Mother-to-Child Transmission of Human Papillomavirus in Burkina Faso

Introduction: Human papillomavirus (HPV) infection is the most widespread sexually transmitted infection in the world. Today, there is growing evidence that HPV can be transmitted early in life, and one potential route is mother-to-child transmission. Data on this route of HPV transmission are scarce in Africa and particularly in Burkina Faso, where no data on the subject are yet available. The aim of our study was to estimate the rate of mother-to-child transmission of HPV infection and to identify circulating genotypes. Methodology: Cervico-uterine samples were collected from 100 full-term pregnant women and, buccal samples were obtained from their newborns at Hopital Saint Camille de Ouagadougou (HOSCO) by the specialist physician. HPV DNA amplification and genotyping were performed by PCR followed by hybridization using the HPV Direct Flow Chips kit, detecting 36 genotypes including 18 high-risk and 18 low-risk. Results: The prevalence of HPV in newborns was 8% (8/100). Six (6) HPV-positive neonates had HPV-positive mothers, while 2 HPV-positive neonates had HPV-negative mothers. The vertical transmission rate was 26.09% (6/23). Mother-newborn genotypes were concordant. However, the genotype profile of the newborns was more restricted than that of the mothers. Conclusion: HPV DNA was found in 8% of newborns in our study. The genotype profile of the mother-newborn pair was concordant. Asymptomatic HPV infection in a pregnant woman could constitute a risk factor for vertical transmission.

A meta-analysis of lamivudine for interruption of mother-to-child transmission of hepatitis B virus

AIM： To determine the therapeutic effect of lamivu- dine in late pregnancy for the interruption of motherto-child transmission （MTCT） of hepatitis B virus （HBV）. METHODS： Studies were identified by searching available databases up to January 2011. Inclusive criteria were HBV-carrier mothers who had been involved in randomized controlled clinical trials （RCTs） with lamivudine treatment in late pregnancy, and newborns or infants whose serum hepatitis B surface antigen （HBsAg）, hepatitis B e antigen （HBeAg） or HBV DNA had been documented. The relative risks （RRs） for inerruption of MTCT as indicated by HBsAg, HBV DNA or HBeAg of newborns or infants were calculated with 95% confidence interval （CI） to estimate the efficacy of lamivudine treatment. RESULTS： Fifteen RCTs including 1693 HBV-carrier mothers were included in this meta-analysis. The overall RR was 0.43 （95% CI, 0.25-0.76; 8 RCTs; Phet- erogeneity= 0.04） and 0.33 （95% CI, 0.23-0.47; 6 RCTs; Pheterogeneity = 0.93） indicated by newborn HBsAg or HBV DNA. The RR was 0.33 （95% CI, 0.21-0.50; 6 RCTs; Pheterogeneity = 0.46） and 0.32 （95% CI, 0.20-0.50; 4 RCTs; Pheterogeneity = 0.33） indicated by serum HBsAg or HBV DNA of infants 6-12 mo after birth. The RR （lamivudine vs hepatitis B immunoglobulin） was 0.27 （95% CI, 0.16-0.46; 5 RCTs; Pheterogeneity = 0.94） and 0.24 （95% CI, 0.07-0.79; 3 RCTs; Pheterogeneity = 0.60） indicated by newborn HBsAg or HBV DNA, respectively. In the mothers with viral load 〈 106 copies/mL after lamivudine treatment, the efficacy （RR, 95% CI） was 0.33, 0.21-0.53 （5 RCTs; Pheterogeneity = 0.82） for the interruption of MTCT, however, this value was not significant if maternal viral load was 〉 106 copies/mL after lamivudine treatment （P = 0.45, 2 RCTs）, as indicated by newborn serum HBsAg. The RR （lamivudine initiated from 28 wk of gestation vs control） was 0.34 （95% CI, 0.22-0.52; 7 RCTs; Pheterogeneity = 0.92） and 0.33 （95% CI, 0.22-0.50; 5 RCTs; Pheterogeneity = 0.86） indicated by newborn HBsAg or HBV DNA. The incidence of adverse effects of lamivudine was not higher in the mothers than in controls （P = 0.97）. Only one study reported side effects of lamivudine in newborns. CONCLUSION： Lamivudine treatment in HBV carrier- mothers from 28 wk of gestation may interrupt MTCT of HBV efficiently. Lamivudine is safe and more efficient than hepatitis B immunoglobulin in interrupting MTCT. HBV MTCT might be interrupted efficiently if maternal viral load is reduced to 〈 106 copies/mL by lamivudine treatment.

Estimating the Health and Economic Outcomes of the Prevention of Mother-to-child Transmission of HIV Using a Decision Tree Model

In 2016, there were 17.8 million (15.4-20.3 million) women living with HIV/AIDS across the world and the prevalence of reproductive desire among this group was 26%-49%[1]. If pregnant women living with HIV/AIDS are left untreated, the rates of HIV transmission from mother-to-child would range from 14% to 48%, depending on the presence and duration of breastfeeding[2].

Eliminating Mother-to-Child Transmission of Syphilis: Chinese Practice before and during COVID-19 Pandemics

Mother-to-child transmission(MTCT)of syphilis remains a leading cause of stillbirth and death among neonates in many developing countries.In 2007,World Health Orgernization launched the global elimination of MTCT(EMTCT)of syphilis.Given the high burden of congenital syphilis,China subsequently released the specific national EMTCT policies and programs to reduce MTCT of syphilis.The congenital syphilis incidence rate per 100,000 live births in China has markedly decreased from 69.9 in 2013 to 11.9 in 2019.However,due to the global pandemic of COVID-19,the current measures for eliminating MTCT of syphilis are greatly challenged.In this article,we summarize the strategies and measures for the EMTCT of syphilis in China in the past 20 years,the remarkable achievements by the policy support under the leadership of the government.In the context of COVID-19 pandemics,strengthening emergency response to the regional outbreaks of COVID-19,adopting safe,rapid,early and high-quality clinical care for 100%of pregnant women to receive prenatal syphilis testing services,ensuring the availability of Benzathine penicillin for the treatment,and strengthening the closed-loop management of pregnant women and newborns infected with syphilis are the key measures to determine the effectiveness of MTCT for syphilis.Lessons from China may be valuable for other countries that are planning to eliminate MTCT of syphilis.

A survey of awareness and knowledge of mother-to-child transmission of HIV in pregnant women attending Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria

Objective: To determine the knowledge and awareness of Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) and mother-to-child transmission (MTCT) among women attending the antenatal clinic. Methods and Subjects: This was primarily a descriptive cross-sectional study carried out at the antenatal clinic of Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Nigeria from July 1st, 2010 to October 31st, 2010. Results: The age range of the respondents was 18 - 41 years, (mean 29 ± 5 years). One hundred and forty-nine (92.5%) were married. All the respondents interviewed were aware of HIV/AIDS and 93 (57.8%) had been aware of the disease for ≥5 years. The main sources of information were television 93 (57.8%), radio 77 (47.8%), health workers 53 (32.9%), friends, relatives and neighbors 41 (25.5%) and posters 34 (21.1%). Majority of the respondents identified sexual intercourse as a route of transmission of HIV. Sharing of sharp objects and blood transfusion were identified as routes of transmission by 99 (61.5%) and 82 (50.9%) respectively. One hundred and sixteen (72%) of the respondents knew an apparently healthy person could be living with HIV. Majority of the respondents 125 (77.6%) were aware that HIV can coexist with pregnancy and 120 (74.5%) were aware of MTCT of HIV. Vaginal delivery and breastfeeding were identified as routes of HIV transmission by 44 (27.3%) and 53 (32.9%) of respondents respectively. Delivery by caesarean section was identified as a method of prevention of MTCT by 25 (15.5%) respondents while as many as 48 (29.8%) respondents did not know any method of prevention of MTCT of HIV. Conclusion: This study demonstrates a low level of awareness of methods of prevention of MTCT of HIV among pregnant women booking for antenatal care in our center. Thus, there is the need for adequate counseling about HIV/AIDS and specific aspects of prevention of mother-to-child transmission in our antenatal clinics.

Examine a dynamic of mother-to-child transmission of HIV in the population-based surveys

The main source of HIV infection in young children is of their mothers, during pregnancy, labor and delivery, or by breastfeeding. The rate of HIV transmission from infected mothers to their newborn children varies from 15% to 40% with one-thirds of these infections was through breastfeeding. This paper examines cross-sectional population-based survey data of HIV test results among mothers and their children in Uganda, Swaziland to estimates of mother-to- child transmission (MTCT) rate of HIV infection. The prevalence of HIV among women aged 15 - 49 who gave birth in the past 5 years in Uganda is 7.3%, and in Swaziland is 37.9%. The HIV prevalence of children who mothers were HIV positive were very similar: 10.3% in Uganda and 11.5% in Swaziland. This association represents the crude rate of MTCT in these two countries at the time of the survey. Presence of HIV antibody in early age (0 - 11 months) is due to both true infection and passive antibody from mothers. The seroconversion dropped nearly half in the second year of age which was likely that many of these children died before reaching the age of 12 - 23 months and passive antibody were gradually cleared at this point. This analysis demonstrated that cross-sectional data can be used to estimate indirectly the magnitude and dynamic of MTCT.

Prevention of Mother-to-Child Transmission of HIV: Experience of a Level 2 Health Center in Senegal

The elimination of vertical transmission of HIV from mother to child is a major global goal. In Senegal, the transmission rate was estimated at 3.2% in 2017. To reduce or even eliminate this transmission, Senegal has implemented various strategies and programs adopted and applied nationally. Thus access to services for the prevention of mother-to-child transmission of HIV has been extended to the level of the health post (the lowest level of the country’s health pyramid) with a delegation of tasks to paramedical staff (nurse, midwife) in the diagnosis and therapeutic management. Objectives: To describe the epidemiological profile of HIV (Human Immunodeficiency Virus)-positive mothers, to assess the care of children born to HIV-positive mothers, to determine the rate of HIV transmission from mother to child. Patients and Method: We carried out a retrospective, cross-sectional and descriptive study of all live newborns of HIV-positive mothers who gave birth at the Gaspard Kamara Health Center (a level 2 health center in Dakar, Senegal) between January 1, 2015 and December 31, 2018. The data were collected from prevention of mother-to-child transmission (PMTCT) prenatal follow-up registers and files, delivery files and registers, and neonatology and pediatric follow-up files, and exploited using the Epi info 7 software. Results: There were 98 children of seropositive mothers. The epidemiological profile of the HIV-positive woman was that of a young woman aged between 16 and 43 with an average of 31.31 years, pauciparous (>65% of cases) from Dakar center (>75% of cases), housewife with a low socio-economic level (63.1% of cases), married in almost all cases, with HIV profile (in almost all cases) and diagnosed before pregnancy (51.02%). The analysis of the children’s data revealed a predominance of girls (52.04%) with a good birth weight (2964g on average) and a pregnancy carried to term in more than 95% of cases. ARV prophylaxis was almost entirely respected with triple therapy (AZT + 3TC + NVP) in a fixed combination as protocol. Protected breastfeeding (80.21%), including 6 months of exclusive protected breastfeeding, was the rule for the mode of feeding. Three children were diagnosed positive with PCR1 as with serology (3.06%). Discussion and Conclusion: the initiatives and strategies put in place in Senegal have enabled a significant reduction in mother-to-child transmission of HIV and deserve to be supported by insisting on primary prevention, programming and good follow-up of pregnancies, and a good support for HIV-positive women.

Mother-to-Child HIV Transmission Factors in Exposed Children at University Hospital Center of Treichville (Abidjan, Cote d’Ivoire)

Background: The elimination of HIV transmission from mother to child is currently possible. Cote d’Ivoire, which has a 4.6% HIV prevalence among women, is one of 22 pilot countries for the elimination of mother-to-child transmission of HIV. Since 2015, Cote d’Ivoire has adopted new strategies according to the WHO B+ guidelines. Objective: To identify factors associated with mother-to-child HIV transmission in children born of seropositive mothers managed at Treichville university hospital. Material and methods: A case-control study was conducted in the obstetrics department at Treichville university hospital, between January 2013 and December 2015. It involved children born to mothers infected with HIV, whose first PCR (Polymerase Chain Reaction) result was available during this period. A standardized questionnaire on data related to exposed children and their mother was used. Factors associated with mother-to-child HIV transmission were investigated using logistic regression. Results: A total of 214 HIV-exposed children were included in the study with a sex ratio of 0.9. The majority of the children were born by vaginal route (52.8%) and received post-exposure prophylaxis (88.3%) and replacement feed (51.9%). Their mothers received antiretroviral therapy during pregnancy in 45.3% of the cases. The first PCR was performed at the sixth week of life in 52.3% of cases. The prevalence of HIV infection in exposed children was 7.5% (95% CI = 4.5% - 11.8%). In multivariate analysis, the absence of antiretroviral prophylaxis in children [aOR = 4.3, 95% (1.2 to 15.6), p = 0.03], the mixed feed [aOR = 3.8, 95% (1.1 - 13.1), p < 0.03], the failure to take antiretroviral regimen during pregnancy [aOR = 8.0, 95% CI (1.9 - 32.4), p < 0.003], were associated with mother-child HIV transmission. Conclusion: The mother-to-child HIV transmission rate remains high in our practice. Strategies to reduce situations that do not comply with current recommendations should be considered to prevent mother-to-child HIV transmission.

Mother-to-Child Transmission of HIV/AIDS during Pregnancy and Delivery and Associated Factors in the Region of Couffo in Benin

Evaluation of the effectiveness of the mother-to-child HIV Prevention Program, in Benin in 2016 reported a national rate of 6.7%. The Region of Couffo, within 12 Regions (departments) in the country, had the highest rate of transmission, which was 16.1%. The study aimed to determine transmission rate during pregnancy and delivery as well as the factors associated with it. This is a retrospective and analytical study based on a sample of seventy (70) babies born to HIV-infected mothers in 2016 in Couffo. Key findings showed, there is a perinatal transmission of five percent (5%) and the factors associated with this transmission are: delay in carrying out first antenatal visits at the health facility, low frequency of visits performed versus number requested and appropriate time, poor health condition of mothers during pregnancy, absence or late start of antiretroviral care and treatment during pregnancy, irregular intake of intermittent presumptive treatment at sulfadoxine-pyrimethamine to prevent malaria, a short antiretroviral therapy (less than three months) for mothers before delivery and the default in cleaning mother’s genital tract with betadine after the woman’s water broke.

Missed Prevention of Mother-to-Child Transmission of HIV (PMTCT) Visits and Associated Programmatic Predictors: A Pilot Study

Missed Prevention of Mother-to-Child Transmission of HIV (PMTCT) visits have contributed to the delayed achievement of elimination of mother-to-child transmission of HIV. Missed visits promote attrition from prevention of mother-to-child transmission of HIV program and antiretroviral drug resistance. The purpose of the study was to determine the prevalence of missed PMTCT visits and its associated predictors. A descriptive cross sectional survey was carried out at a District Hospital in Goromonzi, Zimbabwe. Fifty-three women completed closed-ended questionnaires pertaining to PMTCT visits and exposure to PMTCT activities. A total of 24.5% missed at least one scheduled PMTCT visit. Statistically significant predictors of not missing a PMTCT visit were satisfaction with family support (β = &minus;0.73, p = 0.029) and level of satisfaction with PMTCT services (β = &minus;0.00076;p = 0.04). The number of days by which scheduled visits were missed were inversely correlated with visit number (β = &minus;2.99, p = 0.04). Enhanced family support and quality improvement to improve patient satisfaction may reduce missed visits. Availing women with a more active role in PMTCT may also reduce the prevalence of missed visits.

Status Report on the Elimination of Mother-to-Child Transmission (EMCT) of HIV at the Pikine National Hospital Center (CHNP), Dakar/Senegal

Introduction: For several years, the fight against the human immunodeficiency virus (HIV) has been a major public health issue in Africa. Since 2012, Senegal has adopted WHO option B+, consisting of systematic triple therapy for HIV-positive pregnant women, combined with breastfeeding and antiretroviral (ARV) prophylaxis for exposed newborns. It is in this dynamic that we set ourselves the objectives of evaluating the rate of transmission of HIV from mother to child and taking stock of the monitoring of children born to HIV-positive mothers at the Pediatric Department of the CHN of Pikine located in the Dakar suburbs. Methodology: Thus, we conducted a descriptive and analytical cross-sectional cohort follow-up study from 11/25/2014 to 03/09/2022 including all children born to HIV-positive mothers followed at the Pikine CHN since the start of care. Results: We had collected 51 children exposed to HIV and followed in our structure. They were exposed to HIV1 in 92% of cases. The HIV status of the mothers was known before pregnancy in more than half of the cases. The couples were serodiscordant in 56% of cases. The mothers were in clinical stage 1 of the disease in 69.6% of cases and were already under treatment in 47% of cases. The most used treatment regimen was ATRIPLA with Tenofovir (TDF) + Emtracitabine (FTC) + Efavirenz (EFV) in 59% of cases. Compliance was good in the majority of cases. The CD4 count during pregnancy was low in 10.6% of cases. The pregnancy was well followed in only 36.2% of cases. The mothers had given birth in our structure in 91.4% of cases. The vaginal route was found in 72.5% of cases and delivery was carried out by a midwife in 69.4% of cases. The average birth weight was 2733 ± 564. The majority of newborns had received antiretroviral (ARV) prophylaxis after birth, half of them between 12 and 24 hours. The most used therapeutic protocol was Zidovudine (AZT) + Lamivudine (3TC) + Lopinavir/Ritonavir (LPV/r). Protected breastfeeding was the option chosen in 76.8% of cases. The PCR performed at 6 weeks was negative in more than half of the cases. Retroviral serology was carried out after 14 months in 43% of cases. We noted a single positive case with a negative initial PCR, representing an overall transmission rate of 1.96%. Conclusion: Senegal’s current policy targeting EMTCT of HIV is on good momentum with a fairly low transmission rate thanks to screening of pregnant women and prophylaxis with antiretrovirals (ARV) for HIV-positive mothers during pregnancy and for life. And children exposed from birth and during breastfeeding up to 6 weeks with regular monitoring.

Experiences of Mothers on the Utilization of Elimination of Mother to Child Transmission of HIV Services at Mtendere Clinic, Lusaka

Introduction: Acquired immunodeficiency syndrome is one of the leading causes of mortality among women of reproductive age and Mother to Child Transmission of Human immunodeficiency virus is still a challenge affecting many countries. Globally, an estimation of 180,000 children under 15 years acquire the Human immunodeficiency virus every day, and more than 90% of those infections are due to Mother to Child Transmission. The study sought to explore the experiences of mothers on the Elimination of Mother to Child Transmission-HIV services at Mtendere Clinic, Lusaka. Materials and Methods: Qualitative interpretive phenomenology study design was employed using in-depth interviews to collect data from a sample that was selected using purposive sampling technique. Thirteen participants were recruited, and these were HIV-positive mothers at least between the ages of 15 and 49 years and enrolled in the Elimination of Mother To Child Transmission-HIV program. The in-depth interviews were audiotape recorded and transcribed verbatim. Data was analyzed using thematic method. Findings: Three main themes that emerged are;living with HIV, support system and barriers to utilization of Elimination of Mother To Child Transmission-HIV services. Most of the participants expressed having acquired knowledge from the program, and received counselling and support from spouses, family as well as health personnel at Mtendere health facility which culminated into a positive experience and enhanced their uptake of the Elimination of Mother to Child Transmission-HIV services. However, barriers to service utilization were identified and these included fear of stigma, negative attitudes from health workers, long waiting times, lack of support and lack of transport to the health facility. Conclusion: Interventions such as community awareness campaigns on Elimination of Mother To Child Transmission-HIV, male involvement and implementing mother-to-mother peer support strategies in Elimination of Mother To Child Transmission-HIV service utilization should be prioritized so as to alleviate stigma and enhancing a positive experience for these mothers thus reducing on the Mother to Child HIV Transmission burden and mortality rates.

Exploring the impact of hepatitis B immunoglobulin and antiviral interventions to reduce vertical transmission of hepatitis B virus

Hepatitis B virus(HBV)infection is a major public health burden.In HBV endemic regions,high prevalence is also correlated with the infections acquired in infancy through perinatal transmission or early childhood exposure to HBV,the socalled mother-to-child transmission(MTCT).Children who are infected with HBV at a young age are at higher risk of developing chronic HBV infection than those infected as adults,which may lead to worse clinical outcome.To reduce the incidence of HBV MTCT,several interventions for the infants or the mothers,or both,are already carried out.This review explores the newest information and approaches available in literature regarding HBV MTCT prevalence and its challenges,especially in high HBV endemic countries.This covers HBV screening in pregnant women,prenatal intervention,infant immunoprophylaxis,and postvaccination serological testing for children.

Chronic hepatitis B in pregnant women: Current trends and approaches

Chronic hepatitis B(CHB)is a significant public health problem worldwide.The aim of the present review is to summarize the actual trends in the management of CHB in pregnant women.The prevalence of hepatitis B virus(HBV)infection in pregnant women is usually comparable to that in the general population in the corresponding geographic area.All women have to be screened for hepatitis B surface antigen(HBsAg)during pregnancy.Additional examinations of pregnant women with CHB may include maternal hepatitis B e antigen,HBV viral load,alanine aminotransferase level,and HBsAg level.The management of pregnancy depends on the phase of the HBV infection,which has to be determined before pregnancy.In women of childbearing age with CHB,antiviral therapy can pursue two main goals:Treatment of active CHB,and vertical transmission prevention.During pregnancy,tenofovir is the drug of choice in both cases.A combination of hepatitis B immunoglobulin and vaccine against hepatitis B should be administered within the first 12 h to all infants born to mothers with CHB.In such cases,there are no contraindications to breastfeeding.

Comprehensive review of telbivudine in pregnant women with chronic hepatitis B

AIM:To achieve an evidence-based conclusion regarding the safety and efficacy of telbivudine during pregnancy.METHODS:A pooled analysis of data from a literature search reported 1739 pregnancy outcomes(1673 live births)from 1725 non-overlapping pregnant women treated with telbivudine.The prevalence of live birth defects(3.6/1000)was similar to that of the nonantiviral controls(3.0/1000)and not increased as compared with overall prevalence(14.5 to 60/1000).No target organ toxicity was identified.The prevalence of spontaneous abortion in pregnant women treated with telbivudine(4.2/1000)was not increased compared with the overall prevalence(16/1000).The mother-to-child transmission rate was significantly reduced in pregnant women treated with telbivudine(0.70%)compared to those treated with the non-antiviral controls(11.9%;P<0.0001)or compared to the historical rates of hepatitis B virus(HBV)-infected population without antiviral treatment(10%-15%).RESULTS:Cumulatively 489 pregnancy cases have been reported in the telbivudine pharmacovigilance database(with a cut-off date 31 August 2014),of those,308 had known pregnancy outcomes with 249 cases of live births(239 cases of live birth without congenital anomaly and 10 cases of live birth with congenital anomaly).In the latest antiretroviral pregnancy registry report(1 January 1989 through 31 January 2015)of27 patients exposed to telbivudine during pregnancy(18,6 and 3 during first,second and third trimester,respectively)19 live births were reported and there were no cases of birth defects reported.CONCLUSION:Telbivudine treatment during pregnancy presents a favorable safety profile without increased rates of live birth defects,spontaneous abortion or elective termination,or fetal/neonatal toxicity.Exposure to telbivudine in the first,second and third trimester of pregnancy has been shown to significantly reduce the risk of HBV transmission from mother to child on the basis of standard immune prophylaxis procedure.

Management of chronic hepatitis B in pregnancy

Pregnancy associated with chronic hepatitis B (CHB) is a common and important problem with unique challenges. Pregnant women infected with CHB are different from the general population, and their special problems need to be considered: such as the effect of hepatitis B virus (HBV) infection on the mother and fetus, the effect of pregnancy on replication of the HBV, whether mothers should take HBV antiviral therapy during pregnancy, the effect of these treatments on the mother and fetus, how to carry out immunization of neonates, whether it can induce hepatitis activity after delivery and other serious issues. At present, there are about 350 million individuals with HBV infection worldwide, of which 50% were infected during the perinatal or neonatal period, especially in HBV-endemic countries. Currently, the rate of HBV infection in thechild-bearing age group is still at a high level, and the infection rate is as high as 8.16%. Effective prevention of mother-to-child transmission is an important means of reducing the global burden of chronic HBV infection. Even after adopting the combined immunization measures, there are still 5%-10% of babies born with HBV infection in hepatitis B e antigen positive pregnant women. As HBV perinatal transmission is the main cause of chronic HBV infection, we must consider how to prevent this transmission to reduce the burden of HBV infection. In this population of chronic HBV infected women of childbearing age, specific detection, intervention and follow-up measures are particularly worthy of attention and discussion.

Effects of Antiretroviral Therapy and HIV Exposure in Utero on Adverse Pregnancy and Infant Outcomes:A Prospective Cohort Study in Guangzhou, China

Objective This study aimed to evaluate the effects of in-utero exposure to HIV and ART on pregnancy outcome and early growth of children.Methods This cohort study enrolled 802 HIV-infected pregnant women between October 2009 and May 2018 in Guangzhou, China. The women were assigned to receive combination ART(c ART) or mono/dual ART or no treatment. The primary outcomes were the combined endpoints of any adverse pregnancy outcome [including ectopic pregnancy, spontaneous abortion, stillbirth, preterm birth, small for gestational age(SGA)] and adverse early growth outcome(including infant death, HIV infection of mother-to-child transmission, and underweight, wasting and stunting of infants at 4 weeks of age).Results Adverse pregnancy outcomes occurred in 202(35.1%) of all enrolled HIV-infected women, and121(31.3%) of all infants exhibited adverse effects on early growth at 4 weeks of age. The rates of adverse pregnancy outcomes, spontaneous abortion, ectopic pregnancy, stillbirth, infant death and perinatal HIV infection were higher among women not receiving ART, compared to those treated with c ART or mono/dual ART(P < 0.05). However, women treated with c ART had a higher rate of SGA,compared to untreated women(P < 0.05). No differences in early infant growth were observed among the different treatment regimens.Conclusion Our findings underscore the essentiality of prioritizing HIV-positive pregnant women for ART, as even mono/dual ART available in resource-limited countries could improve pregnancy outcomes and infant survival.

Association of vitamin D and polymorphisms of its receptor with antiviral therapy in pregnant women with hepatitis B

BACKGROUND The interruption of mother-to-child transmission(MTCT)is considered important to decrease the individual and population morbidity of hepatitis B virus(HBV)infection as well as the global burden of hepatitis B.Serum vitamin D(VD)is associated with hepatitis B.AIM To assess whether baseline VD levels and single nucleotide polymorphisms of the VD receptor gene(VDR SNPs)are associated with the efficacy of tenofovir disoproxil fumarate(TDF)in the prevention of MTCT in pregnant women with high HBV viral loads.METHODS Thirty-eight pregnant women who were at high risk for MTCT of HBV(those with an HBV DNA level≥2×10^(5)IU/mL during 12-24 wk of gestation)receiving antiviral therapy of TDF between June 1,2019 and June 30,2021 in Mianyang were included in this retrospective study.The women received 300 mg TDF once daily from gestational weeks 24-28 until 3 mo after delivery.To further characterize the clinical relevance of maternal serum HBV DNA levels,we stratified patients according to HBV DNA level as follows:Those with levels<2×10_(5)(full responder group)vs those levels≥2×10^(5)IU/mL(partial responder group)at delivery.Serum levels of 25-hydroxyvitamin D[25(OH)D],liver function markers,virological parameters,VDR SNPs and other clinical parameters were collected to analyze their association with the efficacy of TDF.The Mann-Whitney U test or t test was used to analyze the serum levels of 25(OH)D in different groups.Multiple linear regressions were utilized to analyze the determinants of the maternal HBV DNA level at delivery.Univariate and multivariate logistic regression analyses were employed to explore the association of targeted antiviral effects with various characteristics at baseline and delivery.RESULTS A total of 38 pregnant women in Mianyang City at high risk for MTCT of HBV were enrolled in the study.The MTCT rate was 0%.No mother achieved hepatitis B e antigen or hepatitis B surface antigen(HBsAg)clearance at delivery.Twenty-three(60.5%)participants were full responders,and 15(39.5%)participants were partial responders according to antiviral efficacy.The present study showed that a high percentage(76.3%)of pregnant women with high HBV viral loads had deficient(<20 ng/mL)or insufficient(≥20 but<31 ng/mL)VD levels.Serum 25(OH)D levels in partial responders appeared to be significantly lower than those in full responders both at baseline(25.44±9.42 vs 17.66±5.34 ng/mL,P=0.006)and delivery(26.76±8.59 vs 21.24±6.88 ng/mL,P=0.044).Serum 25(OH)D levels were negatively correlated with maternal HBV DNA levels[log(10)IU/mL]at delivery after TDF therapy(r=-0.345,P=0.034).In a multiple linear regression analysis,maternal HBV DNA levels were associated with baseline maternal serum 25(OH)D levels(P<0.0001,β=-0.446),BMI(P=0.03,β=-0.245),baseline maternal log10 HBsAg levels(P=0.05,β=0.285)and cholesterol levels at delivery(P=0.015,β=0.341).Multivariate logistic regression analysis showed that baseline serum 25(OH)D levels(OR=1.23,95%CI:1.04-1.44),maternal VDR Cdx2 TT(OR=0.09,95%CI:0.01-0.88)and cholesterol levels at delivery(OR=0.39,95%CI:0.17-0.87)were associated with targeted antiviral effects(maternal HBV DNA levels<2×10^(5) at delivery).CONCLUSION Maternal VD levels and VDR SNPs may be associated with the efficacy of antiviral therapy in pregnant women with high HBV viral loads.Future studies to evaluate the therapeutic value of VD and its analogs in reducing the MTCT of HBV may be justified.

One-Year Outcomes of Women Started on Antiretroviral Therapy during Pregnancy before and after the Implementation of Option B+ in Malawi: A Retrospective Chart Review from Three Facilities

Objective: To compare one-year outcomes of women started on antiretroviral therapy (ART) during?pregnancy in the pre-Option B+ era to those in the Option B+ era. Methods: A retrospective chart review was performed at three sites in Malawi. Women were included in the “pre-Option B+” cohort if they started ART during pregnancy for a CD4 count 3?or WHO 3/4 condition and in the “Option B+” cohort if they started ART during pregnancy regardless of CD4 count or clinical stage. One-year outcomes were compared using Fisher’s exact and ANOVA F-tests. Results: A higher proportion of women in the pre-Option B+ cohort started ART at WHO stage 3/4 (11.9% versus 1.1%, P < 0.001), switched ART regimens (5.9% versus 0%, P = 0.002), or died in the first year after starting treatment (3.9% versus 0.5%, P = 0.05). While more women in the Option B+ cohort had poor adherence or defaulted, these differences were not significant. Conclusions: At our study sites, the transition to Option B+ has been associated with ART initiation in women with less advanced HIV infection, improved medication tolerability, and lower mortality. Further research is needed to better understand outcomes of Option B+.

215例母体乙型肝炎病毒阳性新生儿母婴阻断效果分析

目的:探讨母体乙型肝炎病毒阳性新生儿母婴阻断效果。方法:收集2021年1—12月于金城江区医疗机构内分娩的215例乙肝阳性孕产妇及其新生儿的个案登记卡、河池市金城江区妇幼保健院随访提供的乙型肝炎病毒(HBV)感染产妇所生婴儿的随访卡进行回顾性分析,检测接受规范母婴阻断措施后体内产生乙肝表面抗原和抗体情况,评价母婴阻断效果。结果:215例孕妇中,大三阳58例,占26.97%;小三阳101例,占46.97%;表抗阳性56例,占26.04%。新生儿出生后均在12 h内接种乙肝疫苗和乙肝免疫球蛋白,1 h内及时接种占77.2%,HBV感染率为0。婴儿产生抗体阳性(抗-HBs≥10 mIU/mL)200例,占93.02%;大三阳产生有效抗体率75.86%,小三阳产生有效抗体率为87.13%,表抗阳性产生有效抗体率为85.71%。孕期接受HBV-DNA检测133例,检测率61.86%;其中产时检测39例,占29.32%;HBV-DNA≥2×10^(5)IU/mL 24例,其中接受抗病毒治疗6例。结论:产生有效乙肝表面抗体率与孕妇乙肝病毒载量有关,应加强孕前孕期乙肝母婴传播相关知识宣传,对大三阳孕妇,尤其是HBV-DNA≥2×105IU/mL孕妇进行规范管理及抗病毒治疗,建立产科与感染传染科等多学科联合诊治机制,提高母婴阻断效果。