Insufficient antiretroviral therapy in pregnancy: missed opportunities for prevention of mother-to-child transmission of HIV in Europe

Background: Although mother-to-child transmission (MTCT) rates are at an all-time low in Western Europe, potentially preventable transmissions continue to occur. Duration of antenatal combination antiretroviral therapy (ART) is strongly associated with MTCT risk.Methods: Data on pregnant HIV-infected women enrolled in the Western and Central European sites of the European Collaborative Study between January 2000 and July 2009 were analysed. The proportion of women receiving no antenatal ART or 1-13 days of treatment was investigated, and associated factors explored using logistic regression models.Results: Of 2,148 women, 142 (7%) received no antenatal ART, decreasing from 8% in 2000-2003 to 5% in 2004-2009 (chi(2)=8.73; P= 14 days antenatal ART and 7.4% (10/136) among those with insufficient ART.Conclusions: Over the last 10 years, around one in 11 women in this study received insufficient antenatal ART, accounting for 40% of MTCTs. One-half of these women were diagnosed before conception, suggesting disengagement from care

Neurocognition and quality of life after reinitiating antiretroviral therapy in children randomized to planned treatment interruption

Objective: Understanding the effects of antiretroviral treatment (ART) interruption on neurocognition and quality of life (QoL) are important for managing unplanned interruptions and planned interruptions in HIV cure research. Design: Children previously randomized to continuous (continuous ART, n=41) vs. planned treatment interruption (PTI, n=47) in the Pediatric European Network for Treatment of AIDS (PENTA) 11 study were enrolled. At study end, PTI children resumed ART. At 1 and 2 years following study end, children were assessed by the coding, symbol search and digit span subtests of Wechsler Intelligence Scale for Children (6-16 years old) or Wechsler Adult Intelligence Scale ( 6517 years old) and by Pediatrics QoL questionnaires for physical and psychological QoL. Transformed scaled scores for neurocognition and mean standardized scores for QoL were compared between arms by t-test and Mann-Whitney U test, respectively. Scores indicating clinical concern were compared (<7 for neurocognition and <70 for QoL tests). Results: Characteristics were similar between arms with a median age of 12.6 years, CD4 + of 830 cells/\u3bcl and HIV RNA of 1.7 log 10 copies/ml. The median cumulative ART exposure was 9.6 in continuous ART vs. 7.7 years in PTI (P=0.02). PTI children had a median of 12 months off ART and had resumed ART for 25.2 months at time of first assessment. Neurocognitive scores were similar between arms for all tests. Physical and psychological QoL scores were no different. About 40% had low neurocognitive and QoL scores indicating clinical concern. Conclusion: No differences in information processing speed, sustained attention, short-term memory and QoL functioning were observed between children previously randomized to continuous ART vs. PTI in the PENTA 11 trial

Características sociofamiliares de los niños nacidos de mujeres infectadas por el virus de la inmunodeficiencia humana

ObjetivoEvaluar las características sociofamiliares de los niños nacidos de mujeres infectadas por el virus de la inmunodeficiencia humana (VIH). Como objetivos secundarios, analizar los aspectos de la escolarización, así como el número de ingresos y tiempo de estancia hospitalaria que han requerido estos niños.DiseñoEstudio observacional prospectivo.EmplazamientoUnidad VIH. Hospital Infantil.ParticipantesCriterios de inclusión: todos los niños reclutados en la Unidad VIH que tuvieran definido el estado de la infección durante el período de estudio, comprendido entre el primer caso conocido en 1985 y abril de 1994. La muestra es de 177 niños (62 VIH-infectados y 115 no infectados).Mediciones y resultados principalesMediante entrevista, se recogieron las variables sociofamiliares y escolares. Al comparar los niños infectados con los no infectados, no se detectaron diferencias importantes en cuanto a la situación de desamparo en el recién nacido (8,1 frente a 13%), escasa relación maternofilial (31,2 frente a 36,5%) o respecto a las personas responsables de la custodia de estos niños. Se detectó menor escolarización y mayores problemas de integración escolar en los casos infectados, con odds ratio de 2,68 (p = 0,004) y 11,36 (p = 0,004), respectivamente. Los niños infectados también necesitaron mayor número de ingresos (4,3 ± 5,7) que los no infectados (1,7 ± 0,9) (p = 0,001) y más días de estancia hospitalaria (75,1 ± 110,3 frente a 23,3 ± 19,6) (p = 0,0003).ConclusionesLas características sociofamiliares de los niños infectados fueron similares a las de los niños no infectados. Sin embargo, la menor escolarización, los problemas de integración escolar y el mayor número de ingresos y por más tiempo se relacionaron con la infección VIH en los niños, y no tanto por su condición de hijos de madres seropositivas.ObjectivesTo evaluate the social and family characteristics of children born to women infected by the human immunodeficiency virus (HIV). As secondary objectives, to analyse their schooling and the number of hospital admissions and lengths of stay that these children required.DesignA prospective observation study.SettingHIV unit in a children's hospital.Participants. Inclusion criteria: all the children recruited from the HIV unit who had their infection status defined during the study period, understood as between the first known case in 1985 and April 1994. The sample included 177 children (62 HIV-infected and 115 not infected).Measurements and main resultsThrough an interview the social, family and school variables were collected. On comparison between infected and non-infected children, there were no important differences as to the lack of protection of the new-born (8.1% vs 13%), scant mother-child relationship (31.2% vs 36.5%) or people responsible for the custody of these children. Less schooling and greater problems of school integration were detected in infected cases, with odds ratios of 2.68 (p = 0.004) and 11.36 (p = 0.004), respectively. Children infected also needed more admissions (4.3 ± 5.7) than the non-infected (1.7 ± 0.9) (p = 0.001), and more days of hospital stay (75.1 ± 110.3 vs 23.3 ± 19.6) (p = 0.0003).ConclusionsInfected children and non-infected children had similar social and family characteristics. However, less schooling, problems of school integration, and more and longer hospital admissions were related to HIV infection in children, and not so much to their status as children of seropositive mothers

The management of HCV infected pregnant women and their children European paediatric HCV network

BACKGROUND/AIMS: As evidence accumulates relating to mother-to-child (vertical) transmission of hepatitis C virus (HCV), it is timely to draw up guidelines for the clinical management of HCV infected pregnant women and their children. METHODS: A review of evidence from the European Paediatric HCV Network (EPHN) prospective study of HCV infected women and their children and other published studies. Meeting of EPHN clinical experts to reach a consensus on recommendations for management. Each recommendation was graded according to the level of evidence. RESULTS/CONCLUSIONS: Although several risk factors for mother-to-child transmission have been identified, none are modifiable and there are currently no interventions available to prevent vertical transmission of HCV. Data on timing of loss of maternal antibodies and reliability of diagnostic tests inform the optimum follow-up schedule for confirmation or exclusion of infection in children born to HCV infected women. Based on the current evidence, routine antenatal screening for HCV should not be introduced and neither elective caesarean section nor avoidance of breastfeeding should be recommended to HCV infected women to prevent mother-to-child transmission of HCV. HCV/HIV co-infected women should follow existing HIV guidelines