High rates of posttraumatic stress symptoms in women living with HIV in Canada.

PURPOSE: Women living with HIV experience high levels of trauma exposure before and after diagnosis. One of the most challenging outcomes following trauma exposure is posttraumatic stress disorder. Despite high exposure to traumatic events, the presence and contributors to posttraumatic stress disorder symptoms have not been examined in women living with HIV in Canada. METHODS: The current study examines the presence of, contributors to, and geographical regions associated with self-reported posttraumatic stress symptoms (PTSS) among 1405 women enrolled in the Canadian HIV Women's Sexual & Reproductive Health Cohort Study (CHIWOS). RESULTS: Separate linear regression models were run for the three provinces in the cohort: British Columbia, Ontario and Québec. Scores consistent with posttraumatic stress disorder were reported by 55.9%, 39.1% and 54.1% of the participants in each province, respectively (F(2, 1402) = 13.53, p < .001). CONCLUSIONS: The results demonstrate that women living with HIV have high rates of PTSS, and that rates and variables associated with these symptoms vary by province. These results suggest the need for trauma-informed practices and care for women living with HIV in Canada, which may need to be tailored for the community and identities of the women.

A Ten-Year Review of Antenatal Complications and Pregnancy Outcomes Among HIV-Positive Pregnant Women.

OBJECTIVE: To review the incidence of antenatal complications among a cohort of HIV-positive pregnant women over a 10-year period. METHODS: A retrospective review was performed of all HIV-positive pregnant women receiving multidisciplinary prenatal care at an urban tertiary care centre from March 2000 to March 2010. Collected data included the presence of additional infectious or medical conditions, genetic screening information, and the presence or absence of antenatal complications. RESULTS: One hundred and forty-two singleton pregnancies during the study period were identified. Almost 95% of women were taking combination antiretroviral therapy during pregnancy, and greater than 90% had viral loads less than 1000 copies/ml at delivery. The presence of co-infections was low. Forty-one women (29%) had other medical comorbidities. Genetic screening occurred in 104 pregnancies (73%); 4% were abnormal screens. Rates of any hypertension, gestational diabetes, and fetal growth restriction were all low. Thirty-two percent of women were colonized with group B streptococcus. CONCLUSION: This study adds strength to the argument that good outcomes can be achieved for HIV-positive pregnant women with good access to both prenatal and HIV care, and appropriate management. Women with HIV should be optimally cared for in advance of and during pregnancy in order to maximize the likelihood of good pregnancy outcomes.

HIV and infant feeding in resource-rich settings: considering the clinical significance of a complicated dilemma.

With advances in the care of HIV-positive pregnant women, the likelihood of perinatal transmission is now less than 1%. In resource-rich settings women are instructed to abstain from breastfeeding, as studies have shown that breastfeeding increases the likelihood of infant acquisition of HIV. As practitioners caring for HIV-positive parents, we are now facing growing tension about the complex issues that inform decisions about infant feeding. In the face of changing guidelines and global immigration patterns, simply telling women that breastfeeding is contraindicated may no longer be good enough. We must fully open the lines of communication regarding this important and evolving issue. This commentary will review the clinical, social and cultural considerations that impact decisions regarding infant feeding in the context of HIV.

Demographic and management trends among HIV-positive pregnant women over 10 years at one Canadian urban hospital.

OBJECTIVE: There is limited information about changing trends in the management of HIV-positive pregnancies in Canada as Canadian and international guidelines are updated. We reviewed the experience over a 10-year period of one Canadian urban hospital with regard to trends in the demographics and management of HIV-positive pregnant women. METHODS: We performed a retrospective chart review of all HIV-positive pregnant women delivering between March 2000 and March 2010. Demographic, pregnancy, and intrapartum data were collected and analyzed. RESULTS: During the study period, there were 141 singleton pregnancies in HIV-positive women. The mean age of the cohort was 30.4 years. The number of women seen increased significantly over time (P < 0.001), with 63% of cases in care from 2007 to 2010. Most women were of African descent and had recently immigrated to Canada. There was a statistically significant trend towards increasing numbers of Afro-Caribbean women over the study period (P = 0.03). Only 4% reported illicit drug use in their current pregnancy. Although the majority of women had a known diagnosis of HIV before pregnancy, 30 (22.4%) had the diagnosis made on antepartum testing. Most women were compliant with their highly active antiretroviral therapy (94.3%) and had undetectable viral loads documented at the time of delivery (76.4%). A significant shift towards increased use of protease inhibitor antiretovirals in pregnancy was noted over time (P < 0.001). All neonates received zidovudine after delivery. There were no cases of vertical HIV transmission. CONCLUSION: Our review documented increasing numbers of HIV-positive pregnant women over the past 10 years. The majority of these women were healthy with well-managed disease, and had favourable pregnancy outcomes. There were no infected children born during the study period.

Objectif : Nous ne disposons que de données limitées au sujet de l'évolution (au fur et à mesure que sont mises à jour les lignes directrices canadiennes et internationales) des tendances pour ce qui est de la prise en charge des grossesses séropositives pour le VIH au Canada. Nous avons analysé, sur une période de 10 ans, l'expérience d'un hôpital urbain canadien en ce qui concerne les tendances en matière de caractéristiques démographiques et de prise en charge des femmes enceintes séropositives pour le VIH. Méthodes : Nous avons mené une analyse rétrospective des dossiers de toutes les femmes enceintes séropositives pour le VIH ayant accouché dans cet hôpital entre mars 2000 et mars 2010. Les données liées aux caractéristiques démographiques, à la grossesse et à la période intrapartum ont été recueillies et analysées. Résultats : Au cours de la période d'étude, nous avons recensé 141 grossesses monofœtales chez des femmes séropositives pour le VIH. L'âge moyen au sein de cette cohorte était de 30,4 ans. Le nombre des femmes se présentant à cet hôpital a connu une hausse considérable avec le temps (P < 0,001), 63 % des cas étudiés ayant été pris en charge entre 2007 et 2010. La plupart des femmes étaient d'origine africaine et avaient récemment immigré au Canada. Nous avons constaté une tendance significative sur le plan statistique indiquant une hausse régulière du nombre de femmes d'origine afro-antillaise pendant la période d'étude (P = 0,03). Seulement 4 % des femmes ont signalé avoir consommé des drogues illicites pendant la grossesse alors en cours. Bien que la majorité des femmes aient présenté un diagnostic connu de VIH avant la grossesse, 30 d'entre elles (22,4 %) ont obtenu ce diagnostic à la suite d'un dépistage antepartum. La plupart des femmes faisaient preuve d'observance en ce qui concerne leur traitement antirétroviral hautement actif (94,3 %) et leurs charges virales étaient indétectables au moment de l'accouchement (76,4 %). Une tendance considérable indiquant un accroissement de l'utilisation d'inhibiteurs de protéase (antirétroviraux) pendant la grossesse a été constatée avec le temps (P < 0,001). Tous les nouveau-nés ont reçu de la zidovudine après l'accouchement. Aucun cas de transmission verticale du VIH n'a été constaté. Conclusion : Notre analyse a documenté une croissance du nombre de femmes enceintes séropositives pour le VIH au cours des 10 dernières années. La majorité de ces femmes étaient en santé et leur maladie était bien prise en charge; de plus, elles ont obtenu des issues de grossesse favorables. Aucun enfant infecté n'est né au cours de la période d'étude.