Current Sexual Behaviors Of Hiv-Positive Women

The incidence of HIV among women of childbearing age in the United States continues to rise. Literature and statistics show that the number of new HIV infections continue to increase, despite the fact that the transmission of the disease is preventable. The purpose of this descriptive study was to describe the current sexual practices on HIV-positive women and to determine whether these behaviors had changed since the diagnosis of HIV. A convenience sample (N = 13) of HIV-positive women was obtained from a support group for HIV-positive women in a metropolitan city in the Southeastern United States. Albert Bandura\u27s Social Learning Theory guided the research study. The participants completed a researcher- devised questionnaire with demographic information and questions regarding previous and current sexual practices. The responses were entered onto a spreadsheet and analyzed using frequencies and percentages. The study concluded that although the sample had a decrease in the frequency of sexual activity since the diagnosis of HIV, they 1 1 1 continued to engage in sexual behavior without the use of barrier protection. HIV-positive women expressed fear, lack of interest, and lack of a sexual partner as reasons for sexual behavior changes. Recommendations for further researcher included replication of this study with grounded theory, working with HIV-positive women who are not in a support group, conduction of a study looking at the motivation for changing risk behaviors, and the conduction of a qualitative study exploring the meaning of the experience of being HIV positive

Predictors of Depressive and Anxiety Symptoms among African American HIV-positive Women

This descriptive correlation study had four purposes: describe depressive and anxiety symptom levels in pregnant and non-pregnant African American (AA) HIV-positive women, examine the association between underlying vulnerabilities and depressive symptoms in HIV-positive AA women, determine the association between underlying vulnerabilities and anxiety symptoms in AA HIV-positive women, and determine the predictors of depressive and anxiety symptoms among African American HIV-positive women. A convenience sample of 80 African American HIV-positive women was recruited from university-based obstetrics/-gynecology and infectious disease practices in a large metropolitan city in the Mid-South. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D) and Edinburgh Postnatal depression Scale (EPDS). Anxiety symptoms were measured with the Beck Anxiety Inventory (BAI). Sleep quality was measured with the Pittsburg Sleep Quality Index (PSQI). An investigator-developed demographic data form was used to obtain patient characteristics including data about inherited and acquired vulnerabilities. Inherited vulnerabilities included family history of mood disorders and family history of alcohol and/or drug use. Acquired vulnerabilities included educational level, income level, alcohol and/or use, HIV disclosure status, sleep quality, and history of sexual assault. The stress diathesis theory provided the conceptual basis for the study. The sample consisted of both pregnant (n = 20) and non-pregnant (n = 60) women. Participants were typically single (57.5%), middle-aged (33.21 ± 10.7 years), and had completed high school (30%) or some college (35%). Poverty was prevalent in the sample, with 70.5% reporting annual household incomes below $10,000. Most women (92.5%) had disclosed their HIV status. Almost half of the sample (42%) reported a history of sexual assault. Substance abuse was higher in the non-pregnant group of women (40%) than the non-pregnant group (5%) of women. Median depressive symptom scores for the total sample were mildly elevated. Median anxiety symptom scores for the total sample illustrated little or no anxiety symptoms. Poor sleep quality was prevalent in both groups and was associated with elevated CES-D, EPDS, and BAI scores in both groups of women. Family history of mood disorders was associated with elevated CES-D scores in the group of pregnant women, and elevated BAI scores in both groups. HIV disclosure was associated with elevated CES-D scores in the pregnant group, and substance use with elevated CES-D scores, in the non-pregnant group. Non-pregnant HIV-positive women had higher depressive symptom scores on both the CES-D and EPDS when compared to pregnant HIV-positive women. Regression analyses were performed to determine which independent variables predicted elevated depressive and anxiety symptom scores. Substance use and poor sleep quality were statistically significant predictors, accounting for 55 % of the variance in CES-D scores, 43% of the variance in EPDS scores, and 53% of the variance in BAI scores. Future studies should include testing interventions that improve sleep quality. Untreated mood disorders are problematic in HIV-positive patients, as depression is associated with decreased adherence to highly active antiretroviral medications. Ongoing assessments of depressive and anxiety symptoms are necessary, as clinically significant levels resulting in referrals were warranted

Maraviroc Pharmacokinetics in HIV-1-Infected Pregnant Women

Objective.To describe the pharmacokinetics of maraviroc in human immunodeficiency virus (HIV)-infected women during pregnancy and post partum. Methods.HIV-infected pregnant women receiving maraviroc as part of clinical care had intensive steady-state 12-hour pharmacokinetic profiles performed during the third trimester and ≥2 weeks after delivery. Cord blood samples and matching maternal blood samples were taken at delivery. The data were collected in 2 studies: P1026 (United States) and PANNA (Europe). Pharmacokinetic parameters were calculated. Results.Eighteen women were included in the analysis. Most women (12; 67%) received 150 mg of maraviroc twice daily with a protease inhibitor, 2 (11%) received 300 mg twice daily without a protease inhibitor, and 4 (22%) had an alternative regimen. The geometric mean ratios for third-trimester versus postpartum maraviroc were 0.72 (90% confidence interval, 60-.88) for the area under the curve over a dosing interval (AUCtau) and 0.70 (0.58-0.85) for the maximum maraviroc concentration. Only 1 patient showed a trough concentration (Ctrough) below the suggested target of 50 ng/mL, both during pregnancy and post partum. The median ratio of maraviroc cord blood to maternal blood was 0.33 (range, 0.03-0.56). The viral load close to delivery was <50 copies/mL in 13 women (76%). All children were HIV negative at testing. Conclusions.Overall maraviroc exposure during pregnancy was decreased, with a reduction in AUCtau and maximum concentration of about 30%. Ctrough was reduced by 15% but exceeded the minimum Ctrough target concentration. Therefore, the standard adult dose seems sufficient in pregnancy. Clinical Trials Registration.NCT00825929 and NCT000422890.0SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Fosamprenavir with Ritonavir Pharmacokinetics during Pregnancy.

The purpose of this study was to evaluate the pharmacokinetics of ritonavir-boosted fosamprenavir during pregnancy and postpartum. Amprenavir (the active moiety of fosamprenavir) and ritonavir intensive pharmacokinetic evaluations were performed at steady state during the second and third trimesters of pregnancy and postpartum. Plasma concentrations of amprenavir and ritonavir were measured using high-performance liquid chromatography. The target amprenavir area under the concentration-versus-time curve (AUC) was higher than the 10th percentile (27.7 μg · h/ml) of the median area under the curve for ritonavir-boosted fosamprenavir in adults receiving twice-daily fosamprenavir-ritonavir at 700 mg/100 mg. Twenty-nine women were included in the analysis. The amprenavir AUC from time zero to 12 h (AUC0-12) was lower (geometric mean ratio [GMR], 0.60 [confidence interval {CI}, 0.49 to 0.72] [P &lt; 0.001]) while its apparent oral clearance was higher (GMR, 1.68 [CI, 1.38 to 2.03] [P &lt; 0.001]) in the third trimester than postpartum. Similarly, the ritonavir AUC0-12 was lower in the second (GMR, 0.51 [CI, 0.28 to 0.91] [P = 0.09]) and third (GMR, 0.72 [CI, 0.55 to 0.95] [P = 0.005]) trimesters than postpartum, while its apparent oral clearance was higher in the second (GMR, 1.98 [CI, 1.10 to 3.56] [P = 0.06]) and third (GMR, 1.38 [CI, 1.05 to 1.82] [P = 0.009]) trimesters than postpartum. The amprenavir area under the curve exceeded the target for 6/8 (75%) women in the 2nd trimester, 18/28 (64%) in the 3rd trimester, and 19/22 (86.4%) postpartum, and the trough concentrations (Cmin) of amprenavir were 4- to 16-fold above the mean amprenavir-protein-adjusted 50% inhibitory concentration (IC50) of 0.146 μg/ml. Although amprenavir plasma concentrations in women receiving ritonavir-boosted fosamprenavir were lower during pregnancy than postpartum, the reduced amprenavir concentrations were still above the exposures needed for viral suppression

Markers of Spontaneous Preterm Delivery in Women Living With HIV: Relationship With Protease Inhibitors and Vitamin D

Background: Women living with HIV (WLHIV) have increased risk of spontaneous preterm delivery (SPTD). We sought to identify plasma predictors of SPTD and their correlations with factors that increase the risk of SPTD, such as vitamin D deficiency and use of protease inhibitors. Design: Plasma was obtained from 103 WLHIV with SPTD (= 37 weeds) matched to cases 2:1 by race and gestational age at blood draw. TNF alpha, IFNy gamma, IL6, IL8, IL1 beta, IL18, IL17, granulocyte colony stimulating factor (GCSF), MCP1, IP10, sIL2Ra, sCD14, vascular endothelial factor a, monocyte colony stimulation factor, GRO alpha, MMP9, IL10, TGF beta, sCTLA4, and eicosanoids were compared between cases adjusting for known SPTD risk factors. Results: Participants had similar demographic characteristics, but cases had higher plasma HIV RNA, lower CD4 cells, and more advanced HIV disease compared with controls. High sIL2Ra was associated with increased risk of SPTD. High sCD14, GCSF, PGF2 alpha, and 5-HEPE were marginally associated with increased risk of SPTD. Women who initiated protease inhibitors-containing antiretroviral treatment before or during the first trimester had higher levels of GCSF and 5-HEPE compared with women without such exposure before plasma collection. Vitamin D insufficiency was associated with higher inflammatory sCD14 and PGF2 alpha, and lower anti-inflammatory 5-HEPE. Conclusions: The best plasma predictor of SPTD in WLHIV was sIL2R alpha, a marker of T-cell activation. Markers of monocyte activation and eicosanoids were marginally increased in WLHIV and SPTD, suggesting that they may also play a role in the pathogenesis of this disorder