Browsing by Author "Duffy CR"

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Preterm birth among women with HIV: impact of preconception cART initiation.
(2024-Oct-01) Duffy CR; Herlihy JM; Zulu E; Mwananyanda L; Forman L; Heeren T; Gill CJ; Harper M; Chilengi R; Chavuma R; Payne-Lohman B; Thea DM; Boston University, Chobanian & Avedisian School of Medicine, Department of Pediatrics, Boston Medical Center, Boston, MA, USA.; Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX, USA.; Department of Global Health, Boston University School of Public Health.; Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health.; Centre for Infectious Disease Research in Zambia.; Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School.; Department of Biostatistics, Boston University School of Public Health, Boston, MA.; Institute for Immunology and Informatics, University of Rhode Island, South Kingstown, RI, USA.; Right to Care Zambia, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
OBJECTIVE: To examine the risk of preterm birth (PTB) and small for gestational age (SGA) among women with HIV compared to women without HIV. Secondary objectives were to explore the role of maternal immune activation (IA) and effect of cART timing on these outcomes. DESIGN: Prospective observational cohort. SETTING: Urban government-run clinic at Chawama Hospital in Lusaka, Zambia. PARTICIPANTS: A total of 1481 women with and without HIV with singleton pregnancies enrolled before 26 weeks' gestation by ultrasound dating. METHODS: From August 2019 to November 2022, pregnant women were enrolled in a 1 : 1 ratio of HIV infection. Maternal baseline clinical factors were collected, as well as CD4 + , viral load and CD8 + T-cell IA in women with HIV. Birth outcomes were also collected. The association of HIV-exposure and cART timing on outcomes was assessed by multivariable logistic regression. The independent role of IA was determined by mediation analysis. MAIN OUTCOME MEASURES: PTB (<37 weeks) and SGA. RESULTS: There were 38 fetal deaths and 1230 singleton live births. Maternal HIV infection was associated with PTB [adjusted odds ratio (AOR) 1.60, 95% confidence interval (CI) 1.11-2.32] and to a lesser extent SGA (AOR 1.29, 95% CI 0.98-1.70). Maternal cART timing impacted these associations, with highest risk in women who started cART after conception (PTB AOR 1.77, 95% CI 1.09-2.87, SGA AOR 1.52, 95% CI 1.04-2.22). Maternal IA was not associated with PTB independent of HIV infection. CONCLUSIONS: HIV is associated with PTB. Risk of PTB and SGA was highest in women with HIV who started cART in pregnancy, a modifiable risk factor.
Risk of hospitalization or death does not differ in children exposed to HIV, yet uninfected compared to non-exposed peers in the Zambia Infant Cohort Study (ZICS).
(2025-Feb-12) Herlihy JM; Zulu E; Mwananyanda L; Forman L; Heeren T; Gill CJ; Chilengi R; Namuziya N; Payne-Lohman B; Chavuma R; Duffy CR; Thea DM; Boston University, Chobanian & Avedisian School of Medicine, Department of Pediatrics, Boston Medical Center.; Department of Biostatistics, Boston University School of Public Health.; Department of Pediatrics, University of Zambia.; Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health.; Centre for Infectious Disease Research in Zambia.; Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School.; Right to Care - Zambia.; Right to Care Zambia.; Institute for Immunology and Informatics, University of Rhode Island.; Department of Global Health, Boston University School of Public Health.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
OBJECTIVE: Increased mortality and morbidity has been observed among children who are HIV-exposed, uninfected (CHEU). It is unknown if health disparities remain despite promotion of exclusive breastfeeding and adoption of universal combination antiretroviral therapy (cART) for pregnant women. DESIGN: We conducted a longitudinal cohort study among pregnant women with and without HIV [Zambia Infant Cohort (ZICS)] with the primary goal to measure the morbidity/mortality experienced by CHEU in first 6 months of life, and secondarily whether such disparities could be explained by timing of cART initiation or elevated maternal immune activation. METHODS: Pregnant women with/without HIV (1 : 1) were enrolled prior to 26 weeks gestation by ultrasound and assessed twice antenatally. Infants were seen at birth, 6 days, 6, 10, 14, 20, and 24 weeks of age and assessed for illnesses, sick visits/hospitalizations, infant feeding, immunizations, and co-trimoxazole compliance. RESULTS: From 1276 livebirths, there were 36 deaths and 89 hospitalizations over 6 months. Preconception cART uptake was 73%, and majority of pregnant women with HIV had suppressed viral loads at enrollment. There was no difference in hospitalization or death rates for CHEU as compared to HIV-unexposed children [incidence rate ratio (IRR) 1.27, 95% CI 0.79-2.04, P = 0.33]. This did not shift after adjusting for maternal immune activation prematurity or small for gestational age (SGA). Exclusive breastfeeding reduced risk of hospitalization by 43%. CONCLUSION: In this setting of moderate cART uptake, we found no evidence of increased hospitalizations or deaths among CHEU. We conclude that the observed increased morbidity among CHEU can be effectively mitigated through early initiation of cART and exclusive breastfeeding.
Single-test syphilis serology: A case of not seeing the forest for the trees.
(2024) Zulu EM; Herlihy JM; Duffy CR; Mwananyanda L; Chilengi R; Forman L; Heeren T; Gill CJ; Chavuma R; Payne-Lohman B; Thea DM; Department of Pediatrics, Boston Medical Center, Boston University, Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America.; Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America.; Institute for Immunology and Informatics, University of Rhode Island, Kingston, Rhode Island, United States of America.; Right to Care Zambia, Lusaka, Zambia.; Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts, United States of America.; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.; Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
INTRODUCTION: There have been few empirical studies for diagnostic test accuracy of syphilis using a sequence of rapid tests in populations with low prevalence of syphilis such as pregnant women. This analysis describes syphilis test positivity frequency among pregnant women at an antenatal clinic in Zambia using a reverse-sequence testing algorithm for antenatal syphilis screening. METHODS: Between August 2019 and May 2023, we recruited 1510 pregnant women from a peri-urban hospital in Lusaka, Zambia. HIV positive and HIV negative women were enrolled in a 1:1 ratio. Blood collected at recruitment from the pregnant mothers was tested on-site for syphilis using a rapid treponemal test. Samples that tested positive were further tested at a different laboratory, with rapid plasma reagin using archived plasma. RESULTS: Of the total 1,421 sera samples which were screened with a rapid treponemal test, 127 (8.9%) were positive and 1,294 (91.1%) were negative. Sufficient additional samples were available to perform RPR testing on 114 of the 127 (89.8%) RDT positive specimens. Thirty-one (27.2%) of these 114 were reactive by RPR and 83 (72.8%) were negative, resulting in a syphilis overtreatment rate of 3 fold (i.e, 84/114). Insufficient sample or test kit availability prevented any testing for the remaining 89 (5.9%) participants. CONCLUSION: Use of only treponemal tests in low prevalence populations, like pregnant women, subjects individuals with non-active syphilis to the costs and possible risks of overtreatment. The use of the dual treponemal and non-treponemal tests would minimize this risk at some additional cost.