Incident HIV Infection in Pregnant and Lactating Women and Its Effect on Mother-to-Child Transmission in South Africa

Abstract

We described HIV incidence and mother-to-child transmission (MTCT) among women during pregnancy and lactation. Forty-eight (3.4%) of 1396 women seroconverted during pregnancy or <12 mo after delivery. This group of HIV-exposed children was at 2.3 times higher risk of infection (MTCT 20.5% [8 of 39] vs 9.0% (83 of 925]). An estimated 20% with CD4+ cell counts <350 would have been eligible for antiretroviral therapy (ART), yet all women with incident HIV infections are more likely to transmit HIV to their children. To ensure optimal prevention of MTCT, all women who seroconvert during pregnancy or lactation should be considered for ART for the purpose of prevention of MTCT, and women with CD4+ <350 should continue to receive ART.

Pregnant Women and Disclosure to Sexual Partners After Testing HIV-1–Seropositive During Antenatal Care

“…Several studies have noted high rates of seroconversion among women in high prevalence settings who test negative in pregnancy. 25,26 Bringing male partners of HIV-1-seronegative mothers for testing is still rare, but should be an important complementary activity in the PMTCT setting; this effort will be critical to success of efforts to eliminate pediatric HIV-1.…”

Interactions Among Urogenital, Intestinal, Skin, and Oral Infections in Pregnant and Lactating Panamanian Ngäbe Women: A Neglected Public Health Challenge

“…7,8 Compared with pregnancy, BV is reportedly more prevalent during lactation, 9 whereas periodontal disease (but not periodontitis) and associated microflora are less common in lactating women. 10 Information on other infections during lactation is largely limited to those transmitted during breast-feeding such as HIV 11,12 and cytomegalovirus, 13 mammary infections produced by Staphylococcus spp. and Candida spp., 14,15 UTI associated with institutional vaginal delivery, 16 and puerperal sepsis mostly associated with vaginal infections.…”

Reproductive health needs of female sex workers and opportunities for enhanced prevention of mother-to-child transmission efforts in sub-Saharan Africa

“…Prevention of unintended pregnancy among HIV-negative FSW is also important as a PMTCT strategy. Many FSW continue to sell sex during pregnancy, which is associated with sustained vulnerabilities for primary HIV infection during pregnancy,7 8 and thus there are high and sustained risks for vertical HIV transmission from mother-to-child 9 10…”