...

  8. Recommendations for physical activity for pregnant women

    Directory of Open Access Journals (Sweden)

    Mateja Videmšek

    2015-04-01

    Full Text Available Properly selected and prescribed physical activity during pregnancy has a favorable effects on the health of pregnant women and the fetus, and is excellent preparation for childbirth. Absolute and relative contraindications to exercise during pregnancy are well defined, as well as the warning signs to terminate exercise while pregnant. Knowledge of these is essential for physically active pregnant women and exercise professionals that work with pregnant women. Pregnant women should be moderately physically active every day of the week for at least 30 minutes. The term moderate is thoroughly and clearly defined in the guidelines. Resistance exercises during pregnancy are safe but it is advised to use light loads and a large number of repetitions (e.g. 15-20 repetitions. Strength exercises for the pelvic floor muscles deserves a special place during pregnancy. Appropriate forms of physical activity for pregnant women are walking and jogging, swimming and aquatic exercise, cycling, Pilates and yoga, aerobics, fitness and cross-country skiing. Certain forms of physical activity need special adjustments (alpine skiing, ice skating and rollerblading, racket sports, team ball games, horseback riding and scuba diving. 

  9. Anal Human Papillomavirus (HPV) Prevalences and Factors Associated with Abnormal Anal Cytology in HIV-Infected Women in an Urban Cohort from Rio de Janeiro, Brazil

    Science.gov (United States)

    Luz, Paula M.; Lake, Jordan E.; Levi, José Eduardo; Coutinho, José Ricardo; de Andrade, Angela; Heinke, Thais; Derrico, Mônica; Veloso, Valdilea G.; Friedman, Ruth K.; Grinsztejn, Beatriz

    2015-01-01

    Abstract Identifying factors, including human papillomavirus (HPV) genotypes, associated with abnormal anal cytology in HIV-infected women have implications for anal squamous cell cancer (SCC) prevention in HIV-infected women. Anal and cervical samples were collected for cytology, and tested for high-(HR-HPV) and low-risk HPV (LR-HPV) genotypes in a cross-sectional analysis of the IPEC Women's HIV Cohort (Rio de Janeiro, Brazil). Multivariate log-binomial regression models estimated prevalence ratios for factors associated with abnormal anal cytology [≥atypical squamous cells of undetermined significance, (ASC-US)]. Characteristics of the 863 participants included: median age 42 years, 57% non-white, 79% current CD4+ T-cell count >350 cells/mm3, 53% HIV-1 viral load anal specimens contained ≥1 HR-HPV genotype; 31% had abnormal anal cytology [14% ASC-US, 11% low-grade squamous intra-epithelial lesion, (LSIL); 2% atypical squamous cells-cannot exclude high-grade SIL (ASC-H); 4% high-grade SIL/cancer (HSIL+)]. In multivariate analysis, cervical LSIL+, nadir CD4+ T-cell count ≤50 cells/mm3, HIV-1 viral load ≥50 copies/mL, and anal HPV 6, 11, 16, 18, 33, 45, 52, 56, and 58 were associated with ≥anal ASC-US (panal cytology and HR-HPV prevalences were high. HIV-infected women with cervical LSIL+, low nadir CD4+ counts, or detectable HIV-1 viral loads should be a particular focus for enhanced anal SCC screening efforts. PMID:25361401

  10. Cervical pre-malignant lesions in HIV infected women attending Care and Treatment Centre in a tertiary hospital, Dar es Salaam, Tanzania.

    Science.gov (United States)

    Balandya, Belinda S; Pembe, Andrea B; Mwakyoma, Henry A

    2011-09-01

    The aims of this study was to determine proportion of HIV infected women with cervical pre-malignant lesions; and compare the use of Visual Inspection of the cervix after application of Acetic acid (VIA) and Papanicolau (Pap) smear in screening for cervical premalignant lesions in HIV positive women attending Care and Treatment Centre (CTC) at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania. A total of 316 women aged 18-70 years had a Pap smear taken for cytology, followed by spraying onto the cervix with 4% acetic acid and then inspecting it. Cytology was considered negative when there was no Cervical Intraepithelial Neoplasia (CIN) lesion reported from the Pap smear taken, and positive if CIN lesion 1, 2 or 3 was reported. Detection of a well-defined, opaque acetowhite lesion close to the squamocolumnar junction or close to the external cervical os constituted a positive VIA. Out of 316 women, 132 women had acetowhite lesions on VIA, making the proportion of abnormal cervical lesions to be 42.4%. One hundred and one out of 312 women (32.4%) had CIN lesions detected on Pap smear. The proportion of agreement between these two tests was 0.3. The proportion of agreement was moderate in women with advanced WHO HIV clinical stage of the disease and in women not on ART (Anti Retroviral Therapy). Women with CD-4 count less than 200 cells/mm3 had more abnormal cervical lesions. There is considerable proportion of HIV positive women with premalignant lesions of the cervix. Considering the proportion of HIV women with abnormal lesions and the difficulty in logistics of doing Pap smear in low resource settings, these results supports the recommendation to introduce screening of premalignant lesions of the cervix using VIA to all HIV infected women.

  11. Social risk factors that influence the spread of HIV among pregnant women in Ukraine

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    Slobodianyk, Liudmyla

    2011-05-01

    Full Text Available BACKGROUND. HIV infection in Ukraine is gaining large scale, affecting various population groups including those which are not considered risk groups for HIV infection. Injection drug users (IDUs remain the main source of HIV infection. The potential penetration of the virus into the general population is determined by the chain of transmission of HIV through unprotected sexual contacts of individuals who do not inject drugs with IDUs. The level of HIV infection among women attending prenatal clinics quite accurately reflects the level of HIV prevalence and trends of the epidemic among the general population.METHODS. The project is developed by the Ukrainian National AIDS Centre. Project timeframe is January–August 2011. Expected number of participants is 1041. Target group includes HIV-positive women who were pregnant and first registered as HIV-positive in 2009-2010 and gave birth to their babies in 2010-2011. Preliminary data analysis anticipates identification of traditional risk groups (IDUs, sexual workers’ clients, prisoners, HIV-positives among sexual partners of women from the study group. Social, demographic, and behavioral risk factors are to be estimated among the target group, and the probable transmission routes among the study participants are to be elucidated. As the study is in progress, we report here the results of the analysis of a pilot group of 21 filled-in questionnaires.RESULTS. The majority of the study population are young women aged 15-30 with university (28.6% or college (23.8% education. Most of them are city-dwellers and are married. Nine in ten respondents were tested as HIV-positive during pregnancy. Two thirds of respondents indicated the heterosexual way of transmission as the most probable. Nine in ten denied having injected drugs; however, 15% of them had hepatitis C virus and hepatitis B virus antibodies.CONCLUSION. According to preliminary results, HIV-positive women are young married city-dwelling women

  12. Prevalence and risk factors for Hepatitis C and HIV-1 infections among pregnant women in Central Brazil

    Directory of Open Access Journals (Sweden)

    Stefani Mariane MA

    2009-07-01

    Full Text Available Abstract Background Hepatitis C (HCV and human immunodeficiency virus (HIV infections are a major burden to public health worldwide. Routine antenatal HIV-1 screening to prevent maternal-infant transmission is universally recommended. Our objectives were to evaluate the prevalence of and potential risk factors for HCV and HIV infection among pregnant women who attended prenatal care under the coverage of public health in Central Brazil. Methods Screening and counselling for HIV and HCV infections was offered free of charge to all pregnant women attending antenatal clinic (ANC in the public health system, in Goiania city (~1.1 million inhabitants during 2004–2005. Initial screening was performed on a dried blood spot collected onto standard filter paper; positive or indeterminate results were confirmed by a second blood sample. HCV infection was defined as a positive or indeterminate sample (EIA test and confirmed HCV-RNA technique. HIV infection was defined according to standard criteria. Factors associated with HIV and HCV infections were identified with logistic regression. The number needed to screen (NNS to prevent one case of infant HIV infection was calculated using the Monte Carlo simulation method. Results A total of 28,561 pregnant women were screened for HCV and HIV-1 in ANC. Mean maternal age was 23.9 years (SD = 5.6, with 45% of the women experiencing their first pregnancy. Prevalence of HCV infection was 0.15% (95% CI 0.11%–0.20%, and the risk increased with age (p Conclusion The prevalence of HIV and HCV infections were low among pregnant women, with high acceptability rates in the opt-in strategy in primary care. Older maternal age was a risk factor for HCV and antenatal HCV testing does not fulfill the requirements for screening recommendation. The finding of higher risk of HIV-1 infection among black women despite being in consonance with the HIV-1 ethnic pattern in some American regions cannot be ruled out to be a surrogate

  13. Healthy Aging in Older Women Living with HIV Infection: a Systematic Review of Psychosocial Factors.

    Science.gov (United States)

    Rubtsova, Anna A; Kempf, Mirjam-Colette; Taylor, Tonya N; Konkle-Parker, Deborah; Wingood, Gina M; Holstad, Marcia McDonnell

    2017-02-13

    Due to life-enhancing effects of antiretroviral therapy, HIV-positive persons have the potential for long life comparable to their uninfected peers. Older women (age 50+) living with HIV (OWLH) are often an under-recognized aging group. We conducted a systematic review to examine psychosocial factors that impact how OWLH live, cope, and age with HIV. Initial key word search yielded 1527 records, and 21 studies met our inclusion criteria of original quantitative or qualitative research published between 2013 and 2016 with results specific to OWLH. These focused on health care and self-management, sexual health and risk, stigma, loneliness, mental health (depression, substance use), and protective factors (coping, social support, well-being). Due to the scarcity of studies on each topic and inconclusive findings, no clear patterns of results emerged. As the number of OWLH continues to grow, more research, including longitudinal studies, is needed to fully characterize the psychosocial factors that impact aging with HIV.

  14. Protection for pregnant women in employment.

    Science.gov (United States)

    Potrykus, C

    1994-03-01

    October 19 is the deadline for employers to implement improvements in maternity rights laid down by the Trade Union Reform and Employment Rights Act (TURERA) and the European directive to protect pregnant women's health and safety at work. Christina Potrykus outlines what the government and, separately, the general Whitley council have in store for women employees.

  15. The effect of tenofovir on renal function in HIV-positive pregnant women

    Directory of Open Access Journals (Sweden)

    Stuart Flanagan

    2014-11-01

    Full Text Available Introduction: Tenofovir is a commonly used component of antiretroviral therapy (ART to reduce vertical transmission of HIV. Although systematic review of tenofovir use in pregnancy concluded it to be low risk for foetal abnormalities (1, data is limited on its impact on renal function in pregnant women. A recent South African study (2 concluded that renal dysfunction in HIV-infected pregnant women is significantly less common than in other HIV-infected adults, however there is currently no UK data. We aimed to investigate the effect of tenofovir on renal function in HIV-1 positive pregnant women in a UK clinic. Methods: We retrospectively analyzed data on renal function in pregnancy from a cohort of women attending a busy inner city London antenatal clinic. All women were screened for renal function throughout pregnancy via serum creatinine and estimated glomerular filtration rate (eGFR calculated using modification of diet in renal disease (MDRD and corrected for ethnicity. Results: Ninety-seven HIV-1 positive women were registered at Homerton Hospital antenatal service of a total of 105 pregnancies between January 2010 and September 2013. Tenofovir was prescribed in 71/105 pregnancies (67.6%. Of the 71 pregnancies, 41 were prescribed tenofovir pre-conception (57.7%. Of the pregnant women who started tenofovir in pregnancy, 21/31 (67.7% were initiated before week 24 of pregnancy, in line with British HIV association (BHIVA guidelines (3. There was no deterioration in median serum creatinine or decline in eGFR in women prescribed tenofovir during pregnancy. At six weeks after delivery, in the 42 women who continued tenofovir therapy and had eGFR measured, one woman had eGFR=60, all others eGFR >90 (Table 1. Conclusions: Consistent with current guidelines and experience, this study shows tenofovir did not cause decline in renal function in pregnancy in our cohort of HIV-1 positive women, whether started during pre-conception or during pregnancy

  16. Infant feeding counselling of HIV-infected women in two areas in Kenya in 2008.

    Science.gov (United States)

    Israel-Ballard, Kiersten; Waithaka, Margaret; Greiner, Ted

    2014-11-01

    While WHO no longer recommends individual infant feeding counselling to HIV-positive women, it may still be practised in some settings and for specific cases. In any case, lessons can be learned by examining how well front line health workers are able to take on counselling tasks. This qualitative study was designed to assess how counsellors deal with challenges they face in two Kenyan provinces. It consisted of brief post-counselling exit interviews with 80 mothers, observations of 21 counselling sessions and 11 key informant interviews. Much infant feeding counselling was of reasonable quality, better than often reported elsewhere. However, nutrition and infant feeding were given low priority, counsellors' training was inadequate, individual postnatal counselling as well as growth monitoring and promotion were rarely done and complementary feeding was inadequately covered. Acceptable, feasible, affordable, sustainable and safe (AFASS) assessments were not of satisfactory quality. Breast milk expression was mentioned only to a minority and the possibility of heat treatment during the transition to cessation was not mentioned. Counsellors were often biased in discussing risks of breastfeeding and replacement feeding. Implementing the new WHO guidance will reduce the need for AFASS assessments, greatly simplifying both the government's and counsellors' tasks.

  17. Characterizing the HIV risks and potential pathways to HIV infection among transgender women in Côte d'Ivoire, Togo and Burkina Faso

    Science.gov (United States)

    Stahlman, Shauna; Liestman, Benjamin; Ketende, Sosthenes; Kouanda, Seni; Ky-Zerbo, Odette; Lougue, Marcel; Diouf, Daouda; Anato, Simplice; Tchalla, Jules; Bamba, Amara; Drame, Fatou Maria; Ezouatchi, Rebecca; Kouamé, Abo; Baral, Stefan D

    2016-01-01

    Introduction Transgender women are at high risk for the acquisition and transmission of HIV. However, there are limited empiric data characterizing HIV-related risks among transgender women in sub-Saharan Africa. The objective of these analyses is to determine what factors, including sexual behaviour stigma, condom use and engagement in sex work, contribute to risk for HIV infection among transgender women across three West African nations. Methods Data were collected via respondent-driven sampling from men who have sex with men (MSM) and transgender women during three- to five-month intervals from December 2012 to October 2015 across a total of six study sites in Togo, Burkina Faso and Côte d'Ivoire. During the study visit, participants completed a questionnaire and were tested for HIV. Chi-square tests were used to compare the prevalence of variables of interest between transgender women and MSM. A multilevel generalized structural equation model (GSEM) was used to account for clustering of observations within study sites in the multivariable analysis, as well as to estimate mediated associations between sexual behaviour stigma and HIV infection among transgender women. Results In total, 2456 participants meeting eligibility criteria were recruited, of which 453 individuals identified as being female/transgender. Transgender women were more likely than MSM to report selling sex to a male partner within the past 12 months (p<0.01), to be living with HIV (p<0.01) and to report greater levels of sexual behaviour stigma as compared with MSM (p<0.05). In the GSEM, sexual behaviour stigma from broader social groups was positively associated with condomless anal sex (adjusted odds ratio (AOR)=1.33, 95% confidence interval (CI)=1.09, 1.62) and with selling sex (AOR=1.23, 95% CI=1.02, 1.50). Stigma from family/friends was also associated with selling sex (AOR=1.42, 95% CI=1.13, 1.79), although no significant associations were identified with prevalent HIV infection

  18. Psychological readiness of pregnant women to parenthood

    Directory of Open Access Journals (Sweden)

    Galjautdinova S. I.

    2016-01-01

    Full Text Available In this article the results of a study of psychological readiness of pregnant women to parenthood are presented. Psychological readiness is defined as a structure consisting of three components: the cognitive, emotional, and behavioral, which is consistent with the single theory of psychological processes L. M. Vekkera. It was found that the main component that determines the high level of psychological readiness for motherhood is a cognitive component. The content of the cognitive component includes an understanding of the child as a value. Some results of the research of value orientations of pregnant women in the structure of psychological readiness for parenthood. To identify the value system of pregnant women, the method of “Value Orientations” by M. Rokich was applied. The analysis of empirical data was performed using factor analysis and U criterion of Mann-Whitney. Respondents were distributed into two age groups: first group of 21-25 years (56 persons, second group of 26-30 years (44 persons. All women are nulliparous. The younger age group of pregnant women is characterized by values that are directed at the outside world. Emotional component dominates in the structure of psychological readiness for motherhood. Values of women in the second group are aimed at children. Cognitive and behavioral components dominate in the structure of their psychological readiness for motherhood. Knowledge of the structure of psychological readiness of women to parenthood will help to diagnose disorders of maternal behavior, to design methods of its correction and prevention.

  19. a study of nevirapine toxicity in hiv infected pregnant women at the ...

    African Journals Online (AJOL)

    Esem

    been shown to be true also in developing countries even in. 3,4 the face of breastfeeding . ... Protease inhibitor. (PI) based regimens form the back-bone of second line .... Alternative hypothesis(one sided) The incidence of nevirapine toxicity in ...

  20. Happiness and related factors in pregnant women.

    Science.gov (United States)

    Jayasvasti, Kanthika; Kanchanatawan, Buranee

    2005-09-01

    Pregnancy is a crisis in the human life cycle as an important turning point in aspects of anatomical, physiological and psychosocial changes. An unhappy pregnanus could influence the fetal growth and development and sense of maternal competence as well as bonding with the fetus which profoundly affect the nurture of the infant after delivery. The authors'purposes were to study happiness and related factors in pregnant women having antenatal care at King Chulalongkorn Memorial Hospital. Four hundred and thirty-eight pregnant women from the antenatal clinic at King Chulalongkorn Memorial Hospital were randomly selected to complete a set of questionnaires that consisted of personal information, pregnant information, The Oxford Happiness Questionnaire (OHQ), The Maudsley Personality Inventory (MPI) and The Marital Satisfaction Scale (MSS). Prevalence of happiness level was classified by descriptive analysis. Unpaired t-test, ANOVA and Pearson's Product Moment Correlation analyzed related factors to happiness in pregnant woman. Also Stepwise Multiple Regression Analysis was used to define predictive factors for happiness in pregnant women. The sample had a high level of happiness of 57.3%. Significant related factors to happiness were age between 31-35 years, high education level, high individual and family income, having saving deposition, no drug abuse, improved marital relationship, no conflict with relatives, extrovert and stable personality types and no concerns about post-partum body image. Four predictive factors for happiness in pregnant women were extrovert personality, stable personality, high family income and improved marital relationship. Level of happiness in pregnant women could be predicted by type of personality, family income and marital relationship.

  1. Elimination of perinatal HIV infection in the United States and other high-income countries: achievements and challenges

    Science.gov (United States)

    Nesheim, Steven; Harris, Lauren Fitz; Lampe, Margaret

    2015-01-01

    Purpose of review To describe progress and challenges to elimination of mother-to-child HIV transmission (EMCT) in high-income countries. Recent findings Despite ongoing declines in the number of perinatally HIV-infected infants in most high-income countries, the number of HIV-infected women delivering may be increasing, accompanied by apparent changes in this population, including higher percentages with antiretroviral “pre-treatment” (with possible antiretroviral resistance), other co-infections, mental health diagnoses, and recent immigration. The impact of antiretroviral resistance on mother-to-child transmission is yet to be defined. A substantial minority of infant HIV acquisitions occur in the context of maternal acute HIV infection during pregnancy. Some infant infections occur after pregnancy, e.g., by premastication of food, or breastfeeding (perhaps by an uninfected woman who acquires HIV while breastfeeding). Summary The issues of EMCT are largely those of providing proper care for HIV-infected women. Use of combination antiretroviral therapy by increasing proportions of the infected population may function as a structural intervention important to achieving this goal. Providers and public health systems need to be alert for HIV-serodiscordant couples in which the woman is uninfected and for changes in the population of HIV-infected pregnant women. Accurate data about HIV-exposed pregnancies is vital to monitor progress toward EMCT. PMID:23925002

  2. Higher prevalence of anemia among pregnant immigrant women compared to pregnant ethnic Danish women

    DEFF Research Database (Denmark)

    Nybo, Mads; Friis-Hansen, Lennart; Felding, Peter

    2007-01-01

    The aim of the study was to investigate whether the well-known high anemia prevalence in pregnant women from the eastern Mediterranean and Asian regions decreased when the women immigrated to a low-frequency region (Denmark). During 70 months, 1,741 pregnant immigrant women referred from primary...... status parameters were examined in the two groups. The prevalence of anemia was higher in the immigrant group (20.0%) compared to the Danish women (4.9%) (P ... indicated iron deficiency. Conclusively, the pregnant immigrant women had significantly higher prevalence of anemia compared to pregnant women of Danish origin. It indicates the need for an alternative routine screening procedure for this population group, which should also include nutritional counselling....

  3. Assisting pregnant women to prepare for disaster.

    Science.gov (United States)

    Ewing, Bonnie; Buchholtz, Susan; Rotanz, Richard

    2008-01-01

    Disasters are natural or man-made life-altering events that require preplanning to save lives. Pregnant women are a particularly vulnerable population in such events, because they have special physical and psychosocial needs. Preparations made for labor and birth might have to be drastically altered in the event of an emergency, especially if a woman is separated from her familiar healthcare providers and facilities. The issue of breastfeeding also must be considered in disaster planning for pregnant women, along with occurrences such as food shortages and outbreak of illnesses caused by overcrowding of displaced persons. Recent events such as hurricane Katrina have demonstrated that maternal/child nurses need to become more aware of disaster planning and help to empower pregnant women with knowledge of how to handle their special needs in times of crisis.

  4. Monitoring HIV Epidemic in Pregnant Women: Are the Current Measures Enough?

    Directory of Open Access Journals (Sweden)

    Purva Sarkate

    2015-01-01

    Full Text Available Introduction. Burden of HIV in pregnant women follows overall epidemic in India. Hence, it is imperative that prevalence calculations in this group be accurate. The present study was carried out to determine prevalence of HIV in pregnant women attending our hospital, to determine trend of HIV infection and to compare our results with reported prevalence. Methods. All pregnant women are routinely counselled for HIV testing using opt-out strategy. Year-wise positivity and trend were determined in these patients over a period of five years. The positivity in different age groups was determined. Results. 31,609 women were tested of which 279 (0.88% were positive. Positivity showed a declining trend over study period and significant quadratic trend (biphasic, P<0.05 was observed. The positivity in older age group ≥35 years (1.64% was significantly more than younger age groups (0.76% in 15–24-year and 0.94% in 25–34-year age group (P=0.0052. Conclusion. A significant decline in HIV positivity was seen over the study period. Taking into account heterogeneous nature of HIV epidemic even within the same district, analysis at local levels especially using the prevention of parent to child transmission of HIV program data is critical for HIV programming and resource allocation.

  5. Pharmacokinetics of fenoterol in pregnant women.

    Science.gov (United States)

    von Mandach, U; Böni, R; Danko, J; Huch, R; Huch, A

    1995-02-01

    The beta 2-sympathomimetic drug fenoterol (fenoterol hydrobromide, CAS 1944-12-3, Partusisten) is routinely used to inhibit uterine contractions (tocolysis). Investigations of plasma concentrations of those receiving i.v. or oral tocolysis often show different results, both within particular groups of pregnant women and in comparison with non-pregnant persons. The aim of this study was to determine the pharmacokinetics of fenoterol in pregnant women, an important factor which so far had not been known. Four healthy pregnant women with similar weight and gestational age and all with premature labor were administered a continuous intravenous infusion of 4 micrograms fenoterol/min. During and up to 24 hours after the end of the infusion, venous blood samples were taken in order to determine the fenoterol plasma concentrations by radioimmunoassay. From a steady state concentration (css) of 2242 +/- 391 pg/ml (x +/- S.E.), a non-linear two-phased plasma elimination was seen with half-lives t1/2 of 11.40 min and 4.87 h. The area under the plasma concentration-time curve (AUC0-12h) was 6.27 ng/ml x h. The total clearance (Cltot) was 114.8 l/h. These data are nearly the same as the data already known for healthy non-pregnant (male) volunteers. The deviations which are seen in the plasma concentrations in pregnant women in comparison to non-pregnant persons during or after continuous i.v. infusion can therefore not be caused by differences in the pharmacokinetics. Other factors, however, such as body weight and/or gestational age, might influence the results.

  6. Impact of antiretroviral therapy on incidence of pregnancy among HIV-infected women in Sub-Saharan Africa: a cohort study.

    Directory of Open Access Journals (Sweden)

    Landon Myer

    2010-02-01

    Full Text Available BACKGROUND: With the rapid expansion of antiretroviral therapy (ART services in sub-Saharan Africa there is growing recognition of the importance of fertility and childbearing among HIV-infected women. However there are few data on whether ART initiation influences pregnancy rates. METHODS AND FINDINGS: We analyzed data from the Mother-to-Child Transmission-Plus (MTCT-Plus Initiative, a multicountry HIV care and treatment program for women, children, and families. From 11 programs in seven African countries, women were enrolled into care regardless of HIV disease stage and followed at regular intervals; ART was initiated according to national guidelines on the basis of immunological and/or clinical criteria. Standardized forms were used to collect sociodemographic and clinical data, including incident pregnancies. Overall 589 incident pregnancies were observed among the 4,531 women included in this analysis (pregnancy incidence, 7.8/100 person-years [PY]. The rate of new pregnancies was significantly higher among women receiving ART (9.0/100 PY compared to women not on ART (6.5/100 PY (adjusted hazard ratio, 1.74; 95% confidence interval, 1.19-2.54. Other factors independently associated with increased risk of incident pregnancy included younger age, lower educational attainment, being married or cohabiting, having a male partner enrolled into the program, failure to use nonbarrier contraception, and higher CD4 cell counts. CONCLUSIONS: ART use is associated with significantly higher pregnancy rates among HIV-infected women in sub-Saharan Africa. While the possible behavioral or biomedical mechanisms that may underlie this association require further investigation, these data highlight the importance of pregnancy planning and management as a critical but neglected component of HIV care and treatment services. Please see later in the article for the Editors' Summary.

  7. Impact of Antiretroviral Therapy on Incidence of Pregnancy among HIV-Infected Women in Sub-Saharan Africa: A Cohort Study

    Science.gov (United States)

    Myer, Landon; Carter, Rosalind J.; Katyal, Monica; Toro, Patricia; El-Sadr, Wafaa M.; Abrams, Elaine J.

    2010-01-01

    Background With the rapid expansion of antiretroviral therapy (ART) services in sub-Saharan Africa there is growing recognition of the importance of fertility and childbearing among HIV-infected women. However there are few data on whether ART initiation influences pregnancy rates. Methods and Findings We analyzed data from the Mother-to-Child Transmission-Plus (MTCT-Plus) Initiative, a multicountry HIV care and treatment program for women, children, and families. From 11 programs in seven African countries, women were enrolled into care regardless of HIV disease stage and followed at regular intervals; ART was initiated according to national guidelines on the basis of immunological and/or clinical criteria. Standardized forms were used to collect sociodemographic and clinical data, including incident pregnancies. Overall 589 incident pregnancies were observed among the 4,531 women included in this analysis (pregnancy incidence, 7.8/100 person-years [PY]). The rate of new pregnancies was significantly higher among women receiving ART (9.0/100 PY) compared to women not on ART (6.5/100 PY) (adjusted hazard ratio, 1.74; 95% confidence interval, 1.19–2.54). Other factors independently associated with increased risk of incident pregnancy included younger age, lower educational attainment, being married or cohabiting, having a male partner enrolled into the program, failure to use nonbarrier contraception, and higher CD4 cell counts. Conclusions ART use is associated with significantly higher pregnancy rates among HIV-infected women in sub-Saharan Africa. While the possible behavioral or biomedical mechanisms that may underlie this association require further investigation, these data highlight the importance of pregnancy planning and management as a critical but neglected component of HIV care and treatment services. Please see later in the article for the Editors' Summary PMID:20161723

  8. CD4+ cell count and HIV load as predictors of size of anal warts over time in HIV-infected women.

    Science.gov (United States)

    Luu, Hung N; Amirian, E Susan; Chan, Wenyaw; Beasley, R Palmer; Piller, Linda B; Scheurer, Michael E

    2012-02-15

    Little is known about the associations between CD4(+) cell counts, human immunodeficiency virus (HIV) load, and human papillomavirus "low-risk" types in noncancerous clinical outcomes. This study examined whether CD4(+) count and HIV load predict the size of the largest anal warts in 976 HIV-infected women in an ongoing cohort. A linear mixed model was used to determine the association between size of anal wart and CD4(+) count and HIV load. The incidence of anal warts was 4.15 cases per 100 person-years (95% confidence interval [CI], 3.83-4.77) and 1.30 cases per 100 person-years (95% CI, 1.00-1.58) in HIV-infected and HIV-uninfected women, respectively. There appeared to be an inverse association between size of the largest anal warts and CD4(+) count at baseline; however, this was not statistically significant. There was no association between size of the largest anal warts and CD4(+) count or HIV load over time. There was no evidence for an association between size of the largest anal warts and CD4(+) count or HIV load over time. Further exploration on the role of immune response on the development of anal warts is warranted in a larger study.

  9. Partners at risk: motivations, strategies, and challenges to HIV transmission risk reduction among HIV-infected men and women in Uganda.

    Science.gov (United States)

    Lifshay, Julie; Nakayiwa, Sylvia; King, Rachel; Reznick, Olga Grinstead; Katuntu, David; Batamwita, Richard; Ezati, Enoch; Coutinho, Alex; Kazibwe, Cissy; Bunnell, Rebecca

    2009-06-01

    Prevention with positives (PWP) is a fundamental component of HIV prevention in industrialized countries. Despite the estimated 22.4 million HIV-infected adults in Africa (UNAIDS, 2006), culturally appropriate PWP guidelines have not been developed for this region. In order to inform these guidelines, we conducted 37 interviews (17 women, 20 men, no couples) from October 2003 to May 2004 with purposefully selected HIV-infected individuals in care in Uganda. Participants reported increased condom use and reduced intercourse frequency and numbers of partners after testing HIV-positive. Motivations for behavior change included concerns for personal health and the health of others, and decreased libido. Gender-power inequities (sometimes manifesting in forced sex), pain experienced by women while using condoms, decreased pleasure for men while using condoms, lack of social support, and desire for children appear to have resulted in increased risk for uninfected partners. Interventions addressing domestic violence, partner negotiation, use of lubricants and alternative sexual activities could increase condom use and/or decrease sexual activity and/or numbers of partners, thereby reducing HIV transmission risk.

  10. Who is telling pregnant women about listeriosis?

    Science.gov (United States)

    Smith, Mary Anne E; MacLaurin, Tanya L

    2011-01-01

    During pregnancy, a woman's immune system is compromised and she is at an increased risk of infection and illness. In particular, the risk of contracting foodborne listeriosis is 20 times greater for pregnant women than for other women of reproductive age. Considering the negative effects of listeriosis on the developing fetus and that more than 380,000 babies were born in Canada in 2010, listeriosis is an important public health concern. And yet, in Canada, it is not clear who is responsible for educating pregnant women on the importance of safe food handling and the avoidance of high-risk foods. Not all women attend prenatal education classes and the circle of care during pregnancy is highly variable. Physicians, however, are very often included in the care circle and may represent a consistent, reliable and trustworthy source of food safety information. At present, only one province has prenatal records that prompt physicians to counsel pregnant women on food safety issues, though all include some assessment of nutrition, diet or supplement use. Improving provincial and territorial prenatal records may be one important way of helping to ensure that critical food safety information is reaching pregnant Canadians.

  11. Nevirapine, sodium concentration and HIV-1 RNA in breast milk and plasma among HIV-infected women receiving short-course antiretroviral prophylaxis

    DEFF Research Database (Denmark)

    Salado-Rasmussen, Kirsten; Theilgaard, Zahra Persson; Chiduo, Mercy G.

    2015-01-01

    Introduction Risk factors for breast milk transmission of HIV-1 from mother to child include high plasma and breast milk viral load, low maternal CD4 count and breast pathology such as mastitis. Objective To determine the impact of nevirapine and subclinical mastitis on HIV-1 RNA in maternal plasma...... and breast milk after intrapartum single-dose nevirapine combined with either 1-week tail of Combivir (zidovudine/lamivudine) or single-dose Truvada (tenofovir/emtricitabine). Methods Maternal plasma and bilateral breast milk samples were collected between April 2008 and April 2011 at 1, 4 and 6 weeks...... postpartum from HIV-infected Tanzanian women. Moreover, plasma samples were collected at delivery from mother and infant. Results HIV-1 RNA was quantified in 1,212 breast milk samples from 273 women. At delivery, 96% of the women and 99% of the infants had detectable nevirapine in plasma with a median...

  12. Inflammatory cytokine biomarkers to identify women with asymptomatic sexually transmitted infections and bacterial vaginosis who are at high risk of HIV infection.

    Science.gov (United States)

    Masson, Lindi; Arnold, Kelly B; Little, Francesca; Mlisana, Koleka; Lewis, David A; Mkhize, Nonhlanhla; Gamieldien, Hoyam; Ngcapu, Sinaye; Johnson, Leigh; Lauffenburger, Douglas A; Abdool Karim, Quarraisha; Abdool Karim, Salim S; Passmore, Jo-Ann S

    2016-05-01

    Untreated sexually transmitted infections (STIs) and bacterial vaginosis (BV) cause genital inflammation and increase the risk of HIV infection. WHO-recommended syndromic STI and BV management is severely limited as many women with asymptomatic infections go untreated. The purpose of this cross-sectional study was to evaluate genital cytokine profiles as a biomarker of STIs and BV to identify women with asymptomatic, treatable infections. Concentrations of 42 cytokines in cervicovaginal lavages from 227 HIV-uninfected women were measured using Luminex. All women were screened for BV by microscopy and STIs using molecular assays. Multivariate analyses were used to identify cytokine profiles associated with STIs/BV. A multivariate profile of seven cytokines (interleukin (IL)-1α, IL-1β, tumour necrosis factor-β, IL-4, fractalkine, macrophage-derived chemokine, and interferon-γ) most accurately predicted the presence of a treatable genital condition, with 77% classification accuracy and 75% cross-validation accuracy (sensitivity 72%; specificity 81%, positive predictive value (PPV) 86%, negative predictive value (NPV) 64%). Concomitant increased IL-1β and decreased IP-10 concentrations predicted the presence of a treatable genital condition without a substantial reduction in predictive value (sensitivity 77%, specificity 72%, PPV 82% and NPV 65%), correctly classifying 75% of the women. This approach performed substantially better than clinical signs (sensitivity 19%, specificity 92%, PPV 79% and NPV 40%). Supplementing syndromic management with an assessment of IL-1β and IP-10 as biomarkers of genital inflammation may improve STI/BV management for women, enabling more effective treatment of asymptomatic infections and potentially reducing their risk of HIV infection. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  13. Characterization of Vaginal Escherichia coli Isolated from Pregnant Women in Two Different African Sites.

    Directory of Open Access Journals (Sweden)

    Emma Sáez-López

    Full Text Available The relevance of vaginal colonization of pregnant women by Escherichia coli is poorly understood, despite these strains sharing a similar virulence profile with other extraintestinal pathogenic E. coli producing severe obstetric and neonatal infections. We characterized the epidemiology, antimicrobial susceptibility and virulence profiles of 84 vaginal E. coli isolates from pregnant women from Rabat (Morocco and Manhiça (Mozambique, two very distinct epidemiological settings. Low levels of antimicrobial resistance were observed to all drugs tested, except for trimethoprim-sulfamethoxazole in Manhiça, where this drug is extensively used as prophylaxis for opportunistic HIV infections. The most prevalent virulence factors were related to iron acquisition systems. Phylogroup A was the most common in Rabat, while phylogroups E and non-typeable were the most frequent in Manhiça. Regardless of the apparently "low virulence" of these isolates, the frequency of infections is higher and the outcomes more devastating in constrained-resources conditions, especially among pregnant women and newborns.

  14. HIV among Pregnant Women, Infants, and Children

    Science.gov (United States)

    ... Prevention VIH En Español Get Tested Find an HIV testing site near you. Enter ZIP code or city Follow HIV/AIDS CDC HIV CDC HIV/AIDS See RSS | ... Email Updates on HIV Syndicated Content Website Feedback HIV Among Pregnant Women, Infants, and Children Format: Select ...

  15. Seroprevalence of cytomegalovirus among pregnant women ...

    African Journals Online (AJOL)

    2014-03-03

    Mar 3, 2014 ... es minimal disability, allowing infected individuals to re- ... to evaluate the role of maternal education on CMV and the role ... Conclusion: Seroprevalence of pregnant women to CMV Ig G is high, hence the need for CMV - IgM ...

  16. Pregnant Women Need a Flu Shot

    Centers for Disease Control (CDC) Podcasts

    2010-11-17

    This podcast explains why pregnant women need a flu shot.  Created: 11/17/2010 by National Center for Immunization and Respiratory Diseases (NCIRD), Office of the Director (OD).   Date Released: 11/17/2010.

  17. Prevalence and risk factors of squamous intraepithelial lesions of the cervix among HIV-infected women - a long-term follow-up study in a low-prevalence population.

    Science.gov (United States)

    Lehtovirta, Päivi; Finne, Patrik; Nieminen, Pekka; Skogberg, Kirsi; Savonius, Hannele; Paavonen, Jorma; Heikinheimo, Oskari

    2006-12-01

    HIV-infected women have high risk for precancerous lesions of the uterine cervix. We studied the prevalence and risk factors of squamous intraepithelial lesions (SIL) among systematically followed HIV-infected women enrolled from a population with low HIV prevalence. The study population consisted of 108 HIV-infected women enrolled between 1989 and 2003 with a mean follow-up 4.4 years. Risk factors of SIL were assessed based on samples collected during 2000-02. The overall rates of atypical glandular cells of uncertain significance (AGUS), atypical squamous cells of uncertain significance (ASCUS), low-grade SIL (LSIL) and high-grade SIL (HSIL) were 4, 24, 15 and 5%, respectively. Reduced CD4-lymphocyte count was associated with an increased prevalence of SIL, whereas duration of HIV infection ( or =5 years), use of antiretroviral medication, or HIV viral load ( or =50 copies/mL) was not. The cumulative risk of developing SIL after 1 and 5 years was 17% (95% confidence interval [CI] 7-27%) and 48% (95% CI 33-63%), respectively. The cumulative risk of SIL was increased among women younger than 31 years (P = 0.04) as well as in women displaying high initial HIV viral load (P = 0.01). Our results from a low HIV-incidence population re-emphasize the importance of guidelines for cytologic screening of HIV-seropositive women.

  18. More Pregnant Women Getting Flu Shot, But Improvement Needed

    Science.gov (United States)

    ... https://medlineplus.gov/news/fullstory_162444.html More Pregnant Women Getting Flu Shot, But Improvement Needed All ... and her baby. And while the percentage of pregnant American women who got the vaccine has doubled ...

  19. Pregnant Women Should Avoid Zika-Hit Texas Town: CDC

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_162573.html Pregnant Women Should Avoid Zika-Hit Texas Town: CDC ... 15, 2016 THURSDAY, Dec. 15, 2016 (HealthDay News) -- Pregnant women should avoid traveling to a south Texas ...

  20. A Community-Supported Clinic-Based Program for Prevention of Violence against Pregnant Women in Rural Kenya

    Directory of Open Access Journals (Sweden)

    Janet M. Turan

    2013-01-01

    Full Text Available Objective. Pregnant women are especially vulnerable to adverse outcomes related to HIV infection and gender-based violence (GBV. We aimed at developing a program for prevention and mitigation of the effects of GBV among pregnant women at an antenatal clinic in rural Kenya. Methods. Based on formative research with pregnant women, male partners, and service providers, we developed a GBV program including comprehensive clinic training, risk assessments in the clinic, referrals supported by community volunteers, and community mobilization. To evaluate the program, we analyzed data from risk assessment forms and conducted focus groups (n=2 groups and in-depth interviews (n=25 with healthcare workers and community members. Results. A total of 134 pregnant women were assessed during a 5-month period: 49 (37% reported violence and of those 53% accepted referrals to local support resources. Qualitative findings suggested that the program was acceptable and feasible, as it aided pregnant women in accessing GBV services and raised awareness of GBV. Community collaboration was crucial in this low-resource setting. Conclusion. Integrating GBV programs into rural antenatal clinics has potential to contribute to both primary and secondary GBV prevention. Following further evaluation, this model may be deemed applicable for rural communities in Kenya and elsewhere in East Africa.

  1. Mortality in HIV-infected women, heterosexual men, and men who have sex with men in Rio de Janeiro, Brazil: an observational cohort study.

    Science.gov (United States)

    Coelho, Lara; Grinsztejn, Beatriz; Castilho, Jessica L; De Boni, Raquel; Quintana, Marcel S B; Campos, Dayse P; Ribeiro, Sayonara R; Pacheco, Antonio G; Veloso, Valdilea G; Luz, Paula M

    2016-10-01

    Mortality in HIV-infected individuals might differ by sex and mode of HIV acquisition. We aimed to study mortality in HIV-infected women, heterosexual men, and men who have sex with men (MSM) in a cohort from Rio de Janeiro, Brazil. In this observational cohort study, we included HIV-infected women, heterosexual men, and MSM (aged ≥18 years) from the Instituto Nacional de Infectologia Evandro Chagas database who were enrolled between Jan 1, 2000, and Oct 30, 2011, and who had at least 60 days of follow-up. Causes of deaths, defined with the Coding of Death in HIV protocol, were documented. Cox proportional hazards models accounting for competing risks were used to explore risk factors for AIDS-related and non-AIDS-related deaths. We had 10 142 person-years of follow-up from 2224 individuals: 817 (37%) women, 554 (25%) heterosexual men, and 853 (38%) MSM. Of 103 deaths occurred, 64 were AIDS related, 31 were non-AIDS related, and eight were of unknown causes. In unadjusted analyses, compared with women, the hazard of AIDS-related deaths was higher for heterosexual men (hazard ratio [HR] 3·52, 95% CI 1·30-9·08; p=0·009) and for MSM (2·30, 0·89-5·94; p=0·084). After adjustment for age, CD4 cell counts, last HIV viral load, antiretroviral therapy use, and AIDS-defining infection, AIDS-defining malignant disease, and hospital admission during follow-up, the excess risk of AIDS-related death decreased for heterosexual men (adjusted HR 1·99, 0·75-5·25; p=0·163) but was unchanged for MSM (2·24, 0·82-6·11; p=0·114). Non-AIDS-related mortality did not differ by group. Compared with women, increased risk of AIDS-related death in heterosexual men was partly mitigated by risk factors for AIDS mortality, whereas the excess risk in MSM was unchanged. Further study of reasons for disparity in AIDS-related mortality by mode of transmission is needed. US National Institutes of Health, Brazilian National Council of Technological and Scientific Development (CNPq

  2. Human immune deficiency virus (HIV) infection during pregnancy at Gadarif hospital, Eastern Sudan.

    Science.gov (United States)

    Adam, Gamal K; Ahmed, Mohammed Ahmed A; Ali, AbdelAziem A

    2016-10-01

    This was a prospective study conducted on all pregnant and parturient women attending Gadarif Maternity Hospital, Sudan from January 2009 to December 2013 to investigate the maternal characteristics, pregnancy outcomes and estimate of maternal to child transmission of HIV among HIV infected women. During the study period, there were 26 HIV positive mothers among 6420 tested women yielding an incidence rate of 0.4%. The majority of these 26 infected women were of urban residence (69.2%), presented with normal CD4+ T cell count; ? 350\\cu. mm3 (96.2%), had less than secondary education (57.7%) and housewives (84.6%). The mean age (SD) was significantly varied between the sero-positive and sero-negative women, 25.9 (5.7) vs. 36.1 (5.7), p = <0.001. More proportion of infected women had maternal anaemia and gave preterm birth, and none of the newborn babies was HIV infected until the age of 96 weeks. It is thus HIV infected women in eastern Sudan were young and likely desire more children.

  3. Exploring gender perceptions of risk of HIV infection and related behaviour among elderly men and women of Ga-Rankuwa, Gauteng Province, South Africa.

    Science.gov (United States)

    Lekalakala-Mokgele, Eucebious

    2016-12-01

    The literature shows that there are important differences between women and men in the underlying mechanisms of transmission of HIV infection and AIDS, as well as in the social and economic consequences of HIV/AIDS. These stem from sexual behaviour and socially constructed 'gender' differences between women and men in roles and responsibilities. Despite the fact that numerous gender-related sociocultural factors influence HIV/AIDS protective behaviours, little gender specificity is included in HIV prevention among the elderly. In order to close this gap, this study explored gender-related perceptions of risk of HIV infection among elderly men and women of Ga-Rankuwa in Gauteng Province, South Africa. This qualitative study used purposive sampling to conduct three focus group interviews with 22 women and 10 men who were above 60 years of age. Findings revealed that both genders blame each other for the spreading of HIV/AIDS. Male participants displayed the tendency to have multiple partners, whereas females accepted that males are promiscuous. Mixed perceptions about disclosure of HIV status were found. Condom use was a challenge, as men did not know how to introduce it with their wives, and some female participants indicated that men are resistant to using condoms. The elderly men also believed that women will have sex in exchange for money. It is concluded that there is a need for substantial behaviour change among both elderly males and females, which should address gender power relations. More in-depth and extensive research in this area is recommended.

  4. Factors associated with forced sex among women accessing health services in rural Haiti: implications for the prevention of HIV infection and other sexually transmitted diseases.

    Science.gov (United States)

    Smith Fawzi, M C; Lambert, W; Singler, J M; Tanagho, Y; Léandre, F; Nevil, P; Bertrand, D; Claude, M S; Bertrand, J; Louissaint, M; Jeannis, L; Mukherjee, J S; Goldie, S; Salazar, J J; Farmer, P E

    2005-02-01

    The goals of the current study were to: (1) estimate the prevalence of forced sex among women accessing services at a women's health clinic in rural Haiti; and (2) examine factors associated with forced sex in this population. Based on data from a case-control study of risk factors for sexually transmitted diseases (STDs), a cross-sectional analysis to examine factors associated with forced sex was performed. A number of factors related to gender inequality/socioeconomic vulnerability placed women in rural Haiti at higher risk of forced sex. The strongest factors associated with forced sex in multivariate analyses were: age, length of time in a relationship, occupation of the woman's partner, STD-related symptoms, and factors demonstrating economic vulnerability. The findings suggest that prevention efforts must go beyond provision of information and education to the pursuit of broader initiatives at both local and national levels. At the community level, policy-makers should consider advancing economic opportunities for women who are vulnerable to forced sex. Improving access to community-based income-generating activities may begin to address this problem. However, the viability of these local projects depends largely upon Haiti's 'macro-economic' situation. In order to ensure the success of local initiatives, external humanitarian and development assistance to Haiti should be supported. By broadening the definition of "prevention" interventions, we may begin to address the systemic problems that contribute to the occurrence of forced sex and the increasing incidence of HIV infection throughout the world, such as gender inequality and economic vulnerability. Taking into account factors influencing risk at the local level as well as the macro-level will potentially improve our capacity to reduce the risk of forced sex and the spread of STDs, including HIV infection, for millions of women living in poverty worldwide.

  5. HIV infection in Bophuthatswana

    African Journals Online (AJOL)

    was known about HIV infection and AIDS in the country. However, the health authorities were aware of the report ... natal, family planning and sexually transmitted diseases ..... Francis DP, Chin J. The prevention of acquired immunodeficiency.

  6. When do HIV-infected women disclose their HIV status to their male partner and why? A study in a PMTCT programme, Abidjan.

    Directory of Open Access Journals (Sweden)

    Hermann Brou

    2007-12-01

    Full Text Available BACKGROUND: In Africa, women tested for HIV during antenatal care are counselled to share with their partner their HIV test result and to encourage partners to undertake HIV testing. We investigate, among women tested for HIV within a prevention of mother-to-child transmission of HIV (PMTCT programme, the key moments for disclosure of their own HIV status to their partner and the impact on partner HIV testing. METHODS AND FINDINGS: Within the Ditrame Plus PMTCT project in Abidjan, 546 HIV-positive and 393 HIV-negative women were tested during pregnancy and followed-up for two years after delivery. Circumstances, frequency, and determinants of disclosure to the male partner were estimated according to HIV status. The determinants of partner HIV testing were identified according to women's HIV status. During the two-year follow-up, disclosure to the partner was reported by 96.7% of the HIV-negative women, compared to 46.2% of HIV-positive women (chi(2 = 265.2, degrees of freedom [df] = 1, p < 0.001. Among HIV-infected women, privileged circumstances for disclosure were just before delivery, during early weaning (at 4 mo to prevent HIV postnatal transmission, or upon resumption of sexual activity. Formula feeding by HIV-infected women increased the probability of disclosure (adjusted odds ratio 1.54, 95% confidence interval 1.04-2.27, Wald test = 4.649, df = 1, p = 0.031, whereas household factors such as having a co-spouse or living with family reduced the probability of disclosure. The proportion of male partners tested for HIV was 23.1% among HIV-positive women and 14.8% among HIV-negative women (chi(2 = 10.04, df = 1, p = 0.002. Partners of HIV-positive women who were informed of their wife's HIV status were more likely to undertake HIV testing than those not informed (37.7% versus 10.5%, chi(2 = 56.36, df = 1, p < 0.001. CONCLUSIONS: In PMTCT programmes, specific psychosocial counselling and support should be provided to women during the key

  7. Correlates of anemia in pregnant women

    Directory of Open Access Journals (Sweden)

    Ranjana Singh

    2015-09-01

    Full Text Available Background: Anemia during pregnancy is a global public health challenge facing the world today. Prevalence of anemia in pregnancy in all the age groups is higher in India as compared to other developing countries. Objective: This study is aimed at determining the magnitude and to explore the socio-demographic and other correlates of anemia among pregnant women. Methodology: This descriptive study with cross-sectional design was conducted in a tertiary care hospital. Pregnant who were attending antenatal clinic for a period of one year were comprised the study material. Correlation between variables was analyzed using the chi-square and odd ratio. Results: Three hundred and thirty eight pregnant women were registered for the present study, whose age ranged from 16 to 45 years with a mean age of 26.08 years. Majority (81.95% participants were found to be anemic. It was observed that anemia was more prevalent in pregnant women age groups i.e. 25-29 years and 30+years i.e. 86.67% and 86.21% respectively. Anemia was 82.92% in women were belonging to Hindu and others religion and 82.24% in women having vegetarian diet. Maximum prevalence (83.93% of anemia was observed in women who were booked for antenatal care in the 3rd trimester of pregnancy. The prevalence of anemia is higher (>85% in women having parity two or more, but this association was not statistically significant. Very few (6.21% were found to be severely anemic as compared to women who were moderately anemic (43.19%. Multiple logistic regression analysis of these factors showed that possibility of anemia is less in women who belong to rural area and it is highly significant. Analysis further showed significant association between anemia and type of diet and other factors like women having parity 1 and 4. Conclusion: The prevalence of anemia amongst the pregnant participants was very high. The socio-demographic and obstetrics factors were found to be associated with anemia. To prevent

  8. Clinical malaria in African pregnant women.

    Science.gov (United States)

    Bardají, Azucena; Sigauque, Betuel; Bruni, Laia; Romagosa, Cleofé; Sanz, Sergi; Mabunda, Samuel; Mandomando, Inacio; Aponte, John; Sevene, Esperança; Alonso, Pedro L; Menéndez, Clara

    2008-01-30

    There is a widespread notion, based on limited information, that in areas of stable malaria transmission most pregnant women with Plasmodium falciparum infection are asymptomatic. This study aim to characterize the clinical presentation of malaria in African pregnant women and to evaluate the adequacy of case management based on clinical complaints. A hospital-based descriptive study between August 2003 and November 2005 was conducted at the maternity clinic of a rural hospital in Mozambique. All women attending the maternity clinic were invited to participate. A total of 2,330 women made 3,437 eligible visits, 3129 were analysed, the remainder were excluded because diagnostic results were unavailable or they were repeat visits. Women gave a standardized clinical history and had a medical exam. Malaria parasitaemia and haematocrit in capillary blood was determined for all women with signs or symptoms compatible with malaria including: presence and history of fever, arthromyalgias, headache, history of convulsions and pallor. Outcome measure was association of malaria symptoms or signs with positive blood slide for malaria parasitaemia. In 77.4% of visits pregnant women had symptoms suggestive of malaria; 23% (708/3129) were in the first trimester. Malaria parasitaemia was confirmed in 26.9% (842/3129) of visits. Headache, arthromyalgias and history of fever were the most common symptoms (86.5%, 74.8% and 65.4%) presented, but their positive predictive values for malaria parasitaemia were low [28% (27-30), 29% (28-31), and 33% (31-35), respectively]. Symptoms suggestive of malaria were very frequent among pregnant women attending a rural maternity clinic in an area of stable malaria transmission. However, less than a third of them were parasitaemic. In the absence of microscopy or rapid diagnostic tests, a large proportion of women, including those in the first trimester of gestation, would be unnecessarily receiving antimalarial drugs, often those with unknown

  9. Clinical malaria in African pregnant women

    Directory of Open Access Journals (Sweden)

    Aponte John

    2008-01-01

    Full Text Available Abstract Background There is a widespread notion, based on limited information, that in areas of stable malaria transmission most pregnant women with Plasmodium falciparum infection are asymptomatic. This study aim to characterize the clinical presentation of malaria in African pregnant women and to evaluate the adequacy of case management based on clinical complaints. Methods A hospital-based descriptive study between August 2003 and November 2005 was conducted at the maternity clinic of a rural hospital in Mozambique. All women attending the maternity clinic were invited to participate. A total of 2,330 women made 3,437 eligible visits, 3129 were analysed, the remainder were excluded because diagnostic results were unavailable or they were repeat visits. Women gave a standardized clinical history and had a medical exam. Malaria parasitaemia and haematocrit in capillary blood was determined for all women with signs or symptoms compatible with malaria including: presence and history of fever, arthromyalgias, headache, history of convulsions and pallor. Outcome measure was association of malaria symptoms or signs with positive blood slide for malaria parasitaemia. Results In 77.4% of visits pregnant women had symptoms suggestive of malaria; 23% (708/3129 were in the first trimester. Malaria parasitaemia was confirmed in 26.9% (842/3129 of visits. Headache, arthromyalgias and history of fever were the most common symptoms (86.5%, 74.8% and 65.4% presented, but their positive predictive values for malaria parasitaemia were low [28% (27–30, 29% (28–31, and 33% (31–35, respectively]. Conclusion Symptoms suggestive of malaria were very frequent among pregnant women attending a rural maternity clinic in an area of stable malaria transmission. However, less than a third of them were parasitaemic. In the absence of microscopy or rapid diagnostic tests, a large proportion of women, including those in the first trimester of gestation, would be

  10. Telephone smoking cessation quitline use among pregnant and non-pregnant women.

    Science.gov (United States)

    Bombard, Jennifer M; Farr, Sherry L; Dietz, Patricia M; Tong, Van T; Zhang, Lei; Rabius, Vance

    2013-08-01

    To describe characteristics, referrals, service utilization, and self-reported quit rates among pregnant and non-pregnant women enrolled in a smoking cessation quitline. This information can be used to improve strategies to increase pregnant and non-pregnant smokers' use of quitlines. We examined tobacco use characteristics, referral sources, and use of services among 1,718 pregnant and 24,321 non-pregnant women aged 18-44 years enrolled in quitline services in 10 states during 2006-2008. We examined self-reported 30-day quit rates 7 months after enrollment among 246 pregnant and 4,123 non-pregnant women and, within groups, used Chi-square tests to compare quit rates by type of service received. The majority of pregnant and non-pregnant callers, respectively, smoked ≥10 cigarettes per day (62 %; 83 %), had recently attempted to quit (55 %; 58 %), smoked 5 or minutes after waking (59 %; 55 %), and lived with a smoker (63 %; 48 %). Of callers, 24.3 % of pregnant and 36.4 % of non-pregnant women were uninsured. Pregnant callers heard about the quitline most often from a health care provider (50 %) and non-pregnant callers most often through mass media (59 %). Over half of pregnant (52 %) and non-pregnant (57 %) women received self-help materials only, the remainder received counseling. Self-reported quit rates at 7 months after enrollment in the subsample were 26.4 % for pregnant women and 22.6 % for non-pregnant women. Quitlines provide needed services for pregnant and non-pregnant smokers, many of whom are uninsured. Smokers should be encouraged to access counseling services.

  11. Serum biomarkers of immune activation and subsequent risk of non-hodgkin B-cell lymphoma among HIV-infected women.

    Science.gov (United States)

    Hussain, Shehnaz K; Hessol, Nancy A; Levine, Alexandra M; Breen, Elizabeth Crabb; Anastos, Kathryn; Cohen, Mardge; D'Souza, Gypsyamber; Gustafson, Deborah R; Silver, Sylvia; Martínez-Maza, Otoniel

    2013-11-01

    There is increasing evidence that chronic immune activation predisposes to non-Hodgkin lymphoma (NHL). Whether this association exists among women representative of the current HIV epidemic in the United States who are at high risk of HIV-associated NHL (AIDS-NHL), remains to be determined. We conducted a nested case-control study within the Women's Interagency HIV Study with longitudinally collected risk factor data and sera. Cases were HIV-infected women with stored sera collected at three time-windows 3 to 5 years, 1 to 3 years, and 0 to 1 year before AIDS-NHL diagnosis (n = 22). Three to six HIV-infected controls, without AIDS-NHL, were matched to each case on age, race, CD4(+) T-cell count, and study follow-up time (n = 78). ORs and 95% confidence intervals (CI) for the association between one unit increase in log-transformed biomarker levels and AIDS-NHL were computed using random effect multivariate logistic regression models. Elevated levels of sCD27 (OR = 7.21; 95% CI, 2.62-19.88), sCD30 (OR = 2.64; 95% CI, 1.24-5.64), and CXCL13 (OR = 2.56; 95% CI, 1.32-4.96) were associated with subsequent diagnosis of AIDS-NHL overall. Elevated sCD23 was associated with a two to three-fold increased risk of AIDS-NHL in certain subgroups, whereas elevated interleukin 6 was associated with a two-fold increased risk in the 0 to 1 year time-window, only. These findings support the hypothesis that chronic B-cell activation contributes to the development of AIDS-NHL in women. Soluble CD23 (sCD23), sCD27, sCD30, and CXCL13 may serve as biomarkers for AIDS-NHL. ©2013 AACR.

  12. Mortality among HIV-infected women, heterosexual men, and men who have sex with men: insights from an observational cohort study

    Science.gov (United States)

    Coelho, Lara; Grinsztejn, Beatriz; Castilho, Jessica L.; De Boni, Raquel; Quintana, Marcel S. B.; Campos, Dayse P.; Ribeiro, Sayonara R.; Pacheco, Antonio G.; Veloso, Valdilea G.; Luz, Paula M.

    2016-01-01

    Background Mortality among HIV-infected individuals may differ by sex and mode of HIV acquisition. We studied mortality among women, heterosexual men, and men who have sex with men (MSM) in a cohort from Rio de Janeiro, Brazil. Methods HIV-infected adults followed at Instituto Nacional de Infectologia Evandro Chagas from 2000–2011 were included. Cox proportional hazards models accounting for competing risks were used to explore risk factors for AIDS and non-AIDS related deaths. Findings 2224 individuals were included (36·7%[817/2224] women, 24·9%[554/2224] heterosexual men, and 38·4%[853/2224] MSM). Throughout the study period, 103 deaths occurred: 64 due to AIDS-related causes, 31 due to non-AIDS related causes and 8 of unknown causes. In unadjusted analyses, compared to women, hazard of AIDS-related deaths was higher for heterosexual men (hazard ratio [HR] 3·52, 95% confidence interval [95%CI] 1·30–9·08) and for MSM (HR 2·30, 95%CI 0·89–5·94). After adjusting for confounders, excess risk of AIDS-related death observed for heterosexual men was attenuated (aHR 1·99, 95%CI 0·75–5·25, p-value=0.163), but unchanged for MSM (aHR 2·24, 95%CI 0·82–6·11, p-value=0.114). Non-AIDS related mortality did not differ by group. Interpretation Compared to women, increased risk of AIDS-related death among heterosexual men was partially mitigated by risk factors for AIDS mortality while excess risk observed among MSM was unchanged. Further study of reasons for AIDS-related mortality disparity by mode of transmission is needed. PMID:27658875

  13. Iron supplementation studies among pregnant women.

    Science.gov (United States)

    Kuizon, M D; Platon, T P; Ancheta, L P; Angeles, J C; Nunez, C B; Macapinlac, M P

    1979-12-01

    The effect of iron supplementation alone or in combination with ascorbic acid as a preventive and or corrective measure against anemia were tested using pregnant women seeking pre-natal consultation at various health centers in Greater Manila Area. One tablet containing 65 mg iron alone or in combination with ascorbic acid per day during a supplementation period which varied from 16.5 to 17.8 weeks maintained initial hemoglobin and hematocrit levels in non-anemic women. Three tablets of the same iron preparation (total of 195 mg iron) daily resulted in significant increases in hemoglobin and hematocrit in anemic women. Ascorbic acid had no apparent beneficial effect. Considering the positive response to iron treatment, it is recommended that a nationwide program of iron supplementation of pregnant Filipinos be undertaken.

  14. [Concentration of heavy metals in pregnant women].

    Science.gov (United States)

    Jacyszyn, K; Walas, J; Malinowski, A; Latkowski, T; Cwynar, L

    1982-01-01

    Copper, zinc, and lead concentrations were measured in two groups 72 pregnant women. Twenty-one of them, making up the control group, lived and worked in Wrocław. The other 51 women, the second group, had lived more than five years in Lubin-Polkowice and worked in the local non-ferrous metal plants. They were particularly endangered by their exposure to copper, zinc, and lead concentrations. Pregnancy was normal in all cases. Maternal blood, umbilical cord blood, placenta homogenate, and amniotic fluid were examined by techniques of atom-absorption spectrometry. The metals tested were conspicuously absorbed by placental tissue, but no danger to the pregnant women could be established.

  15. [HIV infection and immigration].

    Science.gov (United States)

    Monge, Susana; Pérez-Molina, José A

    2016-01-01

    Migrants represent around one third of patients newly diagnosed with HIV in Spain and they constitute a population with higher vulnerability to its negative consequences due to the socio-cultural, economical, working, administrative and legal contexts. Migrants are diagnosed later, which worsens their individual prognosis and facilitates the maintenance of the HIV epidemic. In spite of the different barriers they experience to access healthcare in general, and HIV-related services in particular, access to antiretroviral treatment has been similar to that of the autochthonous population. However, benefits of treatment have been not, with women in general and men from Sub-Saharan Africa exhibiting the worse response to treatment. We need to proactively promote earlier diagnosis of HIV infection, the adoption of preventive measures to avoid new infections, and to deliver accessible, adapted and high-quality health-care. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  16. Plasma Micronutrient Concentrations Are Altered by Antiretroviral Therapy and Lipid-Based Nutrient Supplements in Lactating HIV-Infected Malawian Women123

    Science.gov (United States)

    Flax, Valerie L; Adair, Linda S; Allen, Lindsay H; Shahab-Ferdows, Setarah; Hampel, Daniela; Chasela, Charles S; Tegha, Gerald; Daza, Eric J; Corbett, Amanda; Davis, Nicole L; Kamwendo, Deborah; Kourtis, Athena P; van der Horst, Charles M; Jamieson, Denise J; Bentley, Margaret E

    2015-01-01

    Background: Little is known about the influence of antiretroviral therapy with or without micronutrient supplementation on the micronutrient concentrations of HIV-infected lactating women in resource-constrained settings. Objective: We examined associations of highly active antiretroviral therapy (HAART) and lipid-based nutrient supplements (LNS) with concentrations of selected micronutrients in HIV-infected Malawian women at 24 wk postpartum. Methods: Plasma micronutrient concentrations were measured in a subsample (n = 690) of Breastfeeding, Antiretrovirals, and Nutrition (BAN) study participants who were randomly assigned at delivery to receive HAART, LNS, HAART+LNS, or no HAART/no LNS (control). HAART consisted of protease inhibitor–based triple therapy. LNS (140 g/d) met energy and micronutrient requirements of lactation. Multivariable linear regression tested the association of HAART and LNS, plus their interaction, with micronutrient concentrations, controlling for season, baseline viral load, and baseline CD4 count. Results: We found significant HAART by LNS interactions for folate (P = 0.051), vitamin B-12 (P < 0.001), and transferrin receptors (TfRs) (P = 0.085). HAART was associated with lower folate (with LNS: −27%, P < 0.001; without LNS: −12%, P = 0.040) and higher TfR concentrations (with LNS: +14%, P = 0.004; without LNS: +28%, P < 0.001), indicating iron deficiency. LNS increased folate (with HAART: +17%, P = 0.037; without HAART: +39%, P < 0.001) and decreased TfR concentrations (with HAART only: −12%, P = 0.023). HAART was associated with lower vitamin B-12 concentrations only when LNS was present (−18%, P = 0.001), whereas LNS increased vitamin B-12 only when no HAART was present (+27%, P < 0.001). HAART, but not LNS, was associated with higher retinol-binding protein (RBP; +10%, P = 0.007). We detected no association of HAART or LNS with selenium, ferritin, or hemoglobin. Conclusion: The association of HAART with lower folate, iron

  17. Iodine Status in Pregnant & Breastfeeding Women

    DEFF Research Database (Denmark)

    Andersen, Stine Linding

    Iodine is required for the synthesis of thyroid hormones, which are crucial regulator of early brain development. The source of iodine in the fetus and the breastfed infant is maternal iodine, and adequate iodine intake in pregnant and breastfeeding is of major concern. Severe iodine deficiency can...... cause irreversible brain damage, whereas the consequences of mild to moderate iodine deficiency are less clear. Denmark was previously iodine deficient with regional differences (mild iodine deficiency in East Denmark and moderate iodine deficiency in West Denmark), and also pregnant and breastfeeding...... women suffered from iodine deficiency. A mandatory iodine fortification of household salt and salt used for commercial production of bread was introduced in Denmark in the year 2000. The PhD thesis investigates intake of iodine supplements and urinary iodine status in Danish pregnant and breastfeeding...

  18. Executive summary of the consensus statement on assistance to women with HIV infection in the health care sector. National AIDS Plan (PNS) and AIDS Study Group (GeSIDA).

    Science.gov (United States)

    2014-02-01

    The aim of this paper was to develop a consensus on clinical recommendations for health care assistance for women with HIV infection. To this end, a panel of experts, appointed by the Secretariat of the National AIDS Plan and GeSIDA was assembled, that included internal medicine physicians with expertise in the field of HIV infection, gynecologists, pediatricians and psychologists, with two members of the panel acting as coordinators. Scientific information was reviewed in publications and conference reports up to October 2012. In keeping with the criteria of the Infectious Disease Society of America, two levels of evidence were applied to support the proposed recommendations: the strength of the recommendation according to expert opinion (A, B, C) and the level of empirical evidence (I, II, III), already used in previous documents from SPNS/GESIDA. Multiple recommendations are provided for the clinical management of women with HIV infection, considering both the diagnostic and possible therapeutic strategies. This document presents recommendations for the treatment of women with HIV infection. This must be multidisciplinary, taking into account the differences that can be found in the diagnosis, development of disease and treatment between men and women. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  19. A randomized controlled trial of the efficacy of a stigma reduction intervention for HIV-infected women in the Deep South.

    Science.gov (United States)

    Barroso, Julie; Relf, Michael V; Williams, Megan Scull; Arscott, Joyell; Moore, Elizabeth D; Caiola, Courtney; Silva, Susan G

    2014-09-01

    The aim of this study was to compare outcomes (self-esteem, coping self-efficacy, and internalized stigma) across time in HIV-infected women living in the Deep South who received a stigma reduction intervention (n=51) with those of a control group (n=49) who received the usual care at baseline, and at 30 and 90 days. We recruited 99 women from clinics and an AIDS service organization; they were randomized by recruitment site. A video developed from the results of a qualitative metasynthesis study of women with HIV infection was loaded onto iPod Touch devices. Participants were asked to watch the video weekly for 4 weeks, and to record the number of times they viewed it over a 12-week period. We examined the trajectory model results for efficacy outcomes for the intent-to-treat and the supplemental completers groups. There was a treatment-by-time effect for improved self-esteem (intent-to-treat: p=0.0308; completers: p=0.0284) and decreases in internalized stigma (intent-to-treat: p=0.0036; completers: p=0.0060), and a treatment-by-time-by-time effect for improved coping self-efficacy (intent-to-treat: p=0.0414; completers: p=0.0321). A medium effect of the intervention in terms of improving self-esteem was observed when compared with the control condition in those who completed the study. The magnitude of the intervention effect, however, was large with regard to reducing overall stigma, improving social relationships, and decreasing stereotypes in both groups.

  20. Factors influencing uptake of contraceptive implants in the immediate postpartum period among HIV infected and uninfected women at two Kenyan District Hospitals.

    Science.gov (United States)

    Shabiby, Mufida M; Karanja, Joseph G; Odawa, Francis; Kosgei, Rose; Kibore, Minnie W; Kiarie, James N; Kinuthia, John

    2015-08-19

    Family planning is a cost effective strategy for prevention of mother to child transmission of HIV and reduction of maternal/infant morbidity and mortality. Contraceptive implants are a safe, effective, long term and reversible family planning method whose use remains low in Kenya. We therefore set out to determine and compare the uptake, and factors influencing uptake of immediate postpartum contraceptive implants among HIV infected and uninfected women at two hospitals in Kenya. This cross sectional study targeted postpartum mothers at two Kenyan district hospitals (one urban and one rural). All participants received general family planning and method specific (Implant) counseling followed by immediate insertion of contraceptive implants to those who consented. The data was analyzed by descriptive analysis, T-test, Chi square tests and logistic regression. One hundred eighty-five participants were enrolled (91 HIV positive and 94 HIV negative) with a mean age of 26 years. HIV positive mothers were significantly older (27.5 years) than their HIV negative counterparts (24.5 years), P = 0.001. The two groups were comparable in education, employment, marital status and religious affiliation. Overall, the uptake of contraceptive implants in the immediate postpartum period was 50.3% and higher among HIV negative than HIV positive participants (57% vs. 43%, P = 0.046). Multivariate analysis revealed that a negative HIV status (P = 0.017) and prior knowledge of contraceptive implants (P = 0.001) were independently associated with increased uptake of contraceptive implants. There was a high uptake of immediate postpartum contraceptive implants among both HIV infected and un-infected women; efforts therefore need to be made in promoting this method of family planning in Kenya and providing this method to women in the immediate postpartum period so as to utilize this critical opportunity to increase uptake and reduce the high unmet need for family planning.

  1. Folic acid supplementation in pregnant women.

    Science.gov (United States)

    Rasmussen, Mikkel Mylius; Clemmensen, Dorte

    2010-01-01

    Folic acid (FA) deficiency is associated with neural tube defects (NTD). In a non-risk pregnancy, The Danish National Board of Health recommends FA supplementation from planned pregnancy until three months after conception. We explored pregnant women's knowledge about and actual supplementation with FA and related this to education, number of pregnancies and age. Eighty-four consecutive pregnant women with a midwife consultation were included in the period 25-28 August 2008. All filled in a unified questionnaire. 82% had knowledge of FA supplementation and 89% received FA supplementation. 51% followed national recommendations. We found a statistically significant correlation between higher educational level and knowledge about FA supplementation, actual supplementation of FA and FA supplementation in accordance with national recommendations. No statistical associations were found between number of pregnancies or age and any FA-related parameters. Family, friends, general practitioner (GP) and the internet were the main information sources. Correct FA supplementation is quite low; conversely, knowledge about and actual FA supplementation are fairly high. Further intervention is necessary to increase the level of correct FA supplementation. Women with a low educational level--which may herald low socio-economic status--seem to form a suitable target group for information campaigns. Multiple pregnancies or higher age should not be perceived as indicators of a higher information level. Dissemination of information to the pregnant women including family, friends, GPs or the internet is recommended.

  2. Scorpion envenomation symptoms in pregnant women

    Directory of Open Access Journals (Sweden)

    H. Ben Nasr

    2007-01-01

    Full Text Available Scorpion envenomation is common in many countries; however, its effects on pregnancy are still unclear. In the present paper, we described the effects of scorpion envenomation on pregnant patients. A retrospective study was carried out considering the clinical and laboratory exams of patients admitted to the emergency room of Habib Bourguiba Hospital, Sfax, Tunisia, from 1990 to 2004. Variability of these clinical and laboratory profiles according to maternal age, gestational age and number of previous parities was also discussed. Among 167 scorpion-envenomed women, age ranged from 17 to 42 years, 7.18% were pregnant. These presented symptoms similar to those of non-pregnant women envenomed by scorpions. Two pregnant patients developed intense pelvic pain and one manifested vaginal bleeding. Although the studied parameters showed non-significant differences, we could conclude that scorpion envenomation may lead to abnormal uterine contraction probably causing preterm delivery. Maternal disturbances induced by scorpion envenomation may influence the fetus development. The effects were more severe in the second trimester of pregnancy.

  3. Por que o Brasil ainda registra elevados coeficientes de transmissão vertical do HIV? Uma avaliação da qualidade da assistência prestada a gestantes / parturientes infectadas pelo HIV e seus recém-nascidos Why does Brazil still report high rates of vertical HIV transmission? An evaluation of health care quality to HIV-infected pregnant women and their children

    Directory of Open Access Journals (Sweden)

    Ana Lucia Ribeiro de Vasconcelos

    2005-12-01

    Full Text Available OBJETIVOS: avaliar a assistência prestada a parturientes HIV+ e seus recém-nascidos (RN, e determinar os coeficientes de transmissão vertical (TV do HIV em quatro capitais brasileiras. MÉTODOS: foi realizado um estudo de coorte cuja população correspondeu a 1475 parturientes HIV+ e seus RN, assistidas de 1996 a 2003, em 17 maternidades públicas. As informações foram obtidas, retrospectivamente, a partir dos prontuários médicos e de um questionário estruturado (fase prospectiva aplicado em 274 mulheres. RESULTADOS: quanto à assistência dispensada, verificou-se respectivamente nas fases retrospectiva e prospectiva do estudo, que cerca de 24% e 27% das gestantes não tiveram acesso sequer ao AZT oral; 19% e 10% das parturientes não receberam o AZT intravenoso; 8% e 7% dos bebês não foram medicados com o AZT solução oral. O coeficiente de TV foi de 5,6% variando de 2,9% a 7,5% nas cidades, e sendo maior no parto vaginal (8% e na cirurgia cesariana não-eletiva (7%. CONCLUSÕES: o Programa Brasileiro de Redução da TV do HIV se revela frágil no que diz respeito à sua organização, administração e avaliação nos serviços de saúde. Para melhor entendimento dessas etapas, nos vários níveis de gestão, um modelo-guia é sugerido.OBJECTIVES: to assess the health care provided to HIV+pregnant women and their children and determine vertical transmission rates in four Brazilian capitals. METHODS: a cohort study was performed in a population of 1475 HIV+pregnant women and their children, who received health care between 1996 and 2003, in 17 public maternities. Data were collected retrospectively from clinical records and 274 women were interviewed (prospective phase based on a structured questionnaire. RESULTS: regarding quality of health care, it was verified in the retrospective and prospective phases of the study, respectively, that 24% and 27% of women did not even receive oral AZT; 19% and 10% did not receive intravenous AZT

  4. Prevalence of sexually transmitted infections among pregnant women with known HIV status in northern Tanzania

    Directory of Open Access Journals (Sweden)

    Mbizvo Elizabeth M

    2009-02-01

    Full Text Available Abstract Objectives To determine the prevalence of sexually transmitted infections (STIs and other reproductive tract infections (RTIs among pregnant women in Moshi, Tanzania and to compare the occurrence of STIs/RTIs among human immunodeficiency virus (HIV-infected and uninfected women. Methods Pregnant women in their 3rd trimester (N = 2654 were recruited from two primary health care clinics between June 2002 and March 2004. They were interviewed, examined and genital and blood samples were collected for diagnosis of STIs/RTIs and HIV. Results The prevalence of HIV, active syphilis and herpes simplex virus – type 2 (HSV-2 were 6.9%, 0.9% and 33.6%, respectively, while 0.5% were positive for N gonorrhoeae, 5.0% for T vaginalis and 20.9% for bacterial vaginosis. Genital tract infections were more prevalent in HIV-seropositive than seronegative women, statistically significant for syphilis (3.3% vs 0.7%, HSV-2 (43.2% vs 32.0%, genital ulcers (4.4% vs 1.4% and bacterial vaginosis (37.2% vs 19.6%. In comparison with published data, a declining trend for curable STIs/RTIs (syphilis, trichomoniasis and bacterial vaginosis was noted. Conclusion Rates of STIs and RTIs are still high among pregnant women in Moshi. Where resources allow, routine screening and treatment of STIs/RTIs in the antenatal care setting should be offered. Higher STIs/RTIs in HIV-seropositive women supports the expansion of HIV-counseling and testing services to all centers offering antenatal care. After identification, STIs/RTIs need to be aggressively addressed in HIV-seropositive women, both at antenatal and antiretroviral therapy care clinics.

  5. Domestic violence against pregnant women in iran.

    Directory of Open Access Journals (Sweden)

    Mansoureh Jamshidimanesh

    2013-03-01

    Full Text Available To determine the relationship between preterm birth and domestic violence against pregnant women in Iran.This cross-sectional study was carried out on 600 women who were hospitalized for giving birth in one of hospitals affiliated to Tehran Medical Science University in Iran, between September 9, 2010 and December 30, 2010. This study was approved by the Research Ethics Committee affiliated with Tehran University, Iran. We applied Abuse Assessment Screen (AAS Questionnaire.A total of 338 participants (56.3% declared to experience domestic violence during pregnancy. Psychological violence was the most common form of violence against these women in postpartum (51.3%, and followed by physical violence (5%. Prevalence rate of premature labor was 37.7% among all women in this study which 63.3% of this rate belongs to abuse women.It is noted that healthcare providers with screening violence during pregnancy and assessing the prevalence, consequences, and possible interventions may help to reduce domestic violence against pregnant women.

  6. Experiences with HIV testing, entry, and engagement in care by HIV-infected women of color, and the need for autonomy, competency, and relatedness.

    Science.gov (United States)

    Quinlivan, E Byrd; Messer, Lynne C; Adimora, Adaora A; Roytburd, Katya; Bowditch, Natasha; Parnell, Heather; Seay, Julia; Bell, Lynda; Pierce, Jonah K

    2013-07-01

    Self-determination theory examines the needs of people adopting new behaviors but has not been applied to the adoption of HIV healthcare behaviors. The current study applied self-determination theory to descriptions of healthcare behaviors adopted by ethnic minority women after an HIV diagnosis. Women of color were asked to describe their experiences with HIV testing, entry, and engagement-in-care in qualitative interviews and focus groups. Participants were mostly African-American (88%), over 40 years old (70%), had been diagnosed for more than 6 years (87%) and had disclosed their HIV infection to more than 3 people (73%). Women described unmet self-determination needs at different time points along the HIV Continuum of Care. Women experienced a significant loss of autonomy at the time of HIV diagnosis. Meeting competency and relatedness needs assisted women in entry and engagement-in-care. However, re-establishing autonomy was a key element for long-term engagement-in-care. Interventions that satisfy these needs at the optimal time point in care could improve diagnosis, entry-to-care, and retention-in-care for women living with HIV.

  7. [Low back pain in pregnant women].

    Science.gov (United States)

    Majchrzycki, Marian; Mrozikiewicz, Przemysław M; Kocur, Piotr; Bartkowiak-Wieczorek, Joanna; Hoffmann, Marcin; Stryła, Wanda; Seremak-Mrozikiewicz, Agnieszka; Grześkowiak, Edmund

    2010-11-01

    Pain of lumbosacral segment of the vertebral column and the pelvis concerns about 45% of all pregnant women. The change of the body posture during pregnancy is the result of gravity centre relocation, which affects the musculosceletal system. Development of the joint, ligament and myofascial dysfunctions, as well as the pain in the lumbosacral segment and the pelvis, are the most common reasons of spine pain. The aim of this review is to present the current state of knowledge about lumbar spine pain in pregnant women with special focus on the pain connected with muscular, joint and ligament disorders. Pregnancy is a serious burden for the female osteo-skeletal system. Lumbar pain with different location and intensification is the negative consequence of the position changes during pregnancy. Pharmacotherapy could be useful only in cases of intensive low back pain, with possible application of small spectrum of drugs that are safe during pregnancy. Physical therapy including manual therapy exercises, massage and techniques of local anesthesia are alternative methods in case of low back pain in pregnant women.

  8. A randomized trial of Raltegravir replacement for protease inhibitor or non-nucleoside reverse transcriptase inhibitor in HIV-infected women with lipohypertrophy.

    Science.gov (United States)

    Lake, Jordan E; McComsey, Grace A; Hulgan, Todd M; Wanke, Christine A; Mangili, Alexandra; Walmsley, Sharon L; Boger, M Sean; Turner, Ralph R; McCreath, Heather E; Currier, Judith S

    2012-09-01

    Lipohypertrophy in HIV-infected patients is associated with metabolic abnormalities. Raltegravir (RAL) is not known to induce fat changes or severe metabolic perturbations. HIV-infected women with central adiposity and HIV-1 RNA less than 50 copies per milliliter on non-nucleoside reverse transcriptase inhibitor (NNRTI)- or protease inhibitor (PI)-based antiretroviral therapy (ART) continued their nucleoside reverse transcriptase inhibitor (NRTI) backbone and were randomized to switch to open label RAL immediately or after 24 weeks. The primary end point was 24-week between-group change in computed tomography (CT)-quantified visceral adipose tissue (AT) volume. Fasting lipids, glucose, C-reactive protein (CRP), anthropometric measurements, and patient-reported quality of life assessments were also measured. Thirty-six subjects provided 80% power to detect a 10% between-group difference in visceral AT over 24 weeks. Thirty-seven of 39 enrolled subjects completed week 24. At entry, subjects were 75% black or Hispanic, and on 62% PI-based and 38% NNRTI-based regimens. The median age was 43 years, CD4 count 558 cells per microliter, and body mass index (BMI) 32 kg/m(2). After 24 weeks, no statistically significant changes in visceral or subcutaneous AT, anthropometrics, BMI, glucose, or CRP were observed. In subjects receiving RAL, significant improvements in total and LDL cholesterol (p=0.04), self-reported belly size (p=0.02) and composite body size (p=0.02) were observed. Body size changes correlated well with percent visceral AT change. No RAL-related adverse events occurred. Compared to continued PI or NNRTI, switch to RAL was associated with statistically significant 24-week improvements in total and LDL cholesterol but not AT volumes. Additional insights into AT and metabolic changes in women on RAL will be provided by 48-week follow-up of the immediate-switch arm.

  9. Cervical human papillomavirus infection among young women engaged in sex work in Phnom Penh, Cambodia: prevalence, genotypes, risk factors and association with HIV infection

    Science.gov (United States)

    2012-01-01

    Background Although cervical cancer is the leading cancer in Cambodia, most women receive no routine screening for cervical cancer and few treatment options exist. Moreover, nothing is known regarding the prevalence of cervical HPV or the genotypes present among women in the country. Young sexually active women, especially those with multiple sex partners are at highest risk of HPV infection. We examine the prevalence and genotypes of cervical HPV, as well as the associated risk factors among young women engaged in sex work in Phnom Penh, Cambodia. Methods We conducted a cross-sectional study among 220 young women (15–29 years) engaged in sex work in different venues including brothels or entertainment establishments, and on a freelance basis in streets, parks and private apartments. Cervical specimens were collected using standard cytobrush technique. HPV DNA was tested for by polymerase chain reaction (PCR) and genotyping using type-specific probes for 29 individual HPV types, as well as for a mixture of 10 less common HPV types. All participants were also screened for HIV status using blood samples. Multivariate logistic regression analyses were conducted to assess risk factors for any or multiple HPV infection. Results The prevalence of cervical HPV 41.1%. HPV 51 and 70 were the most common (5.0%), followed by 16 (4.6%), 71 (4.1%) and 81 (3.7%). Thirty-six women (16.4%) were infected with multiple genotypes and 23.3% were infected with at least one oncogenic HPV type. In multivariate analyses, having HIV infection and a higher number of sexual partners were associated with cervical HPV infection. Risk factors for infection with multiple genotypes included working as freelance female sex workers (FSW) or in brothels, recent binge use of drugs, high number of sexual partners, and HIV infection. Conclusions This is the first Cambodian study on cervical HPV prevalence and genotypes. We found that HPV infection was common among young FSW, especially among women

  10. Cervical human papillomavirus infection among young women engaged in sex work in Phnom Penh, Cambodia: prevalence, genotypes, risk factors and association with HIV infection

    Directory of Open Access Journals (Sweden)

    Couture Marie-Claude

    2012-07-01

    Full Text Available Abstract Background Although cervical cancer is the leading cancer in Cambodia, most women receive no routine screening for cervical cancer and few treatment options exist. Moreover, nothing is known regarding the prevalence of cervical HPV or the genotypes present among women in the country. Young sexually active women, especially those with multiple sex partners are at highest risk of HPV infection. We examine the prevalence and genotypes of cervical HPV, as well as the associated risk factors among young women engaged in sex work in Phnom Penh, Cambodia. Methods We conducted a cross-sectional study among 220 young women (15–29 years engaged in sex work in different venues including brothels or entertainment establishments, and on a freelance basis in streets, parks and private apartments. Cervical specimens were collected using standard cytobrush technique. HPV DNA was tested for by polymerase chain reaction (PCR and genotyping using type-specific probes for 29 individual HPV types, as well as for a mixture of 10 less common HPV types. All participants were also screened for HIV status using blood samples. Multivariate logistic regression analyses were conducted to assess risk factors for any or multiple HPV infection. Results The prevalence of cervical HPV 41.1%. HPV 51 and 70 were the most common (5.0%, followed by 16 (4.6%, 71 (4.1% and 81 (3.7%. Thirty-six women (16.4% were infected with multiple genotypes and 23.3% were infected with at least one oncogenic HPV type. In multivariate analyses, having HIV infection and a higher number of sexual partners were associated with cervical HPV infection. Risk factors for infection with multiple genotypes included working as freelance female sex workers (FSW or in brothels, recent binge use of drugs, high number of sexual partners, and HIV infection. Conclusions This is the first Cambodian study on cervical HPV prevalence and genotypes. We found that HPV infection was common among young FSW

  11. Telephone Smoking Cessation Quitline Use Among Pregnant and Non-pregnant Women

    OpenAIRE

    Bombard, Jennifer M.; Farr, Sherry L.; Dietz, Patricia M.; Tong, Van T.; Zhang, Lei; Rabius, Vance

    2013-01-01

    To describe characteristics, referrals, service utilization, and self-reported quit rates among pregnant and non-pregnant women enrolled in a smoking cessation quitline. This information can be used to improve strategies to increase pregnant and non-pregnant smokers’ use of quitlines. We examined tobacco use characteristics, referral sources, and use of services among 1,718 pregnant and 24,321 non-pregnant women aged 18–44 years enrolled in quitline services in 10 states during 2006–2008. We ...

  12. Comparison of Sexual Functions in Pregnant and Non-Pregnant Women.

    Science.gov (United States)

    Aydin, Mustafa; Cayonu, Neval; Kadihasanoglu, Mustafa; Irkilata, Lokman; Atilla, Mustafa Kemal; Kendirci, Muammer

    2015-11-14

    The physiology and anatomy of pregnant women change during pregnancy. Pregnancy is an anatomically and physiologically amended process experienced by women and as a result of these changes, sexual life of pregnant women alters during pregnancy. We aimed to compare sexual functions of pregnant and non-pregnant women. Sexually active 246 pregnant women were included into this cross-sectional controlled study. A total of 210 non-pregnant women were served as control. Both groups were compared in terms of age, gestational age, presence of urinary incontinence, body mass index, and obstetrical history. Sexual functions of the women were evaluated with Female Sexual Function Index (FSFI). Data were analyzed using chi-square, Mann-Whitney U, Fisher's Exact, Shapiro Wilk, Kruskal Wallis and Dunnett's tests where appropriate. The Pvalues < .05 were considered statistically significant. Mean age in both groups were comparable (P = .053). Median total FSFI scores in the pregnant women were significantly lower than those non-pregnant (18.9 vs. 22.7; P < .05). Additionally, the subgroup analyses of the FSFI scores were found that, total FSFI score is significantly lower in the pregnant group compared to non-pregnant group (P < .05). Furthermore, rate of sexual dysfunction in pregnant women was significantly higher than those non-pregnant women (91.08% vs. 67.61%, P = .0001). However, in pregnant women, no meaningful difference in rate of sexual dysfunction was found according to the trimesters (P = .632). Moreover, gravidity and parity exhibited negative impacts on the sexual functions. But number of abortions did not affect sexual function. These data demonstrate that pregnancy significantly diminishes sexual function in women. We believe that, couples need to be counseled regarding the impact of pregnancy on sexual functions.

  13. nutritional status in pregnant women attending kiru general hospital ...

    African Journals Online (AJOL)

    DR. AMINU

    2012-12-02

    Dec 2, 2012 ... Blood Glucose (FBS) and Total Cholesterol (TC) in pregnant women (PW) in the three trimesters and in non-pregnant .... carbohydrates, lipids and amino acids metabolism, .... Total Cholesterol Determination. Journal of.

  14. Comparison between Olfactory Function of Pregnant Women and ...

    African Journals Online (AJOL)

    2017-05-22

    May 22, 2017 ... study was carried out to investigate and compare olfactory function of pregnant women with non-pregnant ..... Prevalence and assessment of qualitative olfactory dysfunction in different ... A qualitative and quantitative review.

  15. What Do People Actually Learn from Public Health Campaigns? Incorrect Inferences About Male Circumcision and Female HIV Infection Risk Among Men and Women in Malawi.

    Science.gov (United States)

    Maughan-Brown, Brendan; Godlonton, Susan; Thornton, Rebecca; Venkataramani, Atheendar S

    2015-07-01

    Qualitative studies and polling data from sub-Saharan Africa indicate that many individuals may mistakenly believe that male circumcision directly protects women from contracting HIV. This study examines whether individuals who learn that male circumcision reduces female-to-male HIV transmission also erroneously infer a reduction in direct male-to-female transmission risk (i.e. from an HIV-positive man to an uninfected woman). We used data on Malawian men (n = 917) randomized to receive information about voluntary medical male circumcision (VMMC) and HIV risk in 2008 and a random sample of their wives (n = 418). We found that 72 % of men and 82 % of women who believed that male circumcision reduces HIV risk for men also believed that it reduces HIV risk for women. Regression analyses indicated that men randomly assigned to receive information about the protective benefits of circumcision were more likely to adopt the erroneous beliefs, and that the underlying mechanism was the formation of the belief that male circumcision reduces HIV risk for men. The results suggest the need for VMMC campaigns to make explicit that male circumcision does not directly protect women from HIV-infection.

  16. Pregnancy planning and acceptance among Danish pregnant women

    DEFF Research Database (Denmark)

    Rasch, V; Knudsen, L B; Wielandt, H

    2001-01-01

    OBJECTIVE: To study how living conditions influence pregnancy planning and acceptance among Danish women. METHOD: A cross-sectional questionnaire study performed among 3516 pregnant women attending Odense University Hospital, Denmark. The study population consisted of women with spontaneous abort...

  17. Determinants of prevalent HIV infection and late HIV diagnosis among young women with two or more sexual partners in Beira, Mozambique.

    Directory of Open Access Journals (Sweden)

    Arlinda Zango

    Full Text Available BACKGROUND: The prevalence and determinants of HIV and late diagnosis of HIV in young women in Beira, Mozambique, were estimated in preparation for HIV prevention trials. METHODS: An HIV prevalence survey was conducted between December 2009 and October 2012 among 1,018 women aged 18-35 with two or more sexual partners in the last month. Participants were recruited in places thought by recruitment officers to be frequented by women at higher-risk, such as kiosks, markets, night schools, and bars. Women attended the research center and underwent a face-to-face interview, HIV counseling and testing, pregnancy testing, and blood sample collection. RESULTS: HIV prevalence was 32.6% (95% confidence interval (CI 29.7%-35.5%. Factors associated with being HIV infected in the multivariable analysis were older age (p<0.001, lower educational level (p<0.001, self-reported genital symptoms in the last 3 months (adjusted odds ratio (aOR = 1.4; CI 1.1-2.0, more than one lifetime HIV test (aOR = 0.4; CI 0.3-0.6, and not knowing whether the primary partner has ever been tested for HIV (aOR = 1.7; CI 1.1-2.5. About a third (32.3% of participants who tested HIV-positive had a CD4 lymphocyte count of <350 cells/µl at diagnosis. Factors associated with late diagnosis in multivariable analyses were: not knowing whether the primary partner has ever been tested for HIV (aOR = 2.2; CI 1.1-4.2 and having had a gynecological pathology in the last year (aOR = 3.7; CI 1.2-12.0. CONCLUSIONS: HIV prevalence and late diagnosis of HIV infection were high in our study population of young women with sexual risk behavior in Beira, Mozambique. HIV prevention programs should be strengthened, health care providers should be sensitized, and regular HIV testing should be encouraged to enroll people living with HIV into care and treatment programs sooner.

  18. Acceptability and Accuracy of Cervical Cancer Screening Using a Self-Collected Tampon for HPV Messenger-RNA Testing among HIV-Infected Women in South Africa.

    Directory of Open Access Journals (Sweden)

    Paul C Adamson

    Full Text Available HIV increases women's risk for high-risk human papillomavirus (hrHPV infection and invasive cervical cancer. South Africa has a high HIV prevalence but low cervical cancer screening coverage. Self-collection of cervical specimens and hrHPV testing, including hrHPV messenger-RNA (mRNA testing, are methods aimed at increasing screening rates. However, data are limited on the acceptability and accuracy of tampon-based self-collection for hrHPV mRNA testing in HIV-infected women.We recruited 325 HIV-infected women seeking care at a government HIV clinic in Pretoria, South Africa. A clinician performed a pelvic examination and obtained an endocervical specimen. Study participants performed self-collection using a tampon. Both clinician- and self-collected specimens were tested for hrHPV mRNA. Acceptability of both collection methods was assessed, the prevalence of hrHPV mRNA in our study population was estimated, test positivity of the two collection methods were compared, and test agreement was assessed by calculating the κ-statistic, sensitivity, and specificity.Over 90% of women reported no difficulties self-collecting specimens and 82% were willing to perform the tampon-collection at home. Based on clinician-collection specimens, the prevalence of hrHPV mRNA in our study population was 36.7% (95% CI: 31.4%- 42.0%. There was no difference in test positivity between clinician-collection, 36.7%, and tampon-collection, 43.5% (p-value = 0.08. Using clinician-collection as the reference test, the sensitivity and specificity for hrHPV mRNA of tampon-collection were 77.4% (95% CI: 69.8-85.0% and 77.8% (95% CI: 71.9-83.6%, respectively.Tampon-based self-collection is acceptable to women and has similar hrHPV mRNA positivity rates as clinician-collection, but has reduced sensitivity and specificity compared to clinician-collection. The hrHPV mRNA prevalence in our study population is high, but similar to other high-risk populations, and highlights the

  19. A bio-behavioral intervention to decrease intravaginal practices and bacterial vaginosis among HIV infected Zambian women, a randomized pilot study.

    Science.gov (United States)

    Alcaide, Maria L; Chisembele, Maureen; Malupande, Emeria; Rodriguez, Violeta J; Fischl, Margaret A; Arheart, Kristopher; Jones, Deborah L

    2017-05-12

    Intravaginal practices (IVP) (cleansing or introducing products inside the vagina for hygiene, health or to please sexual partners) are common among women with HIV. IVP increase the risk of developing bacterial Vaginosis (BV), the most common genital infection associated with transmission of sexually transmitted infections and HIV. This study tested a pilot intervention to reduce IVP and BV in HIV infected women in Zambia. One hundred twenty-eight HIV infected women engaging in IVP were randomized to two conditions: enhanced standard of care (n = 70) and experimental (n = 58) from May 1, 2013 to February 28, 2014. All participants received a brief educational counseling session on discontinuation of IVP, and those with BV, were provided with medical treatment for BV. Women in the experimental condition received an additional group-based, culturally tailored intervention. Participants completed questionnaires assessing sexual risk factors and IVP and were assessed for BV using Nugent criteria at baseline, 6 months and 12 months. At 12-month, the proportion of self-reported use of IVPs decreased in the experimental condition: soap (28% vs. 47%); cloth or a rag (19% vs. 38%); and traditional medicines (22% vs. 42%) (all p < 0.05)) compared with the enhanced standard of care condition. The prevalence of BV at 6 and 12 months did not differ by study condition but averaging over study condition, prevalence of BV decreased from 64.2% at baseline to 15.6% at 6 months (p < 0.01) and to 23.6% at 12 months (p = 0.15). Using an enhanced standard of care approach and an enhanced standard of care + a group intervention, IVP and BV decreased over time, but the experimental condition had greater reduction in self-reported use of IVP. Future studies should address interventions in communities with high burden of IVP, BV and HIV. Interventions that could be administered during routine medical care and decrease IVP and BV are needed, and should be considered part of

  20. [Vaginal colonization by genital mycoplasmas in pregnant and non-pregnant women].

    Science.gov (United States)

    Castellano-González, Maribel; Ginestre-Pérez, Messaria; Perozo-Mena, Armindo; Alaña, Freddy; Fernández-Bravo, Marisol; Rincón-Villalobos, Gresleida

    2007-12-01

    To compare vaginal colonization by genital micoplasmas in pregnant and non pregnant women and to determine the association between pregnancy and colonization by these microorganisms, samples of exocervix an endocervix from pregnant (n = 80) and non pregnant (n = 65) women, from two health centers of Maracaibo, Zulia State, Venezuela were processed. The Mycoplasma-Lyo kit (bioMérieux laboratories) was used for the culture and identification of genital micoplasmas. In pregnant women, prevalences of 10% for M. hominis and 26.25% for Ureaplasma spp. were found; 35.38% for M. hominis and 20% for Ureaplasma spp. in non-pregnant, were obtained. Among the pregnant, Ureaplasma spp. was the most frequently isolated micoplasma, in symptomatic and asymptomatic; while in the non pregnant group, M. hominis was more common among the symptomatic patients; only one case (1.54%) was an asymptomatic carrier of Ureaplasma spp. The highest positivity percentages were obtained in primigravidas (48.71%) and during the second gestational trimester (34.21%). No statistically significant differences were found between vaginal colonization by genital micoplasmas according to age, number of pregnancy and gestational trimester; but they were found between the presented symptomatology and vaginal colonization by genital micoplasmas. Genital micoplasmas were isolated from gravid women at approximately the same recovery rate as in non-pregnant women; being M. hominis the most frequently isolated in non-pregnant women and Ureaplasma spp. in the pregnant group.

  1. Recurrence of cervical intraepithelial neoplasia grades 2 or 3 in HIV-infected women treated by large loop excision of the transformation zone (LLETZ

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    Fábio Russomano

    Full Text Available CONTEXT AND OBJECTIVE: Women infected by HIV are more likely to have cervical cancer and its precursors. Treatment of the precursor lesions can prevent this neoplasia. The aim of this study was to assess the likelihood of recurrent cervical intraepithelial neoplasia grades 2 or 3 (CIN 2-3 in HIV-infected women, compared with HIV-negative women, all treated by large loop excision of the transformation zone (LLETZ. DESIGN AND SETTING: A cohort study in Instituto Fernandes Figueira, Fundação Oswaldo Cruz (IFF-Fiocruz, Rio de Janeiro. METHOD: 55 HIV-positive and 212 HIV-negative women were followed up after LLETZ for CIN 2-3 (range: 6-133 months. RESULTS: The incidence of recurrent CIN 2-3 was 30.06/10,000 woman-months in the HIV-positive group and 4.88/10,000 woman-months in the HIV-negative group (relative risk, RR = 6.16; 95% confidence interval, CI: 2.07-18.34. The likelihood of recurrence reached 26% at the 62nd month of follow-up among the HIV-positive women, and remained stable at almost 0.6% at the 93rd month of follow-up among the HIV-negative women. We were unable to demonstrate other prognostic factors relating to CIN recurrence, but the use of highly active antiretroviral therapy (HAART may decrease the risk of this occurrence among HIV patients. CONCLUSION: After LLETZ there is a higher risk of recurrence of CIN 2-3 among HIV-positive women than among HIV-negative women. This higher risk was not influenced by margin status or grade of cervical disease treated. The use of HAART may decrease the risk of this occurrence in HIV patients.

  2. Physical activity of pregnant Hispanic women.

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    Lynch, Kristine E; Landsbaugh, Jill R; Whitcomb, Brian W; Pekow, Penny; Markenson, Glenn; Chasan-Taber, Lisa

    2012-10-01

    A growing body of evidence suggests that physical activity during pregnancy can reduce risk of pregnancy complications. However, factors influencing activity in pregnant Hispanic women, who have high rates of sedentary activity as compared to non-Hispanic whites, are not well characterized. To assess patterns and correlates of physical activity among 1355 participants in Proyecto Buena Salud, a prospective cohort of pregnant Hispanic women in Massachusetts from 2006 to 2011. Analyses were conducted in 2012. Pre-, early-, mid-, and late-pregnancy physical activity were assessed using the Pregnancy Physical Activity Questionnaire. Women reported the frequency and duration of household/caregiving, occupational, sports/exercise, and transportation activities and were classified according to compliance with American College of Obstetricians and Gynecologists guidelines for physical activity. Household/caregiving activity was the primary mode of pregnancy activity ranging from 56% to 60% of total activity while sports/exercise contributed the least (<10%). Compared to nulliparous women, women with two or more children were 85% less likely to become inactive at any time during pregnancy (OR=0.15, 95% CI=0.04, 0.56, p-trend <0.01). Women with one or more children increased their total physical activity on average 9.73±2.04 MET-hours/week and 12.04±2.39 MET-hours/week, respectively, with the onset of pregnancy (p<0.01). Those with the highest levels of total physical activity prior to pregnancy were 87% less likely to become inactive with the onset of pregnancy than those who were inactive prior to pregnancy (OR=0.13, 95% CI= 0.05, 0.29). Findings can inform culturally appropriate interventions designed to reduce pregnancy complications through the promotion of physical activity during pregnancy. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  3. Prevalence of HIV among rural pregnant women attending antenatal clinics at Pravara Rural Hospital, Loni, Maharashtra, India

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    Purushottam A Giri

    2012-01-01

    Full Text Available Background: Many antenatal clinics (ANC-based HIV surveillance systems in India have limited coverage of remote rural sites, a weakness that compromises adequate estimation, monitoring, and development of effective preventive and care programs. To address this void in rural area of western Maharashtra, we conducted antenatal clinic-based sentinel surveillance to know the prevalence of HIV infection among rural pregnant women. Materials and Methods: A cross-sectional study was carried out at ANC clinic, Dept. of Obstetrics and Gynaecology of Pravara Rural Hospital, Loni, Maharashtra. A total of 12,171 pregnant women from rural area accepted HIV testing after counseling who attending ANC clinic in Pravara Rural Hospital, Loni, during January 2008 to December 2011 were included in the study. Data were entered in Microsoft excel and percentage and proportion was calculated. Results: In the present study, out of 12171 pregnant women from the rural area accepted HIV testing after counseling who attending ANC clinic, only 50 (0.41% were HIV positive and remaining 12, 221 (99.59% were HIV negative. The study showed that the prevalence of HIV among pregnant women was 0.41%. Out of the 50 HIV positive pregnant women studied majority, 32 (64.0%, were primigravidas and 18 (36.0% were multigravidas. Conclusion: In our study all 12171 pregnant women from the rural area accepted HIV testing after counseling and prevalence of HIV was found to be 0.41%. The need of the hour is to provide universal access to these services by involving the NGO′s and the private sector.

  4. HIV/AIDS and Associated Conditions among HIV-Infected Refugees in Minnesota, 2000–2007

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    Lowther, Sara A.; Johnson, Glenise; Hendel-Paterson, Brett; Nelson, Kailey; Mamo, Blain; Krohn, Kristina; Pessoa-Brandão, Luisa; O’Fallon, Ann; Stauffer, William

    2012-01-01

    In 2010, the requirement for human immunodeficiency virus (HIV) testing of adult refugees prior to US resettlement was removed, thus leading to a potential for missed diagnosis. We reviewed refugee health assessment data and medical charts to evaluate the health status of HIV-infected refugees who arrived in Minnesota during 2000–2007, prior to this 2010 policy change. Among 19,292 resettled adults, 174 were HIV-infected; 169 (97%) were African (median age 26.4 (range: 17–76) years). Charts were abstracted for 157 (124 (79%) with ≥1 year of follow-up). At initial presentation, two of 74 (3%) women were pregnant; 27% became pregnant during follow-up. HIV clinical stage varied (59%, asymptomatic; 11%, mild symptoms; 10%, advanced symptoms; 3%, severe symptoms; 17%, unknown); coinfections were common (51 tuberculosis, 13 hepatitis B, 13 parasites, four syphilis). Prior to arrival 4% had received antiretrovirals. Opportunistic infections were diagnosed among 13%; 2% died from AIDS-related causes. Arrival screening may be needed to identify these HIV-infected refugees and prevent HIV-related morbidity and mortality. PMID:23202841

  5. HIV/AIDS and Associated Conditions among HIV-Infected Refugees in Minnesota, 2000–2007

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    Kristina Krohn

    2012-11-01

    Full Text Available In 2010, the requirement for human immunodeficiency virus (HIV testing of adult refugees prior to US resettlement was removed, thus leading to a potential for missed diagnosis. We reviewed refugee health assessment data and medical charts to evaluate the health status of HIV-infected refugees who arrived in Minnesota during 2000–2007, prior to this 2010 policy change. Among 19,292 resettled adults, 174 were HIV-infected; 169 (97% were African (median age 26.4 (range: 17–76 years. Charts were abstracted for 157 (124 (79% with ≥1 year of follow-up. At initial presentation, two of 74 (3% women were pregnant; 27% became pregnant during follow-up. HIV clinical stage varied (59%, asymptomatic; 11%, mild symptoms; 10%, advanced symptoms; 3%, severe symptoms; 17%, unknown; coinfections were common (51 tuberculosis, 13 hepatitis B, 13 parasites, four syphilis. Prior to arrival 4% had received antiretrovirals. Opportunistic infections were diagnosed among 13%; 2% died from AIDS-related causes. Arrival screening may be needed to identify these HIV-infected refugees and prevent HIV-related morbidity and mortality.

  6. HIV/AIDS and associated conditions among HIV-infected refugees in Minnesota, 2000–2007.

    Science.gov (United States)

    Lowther, Sara A; Johnson, Glenise; Hendel-Paterson, Brett; Nelson, Kailey; Mamo, Blain; Krohn, Kristina; Pessoa-Brandão, Luisa; O'Fallon, Ann; Stauffer, William

    2012-11-16

    In 2010, the requirement for human immunodeficiency virus (HIV) testing of adult refugees prior to US resettlement was removed, thus leading to a potential for missed diagnosis. We reviewed refugee health assessment data and medical charts to evaluate the health status of HIV-infected refugees who arrived in Minnesota during 2000-2007, prior to this 2010 policy change. Among 19,292 resettled adults, 174 were HIV-infected; 169 (97%) were African (median age 26.4 (range: 17-76) years). Charts were abstracted for 157 (124 (79%) with ≥ 1 year of follow-up). At initial presentation, two of 74 (3%) women were pregnant; 27% became pregnant during follow-up. HIV clinical stage varied (59%, asymptomatic; 11%, mild symptoms; 10%, advanced symptoms; 3%, severe symptoms; 17%, unknown); coinfections were common (51 tuberculosis, 13 hepatitis B, 13 parasites, four syphilis). Prior to arrival 4% had received antiretrovirals. Opportunistic infections were diagnosed among 13%; 2% died from AIDS-related causes. Arrival screening may be needed to identify these HIV-infected refugees and prevent HIV-related morbidity and mortality.

  7. Impact of exposure to intimate partner violence on CD4+ and CD8+ T cell decay in HIV infected women: longitudinal study.

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    Rachel Jewkes

    Full Text Available Intimate partner violence (IPV is a risk factor for HIV acquisition in many settings, but little is known about its impact on cellular immunity especially in HIV infected women, and if any impact differs according to the form of IPV. We tested hypotheses that exposure to IPV, non-partner rape, hunger, pregnancy, depression and substance abuse predicted change in CD4+ and CD8+ T-cell count in a dataset of 103 HIV infected young women aged 15-26 enrolled in a cluster randomised controlled trial. Multiple regression models were fitted to measure rate of change in CD4 and CD8 and including terms for age, person years of CD4+/CD8+ T-cell observation, HIV positivity at baseline, and stratum. Exposure variables included drug use, emotional, physical or sexual IPV exposure, non-partner rape, pregnancy and food insecurity. Mean CD4+ T cell count at baseline (or first HIV+ test was 567.6 (range 1121-114. Participants were followed for an average of 1.3 years. The magnitude of change in CD4 T-cells was significantly associated with having ever experienced emotional abuse from a current partner at baseline or first HIV+ test (Coeff -132.9 95% CI -196.4, -69.4 p<0.0001 and drug use (Coeff -129.9 95% CI -238.7, -21.2 p=0.02. It was not associated with other measures. The change in CD8 T-cells was associated with having ever experienced emotional abuse at baseline or prior to the first HIV+ test (Coeff -178.4 95%CI -330.2, -26.5 p=0.02. In young ART-naive HIV positive women gender-based violence exposure in the form of emotional abuse is associated with a faster rate of decline in markers of cellular immunity. This highlights the importance of attending to emotional abuse when studying the physiological impact of IPV experience and the mechanisms of its impact on women's health.

  8. Food safety: correct information for pregnant women

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    Maria Ausilia Grassi

    2013-04-01

    Full Text Available This study was aimed at investigating the knowledge of pregnant women on food safety with particular attention to the effectiveness of the informative material (pamphlet and poster prepared in a previous study. To this scope, a questionnaire composed by 8 questions (Likert scaled was used except for one which was a Y/N question. Themes of the questionnaire were: level of concerns on food safety, and knowledge on foodborne diseases (salomonellosis, toxoplasmosis and listeriosis, risk factors and preventive measures. Results indicate that knowledge increased in respect to that of the previous study, but in relation to informative material previously distributed.

  9. Smoking in Rural and Underserved Pregnant Women.

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    Handley, Marilyn Cooper; Avery, Daniel M

    2015-09-01

    This article reviews the persistent problem of smoking, especially as it relates to the rural and underserved population. The negative effects of smoking and disparities in health that occur as a result are highlighted. The article reviews the general state of smoking in the United States and discusses health-related issues and concerns of individuals who continue to smoke. The report explores individuals' rationale for smoking, barriers to cessation, and general knowledge related to the outcomes of smoking during pregnancy. The conclusions highlight the need for providers to provide information and interventions to reduce the smoking rates of pregnant women.

  10. Factors Associated with HIV Testing History among Pregnant Women and Their Partners in Georgia: The ANRS 12127 Prenahtest Trial

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    Maia Butsashvili

    2014-01-01

    Full Text Available Despite the benefits of timely diagnosis of HIV infection and the wide availability of VCT services, the acceptance of HIV testing and counseling still remains a challenge in Georgia. The goal of our study was to assess the history of HIV testing and associated factors among pregnant women. The recruitment of study participants took place during routine antenatal care visits at one of the large Maternity Hospitals in Tbilisi, capital of Georgia. A total of 491 pregnant women were included in the sample. More than a third of women (38.5% reported that they were tested for HIV before the current pregnancy and almost all of them (91.5% were tested during previous pregnancies. Bivariate analysis revealed statistically significant association of women’s history of HIV testing with age, education level, remunerated activity, history of STI, and multiparity. In multivariate analysis, the only independent predictor of being HIV tested was ever being pregnant. In conclusion, HIV testing history among women at reproductive age was poor in Georgia. Women mostly received HIV testing at prenatal centers. Efforts should be made to promote HIV testing in primary care settings, which would increase its acceptability and overall testing rate in the population.

  11. Pregnancy and infant outcomes among HIV-infected women taking long-term ART with and without tenofovir in the DART trial.

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    Diana M Gibb

    Full Text Available BACKGROUND: Few data have described long-term outcomes for infants born to HIV-infected African women taking antiretroviral therapy (ART in pregnancy. This is particularly true for World Health Organization (WHO-recommended tenofovir-containing first-line regimens, which are increasingly used and known to cause renal and bone toxicities; concerns have been raised about potential toxicity in babies due to in utero tenofovir exposure. METHODS AND FINDINGS: Pregnancy outcome and maternal/infant ART were collected in Ugandan/Zimbabwean HIV-infected women initiating ART during The Development of AntiRetroviral Therapy in Africa (DART trial, which compared routine laboratory monitoring (CD4; toxicity versus clinically driven monitoring. Women were followed 15 January 2003 to 28 September 2009. Infant feeding, clinical status, and biochemistry/haematology results were collected in a separate infant study. Effect of in utero ART exposure on infant growth was analysed using random effects models. 382 pregnancies occurred in 302/1,867 (16% women (4.4/100 woman-years [95% CI 4.0-4.9]. 226/390 (58% outcomes were live-births, 27 (7% stillbirths (≥22 wk, and 137 (35% terminations/miscarriages (0.4. Of 219 surviving infants, 182 (83% enrolled in the follow-up study; median (interquartile range [IQR] age at last visit was 25 (12-38 months. From mothers' ART, 62/9/111 infants had no/20%-89%/≥90% in utero tenofovir exposure; most were also zidovudine/lamivudine exposed. All 172 infants tested were HIV-negative (ten untested. Only 73/182(40% infants were breast-fed for median 94 (IQR 75-212 days. Overall, 14 infants died at median (IQR age 9 (3-23 months, giving 5% 12-month mortality; six of 14 were HIV-uninfected; eight untested infants died of respiratory infection (three, sepsis (two, burns (one, measles (one, unknown (one. During follow-up, no bone fractures were reported to have occurred; 12/368 creatinines and seven out of 305 phosphates were grade one

  12. Contracepção hormonal e anti-retrovirais em mulheres infectadas pelo HIV Hormonal contraception and antiretroviral therapy among HIV-infected women

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    Eliana Amaral

    2006-11-01

    Full Text Available Há controvérsia sobre a relação entre o uso de contraceptivos hormonais e o risco de adquirir o vírus da imunodeficiência humana (HIV, e pouco se sabe sobre os efeitos da contracepção hormonal em mulheres infectadas (efeitos colaterais, distúrbios menstruais, progressão da doença, interações com terapias anti-retrovirais. O objetivo deste artigo foi revisar os dados disponíveis quanto à vulnerabilidade ao HIV e à sua transmissibilidade na vigência do uso de contraceptivos hormonais bem como as conseqüências potenciais do uso desses contraceptivos por mulheres HIV-positivas sob terapia anti-retroviral (TARV, com ênfase nas interações medicamentosas. Concluiu-se que ainda não é possível elaborar recomendações, baseadas em evidências, sobre a contracepção hormonal em mulheres portadoras do HIV sob TARV. Assim, os infectologistas e os ginecologistas devem estar atentos às interações potenciais que possam representar aumento de efeitos adversos, individualizando a orientação sobre os esteróides contraceptivos, suas doses e vias de administração, considerando a TARV em uso.There is much controversy regarding the realtionship between the use of hormonal contraceptives and the risk of acquiring human immunodeficiency virus (HIV, and little is known about the effects of hormonal contraception in HIV-infected women (adverse events, menstrual disorders, disease progression, antiretroviral therapy interactions. The aim of the present study was to review available data regarding HIV vulnerability and transmission associated with hormonal contraceptives and the use of these contraceptives by women on antiretroviral therapy, with emphasis on drug interactions. In conclusion, it was not possible to offer evidence-based recommendations for the use of hormonal contraceptives among HIV-infected women under antiretroviral therapy. Infectious disease specialists and gynecologists providing care should be cautious about potential

  13. Prevalence of human papillomavirus infection in pregnant versus non-pregnant women in Brazil.

    Science.gov (United States)

    Salcedo, Mila M B P; Damin, Andrea P S; Agnes, Grasiela; Pessini, Suzana A; Beitune, Patricia El; Alexandre, Claudio O P; Schmeler, Kathleen M; da Silveira, Gustavo Py Gomes

    2015-12-01

    To investigate the prevalence of human papillomavirus (HPV) in cervical samples of pregnant and non-pregnant women in South-Brazil. A prospective study of 91 pregnant and 92 non-pregnant women with no previous history of cervical dysplasia or cancer was carried out. Cervical samples for HPV testing and cytology were collected in each trimester of pregnancy and in the puerperium for pregnant women and at matched intervals for the non-pregnant women. All samples were analyzed through PCR with consensus primers GP5+/GP6+. Genotyping was performed using specific primers. To control for confounding factors, the analysis of multivariate logistic regression was applied. The measure of odds ratio (OR) and the 95 % confidence interval (95 % CI) were used. The level of statistical significance was set at 5 % (P ≤ 0.05). HPV DNA was detected in 23/91 (25.3 %) cervical samples from the pregnant women and in 12/92 (13 %) cervical samples from non-pregnant women (P = 0.035). There was a significant association among cervical HPV infection and young age, number of lifetime sexual partners, and the presence of abnormal cervical cytology. HPV16 and HPV18 were the viral types more frequently detected. Out of the 23 HPV-positive pregnant women, 17 (73.9 %) had normal cervical cytology. Our results suggest a higher prevalence of HPV infection in pregnant vs. non-pregnant women. This finding may be related to the relative immunosuppression observed in pregnant women, outlining the importance of the appropriate monitoring of the viral infection in this specific population.

  14. Psychological Empowerment Model in Iranian Pregnant Women

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    Taghipour, Ali; Sadat Borghei, Narjes; Latifnejad Roudsari, Robab; Keramat, Afsaneh; Jabbari Nooghabi, Hadi

    2016-01-01

    ABSTRACT Background: Women’s empowerment programs during pregnancy focus primarily on increasing women’s health goals and psychological empowerment has been considered important in most issues related to pregnant mothers’ mental health. Using path analysis, this study aims to examine the direct and indirect components of psychological empowerment of pregnant mothers. Methods: This model-testing study was conducted in Gorgan, northwest of Iran during three months in spring of 2015. Through random cluster sampling, a total number of 160 pregnant women were selected from 10 urban medical centers and clinics as primary centers. We used Spritzer’s Psychological empowerment scale. Suitable sampling based on Nunally and Bernstein was followed in the model. The relationships between the dependent variables were then examined by means of path analysis using Amos 18. Results: The psychological empowerment of pregnant mothers (PEPW) model is impacted by individual factors, such as marriage age and employment, including some subjectively rated factors such as marital satisfaction and experience of violence. The PEPW model was deemed appropriate as optimum conditions indicators of goodness of fit; low index of χ2/df shows little difference between the conceptual model and observed data, while RMSEA value indicated the goodness of fit. Other indicators such as CMIN=0.957, CMIN/DF=0.957, P-CLOSE=0.418, χ2=0.957 and probability level=0.328 the fact that the model is ideal. The mothers’ employment had the highest coefficient in the PEPW path model .731 (0.443, 0.965) bootstrap confidence intervals by 95%, and with a p-value of less than 0.05. Conclusions: The mothers’ employment is the most important factor in psychological empowerment, but it cannot be addressed quickly. Programming to increase marital satisfaction followed by a decrease in family violence and prevention of early marriage are necessary for promotion of psychological empowerment during pregnancy. PMID

  15. Psychological Empowerment Model in Iranian Pregnant Women

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    Ali Taghipour

    2016-10-01

    Full Text Available Background: Women’s empowerment programs during pregnancy focus primarily on increasing women’s health goals and psychological empowerment has been considered important in most issues related to pregnant mothers’ mental health. Using path analysis, this study aims to examine the direct and indirect components of psychological empowerment of pregnant mothers. Methods: This model-testing study was conducted in Gorgan, northwest of Iran during three months in spring of 2015. Through random cluster sampling, a total number of 160 pregnant women were selected from 10 urban medical centers and clinics as primary centers. We used Spritzer’s Psychological empowerment scale. Suitable sampling based on Nunally and Bernstein was followed in the model. The relationships between the dependent variables were then examined by means of path analysis using Amos 18. Results: The psychological empowerment of pregnant mothers (PEPW model is impacted by individual factors, such as marriage age and employment, including some subjectively rated factors such as marital satisfaction and experience of violence. The PEPW model was deemed appropriate as optimum conditions indicators of goodness of fit; low index of χ2/df shows little difference between the conceptual model and observed data, while RMSEA value indicated the goodness of fit. Other indicators such as CMIN=0.957, CMIN/DF=0.957, P-CLOSE=0.418, χ2=0.957 and probability level=0.328 the fact that the model is ideal. The mothers’ employment had the highest coefficient in the PEPW path model .731 (0.443, 0.965 bootstrap confidence intervals by 95%, and with a p-value of less than 0.05. Conclusions: The mothers’ employment is the most important factor in psychological empowerment, but it cannot be addressed quickly. Programming to increase marital satisfaction followed by a decrease in family violence and prevention of early marriage are necessary for promotion of psychological empowerment during

  16. Risk factors for helminth, malaria, and HIV infection in pregnancy in Entebbe, Uganda.

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    Patrick William Woodburn

    2009-06-01

    Full Text Available Infections during pregnancy may have serious consequences for both mother and baby. Assessment of risk factors for infections informs planning of interventions and analysis of the impact of infections on health outcomes.To describe risk factors for helminths, malaria and HIV in pregnant Ugandan women before intervention in a trial of de-worming in pregnancy.The trial recruited 2,507 pregnant women between April 2003 and November 2005. Participants were interviewed and blood and stool samples obtained; location of residence at enrolment was mapped. Demographic, socioeconomic, behavioral and other risk factors were modelled using logistic regression.There was a high prevalence of helminth, malaria and HIV infection, as previously reported. All helminths and malaria parasitemia were more common in younger women, and education was protective against every infection. Place of birth and/or tribe affected all helminths in a pattern consistent with the geographical distribution of helminth infections in Uganda. Four different geohelminths (hookworm, Trichuris, Ascaris and Trichostrongylus showed a downwards trend in prevalence during the enrolment period. There was a negative association between hookworm and HIV, and between hookworm and low CD4 count among HIV-positive women. Locally, high prevalence of schistosomiasis and HIV occurred in lakeshore communities.Interventions for helminths, malaria and HIV need to target young women both in and out of school. Antenatal interventions for malaria and HIV infection must continue to be promoted. Women originating from a high risk area for a helminth infection remain at high risk after migration to a lower-risk area, and vice versa, but overall, geohelminths seem to be becoming less common in this population. High risk populations, such as fishing communities, require directed effort against schistosomiasis and HIV infection.

  17. Veterinary field test as screening tool for mastitis and HIV-1 viral load in breastmilk from HIV-infected Zambian women.

    Science.gov (United States)

    Dorosko, Stephanie M; Thea, Donald M; Saperstein, George; Russell, Robert M; Paape, Max J; Hinckley, Lynn S; Decker, William D; Semrau, Katherine; Sinkala, Moses; Kasonde, Prisca; Kankasa, Chipepo; Aldrovandi, Grace M; Hamer, Davidson H

    2007-09-01

    Clinical and subclinical mastitis increase the risk of mother-to-child transmission (MTCT) of HIV-1 through breastfeeding. We hypothesized that a field test for mastitis used for bovine milk, the California Mastitis Test, would detect high cell counts in milk of HIV-infected women. We also investigated whether total milk cell count would positively correlate with viral HIV-1 RNA in the milk of 128 HIV-positive Zambian women. Mean cell counts in each California Mastitis Test scoring category were significantly different (p CMT may serve as a screening tool for mastitis in breastmilk, but total cell count does not correlate with HIV-1 RNA levels. Since both cell-free and cell-associated virus are associated with increased risk of MTCT, investigation of the relationship between total milk cell count and HIV-1 proviral DNA is warranted before a conclusive determination is made regarding use of the CMT as a clinical screening tool to detect cases at high risk for breastmilk transmission.

  18. Morbidade puerperal em portadoras e não-portadoras do vírus da imunodeficiência humana Puerperal morbidity in HIV-infected and non-infected women

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    Frederico José Amédeé Péret

    2007-05-01

    Full Text Available OBJETIVO: comparar a morbidade de puérperas portadoras e não-portadoras do vírus da imunodeficiência humana (HIV. MÉTODOS: estudo prospectivo, controlado, realizado entre julho de 2001 e setembro de 2003, com inclusão na ocasião do parto de pacientes portadoras e não-portadoras do HIV. A morbidade foi dividida em menor (sangramento pós-parto aumentado, febre e endometrite e maior (hemotransfusão, alterações profundas da ferida operatória e necessidade de intervenção cirúrgica, e foi avaliada quanto à presença ou não de infecção pelo HIV e o tipo de parto. Foram avaliadas 205 puérperas: 82 portadoras do HIV (grupo HIV-casos e 123 não-portadoras. As variáveis contínuas foram analisadas pelo teste t de Student, e as categóricas pelos testes do chi2 e exato de Fisher, por meio do software Epi-Info 2000 (CDC, Atlanta. RESULTADOS: ocorreu morbidade puerperal em 18 pacientes do grupo HIV-casos (22% e 17 do grupo-controle (14%, com predomínio das variáveis de morbidade menor, sem diferença significativa entre os grupos, exceto pelo risco mais alto de endometrite no grupo HIV-casos (RR=1,05; IC a 95%:1,01-1,1. Não foi observada diferença significativa entre os grupos quanto aos tipos de parto. Houve somente duas ocorrências de morbidade maior: hemotransfusão e fasciite necrotizante. CONCLUSÕES: puérperas portadoras do HIV apresentam morbidade semelhante à das puérperas não-portadoras do vírus, apesar da predominância de morbidade menor e do risco aumentado de endometrite no grupo portador do vírus. O acompanhamento clínico no puerpério imediato é estratégico para a identificação precoce da morbidade materna.PURPOSE: to evaluate puerperal morbidity in HIV-infected and HIV non-infected puerperal women. METHODS: longitudinal and controlled study performed from July 2001 to September 2003, in 205 pregnant women admitted for birth delivery at Odete Valadares Maternity, divided in two groups: HIV-infected women

  19. Food insecurity, but not HIV-infection status, is associated with adverse changes in body composition during lactation in Ugandan women of mixed HIV status.

    Science.gov (United States)

    Widen, Elizabeth M; Collins, Shalean M; Khan, Hijab; Biribawa, Claire; Acidri, Daniel; Achoko, Winifred; Achola, Harriet; Ghosh, Shibani; Griffiths, Jeffrey K; Young, Sera L

    2017-02-01

    Body composition is an important indicator of nutritional status and health. How body composition changes during 12 mo of breastfeeding in HIV-infected women receiving antiretroviral therapy (ART) is unknown. We assessed whether HIV or food insecurity was associated with adverse postpartum body-composition changes in Ugandan women. A cohort of 246 women [36.5% of whom were HIV positive (HIV+) and were receiving ART] were followed to 12 mo postpartum. Repeated measures included weight, fat mass, fat-free mass, midupper arm circumference, triceps skinfold thickness [which allowed for the derivation of arm muscle area (AMA) and arm fat area (AFA)], breastfeeding, and individual food insecurity. Longitudinal regression models were constructed to assess associations between HIV and food insecurity and changes in body composition over time. At baseline, HIV+ women compared with HIV-negative women had a higher mean ± SD food-insecurity score (11.3 ± 5.5 compared with 8.6 ± 5.5, respectively; P composition outcomes, HIV was not associated with body composition (all P > 0.05), whereas food insecurity was inversely associated with body weight and BMI at 6, 9, and 12 mo and with AFA at 6 and 12 mo (all P food-insecurity score was associated with a 0.13-kg lower body weight (P composition changes are minimal during lactation. HIV is not associated with body composition; however, food insecurity is associated with changes in body composition during lactation. This trial was registered at clinicaltrials.gov as NCT02922829 and NCT02925429. © 2017 American Society for Nutrition.

  20. Impact of Extended Combination Antiretroviral Therapy on the Decline of HIV Prevalence in Pregnant Women in Malawi.

    Science.gov (United States)

    Liotta, Giuseppe; Chimbwandira, Frank; Wouters, Kristien; Nielsen-Saines, Karin; Jere, Haswell; Mancinelli, Sandro; Ceffa, Susanna; Erba, Fulvio; Palombi, Leonardo; Marazzi, Maria Cristina

    2016-01-01

    Combination antiretroviral therapy has been shown to reduce HIV transmission and incident infections. In recent years, Malawi has significantly increased the number of individuals on combination antiretroviral drugs through more inclusive treatment policies. Using a retrospective observational cohort design, records with HIV test results were reviewed for pregnant women attending a referral hospital in Malawi over a 5-year period, with viral load measurements recorded. HIV prevalence over time was determined, and results correlated with population viral load. A total of 11 052 women were included in this analysis, with 440 (4.1%) HIV infections identified. HIV prevalence rates in pregnant women in Malawi halved from 6.4% to 3.0% over 5 years. Mean viral loads of adult patients decreased from 120 000 copies/mL to less than 20 000 copies/mL. Results suggest that community viral load has an effect on HIV incidence rates in the population, which in turn correlates with reduced HIV prevalence rates in pregnant women.

  1. Short Communication: Transmitted HIV Drug Resistance in Antiretroviral-Naive Pregnant Women in North Central Nigeria

    Science.gov (United States)

    Sagay, Atiene S.; Chaplin, Beth; Chebu, Philippe; Musa, Jonah; Okpokwu, Jonathan; Hamel, Donald J.; Pam, Ishaya C.; Agbaji, Oche; Samuels, Jay; Meloni, Seema; Sankale, Jean-Louis; Okonkwo, Prosper; Kanki, Phyllis

    2014-01-01

    Abstract The World Health Organization (WHO) recommends periodic surveillance of transmitted drug resistance (TDR) in communities in which antiretroviral therapy (ART) has been scaled-up for greater than 3 years. We conducted a survey of TDR mutations among newly detected HIV-infected antiretroviral (ARV)-naive pregnant women. From May 2010 to March 2012, 38 ARV-naive pregnant women were recruited in three hospitals in Jos, Plateau state, north central Nigeria. Eligible subjects were recruited using a modified version of the binomial sequential sampling technique recommended by WHO. HIV-1 genotyping was performed and HIV-1 drug resistance mutations were characterized according to the WHO 2009 surveillance drug resistance mutation (SDRM) list. HIV subtypes were determined by phylogenetic analysis. The women's median age was 25.5 years; the median CD4+ cell count was 317 cells/μl and the median viral load of 16 was 261 copies/ml. Of the 38 samples tested, 34 (89%) were successfully genotyped. The SDRM rate was <5% for all ART drug classes, with 1/34 (2.9%) for NRTIs/NNRTIs and none for protease inhibitors 0/31 (0%). The specific SDRMs detected were M41L for nucleoside reverse transcriptase inhibitors (NRTIs) and G190A for nonnucleoside reverse transcriptase inhibitors (NNRTIs). HIV-1 subtypes detected were CRF02_AG (38.2%), G′ (41.2%), G (14.7%), CRF06-CPX (2.9%), and a unique AG recombinant form (2.9%). The single ARV-native pregnant woman with SDRMs was infected with HIV-1 subtype G′. Access to ART has been available in the Jos area for over 8 years. The prevalence of TDR lower than 5% suggests proper ART administration, although continued surveillance is warranted. PMID:24164431

  2. Factors associated with Genital Hygiene Behaviours in pregnant and non-pregnant women in Turkey

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    Seyhan Çankaya

    2015-03-01

    Full Text Available Purpose: This descriptive study was conducted to determine the factors associated with genital hygiene behaviours in pregnant and non-pregnant women.Method and material: Seventy pregnant women and 70 non-pregnant women, aged between 25 and 45 years, who were in the third trimester of pregnancy and presented to the Gynecology and Obstetrics Clinic at the Faculty of Medicine in Konya Province, Turkey, were included in the study. The data were gathered using a questionnaire with 26 questions designed by the researcher using the Genital Hygiene Behavior Inventory (GHBI.Results: There was no significant difference between the GHBI scores of the pregnant and non-pregnant women (p>0.05. Therefore, both groups were combined, and it was aimed to discover the factors associated with genital hygiene behaviours more effectively. A positive correlation between the GHBI scores and the monthly income was found, whereas there was a negative correlation between the GHBI scores and age, marriage age, number of pregnancies, and birth (p<0.05. There was a significant difference between the GHBI scores and the educational status of the women and their husbands, the employment status of the women and the perceived income status (p<0.05. A statistically significant difference was found between the groups in terms of GHBI scores and the women’s pain and/or bleeding experience during sexual intercourse, vaginal douching, and training on the hygiene of the genital area (p<0.05.Conclusion: There was no significant difference in genital hygiene behaviours between the pregnant and non-pregnant women. This may be attributed to the fact that the genital hygiene practices of women who did not have sufficient knowledge of genital hygiene before they became pregnant did not change during pregnancy. Therefore, we suggest that midwives provide both pregnant and non-pregnant women with training on genital hygiene.

  3. Carga viral vaginal de HIV em mulheres brasileiras infectadas pelo HIV HIV vaginal viral load in Brazilian HIV-infected women

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    Angela Campos

    2008-02-01

    Full Text Available OBJETIVO: Avaliar os fatores associados à presença de RNA-HIV na vagina. MÉTODOS: Estudo de corte transversal, em mulheres infectadas por HIV, excluindo-se aquelas com antecedente de histerectomia, as em uso de medicações vaginais nas últimas 48 horas, as que se referiram à relação sexual desprotegida há menos de 72 horas, as gestantes e aquelas com sangramento genital. Após consentimento, coletou-se amostra sanguínea para contagem de linfócitos T CD4 e carga viral plasmática de HIV, além de lavado vaginal com 10mL de solução salina, que foi centrifugado, aliquotado e armazenado em freezer -70°C para posterior quantificação de RNA-HIV livre. A mensuração de carga viral de RNA-HIV livre plasmática e vaginal foi realizada utilizando-se o kit HIV Monitor v1.5 Cobas Amplicor®, Roche. Pesquisou-se a presença de HPV de alto e baixo risco, clamídia e gonococo por Captura Híbrida II®, Digene, em amostra endocervical. Colheu-se amostra vaginal para bacterioscopia com coloração de Gram, utilizando-se os critérios de Nugent. RESULTADOS: Entre as 200 mulheres estudadas, 73,5% usavam terapia anti-retroviral (TARV com drogas múltiplas. O RNA-HIV foi detectável no lavado vaginal de 18 delas (9%, mas em apenas uma daquelas que tinham carga viral plasmática indetectável (0,5%. A prevalência de HIV vaginal foi 24 vezes maior naquelas em que HIV plasmático era detectável. Carga viral plasmática de HIV, não usar TARV, CD4 reduzido e vaginose bacteriana aumentaram a prevalência de RNA-HIV vaginal, mas apenas a carga viral plasmática se manteve significativa na análise ajustada. CONCLUSÃO: A prevalência de RNA-HIV vaginal foi baixa (9%. A carga viral acima de 1.500 cópias/mL foi a única variável que permaneceu como fator de risco para RNA-HIV vaginal livre.OBJECTIVE: To evaluate factors associated to presence of free RNA-HIV in the vagina. METHODS: Cross-sectional study with HIV-infected women, excluding those who had

  4. Ocular changes in pregnant Nigerian women.

    Science.gov (United States)

    Ebeigbe, J A; Ebeigbe, P N; Ighoroje, Ada

    2012-01-01

    Pregnancy results in a lot of hormonal changes in the body and the eyes are no exception. These ocular changes could be physiologic, pathologic or a modification of a pre-existing condition. The aim of this study was to determine physiologic ocular changes that are associated with pregnancy in healthy Nigerian women. A total of 100 women were followed longitudinally through out the course of their pregnancy and 6 weeks postpartum. The women were recruited at 8 weeks of pregnancy at the anti-natal clinic in the Department of Obstetrics and Gynecology, University of Benin Teaching Hospital, Nigeria. The women were aged between 20 and 35 years. Tests carried out included visual acuity, ophthalmoscopy, retinoscopy, and tonometry. The tests were carried out in each of the three trimesters of pregnancy and 6 weeks postpartum. There was a fall in intraocular pressure across the trimesters and this was very significant (Pchanges associated with pregnancy are transient and most tend to resolve postpartum, with values returning to near pre-pregnant state.

  5. Assessment of Macular Peripapillary Nerve Fiber Layer and Choroidal Thickness Changes in Pregnant Women with Gestational Diabetes Mellitus, Healthy Pregnant Women, and Healthy Non-Pregnant Women.

    Science.gov (United States)

    Acmaz, Gokhan; Atas, Mustafa; Gulhan, Ahmet; Acmaz, Banu; Atas, Fatma; Aksoy, Huseyin; Zararsiz, Gokmen; Gokce, Gokcen

    2015-06-18

    Gestational diabetes mellitus (GDM) is a risk factor for the development of type II diabetes and it causes maternal and child morbidity. Screening for diabetic retinopathy (DR) is important because patients who develop DR have no symptoms until macular edema and/or proliferative diabetic retinopathy (PDR) are already present. The aim of this study was to determine the early retinal findings of GDM. This study was conducted in a tertiary research center. We conducted a prospective cross-sectional study with 3 groups: Group 1 consisted of 36 pregnant women with GDM, Group 2 consisted of 24 healthy pregnant women, and Group 3 consisted of 38 healthy non-pregnant women of reproductive age. Spectralis optical coherence tomography (OCT) was used for the assessment. Macular, choroid, and retinal nerve fiber layer (RNFL) thicknesses were evaluated in patients with GDM and comparisons were made among pregnant women with GDM, healthy pregnant women, and healthy non-pregnant women for these parameters. The nasal part of the RNFL was significantly thinner in the GDM group than in the healthy pregnant group. None of the patients had retinopathy or macular edema at the time of examination. Decreased nasal part of RNFL thickness may be the first retinal change in patients with GDM. Our study suggests that OCT should be performed for the patients with GDM for detection of early retinal changes associated with GDM.

  6. HIV-1, HSV-2 and syphilis among pregnant women in a rural area of Tanzania: Prevalence and risk factors

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    Evjen-Olsen Bjørg

    2008-06-01

    Full Text Available Abstract Background Evidence suggests that a substantial proportion of new HIV infections in African countries are associated with herpes simplex virus type 2 (HSV-2. Thus, the magnitude of HSV-2 infection in an area may suggest the expected course of the HIV epidemic. We determined prevalence of genital herpes, syphilis and associated factors among pregnant women from a remote rural Tanzanian community that has a low but increasing HIV prevalence. Methods We analysed 1296 sera and responses to a standard structured questionnaire collected from pregnant women aged between 15–49 years, attending six different antenatal clinics within rural Manyara and Singida regions in Tanzania. Linked anonymous testing (with informed consent of the serum for specific antibodies against HSV-2 was done using a non-commercial peptide- 55 ELISA. Antibodies against syphilis were screened by using rapid plasma reagin (RPR and reactive samples confirmed by Treponema pallidum haemagglutination assay (TPHA. Results Previous analysis of the collected sera had shown the prevalence of HIV antibodies to be 2%. In the present study the prevalence of genital herpes and syphilis was 20.7% (95% CI: 18.53–23.00 and 1.6% (95% CI: 1.03–2.51, respectively. The presence of HSV-2 antibodies was associated with polygamy (OR 2.2, 95% CI: 1.62 – 3.01 and the use of contraceptives other than condoms (OR 1.7, 95% CI: 1.21 – 2.41. Syphilis was associated with reporting more than one lifetime sexual partner (OR 5.4, 95% CI: 1.88 – 15.76 and previous spontaneous abortion (OR 4.3, 95% CI: 1.52–12.02. Conclusion The low prevalence of HIV infection offers a unique opportunity for strengthening HIV prevention in a cost-effective manner. The identification and control of other prevalent curable STIs other than syphilis and specific intervention of HSV-2 in specific populations like pregnant women would be one among approaches towards preventing incident HIV infections.

  7. Kaposi's Sarcoma Associated-Herpes Virus (KSHV Seroprevalence in Pregnant Women in South Africa

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    Malope-Kgokong Babatyi I

    2010-08-01

    Full Text Available Abstract Background Factors previously associated with Kaposi's sarcoma-associated herpesvirus (KSHV transmission in Africa include sexual, familial, and proximity to river water. We measured the seroprevalence of KSHV in relation to HIV, syphilis, and demographic factors among pregnant women attending public antenatal clinics in the Gauteng province of South Africa. Methods We tested for antibodies to KSHV lytic K8.1 and latent Orf73 antigens in 1740 pregnant women attending antenatal clinics who contributed blood to the "National HIV and Syphilis Sero-Prevalence Survey - South Africa, 2001". Information on HIV and syphilis serology, age, education, residential area, gravidity, and parity was anonymously linked to evaluate risk factors for KSHV seropositivity. Clinics were grouped by municipality regions and their proximity to the two main river catchments defined. Results KSHV seropositivity (reactive to either lytic K8.1 and latent Orf73 was nearly twice that of HIV (44.6% vs. 23.1%. HIV and syphilis seropositivity was 12.7% and 14.9% in women without KSHV, and 36.1% and 19.9% respectively in those with KSHV. Women who are KSHV seropositive were 4 times more likely to be HIV positive than those who were KSHV seronegative (AOR 4.1 95%CI: 3.4 - 5.7. Although, women with HIV infection were more likely to be syphilis seropositive (AOR 1.8 95%CI: 1.3 - 2.4, no association between KSHV and syphilis seropositivity was observed. Those with higher levels of education had lower levels of KSHV seropositivity compared to those with lower education levels. KSHV seropositivity showed a heterogeneous pattern of prevalence in some localities. Conclusions The association between KSHV and HIV seropositivity and a lack of common association with syphilis, suggests that KSHV transmission may involve geographical and cultural factors other than sexual transmission.

  8. Determinants of measles seroprevalence among pregnant women in Paris, France.

    Science.gov (United States)

    Bodilis, H; Goffinet, F; Krivine, A; Andrieu, T; Anselem, O; Tsatsaris, V; Rozenberg, F; Launay, O

    2014-08-01

    Non-immune pregnant women are at risk of severe measles. As the measles vaccination is contraindicated during pregnancy, women should be vaccinated before conception or during the postpartum period. Nevertheless, measles serology is not recommended during pregnancy in France, and there are no data available concerning measles susceptibility and its associated risk factors among pregnant women. The socio-demographic determinants of measles seronegativity have been identified in a prospective cohort of 826 pregnant women in Paris, France. Measles seronegativity was 10.41% (95% CI 8.32-12.50). Women from higher socio-economic groups, born in France after 1980, were more frequently seronegative.

  9. 539 Prevalence of Vaginal Candidiasis among Pregnant Women in ...

    African Journals Online (AJOL)

    User

    2010-10-17

    Oct 17, 2010 ... parity and is significantly higher in pregnant women who are in their first or .... highly educated women with tertiary education and the others. ... albicans is highly sensitive; there is considerable maternal disability and neonatal ...

  10. Exploring fertility decisions among pregnant HIV- positive women on ...

    African Journals Online (AJOL)

    antenatal clinic at a health centre in Balaka, Malawi. Methods. This was a ... pregnant women enroled in the antiretroviral therapy (ART) programme. A sample size of thirty-five ..... Some women reported suffering the physical and psychological ...

  11. Increasing Numbers of Pregnant Women Also Have Heart Disease

    Science.gov (United States)

    ... html Increasing Numbers of Pregnant Women Also Have Heart Disease Multiple specialists may be needed to care for ... 2017 (HealthDay News) -- Many more American women with heart disease are choosing to have babies, a new study ...

  12. Effects of Antiretroviral Therapy to Prevent HIV Transmission to Women in Couples Attempting Conception When the Man Has HIV Infection - United States, 2017.

    Science.gov (United States)

    Brooks, John T; Kawwass, Jennifer F; Smith, Dawn K; Kissin, Dmitry M; Lampe, Margaret; Haddad, Lisa B; Boulet, Sheree L; Jamieson, Denise J

    2017-08-18

    Existing U.S. guidelines recommend that men with human immunodeficiency virus (HIV) infection should achieve virologic suppression* with effective antiretroviral therapy (ART) before attempting conception (1). Clinical studies have demonstrated that effective ART profoundly reduces the risk for HIV transmission (2-4). This information might be useful for counseling couples planning a pregnancy in which the man has HIV infection and the woman does not (i.e., a mixed HIV-status couple, often referred to as a serodiscordant couple).

  13. Drug use by pregnant women and comparable non-pregnant women in The Netherlands with reference to the Australian classification system

    NARCIS (Netherlands)

    Schirm, Eric; Meijer, W.M.; Tobi, H; de Jong-van den Berg, Lolkje Theodora Wilhelmina

    2004-01-01

    Objective: To describe drug use in pregnancy, and compare drug use of pregnant women with non-pregnant women with respect to possible teratogenicity. Study design: A cross-sectional study based on pharmacy records from 1997 to 2001 was performed. Pregnant women and matched non-pregnant women (same p

  14. Drug use by pregnant women and comparable non-pregnant women in The Netherlands with reference to the Australian classification system

    NARCIS (Netherlands)

    Schirm, Eric; Meijer, W.M.; Tobi, H; de Jong-van den Berg, Lolkje Theodora Wilhelmina

    2004-01-01

    Objective: To describe drug use in pregnancy, and compare drug use of pregnant women with non-pregnant women with respect to possible teratogenicity. Study design: A cross-sectional study based on pharmacy records from 1997 to 2001 was performed. Pregnant women and matched non-pregnant women (same p

  15. Pregnant women become insensitive to cold stress

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    Glover Vivette

    2002-11-01

    Full Text Available Abstract Background The function of the hypothalamic-pituitary-adrenal (HPA axis is known to be altered during pregnancy, but it has not been tested with a natural stressor. Methods A group of pregnant women (n = 10 were tested towards the end of pregnancy (mean 36.8 ± 2.5 weeks gestation and about 8 weeks postpartum (mean 7.8 ± 1.5 weeks, together with a matched control group, with a one minute cold hand stressor test. Saliva samples were collected before and 10 and 20 minutes after the test, and stored for later radioimmunoassay of cortisol. Results The control group showed a highly significant response to the test. The pregnant group showed no response, and the postpartum group a variable but non significant one Conclusions This shows that the HPA axis becomes hypofunctional to a natural stressor at the end of pregnancy. It is suggested that one possible evolutionary function for this is to protect the fetus from the stress responses of the mother.

  16. Do pregnant women contact their general practitioner? A register-based comparison of healthcare utilisation of pregnant and non-pregnant women in general practice

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    Feijen-de Jong Esther I

    2013-01-01

    Full Text Available Abstract Background Midwives and obstetricians are the key providers of care during pregnancy and postpartum. Information about the consultations with a general practitioner (GP during this period is generally lacking. The aim of this study is to compare consultation rates, diagnoses and GP management of pregnant women with those of non-pregnant women. Methods Data were retrieved from the Netherlands Information Network of General Practice (LINH, a nationally representative register. This register holds longitudinal data on consultations, prescriptions and the referrals of all patients listed at 84 practices in the Netherlands in 2007–2009, including 15,123 pregnant women and 102,564 non-pregnant women in the same age-range (15 to 45 years. We compared consultation rates (including all contacts with the practice, diagnoses (ICPC-1 coded, medication prescriptions (coded according to the Anatomical Therapeutic Chemical classification system, and rate and type of referrals from the start of the pregnancy until six weeks postpartum (336 days. Results Pregnant women contacted their GP on average 3.6 times, compared to 2.2 times for non-pregnant women. The most frequently recorded diagnoses for pregnant women were ‘pregnancy’ and ‘cystitis/urinary infection’, and ‘cystitis/urinary infection’ and ‘general disease not otherwise specified’ for non-pregnant women. The mean number of prescribed medications was lower in pregnant women (2.1 against 4.4. For pregnant women, the most frequent referral indication concerned obstetric care, for non-pregnant women this concerned physiotherapy. Conclusions GP consultation rates in pregnancy and postpartum shows that GPs are important providers of care for pregnant women. Therefore, the involvement of GPs in collaborative care during pregnancy and postpartum should be reinforced.

  17. Obstetricians and the rights of pregnant women.

    Science.gov (United States)

    Minkoff, Howard; Paltrow, Lynn M

    2007-05-01

    At times, obstetricians are called upon to assist pregnant women in making clinical choices between options that may selectively disadvantage either the mother or the fetus. If a mother chooses a therapeutic course that disadvantages the fetus the physician may feel distressed. In this paper we argue that the choices made by mothers are almost always in the interests of the fetus, and supported by physicians. When there is disagreement it is often due to poor communication. While acknowledging that the rare circumstances in which the physician and patient wish to pursue different clinical paths can be stressful for the provider, we explain why obstetricians should accept the judgment of their patient in all instances. Finally, we will maintain that positing a choice between maternal and fetal interests is, in fact, creating a false choice, in as much as options are presented as being exclusive, when in fact that is not the case.

  18. Short communication: genital tumor growth factor-β1 levels in HIV-infected Indian women are associated with reduced levels of innate antimicrobial products and increased HIV shedding.

    Science.gov (United States)

    Thakar, Madhuri; Patil, Rahul; Shukre, Subodh; Bichare, Shubhangi; Kadam, Poonam; Khopkar, Priyanka; Ghate, Manisha; Paranjape, Ramesh

    2014-07-01

    Tumor growth factor (TGF)-β1 is a cytokine with potent immunoinhibitory functions and is known to be secreted by vaginal epithelial cells. The present study was designed to determine the association of cervicovaginal levels of TGF- β1 with various innate immune secretions such as cytokines and antimicrobial polypeptides [Trappin-2/Elafin and secretory leukocyte protease inhibitor (SLPI)] and cervical HIV shedding in HIV-infected Indian women. TGF- β1, antimicrobial polypeptides, and cytokine levels were estimated in the cervicovaginal lavages (CVLs) of 36 age-matched HIV-infected and 31 HIV-uninfected asymptomatic Indian women using an ELISA and Bio-Plex Assay, respectively. The nonparametric Mann-Whitney test and Spearman's test were used to compare the levels from both the groups and to determine the association of the TGF-β1 levels with cervical viral shedding and antimicrobial peptides. The levels of Trappin-2/Elafin and SLPI were similar in the CVLs of HIV-infected and HIV-uninfected women, but were significantly associated with a low cervical viral load (r=-0.501, p=0.005 for Trappin-2/Elafin and r=-0.488, p=0.007 for SLPI). Eleven (30.5%) of the 36 HIV-infected women showed 5- to 30-fold higher levels of TGF-β1 as compared to the levels in uninfected women. The TGF-β1 levels were significantly associated with higher cervical viral load (r=0.425, p=0.03) and with lower levels of Trappin-2/Elafin (r=-0.407, p=0.03) and SLPI (r=-0.405, p=0.04). The findings indicate a possible interdependent mechanism driving the identified higher TGF-β1 and lower antimicrobial peptide (Trappin-2/Elafin and SLPI) levels at the genital mucosa surface in HIV-infected women. We postulate that a combination of increased TGF-β1 secretion and altered levels of Trappin-2/Elafin and SLPI contributes to increased HIV shedding. The observation warrants further studies to identify the underlying mechanisms linking increased mucosal TGF-β1 levels and genital HIV shedding

  19. Uptake of family planning methods and unplanned pregnancies among HIV-infected individuals: a cross-sectional survey among clients at HIV clinics in Uganda

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    Wanyenze Rhoda K

    2011-06-01

    Full Text Available Abstract Background Prevention of unplanned pregnancies among HIV-infected individuals is critical to the prevention of mother to child HIV transmission (PMTCT, but its potential has not been fully utilized by PMTCT programmes. The uptake of family planning methods among women in Uganda is low, with current use of family planning methods estimated at 24%, but available data has not been disaggregated by HIV status. The aim of this study was to assess the utilization of family planning and unintended pregnancies among HIV-infected people in Uganda. Methods We conducted exit interviews with 1100 HIV-infected individuals, including 441 men and 659 women, from 12 HIV clinics in three districts in Uganda to assess the uptake of family planning services, and unplanned pregnancies, among HIV-infected people. We conducted multivariate analysis for predictors of current use of family planning among women who were married or in consensual union and were not pregnant at the time of the interview. Results One-third (33%, 216 of the women reported being pregnant since their HIV diagnoses and 28% (123 of the men reported their partner being pregnant since their HIV diagnoses. Of these, 43% (105 said these pregnancies were not planned: 53% (80 among women compared with 26% (25 among men. Most respondents (58%; 640 reported that they were currently using family planning methods. Among women who were married or in consensual union and not pregnant, 80% (242 were currently using any family planning method and 68% were currently using modern family planning methods (excluding withdrawal, lactational amenorrhoea and rhythm. At multivariate analysis, women who did not discuss the number of children they wanted with their partners and those who did not disclose their HIV status to sexual partners were less likely to use modern family planning methods (adjusted OR 0.40, range 0.20-0.81, and 0.30, range 0.10-0.85, respectively. Conclusions The uptake of family planning

  20. STD Clinic Patients' Awareness of Non-AIDS Complications of HIV Infection

    Science.gov (United States)

    Castro, José Guillermo; Granovsky, Inna; Jones, Deborah; Weiss, Stephen M.

    2016-01-01

    Participants were recruited from a sexually transmitted disease (STD) clinic in Florida and were assessed regarding the knowledge and awareness of non-AIDS conditions associated with HIV infection. Questionnaires were administered before and after a brief information session on non-AIDS conditions associated with HIV infection. Participants included men (n = 46) and women (n = 51). Prior to the information session, at baseline, only 34% of the participants were worried about HIV infection. Most participants (82%) agreed that HIV could be treated with antiretroviral therapy (ART), while only 38% were aware that HIV-associated conditions cannot be easily treated with ART. After the information session, almost all participants reported they were concerned regarding the risk of HIV infection. High-risk patients may have limited knowledge about the consequences of HIV infection beyond the traditional AIDS-associated conditions. Increased awareness of these less known consequences of HIV infection may decrease the potential for complacency regarding acquiring HIV infection. PMID:25331221

  1. Muscle sympathetic nerve activity and volume regulating factors in healthy pregnant and non-pregnant women.

    Science.gov (United States)

    Charkoudian, Nisha; Usselman, Charlotte W; Skow, Rachel J; Staab, Jeffery S; Julian, Colleen Glyde; Stickland, Michael K; Chari, Radha S; Khurana, Rshmi; Davidge, Sandra T; Davenport, Margie H; Steinback, Craig D

    2017-07-21

    Healthy, normotensive human pregnancies are associated with striking increases in both plasma volume and vascular sympathetic nerve activity (SNA). In non-pregnant humans, volume regulatory factors including plasma osmolality, vasopressin and the renin-angiotensin-aldosterone system have important modulatory effects on control of sympathetic outflow. We hypothesized that pregnancy would be associated with changes in the relationships between SNA (measured as muscle SNA) and volume regulating factors, including plasma osmolality, plasma renin activity and arginine vasopressin (AVP). We studied 46 healthy, normotensive young women (23 pregnant and 23 non-pregnant). We measured SNA, arterial pressure, plasma osmolality, plasma renin activity, AVP and other volume regulatory factors in resting, semi-recumbent posture. Pregnant women had significantly higher resting SNA (38 ± 12 vs. non-pregnant: 23 ± 6 bursts/minute), lower osmolality and higher plasma renin activity and aldosterone (all P pregnant] vs. 5.17 ± 2.03 [pregnant], P > 0.05). However, regression analysis detected a significant relationship between individual values for SNA and AVP in pregnant (r = 0.71, P pregnant women (r = 0.04). No relationships were found for other variables. These data suggest that the link between AVP release and resting SNA becomes stronger in pregnancy, which may contribute importantly to blood pressure regulation in healthy women during pregnancy. Copyright © 2017, American Journal of Physiology-Heart and Circulatory Physiology.

  2. A linear study of pulmonary function tests in normal pregnant and non-pregnant women.

    Science.gov (United States)

    Gupta, Lata; Dixit, R

    2013-10-01

    Pregnancy is principally a phenomenon of maternal adaptation to the increasing demands of the growing foetus. Pregnancy causes many visible and invisible changes in human body and it represents one of the best example of selective adaptation in terms of respiratory physiology. To evaluate the changes in dynamic pulmonary function tests in all three trimesters of pregnancy and compare the results between normal pregnant women (case group) and normal non-pregnant women (control group) and also to compare the results of the study with other studies, 50 subjects were selected and divided into two groups, non-pregnant women (n = 20, mean age = 26.5 +/- 2.69 years) and normal pregnant women of all three trimesters (n = 30, mean age = 24.84 +/- 3.00 years). Pulmonary function tests were done by medspiror. Significant decrease in all the parameters of pulmonary function tests like forced vital capacity, forced expiratory volume in one second, peak expiratory flow rate, maximum ventilation volume, were noticed in all trimesters of normal pregnant women as compared to normal non-pregnant women. The data suggest that there is alteration in pulmonary function tests in pregnant women. Continuous Monitoring of pulmonary function tests may prove to be of great value in maternal healthcare as cases of restriction and obstruction in lungs during pregnancy can be identified early and its deterioration can be prevented by proper management.

  3. Hemoglobin levels in normal Filipino pregnant women.

    Science.gov (United States)

    Kuizon, M D; Natera, M G; Ancheta, L P; Platon, T P; Reyes, G D; Macapinlac, M P

    1981-09-01

    The hemoglobin concentrations during pregnancy in Filipinos belonging to the upper income group, who were prescribed 105 mg elemental iron daily, and who had acceptable levels of transferrin saturation, were examined in an attempt to define normal levels. The hemoglobin concentrations for each trimester followed a Gaussian distribution. The hemoglobin values equal to the mean minus one standard deviation were 11.4 gm/dl for the first trimester and 10.4 gm/dl for the second and third trimesters. Using these values as the lower limits of normal, in one group of pregnant women the prevalence of anemia during the last two trimesters was found lower than that obtained when WHO levels for normal were used. Groups of women with hemoglobin of 10.4 to 10.9 gm/dl (classified anemic by WHO criteria but normal in the present study) and those with 11.0 gm/dl and above could not be distinguished on the basis of their serum ferritin levels nor on the degree of decrease in their hemoglobin concentration during pregnancy. Many subjects in both groups, however, had serum ferritin levels less than 12 ng/ml which indicate poor iron stores. It might be desirable in future studies to determine the hemoglobin cut-off point that will delineate subjects who are both non-anemic and adequate in iron stores using serum ferritin levels as criterion for the latter.

  4. The study of serum Carnitine, Triglyceride and Cholesterol changes in pregnant and non-pregnant women

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    Zahraei M

    1993-04-01

    Full Text Available Carnitine is a water-soluble quaternary amine which increases the long-chain fatty acid metabolism by facilitation of their transport to the oxidation site (mitochondria. Carnitine most likely is present in all animal species, in many microorganisms, and in many plants. In this study, we determined the carnitine level of sera in pregnant and non-pregnant women by segade modified method. Average concentration of carnitine in the sera of fifty pregnant women was about 25/83 umol/I: First trimester-30.96 umol/I. Second trimester-29.11 umol/I. Third trimester-25.11 umol/I. concentration of cholesterol and triglyceride in the above-mentioned group was the following: Cholesterol: 258.84 mg/dl triglyceride: 267.02 mg/dl. The above values show that the carnitine level in sera of pregnant women decreases significantly and this decrease is tolerated well by pregnant women. According to our results, the serum carnitine concentration in pregnant women gradually decreases as gestation proceeds. So that the end of this period, is half of its concentration before conception. During pregnancy, there was an inverse correlation between carnitine level and that of cholesterol and triglycerides. Decrease in carnitine concentration and increase in cholesterol and triglyceride levels may be due to the following factors: 1 Increase in FFA oxidation in pregnancy. 2 Hormones. 3 Dilution of the blood. 4 Decrease in Fe storage in pregnant women.

  5. HIV infections in otolaryngology

    Science.gov (United States)

    Rzewnicki, Ireneusz; Olszewska, Ewa; Rogowska-Szadkowska, Dorota

    2012-01-01

    Summary HIV (human immunodeficiency virus) infection may produce no clinical symptoms for 10 years on average. However, after many years of infection most people develop symptoms that indicate progression of the disease. There are no regular characteristic symptoms or early stage, and no logical sequence of AIDS indicator disorders has been observed. People who are not aware of the infection are referred to physicians of various specializations, including otolaryngologists. It is on their knowledge about HIV infections, among other factors, that early diagnosis of the disease depends. Appropriate and quick introduction of anti-retroviral drugs may let a person with HIV live decades longer. PMID:22367140

  6. Protein turnover and 3-methylhistidine excretion in non-pregnant, pregnant and gestational diabetic women

    Energy Technology Data Exchange (ETDEWEB)

    Fitch, W.L.; King, J.C.

    1986-03-01

    Protein turnover was studied in nine non-pregnant (NP) women, eight pregnant (P) and two gestational diabetic (GDM) women. Whole body protein turnover, synthesis and catabolism rates were measured using a single oral dose of /sup 15/N-glycine followed by measurement of enrichment of urinary ammonia. Urinary 3-methylhistidine (3MH) excretion was measured for three consecutive days, including the day of the protein turnover study. Whole body protein turnover and synthesis rates did not differ between the P and NP women, although the synthesis rates tended to be higher in the P group. Gestational diabetic women appeared to have considerably higher rates of both turnover and synthesis. Pregnant women excreted significantly more urinary 3MH than did non-pregnant women. GDM women appeared to have lower 3MH excretion than the P women. Correlation between 3MH excretion and protein turnover rates was nearly significant (p = .06) in the NP women, but was poorly correlated (p = .43) in the P women, suggesting that muscles may be a less important site of whole body protein turnover in pregnancy than in the non-pregnant state.

  7. Factors influencing brain natriuretic peptide levels in healthy pregnant women.

    Science.gov (United States)

    Mayama, Michinori; Yoshihara, Masato; Uno, Kaname; Tano, Sho; Takeda, Takehiko; Ukai, Mayu; Kishigami, Yasuyuki; Oguchi, Hidenori

    2017-02-01

    The normal range of plasma brain natriuretic peptide (BNP) in pregnant women is still unclear. Moreover, pregnant women experience dynamic body weight changes and suffer from anemia, but effects on maternal BNP have not been investigated. This study aimed to reveal the normal plasma BNP range and examine the effects of physiological changes on BNP among pregnant women. Plasma BNP, hemoglobin, plasma creatinine and BMI were measured in 58 non-pregnant control women and in 773 normal pregnant women at late pregnancy, early postpartum and 1-month postpartum. Mean plasma BNP (in pg/mL) was 11.8 (95% confidence interval: 0-27.5) in non-pregnant women, 17.9 (0-44.7, pchange during pregnancy (p=0.001) and post-delivery creatinine (p=0.010) but negatively associated with body weight loss at delivery (pchanges, creatinine and hemoglobin levels; therefore, these factors should be considered when analysing cardiac function and the physiological implications of BNP levels in pregnant