Introduction: Infants born to women living with HIV initiating combination antiretroviral therapy (cART) late in pregnancy are at high risk of intrapartum infection. Mother/infant perinatal antiretroviral intensification may substantially reduce this risk.
Methods: In this single-arm Bayesian trial, pregnant women with HIV receiving standard of care antiretroviral prophylaxis in Thailand (maternal antenatal lopinavir-based cART; nonbreastfed infants 4 weeks' postnatal zidovudine) were offered "antiretroviral intensification" (labor single-dose nevirapine plus infant zidovudine-lamivudine-nevirapine for 2 weeks followed by zidovudine-lamivudine for 2 weeks) if their antenatal cART was initiated ≤8 weeks before delivery. A negative birth HIV-DNA polymerase chain reaction (PCR) followed by a confirmed positive PCR defined intrapartum transmission. Before study initiation, we modeled intrapartum transmission probabilities using data from 3738 mother/infant pairs enrolled in our previous trials in Thailand using a logistic model, with perinatal maternal/infant antiretroviral regimen and predicted viral load at delivery as main covariates. Using the characteristics of the women enrolled who received intensification, prior intrapartum transmission probabilities (credibility intervals) with/without intensification were estimated. After including the transmission data observed in the current study, the corresponding Bayesian posterior transmission probability was derived.
Results: No intrapartum transmission of HIV was observed among the 88 mother/infant pairs receiving intensification. The estimated intrapartum transmission probability was 2·2% (95% credibility interval 0·5-6·1) without intensification versus 0·3% (0·0-1·6) with intensification. The probability of superiority of intensification over standard of care was 94·4%. Antiretroviral intensification appeared safe.
Conclusion: Mother/infant antiretroviral intensification was effective in preventing intrapartum transmission of HIV in pregnant women receiving ≤8 weeks antepartum cART.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9741956 | PMC |
| http://dx.doi.org/10.1097/QAI.0000000000002350 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Pregnancy Outcomes and All-Cause Mortality After Pregnancy Among US-Born Women With Perinatally Acquired HIV.
J Acquir Immune Defic Syndr
January 2025
New York City Department of Health of Mental Hygiene, Bureau of HIV, New York City, NY.
Background: Maternal and pregnancy outcomes among women with perinatally acquired HIV (PHIV) versus women with HIV acquired through other routes (NPHIV) are not fully understood.
Setting: US-born women during 2005-2015 in New York City.
Methods: We used data from the New York City HIV surveillance registry, Expanded Perinatal Surveillance database, and Vital Statistics, to compare pregnancy and all-cause mortality outcomes among women with PHIV versus NPHIV delivering infants during 2005-2015.
Group B streptococcal infections in pregnancy and early life.
Clin Microbiol Rev
November 2024
Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington, USA.
SUMMARYBacterial infections with Group B (GBS) are an important cause of adverse outcomes in pregnant individuals, neonates, and infants. GBS is a common commensal in the genitourinary and gastrointestinal tracts and can be detected in the vagina of approximately 20% of women globally. GBS can infect the fetus either during pregnancy or vaginal delivery resulting in preterm birth, stillbirth, or early-onset neonatal disease (EOD) in the first week of life.
View Article and Find Full Text PDFA Controlled, Retrospective, Single-Center Study to Evaluate the Role of a Probiotic Mixture Administered during Pregnancy in Reducing Streptococcus Agalactiae Swab Positivity and the Frequency of Premature Rupture of Amniochorionic Membranes.
Microorganisms
September 2024
Scientific & Research Department, Velleja Research, 20125 Milano, Italy.
Intrapartum antibiotic prophylaxis, considered able to prevent streptococcal transmission from mother to newborn and its severe negative consequences, leads to microbiota dysbiosis, described as having a negative impact on well-being in both elements of the dyad. L3 is a probiotic strain capable of exerting strong antagonistic activity against most streptococci, including , due to the production of bacteriocins (known as enterocins A and B). A proprietary probiotic mixture containing the strain L3 demonstrated, in 2016, a significant reduction in episodes of PROM in pregnant women, with a less-than-expected effect on the vaginal-rectal presence of the pathogen .
View Article and Find Full Text PDFThe acceptability of implementation of group B Streptococcus testing: Perspectives from women and health professionals in the GBS3 trial: A qualitative study.
Women Birth
November 2024
Nottingham Clinical Trials Unit, University of Nottingham, UK. Electronic address:
Objective: To determine the acceptability of different methods of routine testing for group B Streptococcus (GBS) colonisation to pregnant women and health care professionals (HCPs), and to examine barriers and facilitators to their implementation.
Design: Qualitative study, embedded in a cluster randomised trial SETTING: Four NHS maternity units participating in the GBS3 Trial: two conducting routine antenatal enriched culture medium (ECM) testing; and two using routine rapid intrapartum testing. Sample 39 women and 25 HCPs purposively sampled to ensure representation of women with various birthing experiences and different professions.
Characterization of clinical infection and drug resistance of group B streptococcus in Chengdu, China.
Indian J Med Microbiol
December 2024
Department of Obstetrics and Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 611731, China. Electronic address:
Article Synopsis
- The study aimed to analyze the clinical infection characteristics and antibiotic resistance of Group B Streptococcus (GBS) in Chengdu, China, from 2019 to 2021, to aid in effective clinical drug use.
- A total of 203 GBS strains were collected, primarily from obstetrics and neonatology wards, with significant GBS colonization found in pregnant women and high morbidity in infected neonates.
- The findings revealed that while no resistance to penicillin or ampicillin was detected, over 50% of the GBS strains showed resistance to tetracycline and clindamycin, highlighting potential concerns for treatment options.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!