Posts filed under ‘HIV/SIDA Mujeres’

Increased Risk of HIV Acquisition Among Women Throughout Pregnancy and During the Postpartum Period: A Prospective Per-Coital-Act Analysis Among Women With HIV-Infected Partners

The Journal of Infectious Diseases July 1, 2018 V.218 N.1 P.16-25

EDITOR’S CHOICE

Kerry A Thomson; James Hughes; Jared M Baeten; Grace John-Stewart; Connie Celum

The risk of human immunodeficiency virus type 1 (HIV-1) acquisition by women per condomless sex act was 3-fold and 4-fold higher during late pregnancy and the postpartum period, respectively, relative to the nonpregnant period. Enhanced HIV-1 prevention and testing strategies are needed during pregnancy and the postpartum period.

FULL TEXT

https://academic.oup.com/jid/article/218/1/16/4915924

PDF (CLIC en PDF)

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August 13, 2018 at 6:16 pm

Risk of HIV Acquisition During Pregnancy and Postpartum: A Call for Action

The Journal of Infectious Diseases July 1, 2018 V.218 N.1 P.1-4

EDITOR’S CHOICE

Lynne M Mofenson

Prospective studies exploring the relationship between pregnancy and HIV acquisition in women have had inconsistent results, with some studies documenting an increased risk [1–3], while others finding no increase in risk — or even lower risk — after controlling for sexual behavior and other confounding factors such as sexually transmitted infections [4–7]. A meta-analysis of 19 cohort studies estimated a pooled HIV incidence during pregnancy and postpartum of 3.9 per 100 person-years (4.7 per 100 person-years during pregnancy and 2.9 per 100 person-years postpartum) [8], similar to that defined as “substantial risk” in nonpregnant individuals, such as female sex workers, by the World Health Organization (WHO) [9]. The pooled meta-analysis reported that HIV incidence was not significantly higher among pregnant or postpartum women than among nonpregnant/nonpostpartum women, but only 5 studies had appropriate data and were not able to control for a variety of confounding factors, limiting the power to detect associations…

FULL TEXT

https://academic.oup.com/jid/article/218/1/1/4913312

PDF (CLIC en PDF)

August 13, 2018 at 6:15 pm

Protecting Mothers and Babies — A Delicate Balancing Act

N Engl J of Medicine July 24, 2018

PERSEPCTIVE

Protecting Mothers and Babies — A Delicate Balancing Act

S.A. Rasmussen, W. Barfield, and M.A. Honein

More than 50 years ago, an epidemic of serious birth defects caused by prenatal exposure to thalidomide shattered the prevailing notion that the placenta served as a barrier against damaging influences and led to recognition that exposures during pregnancy can result in harm to a developing fetus. Since that time, ensuring that a pregnant woman has access to potentially lifesaving treatments while safeguarding her fetus has become a delicate balancing act, one that requires a careful evaluation of risks and benefits to both the mother and her fetus…

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMp1809688?query=RP

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMp1809688

 

 

 

N Engl J of Medicine July 24, 2018

CORRESPONDENCE

Neural-Tube Defects with Dolutegravir Treatment from the Time of Conception

  1. Zash, J. Makhema, and R.L. Shapiro

Since August 2014, the Botswana Harvard AIDS Institute Partnership has conducted birth outcome surveillance at eight government hospitals throughout Botswana. A primary ongoing aim of the surveillance is to evaluate the prevalence of neural-tube defects associated with exposure to antiretroviral drugs from the time of conception (the risk period for neural-tube defects ends approximately 28 days after conception). At each site, trained government midwives perform surface examinations of consecutive live-born and stillborn infants who are born in the hospital to women infected with human immunodeficiency virus (HIV) and to women without HIV infection. As part of …

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMc1807653?query=RP

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMc1807653

July 24, 2018 at 11:44 am

Comparative safety of dolutegravir-based or efavirenz-based antiretroviral treatment started during pregnancy in Botswana: an observational study.

Lancet Glob Health. July 2018 V.6 N.7 P.e804-e810.

Zash R1, Jacobson DL2, Diseko M3, Mayondi G3, Mmalane M3, Essex M4, Gaolethe T3, Petlo C5, Lockman S6, Holmes LB7, Makhema J3, Shapiro RL4.

Author information

1 Beth Israel Deaconess Medical Center, Division of Infectious Disease, Boston, MA, USA. Electronic address: rzash@bidmc.harvard.edu.

2 Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health, Boston, MA, USA.

3 Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.

4 Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA, USA.

5 Botswana Ministry of Health, Gaborone, Botswana.

6 Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA, USA.

7 Medical Genetics Unit, MassGeneral Hospital for Children, Boston, MA, USA.

Abstract

BACKGROUND:

Global rollout of dolutegravir-based antiretroviral therapy (ART) has been hampered in part by insufficient safety data in pregnancy. We compared birth outcomes among women initiating dolutegravir-based ART with those among women initiating efavirenz-based ART in pregnancy in Botswana.

METHODS:

In this observational study, we captured birth outcome data at eight government hospitals throughout Botswana (~45% of all deliveries in the country) in an ongoing study that started on Aug 15, 2014. In 2016, Botswana changed first-line ART from efavirenz-tenofovir-emtricitabine to dolutegravir-tenofovir-emtricitabine, including for pregnant women. This analysis includes women starting either efavirenz-based ART or dolutegravir-based ART during singleton pregnancy (regimen started and delivery occurring between Aug 15, 2014, and Aug 15, 2016, for efavirenz-based ART and between Nov 1, 2016, and Sept 30, 2017, for dolutegravir-based ART). We excluded births to mothers who had switched regimen or stopped ART. The primary outcomes were the combined endpoints of any adverse outcome (stillbirth, preterm birth [<37 weeks’ gestation], small for gestational age [SGA; less than the tenth percentile of birthweight by gestational age], or neonatal death [within 28 days of age]) and severe adverse outcomes (stillbirth, neonatal death, very preterm birth [<32 weeks’ gestation], and very SGA [less than the third percentile of birthweight by gestational age]). We fitted log-binomial regression models, controlling for maternal age, gravidity, and education, to estimate adjusted risk ratios (aRRs).

FINDINGS:

Our analysis included 1729 pregnant women who initiated dolutegravir-based ART and 4593 who initiated efavirenz-based ART. The risk for any adverse birth outcome among women on dolutegravir versus efavirenz was similar (33·2% vs 35·0%; aRR 0·95, 95% CI 0·88-1·03), as was the risk of any severe birth outcome (10·7% vs 11·3%; 0·94, 0·81-1·11). We found no significant differences by regimen in the individual outcomes of stillbirth, neonatal death, preterm birth, very preterm birth, SGA, or very SGA.

INTERPRETATION:

Adverse birth outcomes were similar among pregnant women who initiated dolutegravir-based and efavirenz-based ART. Dolutegravir-based ART can be safely initiated in pregnancy.

FUNDING: National Institutes of Health.

FULL TEXT

https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30218-3/fulltext

PDF

https://www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X(18)30218-3.pdf

June 26, 2018 at 7:58 am

Antiretroviral therapy in pregnant women living with HIV: A clinical practice guideline.

BMJ 2017 Sep 11; 358:j3961.

Siemieniuk RAC et al.

Approximately 1.4 million women living with HIV become pregnant every year. Most women use antiretroviral therapy, to reduce the risk of vertical transmission or for personal health reasons. Using the GRADE framework according to the BMJ Rapid Recommendation process, we make recommendations for optimal choice of combination antiretroviral regimen considering patient values and preferences, the balance of desirable and undesirable outcomes, their uncertainty, and practical issues. We suggest a zidovudine and lamivudine-based regimen over one that includes tenofovir or emtricitabine (weak recommendation). We recommend alternatives over the combination of tenofovir, emtricitabine, and lopinavir/ritonavir (strong recommendation).

FULL TEXT

http://www.bmj.com/content/358/bmj.j3961

PDF

http://www.bmj.com/content/bmj/358/bmj.j3961.full.pdf

October 5, 2017 at 9:52 am

The Brief Case: A Reactive HIV Rapid Antibody Test in a Pregnant Woman

Journal of Clinical Microbiology April 2016 V.54 N.4 P.826-828

Melanie L. Yarbrough and Neil W. Anderson

A 32-year-old pregnant woman presented to her obstetrician for routine prenatal care during her 3rd month of pregnancy. She reported no major health concerns, with the exception of mild morning sickness that had been gradually improving. Upon physical examination, she appeared healthy and her vitals were stable and within normal limits.

Abdominal ultrasound revealed reassuring fetal heart tones, and her remaining physical exam was unremarkable.

She was counseled regarding the need for several routine prenatal laboratory tests, including testing for human immunodeficiency virus (HIV), to which she agreed.

A rapid HIV test performed in the obstetrician’s office was positive for antibodies against HIV.

The positive rapid antibody result was shared with the patient. She denied any risk factors for HIV infection, including intravenous drug use and sex with multiple partners.

The obstetrician stressed that the results were only preliminary and required confirmatory testing. Prior to sending the patient home, a blood sample was drawn for submission to the local clinical laboratory for additional testing. The obstetrician called the laboratory asking how long it would take for the Western blot confirmatory test to be performed.

A representative from the testing laboratory informed him that they now used the fourth-generation algorithm and therefore no longer performed confirmatory testing by Western blot assay….

PDF

http://jcm.asm.org/content/54/4/826.full.pdf

February 23, 2017 at 7:54 am

2016 BHIVA GUIDELINES for the treatment of HIV-1-positive Adults with antiretroviral therapy

The British HIV Association

Writing Group

Laura Waters (Chair)

N Ahmed, B Angus, M Boffito, M Bower, D Churchill, D Dunn, S Edwards, C Emerson, S Fidler, †M Fisher, R Horne, S Khoo, C Leen, N Mackie, N Marshall, F Monteiro, M Nelson, C Orkin, A Palfreeman, S Pett, A Phillips, F Post, A Pozniak, I Reeves, C Sabin, R Trevelion, J Walsh, E Wilkins, I Williams, A Winston

†Professor Martin Fisher died in April 2015 – he made a significant contribution to these, many other guidelines and our speciality as a whole – he is greatly missed.

Introduction

The overall purpose of these guidelines is to provide guidance on best clinical practice in the treatment and management of adults with HIV infection on antiretroviral therapy (ART).

The scope includes: (i) guidance on the initiation of ART in those previously naïve to therapy; (ii) support of people living with HIV (PLWH) on treatment; (iii) management of individuals experiencing virological failure; and (iv) recommendations in specific populations where other factors need to be taken into consideration.

The guidelines are aimed at clinical professionals directly involved with and responsible for the care of adults with HIV infection, and at community advocates responsible for promoting the best interests and care of HIV-positive adults. They should be read in conjunction with other published BHIVA guidelines.

The 2016 interim update to the 2015 BHIVA antiretroviral guidelines has been published online to include tenofovir-alafenamide/emtricitabine as a preferred NRTI backbone for first-line therapy. Changes were based on new data and the consensus opinion of the writing committee. All changes to the guideline are highlighted and include updates to the chronic kidney disease and bone disease sections of special populations and some small changes to managing virological failure. The next formal update to the guidelines in anticipated in 2017.

PDF

http://www.bhiva.org/documents/Guidelines/Treatment/2016/treatment-guidelines-2016-interim-update.pdf

December 3, 2016 at 9:33 am

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