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1. Evaluating the performance of the GeneXpert HIV‑1 qualitative assay as a consecutive test for a new early infant diagnosis algorithm in South Africa

Author

Mukendi, A, Kufa, T, Murray, T, Burke, M, Strehlau, R, Technau, K-G, Tiemessen, C T, Sherman, G G, and Mazanderani, A H

Abstract

Background. The proportion of HIV-exposed infants and young children infected with HIV in South Africa (SA) has declined markedly over the past decade as a result of the country’s comprehensive prevention of mother-to-child transmission programme. This decrease has in turn reduced the positive predictive value (PPV) of diagnostic assays, necessitating review of early infant diagnosis (EID) algorithms to ensure improved accuracy. Objectives. To evaluate the performance of the GeneXpert HIV-1 qualitative assay (Xpert EID) as a consecutive test for infants with an ‘HIV-detected’ polymerase chain reaction screening test at birth. Methods. We retrospectively analysed a longitudinal cohort of HIV-exposed infants on whom birth testing was performed, using whole-blood ethylenediaminetetra-acetic acid samples, from four tertiary sites in Gauteng Province between June 2014 and December 2019. Birth samples from all infants with a Cobas AmpliPrep/Cobas TaqMan HIV-1 Qualitative Test v2.0 (CAP/CTM v2.0) HIV-detected screening test, a concurrent Xpert EID test and a subsequent confirmatory CAP/CTM v2.0 test on a separate specimen were included. Performance of the Xpert EID in predicting final HIV status was determined as proportions with 95% confidence intervals (CIs). A comparison of indeterminate CAP/CTM v2.0 results, as per National Health Laboratory Service resulting practice, with discordant CAP/CTM v2.0 v. Xpert EID results was performed. Results. Of 150 infants who met the inclusion criteria, 6 (3.9%) had an Xpert EID result discordant with final HIV status: 5 (3.3%) were false negatives and 1 (0.7%) was false positive. As a consecutive test, the Xpert EID yielded a sensitivity of 96.5% (95% CI 92 - 98.9), specificity of 85.7% (95% CI 42.1 - 99.6), PPV of 99.3% (95% CI 95.7 - 99.9), negative predictive value of 54.5% (95% CI 32.5 - 74.9) and overall accuracy of 96.1% (95% CI 91.5 - 98.5). Using discordant CAP/CTM v2.0/Xpert EID results as criteria to verify indeterminate results instead of current practice would have reduced the number of indeterminate screening results by 42.1%, from 18 (12.6%) to 11 (7.2%), without increasing the false-positive rate. Conclusions. Addition of the Xpert EID as a consecutive test for specimens with an HIV-detected PCR screening result has the potential to improve the PPV and reduce the indeterminate rate, thereby reducing diagnostic challenges and time to final status, in SA’s EID programme.

Published
2022

2. The next generation: Pregnancy in adolescents and women living with perinatally acquired HIV in South Africa

Author

Anderson, K, Mutemaringa, T, Technau, K-G, Johnson, L F, Braithwaite, K, Mokotoane, E, Boulle, A, Davies, M-A, and Pediatrics, IeDEA-SA

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

Published
2022

4. Global temporal changes in the proportion of children with advanced disease at the start of combination antiretroviral therapy in an era of changing criteria for treatment initiation

Author

Panayidou K., Davies M. -A., Anderegg N., Egger M., Fatti G., Vinikoor M., Sawry S., Ehmer J., Eley B., Phiri S., Technau K. -G. u. N., Chimbetete C., Rabie H., Boulle A., Tanser F., Wood R., Wools-Kaloustian K., Vreeman R., Oyaro P., Ayaya S., Nakigozi G., Musick B., Yiannoutsos C., Amorissani-Folquet M., Takassi E., Sylla M., Renner L., Malateste K., Desmonde S., Leroy V., Kurniati N., Hansudewechakul R., Nguyen L. V., Ly P. S., Truong K. H., Kariminia A., Sohn A. H., Edmonds A., Yumo H. A., Dusingize J. C., Yotebieng M., Judd A., Rojo P., Smit C., Grabar S., Warszwarski J., Chene G., Raban D., Patel K., Seage G. R., Van Dyke R. B., Oleske J., Williams P. L., Abzug M. J., Succi R., Machado D. M., Pinto J., Rouzier V., Luque M., Mejia F., Khol V., Tucker J., Kumarasamy N., Saghayam S., Chandrasekaran E., Wati D. K., Vedaswari D., Malino I. Y., Muktiarti D., Fong S. M., Lim M., Daut F., Nik Yusoff N. K., Mohamad P., Mohamed T. J., Drawis M. R., Nallusamy R., Chan K. C., Sudjaritruk T., Sirisanthana V., Aurpibul L., Oberdorfer P., Denjanta S., Watanaporn S., Kongphonoi A., Lumbiganon P., Kosalaraksa P., Tharnprisan P., Udomphanit T., Jourdain G., Puthanakit T., Anugulruengkitt S., Phadungphon C., Chokephaibulkit K., Lapphra K., Phongsamart W., Sricharoenchai S., Du Q. T., Nguyen C. H., Do V. C., Ha T. M., An V. T., Khu D. T. K., Pham A. N., Nguyen L. T., Le O. N., Ross J. L., Sethaputra C., Law M. G., Cahn P., Cesar C., Fink V., Sued O., Dell'isola E., Perez H., Valiente J., Yamamoto C., Grinsztejn B., Veloso V., Luz P., de Boni R., Wagner S. C., Friedman R., Moreira R., Ferreira F., Maia M., de Menezes Succi R. C., Barbosa Gouv E A A. F. a. T., Wolff M., Cortes C., Rodriguez M. F., Allendes G., Pape J. W., Marcelin A., Perodin C., Luque M. T., Padgett D., Madero J. S., Ramirez B. C., Belaunzaran P., Vega Y. C., Gotuzzo E., Carriquiry G., McGowan C. C., Shepherd B. E., Sterling T., Jayathilake K., Person A. K., Rebeiro P. F., Giganti M., Castilho J., Duda S. N., Maruri F., Vansell H., P E Lagie N., Gateretse P., Munezero J., Nitereka V., Niyongabo T., Twizere C., Bukuru H., Nahimana T., Biziragusenyuka J., Manyundo R. S., Atsu K., Mbuh T., Ajeh R., Benwi M., Dzudie A., Mbuh A., Ngamani M. L., Nkome V., Amadou D., Ngassam E., Pefura Yone E. W., Ewanoge A. N., Fuhngwa N., Moki C., Akele C., Kitetele F., Lelo P., Tabala M., Okitolonda E. W., Wenzi L., Diafouka M., Ekat M. H., Nsonde D. M., Mafou A., Ntarambirwa F., Tuyishimire Y., Hakizimana T., Ayinkamiye J., Mukantwali S., Kayitesi H., Uwamahoro O., Habumuremyi V., Mukamana J., Kubwimana G., Mugenzi P., Muhoza B., Munyaneza A., Ndahiro E., Nyiransabimana D., D'Amour Sinayobye J., Sugira V., Benekigeri C., Mbaraga G., Adedimeji A., Anastos K., Dilorenzo M., Murchison L., Ross J., Addison D., Baker M., Brazier E., Jones H., Kelvin E., Kulkarni S., Nash D., Tymejczyk O., Elul B., Cai X., Hoover D., Kim H. -Y., Li C., Shi Q., Lancaster K., Kuniholm M., Parcesepe A., Duda S., Kimmel A., McNairy M., Diero L., Plus A. M. P. A. T. H., Bukusi E., Ssali J., Nalugoda F., Somi G. R., Lyamuya R. E., Ngonyani K., Lugina E., Urassa M., Michael D., Zannou M. D., Poda A., Sarfo F. S., Messou E., Chenal H., Minga K. A., Bissagnene E., Tanon A., Seydi M., Patassi A. A., Koumakpai-Adeothy S. A., Renner L. A., N'gbeche S. M., Bosse C. A., Kouakou K., Folquet M. A., Eboua F. c. O. T., Traore F. D., Dabis F. c. O., Arrive E., Balestre E., Becquet R., Bernard C., Arikawa S. C., Doring A., Jaquet A., Rabourdin E., Tiendrebeogo T., Jesson J., Ekouevi D. K., Azani J. -C., Coffi E P., Gnepa G., Kouadio C. G. K., Tchounga B., Maartens G., Lettow M. V., Muhairwe J., Jores A., Kamenova K., Fox M. P., Prozesky H., Zangerle R., Touloumi G., Warszawski J., Meyer L., Krause M. M., Ghosn J., Leport C., Wittkop L., Reiss P., Wit F., Prins M., Bucher H., Gibb D., Fatkenheuer G., Del Amo J., Obel N., Thorne C., Mocroft A., Kirk O., Stephan C., Perez-Hoyos S., Hamouda O., Bartmeyer B., Chkhartishvili N., Noguera-Julian A., Antinori A., D'Arminio Monforte A., Brockmeyer N., Prieto L., Conejo P. R., Soriano-Arandes A., Battegay M., Kouyos R., Mussini C., Tookey P., Casabona J., Miro J. M., Castagna A., Konopnick D., Goetghebuer T., Sonnerborg A., Torti C., Sabin C., Teira R., Garrido M., Haerry D., de Wit S., Costagliola D., Raben D., Barger D., Schwimmer C., Termote M., Campbell M., Frederiksen C. M., Friis-Moller N., Kjaer J., Brandt R. S., Berenguer J., Bohlius J., Bouteloup V., Cozzi-Lepri A., Dorrucci M., Dunn D., Furrer H., Guiguet M., Lambotte O., Lodi S., Matheron S., Miro J. M. ª., Monge S., Nakagawa F., Paredes R., Phillips A., Puoti M., Rohner E., Schomaker M., Sterne J., Thiebaut R., van der Valk M., Hazra R., Heckman B., O'gara E., Siminski S., Panayidou, K, Davies, M, Anderegg, N, Egger, M, Fatti, G, Vinikoor, M, Sawry, S, Ehmer, J, Eley, B, Phiri, S, Technau, K, Chimbetete, C, Rabie, H, Boulle, A, Tanser, F, Wood, R, Wools-Kaloustian, K, Vreeman, R, Oyaro, P, Ayaya, S, Nakigozi, G, Musick, B, Yiannoutsos, C, Amorissani-Folquet, M, Takassi, E, Sylla, M, Renner, L, Malateste, K, Desmonde, S, Leroy, V, Kurniati, N, Hansudewechakul, R, Nguyen, L, Ly, P, Truong, K, Kariminia, A, Sohn, A, Edmonds, A, Yumo, H, Dusingize, J, Yotebieng, M, Judd, A, Rojo, P, Smit, C, Grabar, S, Warszwarski, J, Chene, G, Raban, D, Patel, K, Seage, G, Van Dyke, R, Oleske, J, Williams, P, Abzug, M, Succi, R, Machado, D, Pinto, J, Rouzier, V, Luque, M, Mejia, F, Khol, V, Tucker, J, Kumarasamy, N, Saghayam, S, Chandrasekaran, E, Wati, D, Vedaswari, D, Malino, I, Muktiarti, D, Fong, S, Lim, M, Daut, F, Nik Yusoff, N, Mohamad, P, Mohamed, T, Drawis, M, Nallusamy, R, Chan, K, Sudjaritruk, T, Sirisanthana, V, Aurpibul, L, Oberdorfer, P, Denjanta, S, Watanaporn, S, Kongphonoi, A, Lumbiganon, P, Kosalaraksa, P, Tharnprisan, P, Udomphanit, T, Jourdain, G, Puthanakit, T, Anugulruengkitt, S, Phadungphon, C, Chokephaibulkit, K, Lapphra, K, Phongsamart, W, Sricharoenchai, S, Du, Q, Nguyen, C, Do, V, Ha, T, An, V, Khu, D, Pham, A, Le, O, Ross, J, Sethaputra, C, Law, M, Cahn, P, Cesar, C, Fink, V, Sued, O, Dell'Isola, E, Perez, H, Valiente, J, Yamamoto, C, Grinsztejn, B, Veloso, V, Luz, P, de Boni, R, Wagner, S, Friedman, R, Moreira, R, Ferreira, F, Maia, M, de Menezes Succi, R, Barbosa Gouv E A, A, Wolff, M, Cortes, C, Rodriguez, M, Allendes, G, Pape, J, Marcelin, A, Perodin, C, Padgett, D, Madero, J, Ramirez, B, Belaunzaran, P, Vega, Y, Gotuzzo, E, Carriquiry, G, Mcgowan, C, Shepherd, B, Sterling, T, Jayathilake, K, Person, A, Rebeiro, P, Giganti, M, Castilho, J, Duda, S, Maruri, F, Vansell, H, P E Lagie, N, Gateretse, P, Munezero, J, Nitereka, V, Niyongabo, T, Twizere, C, Bukuru, H, Nahimana, T, Biziragusenyuka, J, Manyundo, R, Atsu, K, Mbuh, T, Ajeh, R, Benwi, M, Dzudie, A, Mbuh, A, Ngamani, M, Nkome, V, Amadou, D, Ngassam, E, Pefura Yone, E, Ewanoge, A, Fuhngwa, N, Moki, C, Akele, C, Kitetele, F, Lelo, P, Tabala, M, Okitolonda, E, Wenzi, L, Diafouka, M, Ekat, M, Nsonde, D, Mafou, A, Ntarambirwa, F, Tuyishimire, Y, Hakizimana, T, Ayinkamiye, J, Mukantwali, S, Kayitesi, H, Uwamahoro, O, Habumuremyi, V, Mukamana, J, Kubwimana, G, Mugenzi, P, Muhoza, B, Munyaneza, A, Ndahiro, E, Nyiransabimana, D, D'Amour Sinayobye, J, Sugira, V, Benekigeri, C, Mbaraga, G, Adedimeji, A, Anastos, K, Dilorenzo, M, Murchison, L, Addison, D, Baker, M, Brazier, E, Jones, H, Kelvin, E, Kulkarni, S, Nash, D, Tymejczyk, O, Elul, B, Cai, X, Hoover, D, Kim, H, Li, C, Shi, Q, Lancaster, K, Kuniholm, M, Parcesepe, A, Kimmel, A, Mcnairy, M, Diero, L, Plus, A, Bukusi, E, Ssali, J, Nalugoda, F, Somi, G, Lyamuya, R, Ngonyani, K, Lugina, E, Urassa, M, Michael, D, Zannou, M, Poda, A, Sarfo, F, Messou, E, Chenal, H, Minga, K, Bissagnene, E, Tanon, A, Seydi, M, Patassi, A, Koumakpai-Adeothy, S, N'Gbeche, S, Bosse, C, Kouakou, K, Folquet, M, Eboua, F, Traore, F, Dabis, F, Arrive, E, Balestre, E, Becquet, R, Bernard, C, Arikawa, S, Doring, A, Jaquet, A, Rabourdin, E, Tiendrebeogo, T, Jesson, J, Ekouevi, D, Azani, J, Coffi E, P, Gnepa, G, Kouadio, C, Tchounga, B, Maartens, G, Lettow, M, Muhairwe, J, Jores, A, Kamenova, K, Fox, M, Prozesky, H, Zangerle, R, Touloumi, G, Warszawski, J, Meyer, L, Krause, M, Ghosn, J, Leport, C, Wittkop, L, Reiss, P, Wit, F, Prins, M, Bucher, H, Gibb, D, Fatkenheuer, G, Del Amo, J, Obel, N, Thorne, C, Mocroft, A, Kirk, O, Stephan, C, Perez-Hoyos, S, Hamouda, O, Bartmeyer, B, Chkhartishvili, N, Noguera-Julian, A, Antinori, A, D'Arminio Monforte, A, Brockmeyer, N, Prieto, L, Conejo, P, Soriano-Arandes, A, Battegay, M, Kouyos, R, Mussini, C, Tookey, P, Casabona, J, Miro, J, Castagna, A, Konopnick, D, Goetghebuer, T, Sonnerborg, A, Torti, C, Sabin, C, Teira, R, Garrido, M, Haerry, D, de Wit, S, Costagliola, D, Raben, D, Barger, D, Schwimmer, C, Termote, M, Campbell, M, Frederiksen, C, Friis-Moller, N, Kjaer, J, Brandt, R, Berenguer, J, Bohlius, J, Bouteloup, V, Cozzi-Lepri, A, Dorrucci, M, Dunn, D, Furrer, H, Guiguet, M, Lambotte, O, Lodi, S, Matheron, S, Monge, S, Nakagawa, F, Paredes, R, Phillips, A, Puoti, M, Rohner, E, Schomaker, M, Sterne, J, Thiebaut, R, van der Valk, M, Hazra, R, Heckman, B, O'Gara, E, and Siminski, S

Subjects
0301 basic medicine, Male, sub-Saharan Africa, Databases, Factual, CD4 cell count, HIV Infections, Global Health, Cohort Studies, 0302 clinical medicine, Central and South America, Advanced disease, Medicine, 030212 general & internal medicine, Prospective Studies, Cd4 cell count, skin and connective tissue diseases, Child, Research Articles, humanities, 3. Good health, Europe, Infectious Diseases, Child, Preschool, Income, Drug Therapy, Combination, Female, advanced HIV disease, antiretroviral therapy, Asia, Caribbean, North America, WHO guidelines, Adolescent, Adult, Anti-HIV Agents, CD4 Lymphocyte Count, Drug Administration Schedule, Follow-Up Studies, Humans, Poverty, World Health Organization, Research Article, medicine.medical_specialty, education, 610 Medicine & health, 03 medical and health sciences, Acquired immunodeficiency syndrome (AIDS), 360 Social problems & social services, Intensive care medicine, business.industry, Public Health, Environmental and Occupational Health, medicine.disease, 030112 virology, Antiretroviral therapy, Who guidelines, sense organs, business, sub‐Saharan Africa
Abstract

Introduction: The CD4 cell count and percent at initiation of combination antiretroviral therapy (cART) are measures of advanced HIV disease and thus are important indicators of programme performance for children living with HIV. In particular, World Health Organization (WHO) 2017 guidelines on advanced HIV disease noted that >80% of children aged 40% of children in low- and middle-income countries started cART with severe immunodeficiency compared to

Published
2018
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5. Pediatric Cancer Burden and Treatment Resources within the Pediatric IeDEA Consortium

Author

Brown, S. A., Abbas, S., Davies, M. A., Bunupuradah, T., Sohn, A. I. I., Technau, K. G., Renner, L., Valeriane Leroy, Edmonds, A., Yotebieng, M., Mcgowan, C. C., Duda, S. N., Mofenson, L., Musick, B., and Wools-Kaloustian, K.

Subjects
Male, Asia, Anti-HIV Agents, Incidence, Lymphoma, Non-Hodgkin, HIV Infections, Pacific Islands, Burkitt Lymphoma, Article, Cross-Sectional Studies, Africa, Humans, Female, Health Services Research, Child, Delivery of Health Care, Sarcoma, Kaposi
Abstract

The incidence and treatment of cancer in HIV-infected children from resource-limited settings has not been extensively studied.Develop and implement a cross-sectional survey to evaluate pediatric cancer burden, diagnostic modalities in use, and treatment availability as perceived by HIV clinic staff at regional International Epidemiology Databases to Evaluate AIDS (IeDEA) sites.IeDEA regional investigators developed a cross-sectional clinical site survey which included questions on the numbers and types of pediatric cancers observed, modalities used to treat identified cancers, and treatment options available at individual sites in the Asia-Pacific, Latin America, Central Africa, East Africa, West Africa, and Southern Africa regions.Kaposi sarcoma, non-Hodgkin lymphoma, and Burkitt lymphoma were reported by site personnel to be the most prevalent types of cancer in the pediatric HIV population. Survey results indicate that access to comprehensive cancer treatment modalities is very limited for children in these regions despite HIV care and treatment sites reporting that they diagnose pediatric cancers. Responses also showed that evaluating cancer in the pediatric HIV population is a challenge due to a lack of resources and varying treatment availability within regions.Further study is needed to increase our understanding of the changing epidemiology of cancer in HIV-infected pediatric populations. Increased financial and technical resources are critical to aid in the advancement of health services to support treatment of these children in resource-constrained settings.

Published
2017

7. Evaluating the performance of the GeneXpert HIV-1 qualitative assay as a consecutive test for a new early infant diagnosis algorithm in South Africa.

Author

Mukendi A, Kufa T, Murray T, Burke M, Strehlau R, Technau KG, Tiemessen CT, Sherman GG, and Mazanderani AH

Subjects
Adult, Female, Humans, Infant, Newborn, Longitudinal Studies, Pregnancy, Retrospective Studies, South Africa, Algorithms, Early Diagnosis, HIV Infections diagnosis, HIV-1, Infectious Disease Transmission, Vertical
Abstract

Background: The proportion of HIV-exposed infants and young children infected with HIV in South Africa (SA) has declined markedly over the past decade as a result of the country's comprehensive prevention of mother-to-child transmission programme. This decrease has in turn reduced the positive predictive value (PPV) of diagnostic assays, necessitating review of early infant diagnosis (EID) algorithms to ensure improved accuracy., Objectives: To evaluate the performance of the GeneXpert HIV-1 qualitative assay (Xpert EID) as a consecutive test for infants with an 'HIV-detected' polymerase chain reaction screening test at birth., Methods: We retrospectively analysed a longitudinal cohort of HIV-exposed infants on whom birth testing was performed, using whole-blood ethylenediaminetetra-acetic acid samples, from four tertiary sites in Gauteng Province between June 2014 and December 2019. Birth samples from all infants with a Cobas AmpliPrep/Cobas TaqMan HIV-1 Qualitative Test v2.0 (CAP/CTM v2.0) HIV-detected screening test, a concurrent Xpert EID test and a subsequent confirmatory CAP/CTM v2.0 test on a separate specimen were included. Performance of the Xpert EID in predicting final HIV status was determined as proportions with 95% confidence intervals (CIs). A comparison of indeterminate CAP/CTM v2.0 results, as per National Health Laboratory Service resulting practice, with discordant CAP/CTM v2.0 v. Xpert EID results was performed., Results: Of 150 infants who met the inclusion criteria, 6 (3.9%) had an Xpert EID result discordant with final HIV status: 5 (3.3%) were false negatives and 1 (0.7%) was false positive. As a consecutive test, the Xpert EID yielded a sensitivity of 96.5% (95% CI 92 - 98.9), specificity of 85.7% (95% CI 42.1 - 99.6), PPV of 99.3% (95% CI 95.7 - 99.9), negative predictive value of 54.5% (95% CI 32.5 - 74.9) and overall accuracy of 96.1% (95% CI 91.5 - 98.5). Using discordant CAP/CTM v2.0/Xpert EID results as criteria to verify indeterminate results instead of current practice would have reduced the number of indeterminate screening results by 42.1%, from 18 (12.6%) to 11 (7.2%), without increasing the false-positive rate., Conclusions: Addition of the Xpert EID as a consecutive test for specimens with an HIV-detected PCR screening result has the potential to improve the PPV and reduce the indeterminate rate, thereby reducing diagnostic challenges and time to final status, in SA's EID programme.

Published
2021

8. The next generation: Pregnancy in adolescents and women living with perinatally acquired HIV in South Africa.

Author

Anderson K, Mutemaringa T, Technau KG, Johnson LF, Braithwaite K, Mokotoane E, Boulle A, and Davies On Behalf Of IeDEA-Sa Pediatrics MA

Subjects
Adolescent, Adult, Anti-Retroviral Agents therapeutic use, CD4 Lymphocyte Count, Child, Female, HIV Infections drug therapy, Humans, Pregnancy, Pregnancy Outcome, South Africa epidemiology, Viral Load, HIV Infections epidemiology, HIV Infections transmission, Infectious Disease Transmission, Vertical, Pregnancy Complications, Infectious epidemiology, Pregnancy in Adolescence
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.

Published
2021
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9. COVID-19 in pregnancy in South Africa: Tracking the epidemic and defining the natural history.

Author

Fairlie L, Sawry S, Patel F, Balkus JE, Kalk E, Mutevedzi P, Technau KG, Yates LM, Slogrove A, Ballot D, Bandini RM, Mehta U, Moodley D, Mhlongo O, Budram S, Maswime S, Vannevel V, Rees H, and Chersich M

Subjects
Betacoronavirus, COVID-19, COVID-19 Testing, Clinical Laboratory Techniques, Coronavirus Infections diagnosis, Female, Humans, Mass Screening, Pandemics, Pneumonia, Viral diagnosis, Pregnancy, Pregnancy Complications, Infectious diagnosis, Prenatal Care, Research, SARS-CoV-2, South Africa epidemiology, Asymptomatic Infections epidemiology, Coronavirus Infections epidemiology, Pneumonia, Viral epidemiology, Pregnancy Complications, Infectious epidemiology, Sentinel Surveillance
Published
2020
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