Tilting the Scale: Current Provider Perspectives and Practices on Breastfeeding with HIV in the United States.

The risk of vertical transmission from breastfeeding with HIV (BFHIV) has been found to be very low in optimal scenarios with sustained maternal viral suppression during pregnancy and postpartum. Medical providers must account for the risk of this serious adverse event alongside parental autonomy, breastfeeding benefits, and patient values. To assess provider practices, comfort, and challenges with BFHIV, an online mixed-method survey was sent to breastfeeding and HIV provider listservs from June to July 2021. The target population was US medical professionals from diverse practice settings with experience in clinical issues associated with BFHIV, including physicians, advanced practice providers, nurses, and lactation consultants. Data analysis utilized nonparametric hypothesis testing, ordinal regression, and reflexive thematic analysis. Most providers reported counseling pregnant people with HIV on infant feeding choices, but fewer specifically endorsed counseling about breastfeeding. Of 84 unique institutions identified by 100 included respondents, 10% had an institutional protocol supporting BFHIV. Institutional protocols were associated with higher degrees of provider comfort with BFHIV in optimal scenario clinical vignettes. Providers perceived that White patients faced fewer BFHIV barriers than patients with other racial identities. Discomfort balancing the goals to protect infants from infection risk and support the parent's role in infant feeding decisions was a key theme in free text responses; this manifested in a spectrum of management styles ranging from patient's informed choice to paternalism. This study highlights the tension providers navigate regarding BFHIV discussions, calling for patient care guidelines and protocols grounded in risk reduction and respect of patient autonomy.

Self-Reported Use of Tobacco, E-cigarettes, and Marijuana Versus Urinary Biomarkers.

BACKGROUND: Surveys have been instrumental in describing adolescent use of tobacco, electronic cigarettes (e-cigarettes), and marijuana. However, objective biomarker data are lacking. We compared adolescent self-reported use to urinary biomarkers. METHODS: From April 2017 to April 2018, adolescents 12 to 21 years old completed an anonymous questionnaire regarding tobacco, e-cigarette, and marijuana use and provided a urine sample. Urine was analyzed for biomarkers cotinine, total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol, and tetrahydrocannabinolic acid (THCA). RESULTS: Of 517 participants, 2.9% reported using tobacco, 14.3% e-cigarettes, and 11.4% marijuana in the past week. Only 2% reporting no smoking had total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol levels above cutoff (14.5 pg/mL); 2% of non-e-cigarette users had cotinine above cutoff (10 ng/mL); 2% of those denying marijuana use had THCA above cutoff (10 ng/mL). Daily e-cigarette users showed significantly higher median cotinine than nondaily users (315.4 [interquartile range (IQR) 1375.9] vs 1.69 ng/mL [IQR 28.2]; P < .003). Overall, 40% who reported using nicotine-free products had cotinine >10 ng/mL. Pod users' median cotinine was significantly higher than in nonpod users (259.03 [IQR 1267.69] vs 1.61 ng/mL [IQR 16.3]; P < .003). Median THCA among daily marijuana users was higher than in nondaily users (560.1 [IQR 1248.3] vs 7.2 ng/mL [IQR 254.9]; P = .04). Sixty-one percent of those with cotinine >10 ng/mL vs 39% of those with cotinine<10 ng/mL had THCA >10 ng/mL (P < .001). CONCLUSIONS: Adolescents' self-report correlated with measured urinary biomarkers, but subjects were unaware of their nicotine exposure. More frequent e-cigarette and pod use correlated with elevated biomarkers. Co-use of tobacco, e-cigarettes, and marijuana was corroborated by higher THCA in those with higher cotinine.

The use of immature oocytes in the fertility preservation of cancer patients: current promises and challenges.

Improved oncological treatments permit increased survival rates, although cancer patients remain at risk of losing ovarian function. An attractive option for fertility preservation includes the use of immature oocytes, a strategy which can occur on a rapid timeline and without hormonal stimulation. As a result, cancer therapy can proceed promptly even in patients with hormone-sensitive tumors. Following retrieval, immature oocytes can be cryopreserved at either the immature germinal vesicle or the mature metaphase-II stage, i.e. either before or after in vitro maturation (IVM). We present a critical review of previous human studies on the cryopreservation of immature oocytes. Evaluations include in vitro developmental competence upon thawing/warming, or organization of the spindle and chromosomes. Reported successes vary, perhaps in relation to the source of the oocytes and protocols for cryopreservation and IVM. Weaknesses exist with the experimental designs implemented to date, so caution must be exercised before considering the use of immature oocytes to be a safe and reliable practice in the fertility preservation of cancer patients. To date, results indicate that with current protocols, it may be best to cryopreserve immature oocytes after IVM at the metaphase-II stage. Nonetheless, efficacy remains very low. Future efforts should tailor and optimize not only cryo-preservation, but also IVM protocols for use in either germinal vesicle or metaphase-II oocytes, together with a comprehensive assessment of oocyte function and developmental competence to term. Despite current challenges, the burgeoning field of immature oocyte cryopreservation constitutes a promising option for cancer patients with impaired ovarian function.