Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 124
Filtrar
1.
Artigo em Inglês | MEDLINE | ID: mdl-32342504

RESUMO

OBJECTIVE: To describe prevalent and persistent oncogenic human papillomavirus (HPV) types detected in women living with HIV (WLWH) in Canada, including women with cervical dyskaryosis, and to determine predictors of type-specific HPV persistence. METHODS: Women and girls living with HIV, recruited from 14 sites of HIV care across Canada, were included in a sub-analysis of a prospective vaccine immunogenicity cohort study (two HPV DNA results, at least one cervical cytology result pre-vaccination). Demographic and clinical data were collected alongside cervical samples for cytology and HPV DNA typing between November 25, 2008, and May 19, 2015. RESULTS: Pre-vaccination, HPV16 and HPV52 were the most prevalent oncogenic HPV types. Of the 252 women and girls who met the eligibility criteria, 45% were infected with at least one oncogenic HPV type and one-third of participants had a persistent oncogenic infection. HPV16, 45, and 52 were the most frequently persistent types. Seventeen percent of women had persistent infections with oncogenic HPV types not within currently available vaccines (HPV35/39/51/56/59/68/82). Lower CD4 count significantly predicted HPV persistence (P=0.024). Cervical cytology results were normal for 82.9% of participants, atypical squamous cells of undetermined significance for 2.4%, low-grade squamous intraepithelial lesions for 11.5%, and high-grade squamous intraepithelial lesions for 2.8%. CONCLUSION: Unvaccinated WLWH were infected with a wide range of oncogenic HPV types. The findings highlighted the importance of optimal treatment of HIV and continued cervical cancer screening as key steps toward the global elimination of cervical cancer.

2.
AIDS Care ; : 1-11, 2020 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-32164422

RESUMO

Planning families is an important issue within the HIV community. The primary objective of this study was to explore the fertility desires and intentions of men living with HIV (MLWH). A cross-sectional survey containing 77 questions in 10 domains was developed, validated and administered to MLWH. The sample was stratified by sexual orientation, ethnicity, and city of residence. Logistic regression analyses were conducted to determine sociodemographic correlates of intention to have children. 276 men were recruited, of whom 118 (43%) identified as heterosexual and 158 (57%) as gay, bisexual, two-spirit or queer (GBTQ). 133 (45%) men wished and 120 (44%) actually intended to become a parent. Significantly more heterosexual men desired fatherhood (63% vs 37%, p < .0001) and intended to have children in the future (57% vs. 34%, p < .0001). Among all men, significant predictors of intention to have children were age ≤40, heterosexual orientation, African/Caribbean/Black ethnicity, living in Toronto, higher household income, and being partnered with an HIV-negative individual. When stratified by sexual orientation, younger age remained a significant correlate for both groups. A significant proportion of heterosexual and GBTQ MLWH desire and intend to become a parent. Health care providers and policy makers must support these individuals in their reproductive parenting needs.

3.
Vaccine ; 38(15): 3073-3078, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32147300

RESUMO

HPV vaccination schedules have changed as evidence has supported reduced dosing and extended intervals. Women living with HIV (WLWH) represent an important population with no data on alternative dosing. Girls and WLWH received quadrivalent HPV (qHPV) vaccine in a pan-Canadian study of immunogenicity and efficacy. Serology was performed at months 0/2/7/12/18/24. Medical and sexual history was collected throughout. Linear regression was used to determine if spacing of doses was associated with peak antibody titer. Multivariable analyses demonstrated significant relationships between peak antibody titer and time to blood draw post last vaccine dose, naivety to the relevant HPV type, and HIV viral load for all qHPV types. There was a significant relationship between peak HPV16/18 antibody titer and age. Taking age, time to serology, CD4 cell count, CD4 nadir, HIV viral load, and HPV naivety into account, spacing of the three qHPV vaccine doses did not significantly impact peak antibody titers.

4.
J Acquir Immune Defic Syndr ; 83(3): 230-234, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31917750

RESUMO

BACKGROUND: Human papillomavirus (HPV) vaccines have promising safety and immunogenicity data in women living with HIV (WLWH). However, it is critical to understand the residual burden of oncogenic HPV within WLWH to inform postvaccination cervical screening needs. We assessed rates of persistent infection with nonquadrivalent HPV (qHPV) oncogenic types in a cohort of qHPV-vaccinated WLWH. SETTING: Multicentre, longitudinal cohort across Canada. METHODS: WLWH were scheduled to receive 3 doses of qHPV vaccine. Participants provided health data and HPV DNA samples. Persistent cases of HPV were defined as new HPV in samples from ≥2 consecutive visits or as HPV present in the last sample. HPV31/33/35/39/45/51/52/56/58/59/68/82 were considered to have oncogenic potential. Median follow-up time was 4 years after initial vaccine dose. RESULTS: A total of 284 participants were eligible for this analysis with 1205 person-years (PY) of follow-up (≥1 dose of vaccine, ≥1 HPV DNA result after vaccination). The highest incidence of persistent infection was with HPV51 (1.38/100 PY), followed by HPV52 (1.18/100 PY), and HPV39 (1.06/100 PY). The incidence of persistent infection with pooled HPV types added in the nonavalent vaccine (HPV31/33/45/52/58) was lower than the incidence of persistent oncogenic HPV types not contained within available vaccines (HPV35/39/51/56/59/68) (2.4/100 PY versus 3.6/100 PY, respectively). CONCLUSIONS: qHPV-vaccinated WLWH continue to face a burden of persistent oncogenic HPV infection. Although the nonavalent vaccine could alleviate some of this burden, 2 of the top 3 persistent oncogenic HPVs in this cohort are not contained within any available vaccine. This highlights the need for ongoing cervical screening in HPV-vaccinated WLWH.

5.
Menopause ; 27(1): 66-75, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31688411

RESUMO

OBJECTIVE: Menopause is a pivotal transition for women. Previous studies have suggested increased risk of early menopause (40-45 years) and premature menopause (<40 years) for women with HIV. We aimed to determine age of menopause, prevalence of early menopause and premature menopause, and risk factors for menopause <45 years in Canadian women with HIV. METHODS: This was a cross-sectional analysis from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study. Analyses were restricted to biologically female participants reporting being postmenopausal (regardless of etiology). Primary outcome was median age at menopause. Predetermined variables, and those with P < 0.10 in univariable analyses were considered for inclusion into multivariable logistic regression model, to determine independent correlates of menopause <45 years. RESULTS: 229 women were included. Median age of menopause was 48 years (interquartile range 43, 51); 29.7% of women experienced menopause <45 years: 16.6% with early menopause and 13.1% with premature menopause. In univariable analyses, menopause <45 years was more likely (P < 0.05) with birth in Canada, white ethnicity, less than high-school education, smoking, recreational drug use, and hepatitis C co-infection. In multivariable modeling, less than high-school education (adjusted odds ratio [aOR] 2.45, 95% confidence interval [CI] 1.22-4.93) and hepatitis C co-infection (aOR 1.90, 95% CI 1.04-3.50) were independently associated with menopause <45 years. CONCLUSIONS: In Canadian women with HIV, median age of menopause was 48 years; 3 years younger than the general population. Only lower education and hepatitis C co-infection were independently associated with menopause <45 years, highlighting importance of socioeconomic factors and comorbidities. These findings have implications for counseling and management of women with HIV.

6.
AIDS Care ; 32(1): 30-36, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31060379

RESUMO

Forced migration and extended time spent migrating may lead to prolonged marginalization and increased risk of HIV. We conducted a population-based cohort study to examine whether secondary migration status, where secondary migrants resided in a transition country prior to arrival in Ontario, Canada and primary migrants arrived directly from their country of birth, modified the relationship between refugee status and HIV. Unadjusted and adjusted prevalence ratios (APR) and 95% confidence intervals (CI) were estimated using log-binomial regression. In sensitivity analysis, refugees with secondary migration were matched to the other three groups on country of birth, age and year of arrival (+/- 5 years) and analyzed using conditional logistic regression. Unmatched and matched models were adjusted for age and education. HIV prevalence among secondary and primary refugees and non-refugees was 1.47% (24/1629), 0.82% (112/13,640), 0.06% (7/11,571) and 0.04% (49/114,935), respectively. Secondary migration was a significant effect modifier (p-value = .02). Refugees with secondary migration were 68% more likely to have HIV than refugees with primary migration (PR = 1.68, 95% CI 1.06, 2.68; APR = 1.68, 95% 1.04, 2.71) with a stronger effect in the matched model. There was no difference among non-refugee immigrants. Secondary migration may amplify HIV risk among refugee but not non-refugee immigrant mothers.

7.
Artigo em Inglês | MEDLINE | ID: mdl-31285168

RESUMO

This study sought to perform a systematic review of adverse events reported with the use of cabergoline for postpartum lactation inhibition or suppression in women aged 15 to 50. Following registration with PROSPERO (CRD42017049894), a comprehensive search of the Ovid databases Medline, Embase, and CENTRAL, along with PubMed, was conducted from January 1, 1985 to January 25, 2018. All study designs investigating cabergoline use for postpartum lactation inhibition or suppression in women aged 15 to 50 were included. A total of 695 articles were retrieved, and 25 articles were eligible for inclusion. Adverse events were then reported in terms of frequency, with percentages calculated according to the total number of women exposed to the intervention. A bias assessment of the articles was also performed. Among a total of 757 women, 108 adverse events were observed in 96 women (14.2%). The most common adverse events were dizziness (35 of 757), headache (30 of 757), and nausea or vomiting (19 of 757). These events were described as short-lived, self-resolving, and dose dependent. One pharmacovigilance study reported 29 "serious" events from a total of 175 events in 72 case reports, which included thromboembolic and neurologic events. Four case studies specifically addressed the psychiatric population, with one half reporting psychiatric symptoms following administration of cabergoline. In conclusion, this systematic review demonstrates that adverse events were generally benign and tolerable following the administration of cabergoline. However, pharmacovigilance data reveal that vigilance is still needed given the occurrence of rare but serious events.

8.
Matern Child Health J ; 23(8): 1071-1078, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31055700

RESUMO

Objectives This study sought to explore how sexual minority women (SMW) and heterosexual women compare in terms of reproductive history, with a particular focus on examining within-group differences among SMW. Methods Women were predominantly recruited through consecutive sampling during presentation for prenatal care in Toronto Canada, and Massachusetts, USA. In total, 96 partnered pregnant women (62 SMW, 34 heterosexual) completed an internet survey during 2013-2015. Results We found few significant differences in reproductive history outcomes when comparing SMW and heterosexual groups. However, when we compared male-partnered SMW to female-partnered SMW, we found potentially important differences in rates of miscarriage and pregnancy complications, indicating that partner gender may be an important contributor to differences in reproductive history among SMW. Conclusions for Practice These findings highlight the need to recognize the unique health risks with which male-partnered SMW may present. Considering that this group is often invisible in clinical practice, the findings from this exploratory study have important implications for providers who treat women during the transition to parenthood. Future research should further examine the differences in social and health access within larger samples of SMW groups, as well as seek to understand the complex relationships between sexual identity and perinatal health for this understudied group of women.


Assuntos
Parto/psicologia , Satisfação do Paciente , Minorias Sexuais e de Gênero/psicologia , Adulto , Feminino , Homossexualidade Feminina/psicologia , Humanos , Renda/estatística & dados numéricos , Acontecimentos que Mudam a Vida , Massachusetts , Ontário , Gravidez , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/normas , Qualidade da Assistência à Saúde/normas , Apoio Social , Inquéritos e Questionários
9.
J Obstet Gynaecol Can ; 41(9): 1289-1294, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30952625

RESUMO

OBJECTIVE: This study sought to determine the proportion of pregnant women who are tested for gonorrhea and chlamydia as part of their prenatal care and to examine patient and provider factors affecting testing rates. METHODS: The study investigators conducted a retrospective chart review of all patients who delivered at St. Michael's Hospital, an urban tertiary care centre in Toronto, Ontario, between November 2015 and April 2016. Rates of testing and the prevalence of positive test results for gonorrhea and chlamydia were calculated. Chi-square tests were used to compare rates of testing among different types of prenatal care providers (obstetricians, maternal-fetal medicine specialists, family practitioners, midwives) and to determine whether testing rates were affected by patient demographics or characteristics. This study was a Canadian Task Force Classification II-2 retrospective cohort study. RESULTS: Of the 1315 women who delivered at St. Michael's Hospital during the study period, 1220 met inclusion criteria for the study. Of these women, 186 (15.3%) were not tested for gonorrhea and chlamydia during their pregnancy. There were 11 cases of chlamydia (1.1%) and no cases of gonorrhea. Testing rates were not affected by patient demographic variables or obstetrical history. Midwives and family physicians had the highest testing rates among the provider groups: 93.8% and 91.4%, respectively. Generalist obstetricians tested 88.5% of their patients. Maternal-fetal medicine specialists had a significantly lower rate of testing than the other provider groups, at 64.8% (P < 0.0001). CONCLUSIONS: Fifteen percent of women were not tested for gonorrhea and chlamydia during the study period even though testing was recommended as part of routine prenatal care. Testing rates varied among providers, and strategies to improve these rates need to be explored.

10.
Paediatr Child Health ; 24(2): e66-e73, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30996609

RESUMO

Objective: To determine the incidence, types of organisms and resistance patterns involved in early-onset neonatal sepsis in Canada. Study design: Early-onset neonatal sepsis cases were identified through the Canadian Paediatric Surveillance Program. Neonates were excluded if they were asymptomatic or if intracranial procedures preceded a positive cerebrospinal fluid culture. Results: One hundred and twenty-seven cases were identified (0.17 cases per 1000 live births). Group B Streptococcus accounted for 41.7%, Escherichia coli for 35.4%. Antibiotic resistance was present in 33.9% of all cases. 55.6% of E coli cases were resistant, most commonly to ampicillin. Infecting organism species were associated with gestational age, being very low birth weight, time at sepsis presentation, maternal antibiotic prophylaxis and rupture of membranes lasting over 18 hours. Group B Streptococcus was most common in term and E coli in preterm neonates. Twenty-two per cent of E coli cases presented after 48 hours, compared to 6% of Group B Streptococcus cases. Conclusion: We identify a lower rate of early-onset neonatal sepsis than historically suggested, with differing dominant organisms based on gestational ages and other factors, as well as high rates of resistance especially among E coli cases.

11.
Clin Infect Dis ; 68(5): 788-794, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-29985988

RESUMO

BACKGROUND: Human papillomavirus (HPV) vaccination is safe and efficacious in women without human immunodeficiency virus (HIV). Although good immunogenicity has been observed in women living with HIV (WLWH), efficacy data in this population are needed. METHODS: We enrolled 420 females aged ≥9 years (range, 9-65) living with HIV. Participants were to receive 3 doses of qHPV vaccine (0/2/6 months). The main endpoint was vaccine failure (ie, incident persistent qHPV infection, cervical intraepithelial neoplasia of grade 2 or higher [CIN2+], or genital warts). We compared these rates to published rates in vaccinated and unvaccinated women without HIV as well as unvaccinated WLWH. RESULTS: Among 279 eligible women, median follow-up was 2 years. In the intention-to-treat population, the incidence rate (IR) of persistent qHPV (HPV6/11/16/18) was 2.3 per 100 person-years (/100PY) (95% confidence interval [CI], 1.1-4.1), and IR of genital warts was 2.3/100PY (95% CI, 1.2-4.1). In the per-protocol efficacy population, IR of persistent qHPV was 1.0/100PY (95% CI, 0.3-2.6) and of genital warts was 1.0/100PY (95% CI, 0.3-2.5). No cases of CIN2+ occurred. Reported rates of qHPV-related infection and disease within vaccinated women without HIV, unvaccinated women without HIV, and vaccinated WLWH: 0.1 (95% CI, 0.02-0.03), 1.5 (95% CI, 1.1-2.0), and 1.2 (95% CI, 0.2-3.4) /100PY, respectively. The rate of persistent qHPV among vaccinated WLWH was lower than among unvaccinated WLWH (2.3 vs 6.0/100PY). CONCLUSIONS: Vaccinated WLWH may be at higher risk for vaccine failure than vaccinated women without HIV. However, overall rates of vaccine failure were low, and rates of persistent qHPV were lower than in unvaccinated WLWH.

13.
J Obstet Gynaecol Can ; 40(8): e652-e657, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30103889

RESUMO

OBJECTIVE: To review the existing data regarding varicella zoster virus infection (chickenpox) in pregnancy, interventions to reduce maternal complications and fetal infection, and antepartum and peripartum management . METHODS: The maternal and fetal outcomes in varicella zoster infection were reviewed, as well as the benefit of the different treatment modalities in altering maternal and fetal sequelae. EVIDENCE: Medline was searched for articles and clinical guidelines published in English between January 1970 and November 2010. VALUES: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice were ranked according to the method described in that report (Table).


Assuntos
Vacina contra Varicela/uso terapêutico , Varicela/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Cuidado Pré-Natal/normas , Canadá , Feminino , Ginecologia , Humanos , Obstetrícia , Gravidez , Sociedades Médicas , Vacinação
15.
J Obstet Gynaecol Can ; 40(8): e687-e693, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30103893

RESUMO

BACKGROUND: One of the major consequences of pregnant women becoming infected by Toxoplasma gondii is vertical transmission to the fetus. Although rare, congenital toxoplasmosis can cause severe neurological or ocular disease (leading to blindness), as well as cardiac and cerebral anomalies. Prenatal care must include education about prevention of toxoplasmosis. The low prevalence of the disease in the Canadian population and limitations in diagnosis and therapy limit the effectiveness of screening strategies. Therefore, routine screening is not currently recommended. OBJECTIVE: To review the prevention, diagnosis, and management of toxoplasmosis in pregnancy. OUTCOMES: Outcomes evaluated include the effect of screening on diagnosis of congenital toxoplasmosis and the efficacy of prophylaxis and treatment. EVIDENCE: The Cochrane Library and Medline were searched for articles published in English from 1990 to the present related to toxoplasmosis and pregnancy. Additional articles were identified through references of these articles. VALUES: The quality of evidence is rated and recommendations made according to guidelines developed by the Canadian Task Force on Preventive Health Care (Table 1). BENEFITS, HARMS, AND COSTS: Guideline implementation should assist the practitioner in developing an approach to screening for and treatment of toxoplasmosis in pregnancy. Patients will benefit from appropriate management of this condition. SPONSOR: The Society of Obstetricians and Gynaecologists of Canada.


Assuntos
Complicações Parasitárias na Gravidez/prevenção & controle , Cuidado Pré-Natal/normas , Toxoplasmose/prevenção & controle , Canadá , Feminino , Ginecologia , Humanos , Obstetrícia , Gravidez , Diagnóstico Pré-Natal/normas , Sociedades Médicas , Toxoplasma , Toxoplasmose Congênita/prevenção & controle
17.
J Health Care Poor Underserved ; 29(2): 687-700, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29805134

RESUMO

We assessed whether eligible refugee claimants faced barriers to accessing prenatal care in the context of changes to Canadian health care policy that generated multiple categories of refugee health care eligibility. METHODS: Prenatal care providers in Toronto were contacted twice using standardized scripts to book appointments for a pregnant non-refugee and refugee claimant, both eligible for prenatal care. PRIMARY OUTCOME: unequivocal offer of appointment. Secondary outcome: reasons for refusal of prenatal care. RESULTS: There was a statistically significantly lower rate of offering prenatal care (34%) to refugee claimants compared with non-refugees (95%) (p < .001). Lack of knowledge, confusion about policies, time-consuming administrative requirements, and slow reimbursement processes were cited as reasons for refusal of care. CONCLUSIONS: Our results highlighted barriers to accessing prenatal care for refugee women. There are important future policy implications when considering the numerous changes to refugee health care policy in the last five years.


Assuntos
Acesso aos Serviços de Saúde , Cuidado Pré-Natal , Refugiados , Canadá , Feminino , Humanos , Auditoria Médica , Ontário , Gravidez , Refugiados/estatística & dados numéricos
19.
J Obstet Gynaecol Can ; 40(2): e134-e141, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29447718

RESUMO

OBJECTIVES: To review the principles of prenatal diagnosis of congenital cytomegalovirus (CMV) infection and to describe the outcomes of the affected pregnancies. OUTCOMES: Effective management of fetal infection following primary and secondary maternal CMV infection during pregnancy. Neonatal signs include intrauterine growth restriction (IUGR), microcephaly, hepatosplenomegaly, petechiae, jaundice, chorioretinitis, thrombocytopenia and anemia, and long-term sequelae consist of sensorineural hearing loss, mental retardation, delay of psychomotor development, and visual impairment. These guidelines provide a framework for diagnosis and management of suspected CMV infections. EVIDENCE: Medline was searched for articles published in English from 1966 to 2009, using appropriate controlled vocabulary (congenital CMV infection) and key words (intrauterine growth restriction, microcephaly). Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. Searches were updated on a regular basis and incorporated into the guideline. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. RECOMMENDATIONS: The quality of evidence reported in this document has been assessed using the evaluation of evidence criteria in the Report of the Canadian Task Force on Preventive Health Care (Table 1).


Assuntos
Infecções por Citomegalovirus/diagnóstico , Doenças Fetais/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Diagnóstico Pré-Natal , Canadá , Feminino , Humanos , Gravidez
20.
J Obstet Gynaecol Can ; 40(2): e142-e150, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29447719
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA