Factors influencing utilization of modern family planning services by persons living with Human Immunodeficiency Virus at Luwero Hospital, Uganda

Introduction: The use of modern family planning methods is key for achieving the prevention of unintended pregnancies among women living with HIV, in the prevention of Mother-to-child transmission (PMTCT) package. The purpose of this study was to examine the factors influencing the utilization of modern family planning services by persons living with HIV at Luwero Hospital, Uganda. Methods: The study was conducted among 210 persons living with HIV attending the ART clinic and was based on cross-sectional descriptive and analytical design. Sampling was by simple random techniques. Data was collected using researcher-administered questionnaires. Results: The uptake of Modern FP services is low (36.7%) among persons living with HIV. It was attributed to client-related factors such as being married [AOR: 2.2, 95% CI [1.123-4.140], p = 0.038]) and other factors. These are; religious views discouraging use of modern FP (p= 0.034), negative side effects (AOR: 1.8, 95% CI [0.043-1.968], p = 0.044) and services being unfriendly for persons living with HIV (p=0.000]). Conclusions: Despite the presence of modern family planning services, uptake among persons living with HIV is low. Poor utilization is a recipe for unintended pregnancy and thus jeopardizes efforts in the elimination of mother-to-child transmission of HIV

Pregnancy Outcome of ART-experienced and ART-naïve HIV-infected Mothers at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

Background:Untreated maternal Human Immunodeficiency Virus (HIV) infection is associated with adverse pregnancy outcome including preterm birth, low birth weight, and mother-to-child transmission of the virus. This study aimed to compare the pregnancy outcome between HIV infected mothers who received ART in pregnancy and those who were ART-naïve. Methods:A cross-sectional study of HIV-infected mothers who brought their infants for follow up between November 2007 and May 2017 at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.Relevant information obtained include: time of diagnosis, antiretroviral therapy (ART) regimen and when it was commenced, gestational age at delivery and birthweight of child, mode of delivery, infant feeding option and ARV prophylaxis. Infection status of the infant was determined by DNA PCR at 6weeks of age. Based on when ART was commenced, mothers were grouped into three [(HAART experienced (HE) if ART was started before pregnancy, HAART in pregnancy (HIP) and HAART naive (NH) if no HAART was taken in pregnancy].Main outcome measures were rates of prematurity, low birth weight, mean birth weight, birth defects and mother-to-child transmission Result:A total of 1,640 HIV-exposed infants were seen (716(43.6%) in HE, 360(22.0%) in HIPand 564(34.4%) in NH groups). There were 825(50.3%) males and 815(49.7%) females. Zidovudine/Lamivudine and Nevirapine/Efavirenz was the most frequently used combined ART in 724 (67.3%) mothers. The mean birthweight was 3.12±0.38Kg; range 1.2 –5.7Kg (3.11±0.58Kg in HE; 3.13±0.53Kg in HIP; 3.18±0.74Kg in NH) Table 3. A hundred and eighty (11.0%) babies were preterm [76(42.2%) in HE; 26(14.4%) in HIP; 78(43.3%) in NH](p=0.007), while 159(9.7%) were LBW [74(46.5%) in HE; 22(13.8%) in HIP; 63(39.6%) in NH](p=0.03). Fourteen (0.9%) babies had birth defects [5(35.7%) in HE; 9(64.3%) in HIP] (p=0.01). The commonest birth defects were neural tube defect 7(50%) and congenital heart defect 4(28.8%). Overall transmission rate was 21.4% [8% in the HE, 4.5% in HIP and 87.5% in NH groups] (p=0.001). The mean birth weights of uninfected babies were higher than their infected counterparts but was not significant (p>0.05).Conclusion:The benefits of early HAART in reducing mother-to-child transmissionmust be weighed against the risks of lower birthweight and potential teratogenic effects of drug exposure on the foetus

Mother-to-child transmission of syphilis / 中华皮肤科杂志

Mother-to-child transmission (MTCT) is a major route of transmission of syphilis,and may occur at any time during pregnancy.MTCT of syphilis can lead to many adverse pregnancy outcomes,seriously affects maternal and infant health,and has been a severe public health and social problem.The risk of MTCT of syphilis is associated with stage of syphilis in pregnancy,stage of pregnancy,receiving or not receiving treatment,and is especially high in patients with early syphilis.With the growth of incidence of syphilis,the prevention for MTCT of syphilis has been becoming more and more important.Screening for and early treatment of syphilis in pregnancy can effectively block MTCT of syphilis.To learn the epidemiology,route,risk,and associated factors of MTCT of syphilis will undoubtedly facilitate the development of strategies for syphilis prevention and control.

Investigation of interruption of mother-to-child transmission among HIV-infected women / 实用医学杂志

Objective To study the method and effectiveness of interruption of mother-to-child transmis-sion among human immunodeficiency virus (HIV)-infected women. Methods Clinical information of 110 cases of HIV-infected pregnant women who gave birth in the eighth municipal hospital of Guangzhou from June 2009 to June 2012 were retrospectively analyzed. Measures such as antiviral treatment , elective caesarean and artificial feeding were taken to interupt mother-to-child transmission , differences in pregnancy outcomes bewteen CD4 t-lymphocyte count > 200/μL and 200 /μL ( 84 cases ) ] and group 2 [< 200/μL group (26 cases)]. In group 1, the rate of anemia, preterm and postpartum hemorrhage was lower than that of group 2; the rate of low birth weight and FGR was obviously lower than that of group 2. There was statisticsly significantly difference between the two groups. 112 infants were all aged 18 months , among those we regularly followed up 88 cases (78.58%) and no infants were HIV-infected. Conclusion Interruptions of moth-er-to-child transmission of HIV are important measures to control AIDS epidemic among children.

Utilization of the prevention of parent-to-child transmission of HIV (PPTCT) services in a tertiary care hospital, Odisha, India.

Aims: To assess seroprevalence of HIV among antenatal women and the extent of utilization of interventions to minimize the risk of mother-to-child transmission. Study Design: Descriptive cross-sectional study was carried out among antenatal women who attended integrated counseling and testing center (ICTC) of HIV. Sample sizes were determined from the number of pregnant women that attended ICTC. Place and Duration of Study: Data and samples were collected from a tertiary care hospital, Odisha, India during January 2009 to December 2012. Methodology: All pregnant women were counseled and tested for HIV by rapid test. All HIV-seropositive antenatal women (ANW) were linked to services and followedup for institutional delivery, single-dose nevirapine (sdNVP) prophylaxis, infant feeding options and testing of children at 18 months. Results: Out of 11,508 ANW registered and pretest counseled, 11,390 (98.97%) accepted HIV testing. Sixty women were found to be seropositive, thus showed seroprevalence rate of 0.53% (60/11,390). CD4 testing was carried out in all ANW and five (8.33%) were eligible for antiretroviral therapy (ART). Seven (11.67%) had opted for medical termination of pregnancy (MTP). All 48 ANW delivered institutionally, only 7 (14.58%) received cesarean delivery. Out of 46 live births, 5 (10.87%) ANW were on ART, 35/41 (85.37%) received sdNVP mother baby-pair prophylaxis and only 8/46 (17.39%) mother opted for replacement feeding. Twenty one children have reached 18 months till date and among them three (14.29%) were HIV-seropositive. All three were delivered vaginally, received sdNVP prophylaxis and were exclusively breast fed for 6 months. Conclusion: The HIV-seroprevalence rate among antenatal women was 0.53% and mother-to-child transmission (MTCT) rate was 14.29%. Reduction in MTCT rate needs pre or early antenatal HIV testing, prenatal antiretroviral medication, preference for cesarean delivery, 100% antiretroviral prophylaxis coverage and education on avoidance of breast feeding.

Antiretroviral treatment, viral load of mothers & perinatal HIV transmission in Mumbai, India.

Background & objectives: Mother-to-child transmission (MTCT) is the most significant route of HIV transmission in children below the age of 15 yr. In India, perinatal HIV transmission, even after treatment, accounts for 5.4 per cent of HIV cases. The present study was conducted to evaluate the efficacy of anti-retro viral therapy (ART) or prophylactic treatment (PT) to control maternal viral load in HIV positive women, and its effect on vertical HIV transmission to their infants. Methods: A total of 58 HIV positive women were enrolled at the time of delivery and their plasma samples were obtained within 24 h of delivery for estimation of viral load. Viral load analysis was completed in 38 women. Infants received single dose nevirapine within 2 h of birth and zidovudine for 6 wk. At the end of 18 month follow up, HIV positive or negative status was available in 28 infants. Results: Results revealed undetectable levels of viral load in 58.3 per cent of women with ART compared to 30.7 per cent of women with PT. No women on ART had viral load more than 10,000 copies/ml, whereas seven (26.9%, P=0.07) women receiving PT had this viral load. Median CD4 count of women on PT (483 cells/μl) was high compared to the women on ART (289 cells/ μl). At the end of 18 months follow up, only two children were HIV positive, whose mothers were on PT. One had in utero transmission; infection detected within 48 h of delivery, while the other child was infected post partum as HIV was detected at six months follow up. Interpretation & conclusions: Women who received a single dose of nevirapine during delivery had higher levels of viral load than women on ART. Combination drug therapy for pregnant women is now a standard of care in most of the western countries; use of nevirapine monotherapy at the time of delivery in our settings is not effective in controlling viral load. This highlights initiation of ART in pregnant women to control their viral load and thus to inhibit mother to child HIV transmission.

HIV-1-mother-to-child transmission and associated characteristics in a public maternity unit in Presidente Prudente, Brazil / Transmissão vertical do HIV e características associadas em maternidade pública em Presidente Prudente, Brasil

In children, vertical transmission is the main form of HIV infection. Our aim was to determine the prevalence of HIV-1 vertical transmission in mother-infant pairs in a public maternity ward in Presidente Prudente, SP. Additionally; we sought to identify characteristics associated with this form of transmission. The files of 86 HIV-1-infected mothers and their newborns referred to a Public Hospital from March 2002 to March 2007 were analyzed. The HIV-1-RNA viral load of the newborns was determined by bDNA. The HIV-1 vertical-transmission rate was 4.6 percent. Children that were born in the pre-term period and breastfed were at a higher risk of HIV-1 infection (p = 0.005 and p = 0.017 respectively) than children born at term and not breastfed. Prophylactic therapy with zidovudine after birth for newborns was associated with a lower risk of infection (p = 0.003). The number of newborns weighing < 2,500 g was significantly higher for infected children (p = 0.008) than for non-infected newborns. About 22.9 percent of mothers did not know the HIV-1 status of their newborns eight months after delivery. The study suggests that it is necessary to increase the identification of HIV-1 infection in pregnant women and their newborns as well as to offer and explain the benefits of ARV prophylaxis.

A transmissão vertical é a principal forma de infecção pelo HIV em crianças. Nosso objetivo foi determinar a prevalência da transmissão vertical do HIV em maternidade pública em Presidente Prudente, SP. Além disso, procuramos identificar características associadas a essa forma de transmissão. De março de 2002 a março de 2007, os prontuários de 86 mães HIV-1 positivo e seus bebês, nascidos na maternidade de Hospital Público foram analisadas. A carga viral do HIV-1-RNA dos recém-nascidos foi determinada por bDNA. A prevalência da transmissão vertical pelo HIV-1 foi de 4,6 por cento. Crianças nascidas a pré-termo e amamentadas tiveram um risco maior de infecção (p = 0,005 e p = 0,017, respectivamente), comparado com crianças nascidas a termo e não amamentadas. A profilaxia com zidovudina depois do nascimento para os recém-nascidos foi associada ao menor risco de infecção (p = 0,003). O número de recém-nascidos com peso < 2.500 g foi maior entre as crianças infectadas (p = 0,008), comparado com crianças não infectadas. Oito meses depois do parto 22,9 por cento das mães não tinham conhecimento da infecção de seus bebês pelo HIV. O presente estudo sugere a necessidade em aumentar a identificação do HIV em gestantes e seus bebês e explicar e oferecer os benefícios da profilaxia antiretroviral.

A review on biological matrices and analytical methods used for determination of drug of abuse.

Drug addiction is a chronic disease with a potential for fatality if not treated. The drugs with potential for abuse are mostly psychoactive drugs. Serious widespread medical and health consequences associated with drug abuse involve neurotoxicity, cardiovascular complications, impairment of the immune system function, and many other physiological effects. Illicit drug use remains the second most common mode of HIV infection. Various analytical techniques and number of biological matrices has been used for the detection of drug of abuse in cases such as drug addiction, driving under influence of drugs, neonatal drug exposure in case of drug abuse by pregnant women etc. Urine and blood sample remain the most widely used conventional biosample for the detection of drug of abuse. Various other alternative biological matrices such as saliva, hair, nails, tears and meconium have also been used for the same purpose. Number of analytical techniques such as liquid chromatography with mass spectrometry (LC-MS) and LC with tandem MS (LC-MS2), enzyme-linked immunosorbent assay (ELISA), radioimmunoassay (RIA), electrospray ionization Time-of- Flight mass spectrometry (ESI-TOF), combination of ultra-performance liquid chromatography (UPLC) and TOF, fluorescence polarization immunoassay (FPIA) and enzyme multiplied immunoassay technique (EMIT) have been used for the detection of drugs of abuse in above mentioned biosamples. This review summarizes the conventional as well as alternative biological matrices and various analytical techniques used for the determination of drugs of abuse.

The Role of HIV Replicative Fitness in Perinatal Transmission of HIV / 中国病毒学·英文版

Perinatal transmission of Human immunodeficiency virus(HIV),also called mother-to-child transmission(MTCT),accounts for 90% of infections in infants worldwide and occurs in 30%-45% of children born to untreated HIV-1 infected mothers.Among HIV-1 infected mothers,some viruses are transmitted from mothers to their infants while others are not.The relationship between virologic properties and the pathogenesis caused by HIV-1 remains unclear.Previous studies have demonstrated that one obvious source of selective pressure in the perinatal transmission of HIV-1 is maternal neutralizing antibodies.Recent studies have shown that viruses which are successfully transmitted to the child have growth advantages over those not transmitted,when those two viruses are grown together.Furthermore,the higher fitness is determined by the gp120 protein of the virus envelope.This suggests that the selective transmission of viruses with higher fitness occurred exclusively,regardless of transmission routes.There are many factors contributing to the selective transmission and HIV replicative fitness is an important one that should not be neglected.This review summarizes current knowledge of the role of HIV replicative fitness in HIV MTCT transmission and the determinants of viral fitness upon MTCT.

Towards the complete eradication of mother-to-child HIV/HBV coinfection at Saint Camille Medical Centre in Burkina Faso, Africa

The coinfection of HIV and hepatitis B virus (HBV) and their vertical transmission constitute a public health problem in sub-Saharan countries of Africa. The objectives of this research are: i) identify the pregnant women that are coinfected by HIV and HBV at Saint Camille Medical Centre; ii) use three antiretroviral drugs (zidovudine, nevirapine and lamivudine) to interrupt the vertical transmission of HIV and HBV from infected mothers; and iii) use the PCR technique to diagnose children who are vertically infected by these viruses in order to offer them an early medical assistance. At Saint Camille Medical Centre, 115 pregnant women, aged from 19 to 41 years, were diagnosed as HIV-positive and, among them, 14 coinfected with HBV. They had at least 32 weeks of amenorrhoea and all of them received the HAART, which contained lamivudine. Two to six months after childbirth, the babies underwent PCR diagnosis for HIV and HBV. The results revealed that, among these mothers, 64.4 percent were housewives, 36.5 percent were illiterates, and only 1.7 percent had a university degree. The rate of vertical transmission of HIV and HBV was 0.0 percent (0/115) and 21.4 percent (3/14), respectively. The 3 mothers who transmitted the HBV to their children had all HBsAg, HbeAg, and HBV DNA positive. An antiretroviral therapy that in addition to zidovudine and nevirapine includes lamivudine could, as in the present study, block or reduce the vertical transmission in HIV positive pregnant women who are coinfected with HBV.

Analysis of correlation between female HIV prevalence and policy resources invested for the prevention of mother-to-child transmission / 中国艾滋病性病

Objective To analyze correlation between female HIV prevalence and policy resources invested for the prevention of mother-tochild transmission(PMTCT).Methods Local policy documents concerning PMCTC published in different periods of time were collected from 4 HIV endemic counties in China,and their main components were analyzed in terms of their correlation with the recent infection rate in local women in general and single and married women of child bearing age in particular.Results The policy resources invested for PMTCT by the county governments had a logarithmic correlation with the female HIV infection rates.Conclusion With the rise of female HIV infection rates,policy resources invested for PMTCT has been increased,but after a rapid increase,recent female HIV infection has exerted little influence on the investment of policy resources.