Prevention of mother-to-child HIV transmission: Similar access for sub-Sahara African immigrants and for French women?

INSERM Unit 822, Le Kremlin-Bicêtre, Paris, France.
AIDS (London, England) (Impact Factor: 5.55). 07/2008; 22(12):1503-11. DOI: 10.1097/QAD.0b013e3283065b8c
Source: PubMed


: To investigate whether mother-to-child transmission (MTCT) management and rate differed between African immigrants and French-born women delivering in France.
: MTCT strategies were studied among human immunodeficiency virus type 1-infected women delivering between 1984 and 2007 in the multicenter French Perinatal Cohort, according to geographical origin.
: Among 9245 pregnancies (in 7090 women), the proportion of African mothers increased from 12% in 1984-1986 to 64% in 2003-2004. African women had later access to care than French women, even in recent years (1997-2004). They more often discovered their HIV infection during pregnancy (40.6 vs. 11.5%, P < 0.001), started prenatal care in the third trimester (14.1 vs. 9.8%, P < 0.001) and started antiretroviral therapy after 32 weeks gestation (7.6 vs. 4.1%, P < 0.001). The association with late treatment initiation disappeared when adjusted for late HIV diagnosis and prenatal care (adjusted odds ratio 1.0, 95% confidence interval 0.7-1.4). African and French women did not differ in terms of access to highly active antiretroviral therapy, nor for substandard management such as vaginal delivery with uncontrolled viral load, lack of intrapartum and postpartum treatment or breastfeeding. The MTCT rate was higher for African than for French women receiving antiretroviral therapy (1.8 vs. 0.8%, P = 0.02), but the difference was no longer significant after adjustment for main transmission risk factors (adjusted odds ratio = 1.7, 95% confidence interval 0.8-3.7, P = 0.17). MTCT did not differ among 2110 term deliveries with maternal viral load less than 400 copies/ml, (0.8 vs. 0.6%, P = 0.5).
: African immigrants more often had late HIV screening in pregnancy than French-born women, but had similar access to MTCT prevention, once the infection was diagnosed.

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    • "Few studies have explored the impact of African ethnicity and migration on pregnancy in women living with HIV [15,20,21,23-26]. This is a complex area of study requiring a range of investigatory approaches. "
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    ABSTRACT: Background The number of reported pregnancies in women with diagnosed HIV in the UK increased from 80 in 1990 to over 1400 in 2010; the majority were among women born in sub-Saharan Africa. There is a paucity of research on how social adversity impacts upon pregnancy in HIV positive women in the UK; furthermore, little is known about important outcomes such as treatment uptake and return for follow-up after pregnancy. The aim of this study was to examine pregnancy in African women living with HIV in the UK. Methods and design This was a two phase mixed methods study. The first phase involved analysis of data on approximately 12,000 pregnancies occurring between 2000 and 2010 reported to the UK’s National Study of HIV in Pregnancy and Childhood (NSHPC). The second phase was based in London and comprised: (i) semi-structured interviews with 23 pregnant African women living with HIV, 4 health care professionals and 2 voluntary sector workers; (ii) approximately 90 hours of ethnographic fieldwork in an HIV charity; and (iii) approximately 40 hours of ethnographic fieldwork in a Pentecostal church. Discussion We have developed an innovative methodology utilising epidemiological and anthropological methods to explore pregnancy in African women living with HIV in the UK. The data collected in this mixed methods study are currently being analysed and will facilitate the development of appropriate services for this group.
    BMC Public Health 08/2012; 12(1):596. DOI:10.1186/1471-2458-12-596 · 2.26 Impact Factor
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    • "Quantification of HIV-1 RNA in cervico-vaginal secretions has been shown to be more useful when investigating vertical transmission risk associated with vaginal delivery [23]. African mothers who are immigrants in Europe have been shown to have lower HIV-1 RNA loads but were more likely to vertically transmit relative to their non-African counterparts [23-26] probably due to differences in HIV-1 subtypes and host genetic factors. This group of mothers with undetectable viral load could be elite controllers [27-29]. "
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    ABSTRACT: To determine HIV-1 RNA load during the third trimester of pregnancy and evaluate its effect on in utero and intra-partum/postpartum transmissions in a breastfeeding population. A nested case-control study within a PMTCT cohort of antiretroviral therapy naive pregnant women and their infants. A case was a mother who transmitted HIV-1 to her infant (transmitter) who was matched to one HIV-1 positive but non-transmitting mother (control). From a cohort of 691 pregnant women, 177 (25.6%) were HIV-1 positive at enrollment and from these 29 (23%) transmitted HIV-1 to their infants, 10 and 19 during in utero and intra-partum/postpartum respectively. Twenty-four mothers sero-converted after delivery and three transmitted HIV-1 to their infants. Each unit increase in log10 viral load was associated with a 178 cells/mm(3) and 0.2 g/dL decrease in TLC and hemoglobin levels, p = 0.048 and 0.021 respectively, and a 29% increase in the risk of transmission, p = 0.023. Intra-partum/postpartum transmitters had significantly higher mean viral load relative to their matched controls, p = 0.034. Antenatal serum HIV-1 RNA load, TLC and hemoglobin levels were significantly associated with vertical transmission but this association was independent of transmission time. This finding supports the rationale for preventive strategies designed to reduce vertical transmission by lowering maternal viral load.
    Virology Journal 08/2010; 7(1):176. DOI:10.1186/1743-422X-7-176 · 2.18 Impact Factor
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    ABSTRACT: Hintergrund Ohne medizinische Maßnahmen werden 40% der Kinder HIV1-positiver Schwangerer (HIV: „human immunodeficiency virus“) mit diesem Virus infiziert. Durch Kombination einer antiretroviralen Behandlung der Schwangeren, einer elektiven Sectio vor Beginn der Wehen, der antiretroviralen Postexpositionsprophylaxe des Neugeborenen und Stillverzicht konnte seit 1994 in entwickelten Ländern bei bekannter HIV1-Infektion der Schwangeren die Übertragungsrate von HIV1 auf 1% gesenkt werden. Inzwischen ist sogar bei nicht nachweisbarer HIV-Last vor der Geburt eine vaginale Entbindung möglich. Derzeitige Situation Bedauerlicherweise werden in Deutschland regelmäßig mehr als 1% der Kinder HIV-positiver Schwangerer infiziert. Die Hauptursachen dafür sind einerseits die mangelnde HIV1-Testung in der Schwangerschaft (zurzeit nur 50–70%) sowie andererseits die bei bekannter HIV1-Infektion nicht leitliniengerechte Behandlung der HIV1-positiven Schwangeren und ihrer Neugeborenen. Schlussfolgerung Nur durch regelmäßige Thematisierung in Publikationen und auf Fortbildungen/Kongressen kann eine stärkere Akzeptanz für die in Deutschland praktizierte Opt-in-Strategie der HIV1-Testung (erst nach Aufklärung und Zustimmung) und die korrekte Prophylaxe bei Mutter und Kind implementiert werden.
    Monatsschrift Kinderheilkunde 12/2012; 160(12). DOI:10.1007/s00112-012-2817-z · 0.23 Impact Factor
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