What Do We Know About Perinatal Sexuality? A Scoping Review on Sexoperinatality - Part II

The intimate and sexual dimension of future and new parenting couples' relationship is the most affected and the most vulnerable during the transition to parenthood. The purpose of this scoping review is to present the portrait of perinatal sexuality through 123 empirical articles published in the last 15 years. This second article in a series of two is about sexuality during labor and birth, during the postpartum, and in relation to breastfeeding. 

A total of 29 sexual variables were analyzed. Sexuality during the intrapartal and postnatal periods is very diversified. Some recurring items, however, can be identified: a period of non-sexuality in the first postnatal months, followed by a gradual return of sexuality from 3 to 6 months postpartum and continuing until 12 months or more. 

Sexuality during the intrapartum is considered taboo and couples' experiences can be at opposite ends: some couples' experiences are sensual and erotic during childbirth, while others experience birth trauma with a negative sexual impact postnatally. 

Sexuality during breastfeeding is also taboo with a negative impact on women's sexuality. In all of these circumstances, women's and men's sexuality are affected and a multitude of simultaneous physiological and psychological factors affect their experiences. 

Fluctuations in the intimate and sexual dimensions of the conjugal relationship are considered as a natural phenomenon but temporary. Sexoperinatal interventions should be part of holistic perinatal health care in order to help couples maintain a positive intimate and sexual relationship.

Purchase full article [in French] at:   http://goo.gl/7zmy9k

By:   de Pierrepont C1, Polomeno V2, Bouchard L3, Reissing E4.

• 1Université d'Ottawa, Ottawa, Canada. Electronic address: catdep@hotmail.com.
• 2École des sciences infirmières, université d'Ottawa, Ottawa, Canada. Electronic address: vpolomen@uottawa.ca.
• 3Département de sociologie, institut de recherche sur la santé des populations, université d'Ottawa, Ottawa, Canada. Electronic address: louise.bouchard@uottawa.ca.
• 4École de psychologie, université d'Ottawa, Ottawa, Canada. Electronic address: reissing@uottawa.ca.
• J Gynecol Obstet Biol Reprod (Paris). 2016 Mar 14. pii: S0368-2315(15)00348-8. doi: 10.1016/j.jgyn.2015.11.001.
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A Risk Score to Identify HIV-Infected Women Most Likely to Become Lost to Follow-Up in the Postpartum Period

Access to lifelong combination antiretroviral therapy (cART) is expanding among HIV-infected pregnant and breastfeeding women throughout sub-Saharan Africa (SSA). For this strategy to meaningfully improve maternal HIV outcomes, retention in HIV care is essential. 

We developed a risk score to identify women with high likelihood of loss to follow-up (LTFU) at 6 months postpartum from HIV care, using data from public health facilities in Lusaka, Zambia. LTFU was defined as not presenting for HIV care within 60 days of the last scheduled appointment. We used logistic regression to assess demographic, obstetric and HIV predictors of LTFU and to develop a simple risk score. Sensitivity and specificity were assessed at each risk score cut-point. 

Among 2029 pregnant women initiating cART between 2009 and 2011, 507 (25%) were LTFU by 6 months postpartum. Parity, education, employment status, WHO clinical stage, duration of cART during pregnancy and number of antenatal care visits were associated with LTFU (p-value < .10). A risk score cut-point of 11 (42nd percentile) had 85% sensitivity (95% CI 82%, 88%) and 22% specificity (95% CI 20%, 24%) to detect women LTFU and would exclude 20% of women from a retention intervention. A risk score cut-point of 18 (69th percentile) identified the 23% of women with the highest probability of LTFU and had sensitivity 32% (95% CI 28%, 36%) and specificity 80% (95% CI 78%, 82%). 

A risk score approach may be useful to triage a subset of women most likely to be LTFU for targeted retention interventions.

Purchase full article at:   http://goo.gl/YZW67P

By:  Bengtson AM1, Chibwesha CJ2, Westreich D1, Mubiana-Mbewe M3, Chi BH2,3, Miller WC1,4, Mapani M2, Pence BW1, Musonda P5, Stringer JS2, Pettifor A1.

• 1 Department of Epidemiology , University of North Carolina , Chapel Hill , NC , USA.
• 2 Department of Obstetrics and Gynecology , University of North Carolina , Chapel Hill , NC , USA.
• 3 Centre for Infectious Disease Research , Zambia , Africa.
• 4 Department of Medicine , University of North Carolina , Chapel Hill , NC , USA.
• 5 Department of Public Health, University of Zambia School of Medicine , Lusaka , Zambia , Africa. 
• AIDS Care. 2016 Feb 17:1-11

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HIV Drug Resistance among Children Initiating First-Line Antiretroviral Treatment (ART) in Uganda

BACKGROUND:

There is limited data on primary HIV drug resistance (HIVDR) in pediatric populations. This study aimed to assess the prevalence of primary HIVDR and associated risk factors among children initiating first-line ART in Uganda.

METHODS:

At three Ugandan clinics children (age<12 years) requiring anti-retroviral therapy (ART) were recruited between January 2010-August 2011. Prior to ART start blood was collected for viral load and pol gene sequencing. Drug resistance mutations were determined using the 2010 IAS-USA mutation list. Risk factors for HIVDR were assessed with multivariate regression analysis.

RESULTS:

319 HIV-infected children with a median age 4.9 years were enrolled. Sequencing was successful for 279 (87.5%). HIVDR was present in 10% of all children and 15.2% of children <3 years. Nucleoside reverse transcriptase inhibitors (NRTI), non-NRTI (NNRTI) and dual-class resistance was present in 5.7%, 7.5% and 3.2% respectively. HIVDR occurred in 35.7% of PMTCT-exposed children, 15.6% in children with unknown PMTCT history and 7.7.% among ARV-naive children. History of PMTCT-exposure (AOR:2.6, 95%-CI:1.3-5.1) or unknown PMTCT status (AOR:3.8, 95%-CI:1.1-13.5), low CD4 (AOR:2.2, 95%-CI:1.3-3.6), current breastfeeding (AOR:7.4, 95%-CI:2.6-21) and current maternal ART use (AOR:6.4, 95%-CI: 3.4-11.9), emerged as risk factors for primary HIVDR in multivariate analysis.

CONCLUSION:

Pretreatment HIVDR is high, especially in children with PMTCT exposure. PI-based regimens are advocated by WHO, but availability in children is limited. Children with (unknown) PMTCT exposure, low CD4 count, current breastfeeding or maternal ART need to be prioritized to receive PI based regimens.

Purchase full article at: http://goo.gl/Ukdcng

By:   Kityo C1, Sigaloff KC2, Boender ST3, Kaudha E4, Kayiwa J5, Musiime V6, Mukuye A7, Kiconco M8, Nankya I9, Nakatudde L10, Calis JC11, Rinke de Wit TF12,Mugyenyi P13.

• 1Joint Clinical Research Centre, Kampala, Uganda, Kampala, Uganda ; ckityo@yahoo.com.
• 2Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands, Amsterdam, Netherlands ; k.sigaloff@pharmaccess.org.
• 3Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands, Amsterdam, Netherlands ; s.boender@aighd.org.
• 4Joint Clinical Research Centre, Kampala, Uganda, Kampala, Uganda ; ekaudha@jcrc.org.ug.
• 5Joint Clinical Research Centre, Kampala, Uganda, Kampala, Uganda ; joshua.kayiwa@gmail.com.
• 6Joint Clinical Research Centre, Kampala, Uganda, Kampala, Uganda ; vmusiime@jcrc.org.ug.
• 7Joint Clinical Research Centre, Kampala, Uganda, Kampala, Uganda ; mukdre@yahoo.com.
• 8Joint Clinical Research Centre, Kampala, Uganda, Kampala, Uganda ; mkiconco@jcrc.org.ug.
• 9Joint Clinical Research Centre, Kampala, Uganda, Kampala, Uganda ; inankya@hotmail.com.
• 10Joint Clinical Research Centre, Kampala, Uganda, Kampala, Uganda ; lnakatudde@yahoo.com.
• 11Emma Children's Hospital, Academic Medical Centre, Amsterdam, Netherlands, Amsterdam, Netherlands ; job.calis@gmail.com.
• 12Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands, Amsterdam, Netherlands ; t.rinkedewit@pharmaccess.org.
• 13Joint Clinical Research Centre, Kampala, Uganda, Kampala, Uganda ; pmugyenyi@jcrc.org.ug.
• AIDS Res Hum Retroviruses. 2016 Jan 1. 

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Mother-to-Child HIV-1 Transmission Events Are Differentially Impacted by Breast Milk and Its Components from HIV-1-Infected Women

Breast milk is a vehicle of infection and source of protection in post-natal mother-to-child HIV-1 transmission (MTCT). Understanding the mechanism by which breast milk limits vertical transmission will provide critical insight into the design of preventive and therapeutic approaches to interrupt HIV-1 mucosal transmission. However, characterization of the inhibitory activity of breast milk in human intestinal mucosa, the portal of entry in postnatal MTCT, has been constrained by the limited availability of primary mucosal target cells and tissues to recapitulate mucosal transmission ex vivo. 

Here, we characterized the impact of skimmed breast milk, breast milk antibodies (Igs) and non-Ig components from HIV-1-infected Ugandan women on the major events of HIV-1 mucosal transmission using primary human intestinal cells and tissues. HIV-1-specific IgG antibodies and non-Ig components in breast milk inhibited the uptake of Ugandan HIV-1 isolates by primary human intestinal epithelial cells, viral replication in and transport of HIV-1- bearing dendritic cells through the human intestinal mucosa. 

Breast milk HIV-1-specific IgG and IgA, as well as innate factors, blocked the uptake and transport of HIV-1 through intestinal mucosa. Thus, breast milk components have distinct and complementary effects in reducing HIV-1 uptake, transport through and replication in the intestinal mucosa and, therefore, likely contribute to preventing postnatal HIV-1 transmission. 

Our data suggests that a successful preventive or therapeutic approach would require multiple immune factors acting at multiple steps in the HIV-1 mucosal transmission process.

Below:  Inhibition of HIV-1 uptake by primary human intestinal epithelial cells (IECs). (A) Breast milk inhibition of subtype A and D HIV-1 uptake by IECs. (B) Dose-dependent breast milk inhibition of IEC uptake of subtype A HIV-1 by breast milk from an HIV-1-infected Ugandan woman. Ugandan subtype A or D viruses were pre-incubated with breast milk from an HIV-1-infected Ugandan woman for 30 min and then incubated with isolated primary IECs for 2 hr. The uptake of virus by IECs was measured by p24 ELISA with the uptake of virus pre-incubated with media defined as 100%, i.e. no inhibition. The range of p24 in samples treated with breast milk was 622–1300 pg/mL. Results are the mean values ±SD using IECs isolated from 4 separate tissue donors. Differences in IEC uptake of virus pre-incubated with breast milk and virus pre-incubated with media was determined by non-parametric Mann-Whitney test with significance indicated by * (p < 0.05).

Full article at:   http://goo.gl/LlKwwd

By:   Shen R1, Achenbach J2, Shen Y3, Palaia J2, Rahkola JT2,4, Nick HJ1, Smythies LE1, McConnell M5, Fowler MG6, Smith PD1,7, Janoff EN2,4.

• 1Department of Medicine (Division of Gastroenterology), University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
• 2Mucosal and Vaccine Research Program Colorado (MAVRC), University of Colorado Denver, Aurora, Colorado, United States of America.
• 3Department of Biological Sciences, Auburn University, Auburn, Alabama United States of America.
• 4Denver Veterans Affairs Medical Center, Denver, Colorado, United States of America.
• 5Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
• 6The Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda.
• 7Veterans Affairs Medical Center, Birmingham, Alabama, United States of America. 

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Surveying Lactation Professionals Regarding Marijuana Use and Breastfeeding

Breastfeeding is associated with substantial benefits for both the child and mother. Most guidelines state that women who use illicit drugs should not breastfeed. Although this recommendation has traditionally included marijuana, this drug's changing legal status and the limited scientific research regarding marijuana's effect on breastfeeding and the nursing child may lead to varying recommendations made by lactation professionals to clients who use marijuana. Additionally, to our knowledge, there are no data estimating the prevalence of marijuana use among breastfeeding women, making it unclear how common it is. This study assessed recommendations around breastfeeding and marijuana use and estimated the prevalence of marijuana use among breastfeeding women.

A convenience sample of lactation professionals who practice throughout New England and were attending the 2014 Vermont Lactation Consultant Association conference was offered the opportunity to complete a five-item survey.

Of 120 conference attendees, 74 completed the survey. Forty-four percent reported their recommendations around breastfeeding and marijuana use depended on factors like the severity of maternal use. Another 41% reported recommending continued breastfeeding because the benefits outweigh the harms. The remaining 15% reported recommending that a woman should stop breastfeeding if she cannot stop using marijuana. Survey completers estimated that 15% (1,203/7,843) of their breastfeeding clients in the past year used marijuana.

Lactation professionals vary widely in their recommendations to breastfeeding clients who use marijuana. The estimate of prevalence also suggests this is a relatively common issue. More research is needed to assess the generalizability of these findings.

Purchase full article at:  http://goo.gl/A6DFxo

By: Bergeria CL1,2, Heil SH1,2,3.

• 1 Vermont Center on Behavior and Health, University of Vermont , Burlington, Vermont.
• 2 Department of Psychological Science, University of Vermont , Burlington, Vermont.
• 3 Department of Psychiatry, University of Vermont , Burlington, Vermont.

 

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Rapid Antiretroviral Therapy Initiation for Women in an HIV-1 Prevention Clinical Trial Experiencing Primary HIV-1 Infection during Pregnancy or Breastfeeding

During an HIV-1 prevention clinical trial in East Africa, we observed 16 cases of primary HIV-1 infection in women coincident with pregnancy or breastfeeding. Nine of eleven pregnant women initiated rapid combination antiretroviral therapy (ART), despite having CD4 counts exceeding national criteria for ART initiation; breastfeeding women initiated ART or replacement feeding. Rapid ART initiation during primary HIV-1 infection during pregnancy and breastfeeding is feasible in this setting...

Primary HIV-1 infection carries a high risk of maternal-to-child HIV-1 transmission (MTCT) when occurring during pregnancy or breastfeeding [1, 2]. HIV-1 acquisition during pregnancy is often not identified because of limited repeat HIV-1 testing, although high HIV-1 incidence during this period has been observed [2, 3, 4]. Initiation of antiretroviral therapy (ART) reduces the risk of MTCT; however, few countries have policies which specifically address primary HIV-1 infection during pregnancy or breastfeeding or prioritize treatment in this situation. Women with primary HIV-1 infection are likely to have higher CD4 counts and thus not qualify for combination ART under many national guidelines for routine ART initiation, or may not be prioritized for urgent initiation where policies for universal treatment during pregnancy (Option B/B+) have been adopted.

Randomized clinical trials of novel HIV-1 prevention strategies frequently enroll reproductive-age women at high HIV-1 risk, who may also become pregnant during study follow-up. Frequent, scheduled HIV-1 testing presents an opportunity to identify HIV-1 acquisition, potentially permitting initiation of combination ART to reduce the risk of MTCT. However, HIV-1 prevention trial sites do not typically provide direct HIV-1 care, instead referring HIV-1 seroconverters to local institutions.

Full article at: http://goo.gl/QIneEb

By: 

Susan Morrison, Grace John-Stewart, Elizabeth A. Bukusi, Connie Celum, Jared M. Baeten

Department of Global Health, University of Washington, Seattle, WA, United States of America

Grace John-Stewart, Connie Celum, Jared M. Baeten

Department of Medicine, University of Washington, Seattle, WA United States of America

Grace John-Stewart, Connie Celum, Jared M. Baeten

Department of Epidemiology, University of Washington, Seattle, United States of America

John J. Egessa, Sylvia Kusemererwa, Jonathan Wangisi

The AIDS Support Organization, Kampala, Uganda

Sezi Mubezi, Nulu Bulya

Infectious Disease Institute, Makerere University, Kampala, Uganda

Dennis K. Bii, Elizabeth A. Bukusi

Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya

Francis Mugume

Kabwohe Clinical Research Center, Kabwohe, Uganda

James D. Campbell

Centers for Disease Control and Prevention, Entebbe, Uganda

  

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Breastfeeding Is Associated with Decreased Risk of Hospitalization among HIV-Exposed, Uninfected Kenyan Infants

Human immunodeficiency virus (HIV)-exposed uninfected (HEU) infants are a growing population in sub-Saharan Africa, with higher morbidity and mortality than HIV-unexposed infants. HEU infants may experience increased morbidity due to breastfeeding avoidance.

We sought to describe the burden and identify predictors of hospitalization among HEU infants in the first year of life.

Using a retrospective cohort of HIV-infected mothers and their HEU infants in Nairobi, Kenya, we identified infants who were HIV-uninfected at birth and were followed monthly until their last negative HIV test, death, loss to follow-up, or study exit at 1 year of age. Incidence, timing, and reason for hospitalization was assessed overall as well as stratified by feeding method. Predictors of first infectious disease hospitalization were identified using competing risk regression, with HIV acquisition and death as competing risks.

Among 388 infants, 113 hospitalizations were reported (35/100 infant-years [the combined years of observation contributed by all infants in the study]; 95% confidence interval [CI], 29-42). Ninety hospitalizations were due to 1 or more infectious diseases (26/100 infant-years; 95% CI, 21-32)-primarily pneumonia (n = 40), gastroenteritis (n = 17), and sepsis (n = 14). Breastfeeding was associated with decreased risk of infectious disease hospitalization (subhazard ratio = 0.39; 95% CI, 0.24-0.64), as was time-updated nutrition status (subhazard ratio = 0.73; 95% CI, 0.61-0.89). Incidence of infectious disease hospitalization among formula-fed infants was 51/100 infant-years (95% CI, 37-70) compared to 19/100 infant-years (95% CI, 14-25) among breastfed infants.

Among HEU infants, breastfeeding and nutrition status were associated with reduced hospitalization during the first year of life.

Via: http://goo.gl/5ftDNE  Purchase full article at: http://goo.gl/Cc8KMl

By: Ásbjörnsdóttir KH1, Slyker JA2, Maleche-Obimbo E3, Wamalwa D3, Otieno P4, Gichuhi CM5, John-Stewart G6.

• 1Department of Epidemiology, University of Washington, Seattle, WA, USA
• 2Department of Global Health, University of Washington, Seattle, WA, USA.
• 3Department of Paediatrics & Child Health, University of Nairobi, Nairobi, Kenya.
• 4Kenya Medical Research Institute, Nairobi, Kenya.
• 5Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya.
• 6Department of Epidemiology, University of Washington, Seattle, WA, USA Department of Global Health, University of Washington, Seattle, WA, USA Department of Medicine, University of Washington, Seattle, WA, USA Department of Pediatrics, University of Washington, Seattle, WA, USA. 

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Hormonal Contraception, Pregnancy, Breastfeeding & Risk of HIV Disease Progression among Zambian Women

Some studies suggest hormonal contraception, pregnancy, and/or breastfeeding may influence rates of HIV disease progression.

From 1994-2012, HIV discordant couples recruited at couples' voluntary HIV counseling and testing centers in Lusaka were followed 3-monthly. Multivariate survival analyses explored associations between time-varying contraception, pregnancy, and breastfeeding and two outcomes among HIV-positive women: 1) time-to-death and 2) time-to-antiretroviral treatment (ART) initiation.

Among 1,656 female seropositive, male seronegative couples followed for 3,359 person years (PY), 224 women died. After 2003, 290 women initiated ART. In a multivariate model of time-to-death, hormonal implant and injectable were significantly protective relative to non-hormonal method use while OCP use was not controlling for baseline HIV disease stage, time-varying pregnancy, time-varying breastfeeding, and year of enrollment. In a multivariate model of time-to-ART initiation, implant was protective while OCP and injectable were not relative to non-hormonal method use controlling for variables above, woman's age, and literacy. Pregnancy was not significantly associated with death or ART initiation while breastfeeding was protective for death and ART initiation.

Hormonal implants and injectables significantly predicted lower mortality; implants were protective for ART initiation. OCPs and pregnancy were not associated with death or ART initiation, while breastfeeding was protective for both. 

Findings from this 18-year cohort study suggest 1) HIV-positive women desiring pregnancy can be counseled to do so and breastfeed, and 2) all effective contraceptive methods including injectables and implants should be promoted to prevent unintended pregnancy.

Via: http://ht.ly/SxVbk Purchase full article at:  http://ht.ly/SxVdj 

By: Wall KM1, Kilembe W, Haddad L, Vwalika B, Lakhi S, Htee Khu N, Brill I, Chomba E, Mulenga J, Tichacek A, Allen S.

• 1aRwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA bDepartment of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, USA cDepartment of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, Georgia, USA dDepartments of Gynecology and Obstetrics (BV) and Internal Medicine (SL), School of Medicine, University of Zambia, Lusaka, Zambia eDepartment of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA fMinistry of Community Development, Mother and Child Health, Lusaka, Zambia.
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Exclusive Breastfeeding & HIV/AIDS: A Crossectional Survey of Mothers Attending Prevention of Mother-To-Child Transmission of HIV Clinics in Southwestern Nigeria

Below:  Infant feeding practices of mothers

Majority of the mothers (86.0%) were married and aged 31.0 ± 5.7years. Slightly above half (53.0%) had≤2 children and more than two-third had disclosed their HIV status to their spouses. About two-third (61.0%) were traders with 75.0% earning monthly income ≤N5,000.00k. Half of the mothers had ≥4 antenatal care visits and 85.0% had infant feeding counselling. Infant feeding choices among the mothers were EBF (61.0%), ERF (26.0%) and MF (13.0%). The choice of EBF was influenced by spouse influence (84.0%), family influence (81.0%) and fear of stigmatisation (53.0%). Predictors of EBF were; monthly income (AOR = 2.6, C.I. =1.4-4.5), infant feeding counselling (AOR = 2.7, C.I. = 1.6-6.9) and fear of stigmatisation (AOR = 7. 2, C.I. = 2.1-23.6).

HIV positive mothers are faced with multiple challenges as they strive to practice exclusive breastfeeding. More extensive and comprehensive approach of infant feeding counseling with emphasis on behavioural change programmes in the context of HIV/AIDS within communities is advocated.

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HIV Testing in Maternity Ward & the Start of Breastfeeding: Survival Analysis

Below:  Survival curve of time to breastfeeding onset in Baby-Friendly Hospitals of the high-risk system. Rio de Janeiro, Brazil, 2006.

Hospitals with median time to breastfeeding onset at birth of up to 60 min were considered as early breastfeeding onset and those with higher medians were considered as late breastfeeding onset at birth. Risk factors common to hospitals considered to be with early and late breastfeeding onset at birth were: cesarean section (RR = 1.75 [95% CI: 1.38–2.22]; RR = 3.83 [95% CI: 3.03–4.85]) and rapid test result after birth (RR = 1.45 [95% CI: 1.12–1.89]; RR = 1.65 [95% CI: 1.35–2.02]), respectively; and hospitals with late onset: starting prenatal care in the third trimester (RR = 1.86 [95% CI: 1.16–2.97]).

The onset of breastfeeding is postponed, even in Baby-Friendly Hospitals, when the results of the rapid HIV test requested in the maternity are not available at the time of delivery.

Via: http://ht.ly/NvCWK  HT @unicentropr