Deborah M. Money

Serious toxicity associated with continuous nevirapine-based HAART in pregnancy

Objectiveu2002 This study was designed to determine the safety of nevirapine (NVP)‐based highly active antiretroviral therapy (HAART) in a cohort of HIV‐positive pregnant women.

A Case Series of Third-Trimester Raltegravir Initiation: Impact on Maternal HIV-1 Viral Load and Obstetrical Outcomes

The use of antiretroviral therapy (ART) has led to a marked reduction in the incidence of perinatal transmission of HIV. With ART, it is possible for the viral load to be reduced to undetectable levels during pregnancy. However, some patients (eg, those with poor adherence or those who acquired HIV during pregnancy) may still exhibit high viral loads by the third trimester. The purpose of this study was to examine the effect of raltegravir in a combination ART regimen in a series of 11 cases in which women presented with high viral loads in the third trimester of pregnancy.

Directive clinique sur la prise en charge du virus de l'herpès simplex pendant la grossesse

Resume Objectif Fournir des recommandations au sujet de la prise en charge de linfection genitale au virus de lherpes chez les femmes qui souhaitent une grossesse ou qui sont enceintes, ainsi quau sujet de la prise en charge de lherpes genital pendant la grossesse et des strategies visant a prevenir la transmission de linfection au nouveau-ne. Issues Hausse de lefficacite de la prise en charge des complications de lherpes genital pendant la grossesse et de la prevention de la transmission de lherpes genital de la mere au nouveau-ne. Resultats Des recherches ont ete menees dans Medline en vue den tirer les articles, publies en francais ou en anglais, portant sur lherpes genital et la grossesse. Par lintermediaire des references de ces articles, nous avons pu identifier des articles additionnels. Tous les types detude et tous les signalements de recommandations ont ete analyses. Valeurs Les recommandations ont ete formulees en fonction des lignes directrices elaborees par le Groupe detude canadien sur les soins de sante preventifs. Recommandations 1.Les antecedents de la patiente quant a lherpes genital devraient etre evalues tot au cours de la grossesse. (III-A) 2.Les femmes chez lesquelles la presence dune infection genitale recurrente au virus de lherpes simplex (VHS) est connue devraient etre avisees des risques de transmission (au moment de laccouchement) du VHS a leur nouveau-ne. (III-A) 3.Au moment de laccouchement, en presence de symptomes prodromiques ou dune lesion semblant indiquer une infection au VHS, les femmes qui presentent une infection recurrente au VHS devraient se voir offrir une cesarienne. (II-2A) 4.Les femmes chez lesquelles la presence dune infection genitale recurrente au VHS est connue devraient se voir offrir un traitement suppressif a lacyclovir ou au valacyclovir des la 36e semaine de gestation, et ce, afin dattenuer le risque de lesions cliniques et delimination virale au moment de laccouchement, et dainsi attenuer le risque de devoir subir une cesarienne. (I-A) 5.Les femmes qui presentent une infection genitale primaire au virus de lherpes au cours du troisieme trimestre de la grossesse courent un risque eleve de transmettre le VHS a leur nouveau-ne; par consequent, elles devraient faire lobjet de services de counseling appropries et se voir offrir une cesarienne afin dattenuer ce risque. (II-3B) 6.Les femmes enceintes qui ne presentent pas dantecedents dinfection au VHS, mais qui ont connu un partenaire presentant une infection genitale au VHS, devraient (avant la grossesse ou des que possible pendant la grossesse) faire lobjet dun depistage serologique specifique de type afin de determiner leur risque de contracter une infection genitale au VHS pendant la grossesse. Ce depistage devrait etre repete pendant la periode se situant entre la 32e et la 34e semaine de gestation. (III-B) Validation La presente directive clinique a ete analysee et approuvee par le comite sur les maladies infectieuses de la SOGC.

Missed opportunities for prevention of vertical HIV transmission in Canada, 1997-2016: a surveillance study

BACKGROUNDnVertical HIV transmission has declined in Canada, but missed opportunities for prevention continue to occur. We sought to determine the adequacy, and changes over time in adequacy, of uptake of maternal and neonatal antiretroviral therapy for the prevention of vertical HIV transmission, and to determine the vertical transmission rate over time and according to adequacy of antenatal antiretroviral therapy during the combination antiretroviral therapy era in Canada.nnnMETHODSnThe Canadian Perinatal HIV Surveillance Program collects data annually through retrospective chart review concerning HIV-infected women and their infants. We determined receipt of adequate antiretroviral treatment (antenatal combination antiretroviral treatment for ≥ 4 wk, intrapartum intravenous zidovudine treatment and 4-6 wk of infant oral zidovudine treatment) and predictors of inadequate antenatal combination antiretroviral therapy (none or < 4 wk) in Canada in 1997-2016.nnnRESULTSnWe identified 3785 mother-infant pairs. Uptake of 4 weeks or more of antenatal combination antiretroviral therapy increased over time across all provinces/territories and regardless of maternal race/ethnicity or risk category (p < 0.001). During 2011-2016, 92 women (6.5%) received no or less than 4 weeks of antenatal combination antiretroviral therapy, 146 women (10.7%) received no intrapartum zidovudine treatment, and 43 infants (3.1%) received less than 4 weeks of zidovudine treatment. In multivariate analysis restricted to 2011-2016, higher uptake of adequate antenatal combination antiretroviral therapy was seen among black women than among Indigenous (odds ratio [OR] 2.99, 95% confidence interval [CI] 1.23-7.26) or white (OR 1.87, 95% CI 0.99-1.27) women and in British Columbia/Yukon Territory than in Alberta (OR 3.31, 95% CI 1.06-10.32), Ontario (OR 3.16, 95% CI 1.08-9.26) or Quebec (OR 3.44, 95% CI 1.09-10.84). Among the 14 vertical HIV transmission events during 2011-2016 (vertical transmission rate 1.0%), maternal HIV infection was diagnosed before the onset of labour in 5 cases, and only 2 women received adequate antenatal combination antiretroviral therapy.nnnINTERPRETATIONnEfforts to improve timely access to care, HIV screening and treatment for all women, combined with enhanced resources targeting populations at increased risk for HIV infection, will be needed if vertical HIV transmission is to be eliminated in Canada.

P3.105 Maternal syphilis in british columbia, canada: 2010 to 2016

Introduction From 2010 to 2016, syphilis rates have tripled among women in British Columbia (BC), Canada. We sought to characterise maternal syphilis cases in BC to identify areas to strengthen syphilis prevention programming. Methods Virtually all syphilis tests in BC are performed at the provincial laboratory. Positive tests are reviewed by centrally-located expert clinicians who diagnose, stage, and recommend treatment. Demographic and treatment information of syphilis cases (primary, secondary, early and late latent) diagnosed in pregnant women (or within 90 days after delivery) from January 2010 to July 2016 were reviewed and descriptive analyses performed. We assessed prenatal syphilis screening based on the prenatal flag on the laboratory requisition and compared against the number of live births reported by BC Vital Statistics. Results From 2010 to 2015, 2u200983u2009168 syphilis tests were done as part of prenatal testing, compared with 2u200964u2009496 live births. From 2010 to July 2016, there were 45 maternal syphilis cases reported (18 early latent, 27 late latent–of note, syphilis screening by EIA commenced July 2014). The majority of cases (38/45) lived in Greater Vancouver; median age 30 years (range: 20–46). 27, 13, and 3 cases were diagnosed in the first, second, and third trimester, respectively; 2 were diagnosed post-partum. Treatment information was available on 44/45 cases: 42 cases received ≥2u2009penicillin injections and 2 received doxycycline. Being born outside Canada or having a partner in a developing country was the most common risk factor identified (n=13). One case reported sex trade work, 4 reported having casual sex (>4 partners), and 4 reported substance use. Few cases (6/34) reported ≥2 partners in the last year. Conclusion Most maternal syphilis cases are diagnosed by first trimester prenatal screening, but a few remain diagnosed post-partum. Increasing efforts to engage early for those born in high syphilis incidence countries (or whose partners remain in such countries) and repeat screening may be areas for focus.

Do protease inhibitor-containing combination antiretroviral therapy regimens increase risk of spontaneous preterm birth in pregnant HIV-Positive women?

administration with a meal or soft foods, and the impact of high doses of secnidazole on cardiac safety. SYM-1219 was administered in either applesauce, yogurt, or pudding, followed by 240 mL of water. Serial blood samples were collected to determine secnidazole plasma concentrations and PK parameters for each treatment group are reported. Safety assessments, ECGs, and vital signs were performed during each study. An in vitro metabolism program, including CYP metabolism, inhibition, and induction, substrate and inhibition potential for transporters, and the potential for secnidazole to inhibit ethanol metabolism was performed. RESULTS: A single 2-g oral dose of SYM-1219 achieves an average maximum plasma secnidazole concentration (Cmax) of 35.7 to 46.3 mg/mL approximately 2 to 3 hours after dosing (Tmax). Exposure, as assessed by area under the plasma-concentration time curve (AUC), increases linearly with dose. Secnidazole has a prolonged terminal elimination half-life (t1/2) of w17 hours. SYM-1219 can be administered in applesauce, pudding, or yogurt and the timing and content of a meal does not have an impact on drug bioavailability. Secnidazole is not a substrate or inhibitor of transporters nor does it induce or inhibit hepatic CYP450 enzymes, therefore the potential for clinically important interactions with CYP450 substrates, inhibitors, or inducers is minimal. In a clinical study, secnidazole had negligible impact on the PK of ethinyl estradiol or norethindrone, suggesting that a single dose of SYM-1219 will not impact the efficacy of oral contraceptives. Secnidazole does not inhibit aldehyde dehydrogenase in vitro and therefore does not alter ethanol metabolism. There were no clinically significant abnormalities in laboratory, vital signs, or ECGs following administration of SYM-1219 to study subjects. CONCLUSIONS: The favorable safety and efficacy profile of SYM-1219, coupled with its PK characteristics, are the foundation for this single-dose oral treatment regimen for BV.

Assessing maternity care providers’ knowledge of the management of hepatitis B in pregnancy

METHODS: An IRB approved retrospective chart review was conducted from January 2016 through December 2016 at multiple tertiary care centers in Miami-Dade County (FL, USA). Data was extracted from charts of all pregnant women screened for evidence of Zika infection. Demographic data including language, ethnicity and insurance status were extracted. RESULTS: Of the 2327 women who were screened for Zika virus, 350 (15%) had private health insurance, 1534 (66%) had a form of public health insurance, and 441 (19%) were without insurance coverage. Of those with private insurance, 8 (2.3%) had positive Zika testing and 43 (2.8%) of those with public insurance tested positive, while 37 (8.4%, p <0.05) of those without insurance coverage tested positive. The self-identified race of women who tested positive for Zika in pregnancy was 2.7% of Caucasian women, 5% of Latina women, 6% of Haitian women, 1.8% of African American women and 4.8% of Asian women. Of 88 women who had positive Zika testing in pregnancy, 36 (41%) reported English as their language of preference, (37) 42% reported Spanish and 14 (16%) Haitian Creole. The percentage of women who tested positive for Zika in pregnancy was analyzed by the primary language preference, and showed that 2.4% of English speakers, 6.1% (p<0.05) of Spanish speakers and 6.5% (p<0.05) of Haitian Creole speakers had positive Zika testing. Twenty-seven percent of women with evidence of Zika infection in pregnancy, or their infants, were lost to follow up. CONCLUSIONS: There were significant differences in the insurance status and the primary languages spoken by women who screened positive for Zika infection in pregnancy, with more uninsured and non-English speaking women having evidence of Zika infection in pregnancy. These data should be incorporated into future prevention and care planning.