Welcome to this issue of Preventing Perinatal HIV Transmission: Field Update. You are receiving this newsletter because you expressed an interest in perinatal HIV prevention in hospitals or have signed up to receive it. This free quarterly email newsletter connects its subscribers to news updates, trends, statistics, prevention programs, policy initiatives, tools, and useful practices relating to perinatal HIV prevention in U.S. hospitals. The Health Research and Educational Trust (HRET), with support from the Centers for Disease Control and Prevention (CDC), produces this newsletter as a forum for information dissemination and for communication among and between hospital staff, HIV experts, and researchers.
For more information on HRET’s Perinatal HIV Prevention project, please visit our website.
If you have comments or suggestions for future issues of this newsletter, please contact Jennifer Reiter at firstname.lastname@example.org.
State-by-State Map of HIV Laws Available Online
HRET recently added a comprehensive map of state laws to its Perinatal HIV Prevention project’s website. This map compiles the HIV testing laws of all 50 states in one accessible place, and provides text of the relevant laws. States are divided into two sections for comparison: Alabama to Missouri and Montana to Wyoming. Perinatal-relevant categories include rapid HIV testing, testing of pregnant women and/or newborns, mandatory offering of HIV/AIDS information or testing, and several more. The map and its charts were put together by former HRET staff member and current University of California, San Francisco (UCSF) medical student, Kali Stanger, as part of an internship at UCSF.
To access the maps directly, click here.
ACOG and AMCHP to Host Webcast on HIV Testing for Pregnant Women
The American College of Obstetricians and Gynecologists and The Association of Maternal and Child Health Programs will co-host a webcast on HIV Testing for Pregnant Women on Monday, July 10th from 10:30-12:30 EDT. A guest panel will include speakers from CDC, NIH, AIDS Alliance for Children, other national organizations, and physicians who treat HIV-positive pregnant women. For further information and log-on details (available after June 15th), or if you are interested in attending the webcast in person in Washington DC, please contact Sharron Corle at email@example.com or Becky Carlson at firstname.lastname@example.org.
CDC Releases Recommendations in MMWR on Improving Preconception Health and Health Care
In this recently released report from the CDC, recommendations are provided to improve both preconception health and care. The goal of these recommendations is to improve the health of women and couples, before conception of a first or subsequent pregnancy. The 10 recommendations in this report are aimed at achieving four goals:
1) Improve the knowledge, attitudes, and behaviors of men and women related to preconception health;
2) Assure that all women of childbearing age in the United States receive preconception care services (i.e., evidence-based risk screening, health promotion, and interventions) that will enable them to enter pregnancy in optimal health;
3) Reduce risks indicated by a previous adverse pregnancy outcome through interventions during the interconception period, which can prevent or minimize health problems for a mother and her future children; and
4) Reduce the disparities in adverse pregnancy outcomes.
To view the full recommendations, click here.
Coming Soon: CDC Recommendations for Routine HIV Testing
Details of the CDC’s new guidelines for routine HIV testing of U.S. residents ages 13 to 64 will be published this summer in MMWR.
CDC is likely to recommend “opt out” testing for all Americans. This means that patients should no longer be required to sign an informed consent form before taking an HIV test. In addition, it plans to suggest abolishing or shortening requirements for lengthy pretest counseling. HIV testing would be one of a panel of routine screening tests such as those for blood glucose and cholesterol that are part of standard care in doctor's offices, clinics, hospitals and emergency rooms. A doctor would orally offer the test, and a patient's oral consent or refusal would suffice. A patient who tests positive would be taken aside for private counseling. A confirmatory blood test would be conducted to rule out a false positive, and if still positive, the patient would ideally receive more detailed counseling about prevention, care, and treatment.
CDC’s goal is to simplify the HIV testing process in order to reach more infected people earlier. CDC estimates that around 25% of the 1 million Americans with HIV are unaware they are infected, and some of those people are diagnosed only when the virus has progressed to AIDS. CDC says more than half of new HIV infections are believed to be transmitted by people who do not know they are HIV-positive.
National Prevention Information Network (NPIN)
Launches Website Redesign
New features include:
NPIN’s Phase II web redesign will include improved functionality and further enhancing features. Bookmark their website here.
If you are interested in possibly participating in NPIN’s Phase II web redesign effort, please contact Eunice Wallace at email@example.com.
Send other comments/suggestions to Melissa Beaupierre, NPIN Director at firstname.lastname@example.org.
Study Looks into Possible ARV Effects on Pregnant Women’s Labor and Delivery
Published in April in the Journal of Infectious Diseases, "Is Antiretroviral Therapy During Pregnancy Associated With an Increased Risk of Preterm Delivery, Low Birthweight or Stillbirth?" looked for a connection between preterm delivery, low birthweight infants or stillbirth, and antiretroviral therapy. Amanda Cotter of the Department of Obstetrics and Gynecology at the University of Miami and colleagues looked at the records of women who gave birth at the University of Miami Jackson Memorial Medical Center between 1990 and 2002. Their study examined data of 999 women who received antiretroviral therapy -- 492 who received monotherapy, 373 who received combination therapy without a protease inhibitor, and 134 who received combination therapy with a protease inhibitor -- during pregnancy and 338 women who did not receive antiretroviral therapy during pregnancy. Results showed that only combination therapy with a protease inhibitor increased a woman's risk of preterm delivery. Additionally, the study found that there were no increased risks of low birthweight or stillbirth in women receiving any of the antiretroviral therapies.
To read the article’s abstract, click here.
Study Finds More Than 20% of Pregnant Women in South Africa Taking Nevirapine Have Some Resistance One Year Later
According to a study published in the April 25 edition of the journal Proceedings of the National Academy of Sciences, more than one-fifth of HIV-positive pregnant women who take a single dose of the antiretroviral drug nevirapine to prevent mother-to-child HIV transmission have some resistance to the drug one year after treatment. Previous studies indicated that drug resistance diminishes in women shortly after taking the drug. Sarah Palmer, manager of the Virology Core of the HIV Drug Resistance Program at the National Cancer Institute, and colleagues looked for nevirapine-resistant HIV mutations in 22 women who were given nevirapine in Soweto, South Africa. They examined the plasma samples of the women, all of whom were living with HIV-1 subtype C. Tests using standard genotype analysis found that six of the women had nevirapine resistance two to six months after treatment, but not at one year; nine of the women had resistance at two months, but not at six months; and seven of the women had no resistance at any time, according to the study. However, researchers found that 16 of the 21 women who tested negative for nevirapine resistance one year after treatment actually had some element of resistance, which was determined using tests with greater sensitivity. At least 23% of the women more than one year after treatment had a greater nevirapine resistance than they had before taking the drug.
To read the article’s abstract, click here.
Study Examines Effect of Mother-to-Child HIV Transmission on Cognition Among Children
A study entitled, "Effects of Perinatal HIV Infection and Associated Risk Factors on Cognitive Development Among Young Children," was published in Pediatrics in March. The study was conducted by Renee Smith of the University of Illinois-Chicago and her colleagues, who examined 117 HIV-positive children who acquired the virus through vertical transmission, as well as 422 children who were exposed to HIV but did not contract the virus. After assessing the children's neurocognitive development at ages 3 and 7, the researchers found that children with an AIDS diagnosis had significantly lower cognitive development scores at both ages than the HIV-negative children and those who had not progressed to AIDS.
To read the article’s abstract, click here.
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