| From: |
joya banerjee [ profile ] |
| Subject: |
FW: Pregnancy increases risk of HIV : Message from Melanie Pleaner
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| Sent: |
Aug 10th, 2011 - 05:14:53 |
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From: Susie Cornell [mailto:scornell (at) wrhi.ac.za]
Sent: Monday, August 08, 2011 10:35 AM
Please see article below, note the conclusion:
The authors underscore the public health importance of these new
findings showing pregnancy increases the risk of female-to-male
transmission two-fold. New strategies, they add, are needed to
strengthen family planning and maternal health services for women with
and at risk for HIV in order to reduce unwanted pregnancies and avert
HIV transmission to pregnant women and from pregnant women to their
infants and partners.
Regards
Mel
Melanie Pleaner
PLEASE SEND ANY COMMUNICATIONS TO REPLIES TO CONTRACEPTION EXPERT
MAILING GROUP TO mpleaner (at) mweb.co.za
________________________________
http://aidsmap.com/page/2033107/
Pregnancy doubled risk of female-to-male HIV transmission in Partners
in Prevention study
Carole Leach-Lemens
Published: 05 August 2011
Pregnancy increased the risks of female-to-male HIV transmission
two-fold among over 3300 serodiscordant couples from seven African
countries Nelly R Mugo and colleagues reported in a prospective study
published in the advance online edition of AIDS.
The risks of becoming infected with HIV during pregnancy increased at
the same rate. However, this was partly explained by other factors
including unprotected sex.
Women now account for 60% of HIV infections in adults in sub-Saharan
Africa. Many African countries with high HIV prevalence also have high
fertility rates and often women are pregnant for a considerable part
of their adult lives.
Pregnancy brings biological and behavioural changes that may make a
woman more susceptible to getting HIV as well as making her more
infectious, so increasing the risks of transmission.
To date limited prospective studies have found inconsistent results,
showing both an increased risk and no elevated risk of acquiring HIV
during pregnancy. However, evidence shows that women infected during
their pregnancy have a high rate of HIV transmission to their infants.
The authors note one study which showed increased HIV shedding in
genital secretions during pregnancy, suggesting increased
infectiousness, yet no prospective study has looked specifically at
pregnancy as a risk factor for female-to-male transmission.
The authors chose to look at the association between pregnancy and the
risks of getting HIV as well as the risks of transmitting HIV from
females-to-males in a secondary analysis of a prospective study of
African HIV sero-discordant couples.
From November 2004 to April 2007 3408 HIV serodiscordant couples from
Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda and Zambia
were enrolled in the Partners in Prevention HSV-2/HIV transmission
study, a randomised, placebo-controlled, clinical trial of aciclovir
as herpes simplex virus-2 (HSV-2) suppressive therapy for the
prevention of HIV transmission. Aciclovir did not decrease HIV
transmission risk within the couples.
Of the 3321 couples in the analysis about a third (1085) included an
HIV-infected male partner and the remaining two-thirds (2236) included
an HIV-infected female partner.
Eligibility included being over 18 years of age, having three or more
episodes of vaginal intercourse in the three months before screening
and having the intention of remaining a couple.
HIV infected partners were positive for HSV-2, had CD4 cell counts
over 250 cells/mm3 and were not taking antiretrovirals. HIV-infected
women pregnant at the screening were excluded from the study. Women
who became pregnant stopped the study medication until the end of
pregnancy. Pregnant HIV-uninfected women were included as were those
who became pregnant during follow-up.
HIV infected partners were seen monthly and HIV uninfected partners
were seen every three months. Sexual behaviour data including condom
use was recorded at each visit as was contraceptive use.
Comprehensive prevention services included individual and couple HIV
risk reduction counselling, quarterly syndromic management of sexually
transmitted infection treatment and free condoms.
The majority were married and living together. Median CD4 cell count
was 461 cells/mm3. The couples were followed for up to 24 months;
median time for HIV-negative and HIV-positive partners was 20.9 months
(IQR: 15.6-24.1) and 19.9 months (IQR: 14.3-23.9), respectively.
Of the 61 HIV seroconversions among women close to 30% (17) happened
during pregnancy. HIV incidence during pregnancy was 7.35 per 100
person years compared to 3.01 per 100 person years during non-pregnant
periods, (HR: 2.34, 95% CI: 1.33-4.09, p=0.003). Risk was high during
both early and late pregnancy. However, in multivariate analysis after
controlling for age, contraceptive use and unprotected sex, the effect
of pregnancy on HIV risk was not statistically significant.
Of the 58 HIV transmissions to men, 12 (20.7%) happened during
pregnancy. The incidence of female-to-male transmission was 3.46 per
100 person years during pregnancy compared to 1.58 per 100
person-years when the female partner was not pregnant. This was
statistically significant (HR 2.31, p=0.01) and remained significant
after adjusting for confounding factors (HR.2.47, p=0.01).
The authors underscore the public health importance of these new
findings showing pregnancy increases the risk of female-to-male
transmission two-fold. New strategies, they add, are needed to
strengthen family planning and maternal health services for women with
and at risk for HIV in order to reduce unwanted pregnancies and avert
HIV transmission to pregnant women and from pregnant women to their
infants and partners.
Strengths of the study include a large sample size and multinational
cohort. The study also established a genetic viral linkage of
transmitted HIV within partnerships so minimising the potential for
misclassification of female-to-male transmission.
The authors note their findings can be generalised; all participants
were co-infected with HSV-2 as are over 80% of all HIV infected adults
in sub-Saharan Africa.
The authors conclude increased risk for HIV female-to-male
transmission during pregnancy requires further studies to understand
the possible biologic mechanisms that may explain this finding. They
add: Prenatal couples HIV counselling and testing, implementation of
repeat HIV testing in pregnancy, and earlier initiation of combination
ART should become part of routine antenatal care to protect mothers,
infants and male partners from HIV.
Reference
Mulago NR et al. Increased risk of HIV-1 transmission in pregnancy: a
prospective study among African HIV-1 serodiscordant couples. Advance
online edition of AIDS 25, doi: 10.1097/QAD.0b013e32834a9338, 2011.
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