Vielä B-hepatiitin kantajan raskaudesta

Kommentti Martti Färkkilän ja Aila Tiitisen artikkeliin Duodecim 132(18):1726-1731, 2016Non peer reviewe

Switching from tenofovir alafenamide to tenofovir disoproxil fumarate improves lipid profile and protects from weight gain

Background: Switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) increases low-density lipoprotein cholesterol (LDL-C) and body weight. Metabolic effects of the opposite TAF-to-TDF switch are unknown. Objectives: To investigate the effect of TAF-to-TDF switch on plasma lipids, body weight, and atherosclerotic cardiovascular disease (ASCVD) risk score. Design: A retrospective chart review. Methods: One hundred and forty-six patients with TAF-to-TDF switch (Switch group) were compared with 146 patients matched for sex, age, and third antiretroviral agent class who continued unchanged TAF-containing regimen (Control group). Data were collected at approximately 1 year (follow-up FU-1) and 2 years (follow-up FU-2) after baseline values. Results: In Switch group at FU-1, total cholesterol (TC) and LDL-C decreased 12.1% and 12.4% (P < 0.001 in both), respectively. High-density lipoprotein cholesterol (HDL-C) also decreased 8.2% (P < 0.001) in Switch group, but TC/HDL-C ratio did not change. No statistically significant changes were observed in Control group in any lipid values. TC remained similarly decreased through FU-2 in Switch group, but LDL-C increased from FU-1 to FU-2 in both groups. ASCVD risk score decreased from 6.3% at baseline to 6.0% at FU-2 (P = 0.012) in Switch group but increased from 8.4 to 9.1% (P = 0.162) in Control group. Body weight increased from 83.4 kg at baseline to 84.9 kg at FU-2 (P = 0.025) in Control group but remained stable in Switch group (83.1-83.7 kg, P = 0.978). Conclusions: TAF-to-TDF switch improved plasma lipid profile and ASCVD risk score, as well as prevented weight gain, when compared with ongoing TAF-based antiretroviral therapy.Peer reviewe

HIV-positiivisen naisen raskaus ja synnytys

Vertaisarvioitu. English summary.Noin joka kolmas HIV-positiivisen naisen lapsi saa HIV-tartunnan raskauden, synnytyksen tai imetyksen aikana, jos tehokkaita tartunnan ehkäisykeinoja ei ole käytössä. Yhdistämällä viruksen tarttumista vähentävät keinot lapsen tartuntariski on pienentynyt alle 1 %:iin. Perinataalitartunnan ehkäisyn kulmakivenä on HIV-positiivisen naisen varhainen tunnistaminen, mieluiten jo ennen raskautta. Tehokas lääkitys on tärkein tartuntariskiä pienentävä tekijä, mutta sen valitseminen raskauden yhteydessä ei ole aina yksinkertaista. Hyvin hoidetun HIV:n yhteydessä alatiesynnytys ei lisää tartuntariskiä. Suomessa tartuntariski on hyvin pieni mutta mahdollinen, ja tapahtuessaan tartunta johtaa vastasyntyneen lapsen elinikäiseen HIV-infektioon. Suomessa HIV-positiivisille naisille arvioidaan syntyneen 400-450 lasta. HIV-tartuntojen tehokas ehkäisy edellyttää moniammatillista yhteistyötä.Peer reviewe

Liikenne- ja viestintäarkkitehtuuri 2030 ja 2050

Liikenne- ja viestintäministeriö asetti kolme selvityshenkilöä tuottamaan vision siitä, miten liikenne- ja viestintäjärjestelmän rohkealla kehittämisellä luodaan Suomen hyvinvoinnille, kilpailukyvylle ja kansantaloudelle suotuisa ympäristö vuosille 2030 ja 2050. Työssä on määritetty visio vuosille 2030 ja 2050 seuraavasti: 1. Globaalisti on syntymässä vallankumouksellisia uusia teknologisia läpimurtoja, jotka mullistavat nykyiset liikenne- ja viestintäjärjestelmät. 2. Perinteinen liikenne ja digitaaliset ratkaisut sulautuvat. 3. Tiedosta tulee kriittisin tuotannon- ja kilpailutekijä. 4. Suomen suurimmat mahdollisuudet ovat globaalisti syntyvien teknologisten ratkaisujen nopeassa ja laajamittaisessa hyödyntämisessä. 5. Mahdollisuuteen on tartuttava, koska näin voidaan kestävästi ratkaista Suomen erityiset sisäiset ja ulkoiset saavutettavuushaasteet. 6. Suomen on pakko radikaalisti uudistaa olemassa olevia rakenteita ja toimintamalleja sekä päätöksentekoa. 7. Tavoitteeksi tulee asettaa, että Suomen tulee olla globaalisti johtava älykkään liikenteen ekosysteemi. 8. Edellyttää investointeja, muutosvalmiutta, riskinottoa, uutta osaamista ja kokeilemisen kulttuuria. 9. Jos tässä onnistutaan, syntyy kestävää taloudellista kasvua, luodaan uutta liiketoimintaa sekä mahdollistetaan laadukkaat kansalaisten liikenne- ja viestintäpalvelut. 10. Muutos tehtävä niin, että se hyödyttää jokaista suomalaista. Raportissa kuvataan toimialaan vaikuttavia muutosvoimia sekä toimivan liikenne- ja viestintäarkkitehtuurin osatekijöitä, joita ovat teknologia ja tieto, kyvykkyydet, infrastruktuuri, hinnoittelu ja verotus, sääntely, turvallisuus, saavutettavuus, avoimet rajapinnat, public–private–people-kumppanuudet, riskinotto ja markkinoiden edelläkävijyys sekä päätöksenteko

Transport and Communications Architecture 2030 and 2050. Final report by rapporteurs

The Ministry of Transport and Communications appointed three rapporteurs to produce a vision of how bold development of the transport and communication system could be used to create favourable conditions for Finland's well-being, competitiveness and economy in 2030 and 2050. The following vision has been defined in the work for 2030 and 2050: 1. New revolutionary technological breakthroughs that will transform the current transport and communication systems are about to happen globally. 2. Traditional traffic and digital solutions will merge. 3. Data will become the primary factor of production and competition. 4. Finland's greatest opportunities lie in quickly and comprehensively utilising the technological solutions being created globally. 5. These opportunities must be seized, as this would allow Finland's particular challenges in internal and external accessibility to be overcome in a sustainable manner. 6. Finland must make radical changes to its existing structures, operating models and decision-making. 7. The objective must be to make Finland the global leader of intelligent transport ecosystems. 8. This requires investment, readiness for change, risk-taking, new skills and a culture of experimentation. 9. Succeeding in this would bring sustainable economic growth, create new business and enable high-quality transport and communications services for citizens. 10. This change must be brought about in a way that benefits every Finnish citizen. The report describes the dynamics and components of a functional transport and communications architecture: technology and knowledge, skills, infrastructure, pricing and taxation, regulation, safety, accessibility, open interfaces, risk-taking and market pioneering, public-private-people partnerships, and decision-making. This report is the English version of the Finnish report number 7/2017

Induced abortions of women living with HIV in Finland 1987-2019 : a national register study

BackgroundRecent data on the rate and risk factors of induced abortion among women living with HIV (WLWH) are limited. Our aim was to use Finnish national health register data to 1) determine the nationwide rate of induced abortions of WLWH in Finland during 1987-2019, 2) compare the rates of induced abortions before and after HIV diagnosis over different time periods, 3) determine the factors associated with terminating a pregnancy after HIV diagnosis, and 4) estimate the prevalence of undiagnosed HIV at induced abortions to see whether routine testing should be implemented.MethodsA retrospective nationwide register study of all WLWH in Finland 1987-2019 (n = 1017). Data from several registers were combined to identify all induced abortions and deliveries of WLWH before and after HIV diagnosis. Factors associated with terminating a pregnancy were assessed with predictive multivariable logistic regression models. The prevalence of undiagnosed HIV at induced abortion was estimated by comparing the induced abortions among WLWH before HIV diagnosis to the number of induced abortions in Finland.ResultsRate of induced abortions among WLWH decreased from 42.8 to 14.7 abortions/1000 follow-up years from 1987-1997 to 2009-2019, more prominently in abortions after HIV diagnosis. After 1997 being diagnosed with HIV was not associated with an increased risk of terminating a pregnancy. Factors associated with induced abortion in pregnancies that began after HIV diagnosis 1998-2019 were being foreign-born (OR 3.09, 95% CI 1.55-6.19), younger age (OR 0.95 per year, 95% CI 0.90-1.00), previous induced abortions (OR 3.36, 95% CI 1.80-6.28), and previous deliveries (OR 2.13, 95% CI 1.08-4.21). Estimated prevalence of undiagnosed HIV at induced abortion was 0.008-0.029%.ConclusionsRate of induced abortions among WLWH has decreased. Family planning should be discussed at every follow-up appointment. Routine testing of HIV at all induced abortions is not cost-effective in Finland due to low prevalence.Peer reviewe

Finnish HIV Quality of Care Register (FINHIV)

Purpose The Finnish HIV Quality of Care Register (FINHIV) was created to: (1) estimate the number of people living with HIV (PLWH) in Finland, (2) evaluate the national level of antiretroviral medication use and viral suppression, (3) examine the change in the HIV epidemic in Finland to pinpoint issues to address and (4) enable evaluation of the health of the PLWH by combining the FINHIV data with other national healthcare data. Participants The FINHIV includes all people diagnosed or being treated for HIV infection in Finland since 1984. The register was formed in 2020 by combining data from the National Infectious Diseases Register (information from time of diagnosis, data from 1984) and from the 21 HIV Clinics that treat HIV-positive patients in Finland (earliest data from 1998). The register population forms a nationwide, open cohort with yearly updates; currently it consists of 4218 PLWH (including 718 deceased) with HIV diagnosed or treated in Finland 1984-2019. Current rate of new cases is 150 cases/year. Findings to date From the FINHIV data, we can confirm that Finland has reached the Joint United Nations Programme for HIV/AIDS (UNAIDS) 90-90-90 targets set for 2020, and that the proportion of virally suppressed is constant between all 21 HIV Clinics in Finland, despite their varying size. Linkage to care is estimated at 94.3% of those diagnosed. In contrast to the treatment results, more than half of the PLWH have been diagnosed at a late stage, and the proportion has increased since 2000. Future plans Combinations of FINHIV data with other national healthcare register data in Finland will provide further information on other aspects of the health of the PLWH in a high-resource setting (eg, comorbidities, sexual health and use of healthcare resources). Additionally, implementation of patient-reported experience and outcome measures within the FINHIV is ongoing.Peer reviewe

Exposure to dolutegravir in pregnant women living with HIV in Central and Eastern Europe and neighboring countries — data from the ECEE Network Group

Objectives: The purpose of this study was to investigate dolutegravir (DTG) use among women and exposure to DTG during pregnancy in real world in Central and Eastern Europe and neighboring countries. Material and methods: Centres from 20 countries included in the Euroguidelines in Central and Eastern Europe (ECEE) Network and Finland were asked to complete an on-line questionnaire. Results: Seven centres from Czech Republic, Finland, Greece, Poland, Slovakia, and Turkey provided detailed information. DTG exposure was reported in 415 women, of which 26 were during pregnancy. Of those, 22 were on DTG at the time of conception and 4 had started DTG during pregnancy. Few women had conventional risk factors. The data on folic acid usage was unknown for eight women; 14 were using and four were not using folic acid. Four pregnancies were ongoing at the time of the study and of those with an outcome, 77.3% resulted with term, 13.6% preterm delivery, 4.5% spontaneous and 4.5% medical abortion. Conclusions: The DTG signal report indicates the importance of safety research for drug use in pregnancy and highlights the urgent need for systematic surveillance of pregnancy outcomes and neonatal surveillance. Countries with low- or moderate HIV prevalence should be included in studies reviewing pregnancy outcomes and in any surveillance system to ensure the accuracy of drug safety revision

Psychosocial health in pregnancy and postpartum among women living with-and without HIV and non-pregnant women living with HIV living in the Nordic countries - Results from a longitudinal survey study

Background The success of antiretroviral therapy has normalized pregnancy among women living with HIV (WWH) with a very low risk of perinatal transmission of HIV. Despite these advances, WWH still face complex medical and psychosocial issues during pregnancy and postpartum. The aim of this study was to assess differences in psychosocial health outcomes between pregnant WWH, non-pregnant WWH, and pregnant women without HIV, and further identify factors associated with probable depression in the third trimester and postpartum. Methods In a longitudinal survey study, participants were included from sites in Denmark, Finland, and Sweden during 2019-2020. Data was collected in the 3rd trimester, 3 and 6 months postpartum using standardized questionnaires assessing depression, perceived stress, loneliness, and social support. Mixed regression models were used to assess changes over time within and between groups. Logistic regression models were used to identify factors associated with depression in pregnancy and postpartum. Results A total of 47 pregnant WWH, 75 non-pregnant WWH, and 147 pregnant women without HIV were included. The prevalence of depression was high among both pregnant and non-pregnant WWH. There was no significant difference between pregnant and non-pregnant WWH in depression scores, perceived stress scores, or social support scores at any time point. Compared to pregnant women without HIV, pregnant WWH reported worse outcomes on all psychosocial scales. Social support and loneliness were associated with an increased odds of depressive symptoms in the adjusted analysis. Conclusions A high burden of adverse psychosocial outcomes was observed in both pregnant and non-pregnant women living with HIV compared to pregnant women without HIV. Loneliness and inadequate social support were associated with increased odds of depression in pregnancy and should be a focus in future support interventions.Peer reviewe

The experience of pregnancy among women living with HIV in Nordic countries : A qualitative narrative enquiry

Objective: The success of antiretroviral therapy has resulted in the normalization of pregnancy among women living with HIV and a very low risk of perinatal transmission of HIV. Despite these advances, women living with HIV still face complex medical and psychosocial issues during pregnancy. The purpose of this study is to describe experiences of pregnancy and the relevance of social support among women living with HIV in Nordic countries. Methods: This qualitative study examined data from pregnant women living with HIV from sites in Denmark, Sweden and Finland from 2019 to 2020. Data were collected in the third trimester via individual interviews using a hybrid, narrative/semistructured format. The transcribed interviews were analyzed using narrative thematic analysis. Results: In total, 31 women living with HIV were enrolled, of whom 61% originated from an African country and 29% from a Nordic country. The analysis generated four primary narrative themes: just a normal pregnancy, unique considerations and concerns, interactions with healthcare, and social support. Women living with HIV have a strong desire to have normal pregnancies and to be treated like any other pregnant woman. However, this normality is fragile, and being pregnant and living with HIV does come with unique considerations and concerns, such as fear of transmission, antiretroviral therapy, and the need for specialized care, which are fundamental to the women's experiences. Interactions with healthcare providers and social support influence their experiences in both positive and negative ways. Conclusion: The findings emphasize a sense of normality in pregnancy among women living with HIV. However, pregnancy does come with unique considerations and concerns, which highly influence the women's experience of pregnancy. Healthcare providers should focus on person-centered care, ensuring continuity and that women living with HIV do not feel discriminated against throughout their pregnancy.Peer reviewe