2013

3

Jul, 2013

HCV treatment in children and young adults with HIV/HCV co-infection in Europe

 

Authors: A Turkova, C Thorne, L Galli, T Goetghebuer, M de Martino, C Oprea, JT Ramos Amador, C Giaquinto for the European Pregnancy and Paediatric HIV Cohort Collaboration in EuroCoord.

Published in: 7th International AIDS Society Conference (IAS 2013), Kuala Lumpur, 30 June – 3 July 2013

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3

Jul, 2013

Missed opportunities for prevention of hepatitis B infection in childbearing women with HIV in Ukraine

 

Authors: C Thorne, H Bailey, I Semenenko, R Tereschenko, I Adeyanova, E Kulakovskaya, L Ostrovskaya, R Malyuta.

Published in: 7th International AIDS Society Conference (IAS 2013), Kuala Lumpur, 30 June – 3 July 2013

18

Apr, 2013

Prevalence of depressive symptoms in pregnant and postnatal HIV-positive women in Ukraine: a cross-sectional survey

 

Authors: Bailey H, Malyuta R, Townsend C, Cortina Borja M, Thorne C for the Ukraine European Collaborative Study in EuroCoord.

Published in: Reprod Health. 2016;22(3):13-27.

Background Perinatal depression among HIV-positive women has negative implications for HIV-related and other maternal and infant outcomes. The aim of this study was to investigate the burden and correlates of perinatal depression among HIV-positive women in Ukraine, a lower middle income country with one of the largest HIV-positive populations in Europe.

Methods Cross-sectional surveys nested within the Ukraine European Collaborative Study were conducted of HIV-positive women at delivery and between 1 and 12 months postpartum. Depressive symptoms in the previous month were assessed using a self-report screening tool. Other data collected included demographics, antiretroviral therapy (ART)-related self-efficacy, and perceptions of risks/benefits of interventions to prevent mother-to-child transmission (PMTCT). Characteristics of women with and without a positive depression screening test result were compared using Fisher’s exact test and χ2 test for categorical variables.

Results A quarter (27% (49/180) antenatally and 25% (57/228) postnatally) of participants screened positive for depressive symptoms. Antenatal risk factors were living alone (58% (7/12) vs. 25% (42/167) p = 0.02), being somewhat/terribly bothered by ART side effects (40% (17/43) vs. 23% (30/129) not /only slightly bothered, p = 0.05) and having lower ART-related self-efficacy (43% (12/28) vs. 23% (25/110) with higher self-efficacy, p = 0.05). Postnatally, single mothers were more likely to screen positive (44% (20/45) vs. 21% (18/84) of cohabiting and 19% (19/99) of married women, p < 0.01) as were those unsure of the effectiveness of neonatal prophylaxis (40% (20/45) vs. 18% (28/154) sure of effectiveness, p < 0.01), those worried that neonatal prophylaxis could harm the baby (30% (44/146) vs. 14% (10/73) not worried p < 0.01) and those not confident to ask for help with taking ART (48% (11/23) vs. 27% (10/37) fairly confident and 15 % (4/26) confident that they could do this). Of women who reported wanting help for their depressive symptoms, 82% (37/45) postnatally but only 31% (12/39) antenatally were already accessing peer counselling, treatment adherence programmes, support groups or social services.

Conclusions A quarter of women screened positive for depression. Results highlight the need for proactive strategies to identify depressive symptoms, and an unmet need for provision of mental health support in the perinatal period for HIV-positive women in Ukraine.

 

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18

Apr, 2013

Vaginal delivery as an option for HIV-infected women: decreasing late preterm delivery rates in a European cohort collaboration.

 

Authors: Aebi-Popp K, Mulcahy F, Glass T, Rudin C, Martinez de Tejada B, Bertisch B, Grawe C, Rickenbach M, Scheibner K, Hösli I and Thorne C  for the European Collaborative Study in EuroCoord and the Swiss Mother & Child HIV Cohort Study.

Published in: 5th International HIV Pediatrics Workshop, Kuala Lumpur, 28-29 June 2013.

 

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18

Apr, 2013

Missed Opportunities Among HIV-Positive Women to Control Viral Replication During Pregnancy and to Have a Vaginal Delivery

 

Authors: Aebi-Popp K, Mulcahy F, Glass TR, et al.; for the European Collaborative Study in EuroCoord and the Swiss Mother & Child HIV Cohort Study.

Published in: J Acquir Immune Defic Syndr. 2013;64(1):58-65

Introduction Most national guidelines for the prevention of mother-to-child transmission of HIV in Europe updated between 2001 and 2010 recommend vaginal deliveries for women with undetectable or very low viral load (VL). Our aim was to explore the impact of these new guidelines on the rates of vaginal deliveries among HIV-positive women in Europe.

Methods In a pooled analysis of data on HIV-positive pregnant women enrolled in the Swiss Mother & Child HIV Cohort Study and the European Collaborative Study 2000 to 2010, deliveries were classified as occurring pre- or postpublication of national guidelines recommending vaginal delivery.

Results Overall, 2663 women with 3013 deliveries were included from 10 countries; 28% women were diagnosed with HIV during pregnancy. Combination antiretroviral therapy was used in most pregnancies (2020, 73%), starting during the first or second trimester in 78% and during the third trimester in 22%; in 25% pregnancies, the woman conceived on combination antiretroviral therapy. Overall, in 86% pregnancies, a VL < 400 copies per milliliter was achieved before delivery. The proportion of vaginal deliveries increased from 17% (414/2377) before the change in guidelines to 52% (313/600) after; elective Caesarean section rates decreased from 65% to 27%. The proportion of women with undetectable VL having a Caesarean section was 55% after implementation of new guidelines. We observed a decrease of late preterm deliveries from 16% (377/2354) before to 7% (42/599) after the change in guidelines (P < 0.001).

Conclusion There are still missed opportunities for women with HIV to fully suppress their VL and to deliver vaginally in Europe.

18

Apr, 2013

Improvements in virological control among women conceiving on cART in Western Europe

 

Authors: Bailey H, Townsend CL, Cortina-Borja M, Thorne C; for the European Collaborative Study in EuroCoord.

Published in: AIDS 2013; 27:2312-2315

Abstract Among 396 HIV-infected women conceiving on combination antiretroviral therapy and enrolled in the European Collaborative Study in 2000–2011, the proportion with virological failure (>200 copies/ml after ≥24 weeks of treatment) declined substantially from 34% in 2000–2001 to 3% in 2010–2011. In adjusted analyses, younger women and those with at least two children were at increased risk of virological failure, highlighting the importance of close monitoring and adherence support.

 

 

27

Mar, 2013

Use of combination neonatal prophylaxis for the prevention of mother-to-child transmission of HIV infection in European high-risk infants. 

 

Authors: Chiappini E, Galli L, Giaquinto C, et al. European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) study group in EuroCoord.

Published in: AIDS 2013; 27(6): 991-1000

Objectives To evaluate use of combination neonatal prophylaxis (CNP) in infants at high risk for mother-to-child transmission(MTCT) of HIV in Europe and investigate whether CNP is more effective in preventing MTCT than single drug neonatal prophylaxis (SNP).

Design Individual patient-data meta-analysis across eight observational studies.

Methods Factors associated with CNP receipt and with MTCT were explored by logistic regression using data from non-breastfed infants, born between 1996 and 2010 and at high risk for MTCT.

Results In 5285 mother-infant pairs, 1463 (27.7%) had no antenatal or intrapartum antiretroviral prophylaxis, 915 (17.3%) had only intrapartum prophylaxis and 2907 (55.0%) mothers had detectable delivery viral load despite receiving antenatal antiretroviral therapy. Any neonatal prophylaxis was administered to 4623 (87.5%) infants altogether; 1105 (23.9%) received CNP. Factors significantly associated with the receipt of CNP were later calendar birth year, no elective caesarean section, maternal CD4 cell count less than 200 cells/μl, maternal delivery viral load more than 1000 copies/ml, no antenatal antiretroviral therapy, receipt of intrapartum single-dose nevirapine and cohort. After adjustment, absence of neonatal prophylaxis was associated with higher risk of MTCT compared to neonatal prophylaxis [adjusted odds ratio (aOR) 2.29; 95% confidence interval (95% CI) 1.46-2.59; P < 0.0001]. Further, there was no association between CNP and MTCT compared to SNP (aOR 1.41; 95% CI 0.97-2.5; P = 0.07).

Conclusion In this European population, CNP use is increasing and associated with presence of MTCT risk factors. The finding of no observed difference in MTCT risk between one drug and CNP may reflect residual confounding or the fact that CNP may be effective only in a subgroup of infants rather than the whole population of high-risk infants.