Human immunodeficiency virus type 1 mother-to-child transmission and prevention: successes and controversies

Cavarelli, Mariangela; Scarlatti, Gabriella

doi:10.1111/j.1365-2796.2011.02458.x

Cited by 18 publications

(12 citation statements)

References 196 publications

(203 reference statements)

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“…Much progress has been made in reducing mother-to-child transmission of HIV over the past decade, with six countries in Africa reducing the number of new infections by over 40% [1], [2]. Even so, in 2011 there were an estimated 330,000 (280,000–390,000) new infections among children, most of whom were perinatally infected [3], [4] and over 90% of whom were living in sub-Saharan Africa [5].…”

Section: Introductionmentioning

confidence: 99%

Enhancing Psychosocial Support for HIV Positive Adolescents in Harare, Zimbabwe

et al. 2013

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BackgroundThere is a recognized gap in the evidence base relating to the nature and components of interventions to address the psycho-social needs of HIV positive young people. We used mixed methods research to strengthen a community support group intervention for HIV positive young people based in Harare, Zimbabwe.MethodsA quantitative questionnaire was administered to HIV positive Africaid support group attendees. Afterwards, qualitative data were collected from young people aged 15–18 through tape-recorded in-depth interviews (n = 10), 3 focus group discussions (FGDs) and 16 life history narratives. Data were also collected from caregivers, health care workers, and community members through FGDs (n = 6 groups) and in-depth interviews (n = 12). Quantitative data were processed and analysed using STATA 10. Qualitative data were analysed using thematic analysis.Results229/310 young people completed the quantitative questionnaire (74% participation). Median age was 14 (range 6–18 years); 59% were female. Self-reported adherence to antiretrovirals was sub-optimal. Psychological well being was poor (median score on Shona Symptom Questionnaire 9/14); 63% were at risk of depression. Qualitative findings suggested that challenges faced by positive children include verbal abuse, stigma, and discrimination. While data showed that support group attendance is helpful, young people stressed that life outside the confines of the group was more challenging. Caregivers felt ill-equipped to support the children in their care. These data, combined with a previously validated conceptual framework for family-centred interventions, were used to guide the development of the existing programme of adolescent support groups into a more comprehensive evidence-based psychosocial support programme encompassing caregiver and household members.ConclusionsThis study allowed us to describe the lived experiences of HIV positive young people and their caregivers in Zimbabwe. The findings contributed to the enhancement of Africaid’s existing programme of support to better promote psychological well being and ART adherence.

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Section: Introductionmentioning

confidence: 99%

Enhancing Psychosocial Support for HIV Positive Adolescents in Harare, Zimbabwe

et al. 2013

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“…33-35 We assumed that PMTCT intervention would affect the proportion of infant infections occurring perinatally; with 57% of HIV infections occurring perinatally as opposed to postpartum when a PMTCT intervention was provided compared with 70% when a woman received no PMTCT intervention. 23,36 In total, this meant that 67.5% of HIV-positive infants in our model were infected perinatally.…”

Section: Methodsmentioning

confidence: 99%

Optimizing Infant HIV Diagnosis in Resource-Limited Settings: Modeling the Impact of HIV DNA PCR Testing at Birth

Chiu

Modi

Rivadeneira³

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Early antiretroviral therapy (ART) initiation in HIV-infected infants significantly improves survival but is often delayed in resource-limited settings. Adding HIV testing of infants at birth to the current recommendation of testing at age 4–6 weeks may improve testing rates and decrease time to ART initiation. We modeled the benefit of adding HIV testing at birth to the current 6-week testing algorithm. Methods Microsoft Excel was used to create a decision-tree model of the care continuum for the estimated 1,400,000 HIV-infected women and their infants in sub-Saharan Africa in 2012. The model assumed average published rates for facility births (42.9%), prevention of mother-to-child HIV transmission utilization (63%), mother-to-child-transmission rates based on prevention of mother-to-child HIV transmission regimen (5%–40%), return of test results (41%), enrollment in HIV care (52%), and ART initiation (54%). We conducted sensitivity analyses to model the impact of key variables and applied the model to specific country examples. Results Adding HIV testing at birth would increase the number of infants on ART by 204% by age 18 months. The greatest increase is seen in early ART initiations (543% by age 3 months). The increase would lead to a corresponding increase in survival at 12 months of age, with 5108 fewer infant deaths (44,550, versus 49,658). Conclusion Adding HIV testing at birth has the potential to improve the number and timing of ART initiation of HIV-infected infants, leading to a decrease in infant mortality. Using this model, countries should investigate a combination of HIV testing at birth and during the early infant period.

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“…Without access to drugs, rates of HIV-1 Mother-to-child transmission (MTCT) are 15–30% in non breastfeeding populations. Breastfeeding by an infected mother adds an additional 5–20% risk leading to an overall transmission rate of 20–45% as shown in some African and Asian settings [2]. Development of effective and safe neonatal and/or adult vaccines is the best solution to prevent infection or reduce the severity of HIV-related diseases.…”

Section: Introductionmentioning

confidence: 99%

Pre-Clinical Development of BCG.HIVACAT, an Antibiotic-Free Selection Strain, for HIV-TB Pediatric Vaccine Vectored by Lysine Auxotroph of BCG

et al. 2012

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In the past, we proposed to develop a heterologous recombinant BCG prime-recombinant modified vaccinia virus Ankara (MVA) boost dual pediatric vaccine platform against transmission of breast milk HIV-1 and Mycobacterium tuberculosis (Mtb). In this study, we assembled an E. coli-mycobacterial shuttle plasmid pJH222.HIVACAT expressing HIV-1 clade A immunogen HIVA. This shuttle vector employs an antibiotic resistance-free mechanism based on Operator-Repressor Titration (ORT) system for plasmid selection and maintenance in E. coli and lysine complementation in mycobacteria. This shuttle plasmid was electroporated into parental lysine auxotroph (safer) strain of BCG to generate vaccine BCG.HIVACAT. All procedures complied with Good Laboratory Practices (GLPs). We demonstrated that the episomal plasmid pJH222.HIVACAT was stable in vivo over a 20-week period, and genetically and phenotypically characterized the BCG.HIVACAT vaccine strain. The BCG.HIVACAT vaccine in combination with MVA.HIVA induced HIV-1- and Mtb-specific interferon γ-producing T-cell responses in newborn and adult BALB/c mice. On the other hand, when adult mice were primed with BCG.HIVACAT and boosted with MVA.HIVA.85A, HIV-1-specific CD8+ T-cells producing IFN-γ, TNF-α, IL-2 and CD107a were induced. To assess the biosafety profile of BCG.HIVACAT-MVA.HIVA regimen, body mass loss of newborn mice was monitored regularly throughout the vaccination experiment and no difference was observed between the vaccinated and naïve groups of animals. Thus, we demonstrated T-cell immunogenicity of a novel, safer, GLP-compatible BCG-vectored vaccine using prototype immunogen HIVA. Second generation immunogens derived from HIV-1 as well as other major pediatric pathogens can be constructed in a similar fashion to prime protective responses soon after birth.

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Human immunodeficiency virus type 1 mother-to-child transmission and prevention: successes and controversies

Cited by 18 publications

References 196 publications

Enhancing Psychosocial Support for HIV Positive Adolescents in Harare, Zimbabwe

Enhancing Psychosocial Support for HIV Positive Adolescents in Harare, Zimbabwe

Optimizing Infant HIV Diagnosis in Resource-Limited Settings: Modeling the Impact of HIV DNA PCR Testing at Birth

Pre-Clinical Development of BCG.HIVACAT, an Antibiotic-Free Selection Strain, for HIV-TB Pediatric Vaccine Vectored by Lysine Auxotroph of BCG

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