The next generation : pregnancy in adolescents and women living with perinatally acquired HIV in South Africa
Background. An increasing number of girls living with perinatally acquired HIV (PHIV) are reaching adolescence and adulthood and becoming pregnant. Youth living with PHIV (YLPHIV) may have HIV-associated infections/complications, long-term exposure to antiretroviral treatment (ART), drug resistance...
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| Veröffentlicht in: | SAMJ: South African Medical Journal 2021-03, Vol.111 (3), p.260-264 |
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| creator | Anderson, K Mutemaringa, T Technau, K-G Johnson, L.F Braithwaite, K Mokotoane, E Boulle, A Davies, M-A |
| description | Background. An increasing number of girls living with perinatally acquired HIV (PHIV) are reaching adolescence and adulthood and becoming pregnant. Youth living with PHIV (YLPHIV) may have HIV-associated infections/complications, long-term exposure to antiretroviral treatment (ART), drug resistance and increased psychosocial challenges, which may adversely affect pregnancy outcomes. There is a lack of published studies on pregnancy in YLPHIV in sub-Saharan Africa. Objectives. To describe characteristics of pregnant South African (SA) YLPHIV and their pregnancy outcomes. Methods. We retrospectively identified pregnancies in YLPHIV, who were diagnosed with HIV when they were |
| doi_str_mv | 10.7196/SAMJ.2021.v111i3.14987 |
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An increasing number of girls living with perinatally acquired HIV (PHIV) are reaching adolescence and adulthood and becoming pregnant. Youth living with PHIV (YLPHIV) may have HIV-associated infections/complications, long-term exposure to antiretroviral treatment (ART), drug resistance and increased psychosocial challenges, which may adversely affect pregnancy outcomes. There is a lack of published studies on pregnancy in YLPHIV in sub-Saharan Africa. Objectives. To describe characteristics of pregnant South African (SA) YLPHIV and their pregnancy outcomes. Methods. We retrospectively identified pregnancies in YLPHIV, who were diagnosed with HIV when they were <12 years old and before their first pregnancy (as a proxy for perinatal route of infection), from routinely collected data in Western Cape Province, SA (2007 - 2018). We combined these with pregnancies from a Johannesburg cohort of YLPHIV. Results. We identified 258 pregnancies among 232 females living with likely PHIV; 38.8% of pregnancies occurred in YLPHIV ≤16 years old, 39.1% at age 17 - 19 years and 22.1% at age ≥20 years. In recent years, a steady increase in the number of pregnancies in YLPHIV was noted; more than two-thirds occurred during 2016 - 2018. ART was commenced prior to pregnancy in 84.9% of YLPHIV, during pregnancy in 6.6% and was not commenced by pregnancy end date in 8.5%. Of the pregnancies in young women with documented outcomes (88.8%; n=229), 80.3% were live births, 14.4% terminations, 3.1% miscarriages and 2.2% stillbirths. Mother-to-child transmission of HIV occurred in 2.2% of infants, 75.3% were uninfected when last tested and 22.6% had unknown HIV status. Among YLPHIV with CD4 counts available within 12 months of pregnancy end date (n=202), 20.3% had a CD4 count <200 cells/µL, 43.1% CD4 count 200 - 499 cells/µL and 36.6% CD4 count ≥500 cells/µL. Among those with a viral load (VL) available within 12 months of pregnancy end date (n=219), 66.7% had a VL <400 copies/mL, 5.0% VL 400 - 999 copies/mL and 28.3% VL ≥1 000 copies/mL. Of 186 neonates, 20.4% were preterm deliveries (<37 weeks' gestation). Among neonates with known birthweight (n=176), the mean birthweight was 2 900 g (95% confidence interval (CI) 2 747 - 2 935 g) and 20.5% had a low birthweight (<2 500 g). One congenital malformation (musculoskeletal) and 2 neonatal deaths were recorded. Conclusions. In recent years, the number of pregnancies in YLPHIV has increased. A considerable proportion of pregnancies occurred in YLPHIV ≤16 years old. A high proportion of pregnancies was electively terminated. The prevalence of elevated VL and poor immunological status among pregnant YLPHIV is concerning.</description><identifier>ISSN: 0256-9574</identifier><identifier>ISSN: 2078-5135</identifier><identifier>EISSN: 2078-5135</identifier><identifier>DOI: 10.7196/SAMJ.2021.v111i3.14987</identifier><identifier>PMID: 33944749</identifier><language>eng</language><publisher>South Africa: Health and Medical Publishing Group (HMPG)</publisher><subject>Adolescent ; Adult ; Anti-Retroviral Agents - therapeutic use ; Antiviral agents ; CD4 Lymphocyte Count ; Child ; Complications and side effects ; Demographic aspects ; Drug therapy ; Female ; Health aspects ; Health Care Sciences & Services ; Health Policy & Services ; HIV Infections - drug therapy ; HIV Infections - epidemiology ; HIV Infections - transmission ; HIV seropositivity ; Humans ; Infectious Disease Transmission, Vertical ; Medical Ethics ; Medicine, General & Internal ; Medicine, Legal ; Medicine, Research & Experimental ; Pregnancy ; Pregnancy Complications, Infectious - epidemiology ; Pregnancy in Adolescence ; Pregnancy Outcome ; Pregnancy, Complications of ; Risk factors ; South Africa - epidemiology ; Teenage girls ; Teenage pregnancy ; Viral Load</subject><ispartof>SAMJ: South African Medical Journal, 2021-03, Vol.111 (3), p.260-264</ispartof><rights>COPYRIGHT 2021 Health & Medical Publishing Group</rights><rights>This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c567t-73af2df13ef3c22fddac71c1e366470d4f4f7b9f43687f57eeb0b0d29fd09943</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,864,885,27924,27925,39242</link.rule.ids><linktorsrc>$$Uhttps://hdl.handle.net/10520/ejc-m_samj-v111-n3-a24$$EView_record_in_Sabinet_Online_Ltd.$$FView_record_in_$$GSabinet_Online_Ltd.</linktorsrc><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33944749$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Anderson, K</creatorcontrib><creatorcontrib>Mutemaringa, T</creatorcontrib><creatorcontrib>Technau, K-G</creatorcontrib><creatorcontrib>Johnson, L.F</creatorcontrib><creatorcontrib>Braithwaite, K</creatorcontrib><creatorcontrib>Mokotoane, E</creatorcontrib><creatorcontrib>Boulle, A</creatorcontrib><creatorcontrib>Davies, M-A</creatorcontrib><title>The next generation : pregnancy in adolescents and women living with perinatally acquired HIV in South Africa</title><title>SAMJ: South African Medical Journal</title><addtitle>S Afr Med J</addtitle><description>Background. An increasing number of girls living with perinatally acquired HIV (PHIV) are reaching adolescence and adulthood and becoming pregnant. Youth living with PHIV (YLPHIV) may have HIV-associated infections/complications, long-term exposure to antiretroviral treatment (ART), drug resistance and increased psychosocial challenges, which may adversely affect pregnancy outcomes. There is a lack of published studies on pregnancy in YLPHIV in sub-Saharan Africa. Objectives. To describe characteristics of pregnant South African (SA) YLPHIV and their pregnancy outcomes. Methods. We retrospectively identified pregnancies in YLPHIV, who were diagnosed with HIV when they were <12 years old and before their first pregnancy (as a proxy for perinatal route of infection), from routinely collected data in Western Cape Province, SA (2007 - 2018). We combined these with pregnancies from a Johannesburg cohort of YLPHIV. Results. We identified 258 pregnancies among 232 females living with likely PHIV; 38.8% of pregnancies occurred in YLPHIV ≤16 years old, 39.1% at age 17 - 19 years and 22.1% at age ≥20 years. In recent years, a steady increase in the number of pregnancies in YLPHIV was noted; more than two-thirds occurred during 2016 - 2018. ART was commenced prior to pregnancy in 84.9% of YLPHIV, during pregnancy in 6.6% and was not commenced by pregnancy end date in 8.5%. Of the pregnancies in young women with documented outcomes (88.8%; n=229), 80.3% were live births, 14.4% terminations, 3.1% miscarriages and 2.2% stillbirths. Mother-to-child transmission of HIV occurred in 2.2% of infants, 75.3% were uninfected when last tested and 22.6% had unknown HIV status. Among YLPHIV with CD4 counts available within 12 months of pregnancy end date (n=202), 20.3% had a CD4 count <200 cells/µL, 43.1% CD4 count 200 - 499 cells/µL and 36.6% CD4 count ≥500 cells/µL. Among those with a viral load (VL) available within 12 months of pregnancy end date (n=219), 66.7% had a VL <400 copies/mL, 5.0% VL 400 - 999 copies/mL and 28.3% VL ≥1 000 copies/mL. Of 186 neonates, 20.4% were preterm deliveries (<37 weeks' gestation). Among neonates with known birthweight (n=176), the mean birthweight was 2 900 g (95% confidence interval (CI) 2 747 - 2 935 g) and 20.5% had a low birthweight (<2 500 g). One congenital malformation (musculoskeletal) and 2 neonatal deaths were recorded. Conclusions. In recent years, the number of pregnancies in YLPHIV has increased. A considerable proportion of pregnancies occurred in YLPHIV ≤16 years old. A high proportion of pregnancies was electively terminated. The prevalence of elevated VL and poor immunological status among pregnant YLPHIV is concerning.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Anti-Retroviral Agents - therapeutic use</subject><subject>Antiviral agents</subject><subject>CD4 Lymphocyte Count</subject><subject>Child</subject><subject>Complications and side effects</subject><subject>Demographic aspects</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Health aspects</subject><subject>Health Care Sciences & Services</subject><subject>Health Policy & Services</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - epidemiology</subject><subject>HIV Infections - transmission</subject><subject>HIV seropositivity</subject><subject>Humans</subject><subject>Infectious Disease Transmission, Vertical</subject><subject>Medical Ethics</subject><subject>Medicine, General & Internal</subject><subject>Medicine, Legal</subject><subject>Medicine, Research & Experimental</subject><subject>Pregnancy</subject><subject>Pregnancy Complications, Infectious - epidemiology</subject><subject>Pregnancy in Adolescence</subject><subject>Pregnancy Outcome</subject><subject>Pregnancy, Complications of</subject><subject>Risk factors</subject><subject>South Africa - epidemiology</subject><subject>Teenage girls</subject><subject>Teenage pregnancy</subject><subject>Viral Load</subject><issn>0256-9574</issn><issn>2078-5135</issn><issn>2078-5135</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkt9u0zAUxiMEYmPwClMkJLSbFv-J44QLpGqCbWiIi1bcHrnOcePKsbs42djb8Cw8Gc46xqooihz_vnN8Pn9ZdkrJXNK6_LhcfP82Z4TR-S2l1PI5LepKvsiOGZHVTFAuXmbHhIlyVgtZHGVvYtyStBZ1-To74rwuClnUx5lftfjnt8dfQ75Bj70abPD5p3zX48Yrr-9z63PVBIdRox9irnyT34UOfe7srfWb_M4Obb7D3no1KOfuc6VvRttjk19e_ZzUyzAmYmF6q9Xb7JVRLuK7x-9Jtvr6ZXV-Obv-cXF1vrieaVHKYSa5MqwxlKPhmjHTNEpLqinysiwkaQpTGLmuTcHLShohEddkTRpWm4bUdcFPsvm-bNQWXYBtGHuf-sFysgQmSybvCCE8vWwSfN4LduO6w2YatVcOdr3tVH8PQVk43PG2hU24haoqZEXKVODssUAfbkaMA3Q2Oeac8hjGCEwwxqu6ECKh7_foRjkE601IFfWEw6IUvCpLzsX_EQ6o9DTYWR08Gpv-Hwg-PBO0qNzQxuDG6ULjIVjuQd2HGHs0T2NSAlO4YAoXTAbBPlzwEK4kPH1u0pPsX5oScPFou1pbjwNEhYmFdhh2EdrGQZvik0437VEiGAHcaugS120feoHnoNJ9_AVixORc</recordid><startdate>20210301</startdate><enddate>20210301</enddate><creator>Anderson, K</creator><creator>Mutemaringa, T</creator><creator>Technau, K-G</creator><creator>Johnson, L.F</creator><creator>Braithwaite, K</creator><creator>Mokotoane, E</creator><creator>Boulle, A</creator><creator>Davies, M-A</creator><general>Health and Medical Publishing Group (HMPG)</general><general>Health & Medical Publishing Group</general><general>South African Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><scope>GPN</scope></search><sort><creationdate>20210301</creationdate><title>The next generation : pregnancy in adolescents and women living with perinatally acquired HIV in South Africa</title><author>Anderson, K ; Mutemaringa, T ; Technau, K-G ; Johnson, L.F ; Braithwaite, K ; Mokotoane, E ; Boulle, A ; Davies, M-A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c567t-73af2df13ef3c22fddac71c1e366470d4f4f7b9f43687f57eeb0b0d29fd09943</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Anti-Retroviral Agents - therapeutic use</topic><topic>Antiviral agents</topic><topic>CD4 Lymphocyte Count</topic><topic>Child</topic><topic>Complications and side effects</topic><topic>Demographic aspects</topic><topic>Drug therapy</topic><topic>Female</topic><topic>Health aspects</topic><topic>Health Care Sciences & Services</topic><topic>Health Policy & Services</topic><topic>HIV Infections - drug therapy</topic><topic>HIV Infections - epidemiology</topic><topic>HIV Infections - transmission</topic><topic>HIV seropositivity</topic><topic>Humans</topic><topic>Infectious Disease Transmission, Vertical</topic><topic>Medical Ethics</topic><topic>Medicine, General & Internal</topic><topic>Medicine, Legal</topic><topic>Medicine, Research & Experimental</topic><topic>Pregnancy</topic><topic>Pregnancy Complications, Infectious - epidemiology</topic><topic>Pregnancy in Adolescence</topic><topic>Pregnancy Outcome</topic><topic>Pregnancy, Complications of</topic><topic>Risk factors</topic><topic>South Africa - epidemiology</topic><topic>Teenage girls</topic><topic>Teenage pregnancy</topic><topic>Viral Load</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Anderson, K</creatorcontrib><creatorcontrib>Mutemaringa, T</creatorcontrib><creatorcontrib>Technau, K-G</creatorcontrib><creatorcontrib>Johnson, L.F</creatorcontrib><creatorcontrib>Braithwaite, K</creatorcontrib><creatorcontrib>Mokotoane, E</creatorcontrib><creatorcontrib>Boulle, A</creatorcontrib><creatorcontrib>Davies, M-A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SciELO</collection><jtitle>SAMJ: South African Medical Journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Anderson, K</au><au>Mutemaringa, T</au><au>Technau, K-G</au><au>Johnson, L.F</au><au>Braithwaite, K</au><au>Mokotoane, E</au><au>Boulle, A</au><au>Davies, M-A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The next generation : pregnancy in adolescents and women living with perinatally acquired HIV in South Africa</atitle><jtitle>SAMJ: South African Medical Journal</jtitle><addtitle>S Afr Med J</addtitle><date>2021-03-01</date><risdate>2021</risdate><volume>111</volume><issue>3</issue><spage>260</spage><epage>264</epage><pages>260-264</pages><issn>0256-9574</issn><issn>2078-5135</issn><eissn>2078-5135</eissn><abstract>Background. An increasing number of girls living with perinatally acquired HIV (PHIV) are reaching adolescence and adulthood and becoming pregnant. Youth living with PHIV (YLPHIV) may have HIV-associated infections/complications, long-term exposure to antiretroviral treatment (ART), drug resistance and increased psychosocial challenges, which may adversely affect pregnancy outcomes. There is a lack of published studies on pregnancy in YLPHIV in sub-Saharan Africa. Objectives. To describe characteristics of pregnant South African (SA) YLPHIV and their pregnancy outcomes. Methods. We retrospectively identified pregnancies in YLPHIV, who were diagnosed with HIV when they were <12 years old and before their first pregnancy (as a proxy for perinatal route of infection), from routinely collected data in Western Cape Province, SA (2007 - 2018). We combined these with pregnancies from a Johannesburg cohort of YLPHIV. Results. We identified 258 pregnancies among 232 females living with likely PHIV; 38.8% of pregnancies occurred in YLPHIV ≤16 years old, 39.1% at age 17 - 19 years and 22.1% at age ≥20 years. In recent years, a steady increase in the number of pregnancies in YLPHIV was noted; more than two-thirds occurred during 2016 - 2018. ART was commenced prior to pregnancy in 84.9% of YLPHIV, during pregnancy in 6.6% and was not commenced by pregnancy end date in 8.5%. Of the pregnancies in young women with documented outcomes (88.8%; n=229), 80.3% were live births, 14.4% terminations, 3.1% miscarriages and 2.2% stillbirths. Mother-to-child transmission of HIV occurred in 2.2% of infants, 75.3% were uninfected when last tested and 22.6% had unknown HIV status. Among YLPHIV with CD4 counts available within 12 months of pregnancy end date (n=202), 20.3% had a CD4 count <200 cells/µL, 43.1% CD4 count 200 - 499 cells/µL and 36.6% CD4 count ≥500 cells/µL. Among those with a viral load (VL) available within 12 months of pregnancy end date (n=219), 66.7% had a VL <400 copies/mL, 5.0% VL 400 - 999 copies/mL and 28.3% VL ≥1 000 copies/mL. Of 186 neonates, 20.4% were preterm deliveries (<37 weeks' gestation). Among neonates with known birthweight (n=176), the mean birthweight was 2 900 g (95% confidence interval (CI) 2 747 - 2 935 g) and 20.5% had a low birthweight (<2 500 g). One congenital malformation (musculoskeletal) and 2 neonatal deaths were recorded. Conclusions. In recent years, the number of pregnancies in YLPHIV has increased. A considerable proportion of pregnancies occurred in YLPHIV ≤16 years old. A high proportion of pregnancies was electively terminated. The prevalence of elevated VL and poor immunological status among pregnant YLPHIV is concerning.</abstract><cop>South Africa</cop><pub>Health and Medical Publishing Group (HMPG)</pub><pmid>33944749</pmid><doi>10.7196/SAMJ.2021.v111i3.14987</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | SAMJ: South African Medical Journal, 2021-03, Vol.111 (3), p.260-264 |
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| source | Sabinet African Journals Open Access Collection |
| subjects | Adolescent Adult Anti-Retroviral Agents - therapeutic use Antiviral agents CD4 Lymphocyte Count Child Complications and side effects Demographic aspects Drug therapy Female Health aspects Health Care Sciences & Services Health Policy & Services HIV Infections - drug therapy HIV Infections - epidemiology HIV Infections - transmission HIV seropositivity Humans Infectious Disease Transmission, Vertical Medical Ethics Medicine, General & Internal Medicine, Legal Medicine, Research & Experimental Pregnancy Pregnancy Complications, Infectious - epidemiology Pregnancy in Adolescence Pregnancy Outcome Pregnancy, Complications of Risk factors South Africa - epidemiology Teenage girls Teenage pregnancy Viral Load |
| title | The next generation : pregnancy in adolescents and women living with perinatally acquired HIV in South Africa |
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