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  Table of Contents  
LETTER TO EDITOR
Year : 2022  |  Volume : 43  |  Issue : 1  |  Page : 90-91
 

Study of impact of WHO option B+ on maternal and perinatal outcome in HIV-positive women delivering at a tertiary care hospital, Delhi


Department of Obstetrics and Gynecology, Lady Hardinge Medical College, New Delhi, India

Date of Submission18-Mar-2021
Date of Decision17-Aug-2021
Date of Acceptance16-Sep-2021
Date of Web Publication07-Jun-2022

Correspondence Address:
Dr. Kanika Chopra
158, First Floor 1, Gyankhand 1, Indirapuram, Ghaziabad - 201 014, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijstd.ijstd_24_21

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How to cite this article:
Yadav R, Chopra K, Jaiswal N. Study of impact of WHO option B+ on maternal and perinatal outcome in HIV-positive women delivering at a tertiary care hospital, Delhi. Indian J Sex Transm Dis 2022;43:90-1

How to cite this URL:
Yadav R, Chopra K, Jaiswal N. Study of impact of WHO option B+ on maternal and perinatal outcome in HIV-positive women delivering at a tertiary care hospital, Delhi. Indian J Sex Transm Dis [serial online] 2022 [cited 2022 Jul 3];43:90-1. Available from: https://www.ijstd.org/text.asp?2022/43/1/90/346581




Sir,

Mother to child transmission (MTCT) is responsible for the majority of pediatric population infection accounting to more than 90%.[1] WHO Option B+ was adapted in 2014 with the aim of not only reducing the rate of PMTCT but also for the patient's health.[2] Triple antiretroviral therapy, i.e., tenofovir (300 mg), lamivudine (300 mg), and efavirenz (600 mg) is started at the point of diagnosis without the need for CD4 counts. Infant receives daily dose of nevirapine till 6 weeks of age irrespective of type of feeding. Pediatric antiretroviral therapy (ART) is started if infant is diagnosed positive.

There is the absence of lack of consensus on the effects of ART and also the effect of WHO option B+ On maternal and perinatal outcomes. This study was planned with the aim of evaluating maternal and perinatal outcome in HIV-infected women delivering in a tertiary care facility after the adaptation of WHO option B+.

[Table 1] depicts the sociodemographic profile of 159 women. Anemia was seen in 54%, followed by preterm delivery in 13.8% women, as shown in [Table 1] along with other obstetrical and neonatal outcomes. Associated comorbidities were present in 3 women, one had pulmonary tuberculosis, and other 2 were hepatitis B reactive. There was no maternal mortality. Low birth weight was seen in 30.8% neonates and 5.6% required nursery admission. Majority were exclusively breast fed. All infants underwent HIV testing at 6 weeks, 6, 12, and 18 months. Positivity rate was seen to be 10% in our study.
Table 1: Sociodemographic profile

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The increased prevalence of poor pregnancy outcome in HIV-positive women can be explained by the social stigma associated with the disease, poor socioeconomic status of affected population in majority, and lack of efficient antenatal care in terms of poor compliance by the patient and lack of patient and family counseling. High prevalence of anemia in our study should be seen as a reflection of the above factors, and all health-care professionals involved in the management of HIV-positive women should ensure treatment of anemia in preconception, antenatal, and postnatal phases.

Vaginal delivery and exclusive breastfeeding have been emphasized in WHO option B + plan, and our study shows a higher rate of both.

Low birth weight was almost half in our study as compared to in Nagar et al. study where it was 60%.[3] Olagbuji et al. found a statistically significant association between patients on ART and low birth weight.[4] Perinatal transmission was 10% in our study, but this cannot be considered as a negative impact of WHO option B+. A study conducted in Rwanda showed a 46% reduction in the rate of perinatal transmission postpolicy change.[5]

There is a scope of further improvement in antenatal registration in India and HIV screening at the first antenatal visit. It will help in early detection, starting of treatment, appropriate counseling of the patient and her family, and referral to appropriate center if required.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Alemu FM, Yalew AW, Fantahun M, Ashu EE. Antiretroviral therapy and pregnancy outcomes in developing countries: A systematic review. Int J MCH AIDS 2015;3:31-43.  Back to cited text no. 1
    
2.
HIV and Pregnancy. Reviewed August Development by the US Department of Health & Human Services Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Working Group of Office of AIDS Research Advisory Council, 2015. Fact Sheet. Available from: http://aidsinfo.nih.gov/.Last updateddate20/4/15.  Back to cited text no. 2
    
3.
Nagar O, Agrawal S, Jain S, Sharma A, Agrawal G. A retrospective study of maternal and perinatal outcome of seropositive pregnant women attending PPTCT center at a tertiary center. Int J Clin Obs Gyn 2019;3(1):139-43.  Back to cited text no. 3
    
4.
Olagbuji BN, Ezeanochie MC, Ande AB, Oboro VO. Obstetric and perinatal outcome in HIV positive women receiving HAART in Urban Nigeria. Arch Gynecol Obstet 2010;281:991-4.  Back to cited text no. 4
    
5.
Abimpaye M, Kirk CM, Iyer HS, Gupta N, Remera E, Mugwaneza P, et al. The impact of “Option B” on HIV transmission from mother to child in Rwanda: An interrupted time series analysis. PLoS One 2018;13:e0192910.  Back to cited text no. 5
    



 
 
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