Research
Special Issue on PrEP in the US - American Journal of Preventive Medicine
The American Journal of Preventive Medicine published a special issue on PrEP in the United States. Articles in the supplement focus on implementation of pre-exposure prophylaxis (PrEP), lessons learned from implementation of post-exposure prophylaxis (PEP), and adherence, among others.…
HIV Screening by OB-GYNs - What Influences It?
Researchers surveyed ACOG Fellows to determine rates of HIV testing among patient populations. Respondents reported almost universal levels of recommendation of HIV testing to pregnant women, however low levels of repeat third trimester recommendations. Practitioners were less influenced by local…
Ruptured Membranes and Perinatal HIV Transmission Risk
A prospective study showed that perinatal HIV transmission rates were slightly higher in women who had ruptured membranes for four hours or more (1.9% versus 1% in women with less than 4 hours of rupture). Of the women in the cohort with viral loads less than 1000 copies/mL at delivery, there were…
Success of Perinatal Rapid HIV Testing in Illinois
Implementation of the Perinatal Rapid Testing Implementation Initiative in Illinois (PRTII) has contributed to significant and sustained decreases in the number of women and infants being discharged after delivery with an unknown HIV status. Between 2005 and 2011, Illinois saw a 63% decrease in…
Adolescent HIV Infection and Increased Perinatal Transmission
A review of HIV-positive infants at an urban referral center documented four cases of perinatal transmission where the mother was an adolescent who tested HIV-negative during pregnancy. These cases provide support for repeat third trimester HIV testing, especially in adolescents.
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A Framework to Eliminate HIV MTCT
In the current issue of Pediatrics, the CDC describes in detail its framework for elimination of perinatal HIV in the United States. The CDC presents a model by which elimination efforts can be coordinated, beginning with comprehensive reproductive health care and real-time case finding of…
Coping of African-American Women Living with HIV
The authors extensively interviewed 30 African American women to determine how they moved forward from their HIV diagnosis and learned to live with the disease. They found that various non-profits assisted in the shift of their belief of HIV as a death sentence. Citation: Watkins-Hayes C,…
Seroconversion During Pregnancy and Perinatal Transmission
Researchers at the CDC found an eight-fold increase in perinatal transmission of HIV in those women that seroconverted during pregnancy compared to those that seroconverted prior to pregnancy. This statistic strengthens the case for early HIV testing during pregnancy and repeat third trimester…
Non-Disclosure of HIV Status to Partner and Prevention of Perinatal HIV
The French Perinatal Cohort study found that while non-disclosure of HIV status to the male partner was associated with late initiation of ART, detectable viral load at delivery and lack of infant treatment, overall rates of perinatal transmission were not different between women who did not…
Artificial Reproduction Techniques for Conception in Serodiscordant Couples
Serodiscordant couples in which the infected partner is the male have been successful in utilizing sperm washing in combination with other techniques such as intrauterine insemination (IUI) to reduce the risk of HIV transmission to the female partner during conception. A detailed literature review…
ART Use Can Prevent HIV Transmission to Uninfected Partner
NIAID study HPTN 052 released early results due to overwhelming success in prevention of HIV transmission among serodiscordant couples. Those HIV-infected individuals that started ART immediately were overwhelmingly more likely to not transmit HIV to the uninfected partner than those individuals…
Why Women Decline Rapid HIV Test at Delivery
Women with an undocumented HIV status at time of labor who declined a rapid HIV test via informed consent were more likely to have had prenatal care than those who consented. This declination may result from a prior offer of HIV testing during routine prenatal care or discussions via informed…
PrEP to Prevent HIV During Conception
Pre-exposure prophylaxis (PrEP) should be considered as an option for serodiscordant couples wishing to conceive since most other options (sperm washing and artifical insemination for example) are not viable options for most couples. Especially in countries where HIV is endemic, the use of PrEP to…
Recent HIV Infection Associated with In-Utero HIV Transmission
Using mathematical modeling, women in Malawi who were determined to be recently infected with HIV were almost three times as likely to see in-utero HIV transmission than those who had been infected for longer periods of time. Transmission rates were 17.8% for recently infected women and 6.7% for…
Case Studies Supporting Third Trimester HIV Screening
This article presents three case studies in which women had negative HIV tests during regular first trimester screening but were later diagnosed as HIV-positive after delivery. Two of the three infants were also HIV-positive. As all three women were not considered to be high-risk for HIV…
Cost-Effectiveness of Directly Observed Therapy for Perinatal HIV Prevention
Researchers used mathematical modeling to analyze the effect of women on self-administered HAART versus HAART using directly observed therapy (DOT) versus no HAART on quality of life of their infants. DOT was overall highly cost-effective in reducing mother-to-child transmission. Especially…
New Estimates of Number of Infants Born to HIV-Infected Women
New data on the number of HIV-exposed infants born in the U.S. estimates 9,000 infants were born in 2006. This is an increase of up to 30% as compared to the estimate of infants born in 2000. The authors suggest this increase is likely reflective of an overall increase in the number of women…
Estimated Number of HIV-Exposed Infants Born in US
This study aimed to estimate the number of infants born to HIV-infected women in the U.S. and its dependencies in 2006. The estimated number of births in 2006 to all women living with HIV (diagnosed or undiagnosed) was 8,700. This number is approximately 30% greater than the number of such births…
Promising Results for Preventing HIV MTCT in Resource-Limited Settings
Two recent studies published in the New England Journal of Medicine and summarized here in Obstetrical and Gynecological Survey, describe promising approaches to reducing HIV MTCT in the developing world. The first study conducted at antenatal clinics in Malawi examined the efficacy of a…
A Comprehensive Approach to Preventing MTCT of HIV
The Journal of Public Health Management Practice features a recent issue with articles from the New York State Department of Health describing the programs and policies that have led to a significant reduction in perinatal transmission of HIV in that state. See below to access a selection of…
Missed Opportunities in Perinatal HIV Prevention
The Enhanced Perinatal Surveillance (EPS) data collected in 10 states and 5 cities from 2005-2008 showed a number of missed opportunities for prevention of transmission of HIV from mom to baby. Overall, 60% of women did not receive all the recommended interventions to prevent transmission. These…
Risk Factors for Detectable HIV-1 RNA at Delivery
In the United States, more than 6000 women with HIV become pregnant each year. Numerous interventions have been put into place which can decrease the risk of newborn HIV infection to less than one percent for many patients. The Women and Infants Transmission Study (WITS) previously published data…
Opt-Out HIV Testing in EDs - Effective?
Diagnostic HIV testing was compared to nontargeted opt-out rapid HIV testing in an emergency department. Approximately 75% of ED patients declined HIV testing when offered. Of those identified to have a new HIV diagnosis, slightly more were identified through opt-out testing. A majority of…
Factors Associated with Declining a Rapid HIV Test
A secondary analysis of data from the Mother-Infant Rapid Intervention at Delivery (MIRIAD) study found that decliners of rapid HIV testing in labor and delivery were more likely to have received prenatal care. Testing in labor and delivery was seen as redundant, although in some cases women may…
Factors Associated with Prenatal Care Among Women in MIRIAD Study
Prenatal care allows not only for the opportunity to provide obstetrical care to women during pregnancy, but also to screen women at risk for other health conditions or complications of pregnancy, and identify medical and psychological risk factors. This study sought to evaluate factors associated…