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Teens With HIV At High Risk For Pregnancy, Complications

July 19, 2011

Teenage girls and young women infected with HIV get pregnant more often and suffer pregnancy complications more frequently than their HIV-negative peers, according to new research led by Johns Hopkins investigators.

A report on the multi-center study, based on an analysis of records from 181 patients with HIV, ages 13 to 24, treated at four hospitals over 12 years, will be published in the Feb. 2 issue of the Journal of the American Medical Association.

The findings are alarming for at least two reasons, the investigators say. First, teen pregnancies - planned or not - put these already vulnerable patients and their fetuses in grave danger for complications. Second, the findings signal that HIV-infected teens and young women continue to practice unsafe sexual behaviors and to have unprotected sex, the researchers say.

Pregnancy rates were especially high in one subgroup of HIV-infected youth - teens who acquired the virus behaviorally rather than during birth. Behaviorally infected teens had five times the number of pregnancies compared to their HIV-negative counterparts and were more prone to premature births and spontaneous abortions than their HIV-negative peers.

Because of its retrospective nature, the study did not capture why the patients got pregnant. The answer to this question, the researchers say, would supply critical information for future pregnancy-counseling and risk-reduction efforts.

"Our analysis revealed a problem. Now we need to figure out why that is and how we, as providers, can give appropriate counseling and care to these girls and women," says lead investigator Allison Agwu, M.D., Sc.M., a pediatric infectious disease specialist at the Johns Hopkins Children's Center.

All HIV-infected patients should be informed about pregnancy risk, including the risk of transmitting HIV to their partners during attempts to become pregnant and to their babies during the pregnancy itself, the researchers say. Therefore, physicians who treat HIV-infected youth should have regular and honest discussion about these risks, they say.

More than one-third (66) of the 181 patients in the study got pregnant, some of whom had more than one pregnancy for a total of 96 pregnancies. Premature births were more common among HIV-infected mothers (34 percent), compared with moms in the general population (22 percent) as were spontaneous abortions, 14 percent among HIV-infected moms compared with 9 percent among pregnant women in the general population.

Twenty-eight of the 130 teen girls and women infected at birth got pregnant compared with 38 of those 51 who were behaviorally infected. The pregnancy rate of behaviorally infected patients was seven times higher than the rate of those infected at birth, the researchers found. Teen girls and women with behaviorally acquired HIV tended to have repeated pregnancies more often - 37 percent of them had more than one pregnancy - than their counterparts infected at birth, of whom 14 percent got pregnant more than once.

Those infected at birth were four times more likely to choose to terminate the pregnancy - 41 percent of them did so - compared with those who contracted HIV later in life, 10 percent of whom ended the pregnancy.

Despite the small number of patients involved in the study, the researchers say their analysis shows intriguing differences among youth with HIV, depending on how they got infected in the first place.

"Our findings suggest that teens who were infected with HIV later in life may engage in different sexual behaviors than those infected at birth. Further analysis into these differences will help us find ways to prevent unwanted pregnancies and avoid complications from planned ones," said senior investigator Kelly Gebo, M.D., M.P.H., a Johns Hopkins infectious disease specialist.

Funding for the study came from the National Institutes of Health and the Doris Duke Charitable Foundation.

Conflict-of-interest disclosure: Kelly Gebo has received research funding from Tibotec, developer of anti-infective pharmaceuticals, including HIV/AIDS drugs. The terms of these arrangements are being managed by The Johns Hopkins University in accordance with its conflict-of-interest policies.

Co-authors on the study: Susie Jang, M.D., of the Beth Israel Deaconess Medical Center in Boston; P. Todd Korthuis, M.D. M.P.H., of Oregon Health and Science University in Portland, Ore.; and Maria Rosario G. Araneta, Ph.D., of the University of California-San Diego.

Source:
Johns Hopkins Medicine


Tags: Pregnancy

Incidence Of Hepatitis C Infection In HIV-Infected Men

July 07, 2011

Hepatitis C is a leading cause of illness and death for individuals infected with both HIV and hepatitis C. Recent reports from around the world demonstrate that hepatitis C is emerging as a sexually transmitted infection among HIV-infected men who do not inject drugs. However, many HIV-infected men do not receive continued screening for hepatitis C throughout their HIV care. Hepatitis C symptoms often do not manifest themselves until the later stages of the illness, so people are not as likely to know that they have become infected and hence need further testing and treatment. Researchers examined the role of later acquisition of hepatitis C in HIV patients in a new study published in Clinical Infectious Diseases, which is currently available online.

In the study, 1,800 HIV-infected men had an initial negative hepatitis C blood test result, with at least one subsequent test. At the time of their initial negative hepatitis C results, 94 percent were receiving antiretroviral therapy for HIV and 6 percent reported current or prior injection drug use.

Ultimately, 36 patients were subsequently diagnosed with hepatitis C. Of those, 25 percent reported an injection drug use history, although 75 percent reported no current or previous injection drug use.

"Screening HIV-infected patients for hepatitis C only once upon entry into HIV care is not sufficient," according to study author Lynn E. Taylor, MD, of Brown University in Providence, R. I. "The standard of care needs to change. HIV-infected persons should have access to ongoing screening for hepatitis C. Doctors and patients may not be aware of or freely discuss all risk behaviors that may lead to hepatitis C infection. These behaviors are often stigmatized. Patients may not feel comfortable discussing these risk factors nor may they be aware of all the ways in which hepatitis C may be transmitted via blood."

Source:
John Heys
Infectious Diseases Society of America


Tags: Pregnancy


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