Pregnant women at risk of HIV infection


Motherhood is a wonderful experience. Every woman may want to have children but then they are at high risk of HIV infection as well as infecting the baby – that is what a new study is trying to tell us.

The latest study by US researchers published in this past week's PLOS Medicine has revealed that women living in regions where HIV infection is common are at high risk of acquiring HIV during pregnancy and the postpartum period. Mothers who acquire the virus during prenatal period or postpartum are more likely to pass the infection on to their offspring’s than mothers with chronic HIV infections, the study also reveals.

The study by Dr Alison Drake of University of Washington’ International AIDS Research and Training Programme and his team, reveals that mothers who acquire HIV during pregnancy or postpartum are more likely to pass the infection on to their offspring than mothers with chronic HIV infections.

They conclude that, “HIV can be spread to your baby during pregnancy, while in labour, while giving birth, or by breastfeeding”.

The researchers came to these conclusions by reviewing relevant published studies as a model to estimate the HIV incidence rate and the association between pregnancy and postpartum status, HIV incidence and the risk and rates of mother-to-child transmission (MTCT).

They use random effects statistical models to estimate the pooled HIV incidence rate and the cumulative number of new infections per number of people at risk, and the association between pregnancy and postpartum status and HIV incidence as well as MTCT risk and rates.

About 47 studies were identified, 35 of which were undertaken in Africa, and recent HIV acquisition by women during pregnancy and the 12-month postpartum period was examined.

The results revealed that the pooled cumulative HIV incidence was significantly higher in African countries than in non-African countries (3.6 percent and 0.3 percent, respectively; a “significant” difference is one that is unlikely to arise by chance).

“In the five studies that provided suitable data, the risk of HIV acquisition was similar in pregnant, postpartum, and non-pregnant/non-postpartum women.

Finally, among African women, the risk of MTCT was 2.9-fold higher during the postpartum period among those who had recently acquired HIV than among those with chronic HIV infection, and 2.3-fold higher during the pregnancy/postpartum periods combined” the study reveals.

Therefore, the study recommends that women living in regions where HIV infection is prevalent should be offered repeated HIV testing during pregnancy and in the postpartum period to detect incident HIV infections. The report also recommend that preventing the virus transmission during pregnancy and the postpartum period should be prioritised, for example, by counselling women about the need to use condoms to prevent transmission during this period of their lives.

The researchers further recommend that the rate of MTCT and deaths among HIV-positive pregnant women from complications related to HIV infection can be greatly reduced by testing women for HIV infection during pregnancy, putting HIV-positive women on antiretroviral (ARV) drugs that control HIV replication and allow the immune system to recover.

Globally, about 3.4 million children younger than 15 years old, mostly living in sub-Saharan Africa are infected with HIV, thereby leaving infected individuals vulnerable to other serious infections.

According to UNAIDS, in 2012 alone, 230 000 children were newly infected with HIV. Most HIV infections among children are the result of mother-to-child HIV transmission (MTCT) during pregnancy, delivery, or breastfeeding.

The World Health Organisation (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have developed a global plan that aims to move towards eliminating new HIV infections among children by 2015 and towards keeping their mothers alive.

To ensure the plan's success, the incidence of HIV among women and the rate of MTCT must be reduced by increasing ARV uptake by mothers and their infants for the prevention of MTCT.

However, the risk of HIV infection among pregnant women and among women who have recently given birth  also referred to as postpartum women is poorly understood because, although guidelines recommend repeat HIV testing during late pregnancy or at delivery in settings where HIV infection is common, pregnant women are often tested only once for HIV infection.

The study further reveals that lack of re-testing represents a missed opportunity to identify pregnant and postpartum women who have recently acquired HIV and to prevent MTCT by initiating ARV therapy.

“Detection and prevention of incident HIV in pregnancy and postpartum should be prioritized, and is critical to decrease mother to child transmission” the study reads.

March 2014
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