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Available from: Susan E Cohn, Mar 14, 2014
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    • "The non-medically recommended pregnancies issue in clinical trial is not a new topic. An interesting point made by Le Gac et al. in Senegal [8] and Watts et al. in US [9] is that the proportion of women who got pregnancies during a trial is lower than in the general population of PLWA in both countries. This would be interesting to calculate also in Cambodia. "
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    ABSTRACT: At the Institute Pasteur du Cambodge, existing links among researchers involved in programs funded by the National Agency for Research on AIDS and Hepatitis led principal investigators of clinical trial and social scientists to work together. This paper presents how we framed this research that aims to document, from an anthropological point of view, various issues related to procreation and contraception for people living with HIV within the clinical trial "Camelia” (ANRS 1295–CIPRA KH001). Indeed, in the CAMELIA clinical trial a total of 661 patients (236 women) were enrolled. Despite the strong requirement stated in the informed consent form, 19 women enrolled in the trial became pregnant. The anthropological research was helpful to bring insights into how the clinical trial deal with various social forms related to reproductive practices produced globally, reinterpreted locally and negotiated by patients. It provides body rich stories of lived bodies and various insights on how HIV/Aids mostly combines to poverty challenge both the reproductive norms and “choices” and the “emic” notion of «couple» and « family ». For example, we describe why CAMELIA patients do not always disclose their HIV status to their partner and the social construction and social implications of such decision. We explored the reasons and strategies they mobilized to maintain a couple relationship. We analyzed how CAMELIA team deals within those complexities and pointed out the individual and structural intertwined logics behind discourses and facts. Thus we illustrate also how reproductive bodies are enacting and being enacted when medical things travel in poor Cambodian settings and where medicine and biological risks figure only as a reduced part of daily life.
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    • "With the improvements in HIV care and management, HIV-infected women are now considering having more children. Several reports indicate that women are going through many cycles of PMTCT (Prevention of Mother to Child Transmission of HIV).1,2 This problem has become significant in areas of high HIV prevalence, particularly where resources are few and breastfeeding is the norm. "
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    ABSTRACT: Several studies indicate that HIV-infected women continue to have children. We set out to determine the trend in HIV transmission at subsequent pregnancies. From 2002-2003, pregnant women were enrolled in a single dose nevirapine-based Prevention of Mother-to-Child Transmission of HIV (PMTCT) programme. Six years later, women with subsequent children in this cohort were identified and their children's HIV status determined. From 330 identified HIV-infected mothers, 73 had second/subsequent children with HIV results. Of these, nine (12.3%, 95% confidence interval [CI]: 4.6-20.1%) children were HIV-infected. Of the 73 second children, 51 had older siblings who had been initially enrolled in the study with definitive HIV results with an infection rate of 17/51 (33.3%, 95% CI: 19.9-46.7). About 35% of the women had been on antiretroviral drugs. These results demonstrate lower subsequent HIV transmission rates in women on a national PMTCT programme in a resource-poor setting with the advent of antiretroviral therapy.
    Tropical Doctor 05/2011; 41(3):132-5. DOI:10.1258/td.2011.100458 · 0.48 Impact Factor
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    ABSTRACT: To determine if inter-pregnancy HIV viral load suppression affects outcomes in subsequent pregnancies. This is a retrospective review of all women who delivered two consecutive pregnancies while diagnosed with HIV from January 1, 1984 until January 1, 2012. Medical records were reviewed for maternal, infant, and delivery data. Pregnancies were divided into index and subsequent pregnancy, and analyzed for outcomes. During the study period, 172 HIV infected women were identified who delivered 2 pregnancies at our institution. There was no difference in median HIV viral load at presentation or delivery between the index and subsequent pregnancies. During the subsequent pregnancy, more women presented on antiretroviral therapy (ART) and more often remained compliant with ART, however there was no difference in vertical transmission risk between the pregnancies. Of those with a viral load <1000 copies/mL at the end of their index pregnancy (N=103), 57 (55%) presented for their subsequent pregnancy with viral load still <1000 copies/mL. Those women who maintained viral load suppression between pregnancies were more likely to present for their subsequent pregnancy on ART, maintained greater viral load suppression and CD4 counts during the pregnancy , and had fewer vertical transmissions compared to those who presented with higher viral loads their subsequent pregnancy(0 vs. 9%, p=0.02). Maintaining HIV viral load suppression between pregnancies is associated with improved HIV disease status at delivery in subsequent pregnancies. Inter-pregnancy HIV viral load suppression is associated with less vertical transmission, emphasizing the importance of maintaining HIV disease control between pregnancies.
    American journal of obstetrics and gynecology 04/2014; 211(3). DOI:10.1016/j.ajog.2014.04.020 · 4.70 Impact Factor