Person:

Wu, Samantha

Introduction: To prevent mother-to-child transmission (MTCT) of HIV in developing countries, new World Health Organization (WHO) guidelines recommend maternal combination antiretroviral therapy (cART) during pregnancy, throughout breastfeeding for 1 year and then cessation of breastfeeding (COB). The efficacy of this approach during the first six months of exclusive breastfeeding has been demonstrated, but the efficacy of this approach beyond six months is not well documented. Methods: A prospective observational cohort study of 279 HIV-positive mothers was started on zidovudine/3TC and lopinavir/ritonavir tablets between 14 and 30 weeks gestation and continued indefinitely thereafter. Women were encouraged to exclusively breastfeed for six months, complementary feed for the next six months and then cease breastfeeding between 12 and 13 months. Infants were followed for transmission to 18 months and for survival to 24 months. Text message reminders and stipends for food and transport were utilized to encourage adherence and follow-up. Results: Total MTCT was 9 of 219 live born infants (4.1%; confidence interval (CI) 2.2–7.6%). All breastfeeding transmissions that could be timed (5/5) occurred after six months of age. All mothers who transmitted after six months had a six-month plasma viral load >1,000 copies/ml (p<0.001). Poor adherence to cART as noted by missed dispensary visits was associated with transmission (p=0.04). Infant mortality was lower after six months of age than during the first six months of life (p=0.02). The cumulative rate of infant HIV infection or death at 18 months was 29/226 (12.8% 95 CI: 7.5–20.8%). Conclusions: Maternal cART may limit MTCT of HIV to the UNAIDS target of <5% for eradication of paediatric HIV within the context of a clinical study, but poor adherence to cART and follow-up can limit the benefit. Continued breastfeeding can prevent the rise in infant mortality after six months seen in previous studies, which encouraged early COB.

Purpose: There is increased interest in the impact of cancer and cancer treatment on health in aging. Cognitive function has been a focus of such research, however, inadequate understanding of the underlying risk profile, or prevalence of risk factors for cognitive decline across different groups of cancer survivors or persons without cancer limits interpretation of these studies. Methods: Utilizing Nurses’ Health Study questionnaires, we compared lifestyle and health characteristics which are considered primary risk factors for cognitive decline among 6,159 breast, 876 colorectal, and 602 uterine cancer survivors and 94,762 women with no cancer history.
Results: Cognitive risk factor profiles were generally similar across groups. However, uterine cancer survivors had greater BMI (40% with BMI≥30 kg/m2 versus 22-24% in other groups), higher prevalence of type 2 diabetes (19% versus 9-11%), and high blood pressure (61% versus 48-52%) compared to other groups, and use of postmenopausal hormone therapy was more common in breast cancer survivors than other groups (38% versus 22-33%). Conclusions: Breast and colorectal cancer survivors, and women with no cancer history demonstrated similar cognitive risk factor profiles. However, uterine cancer survivors have a unique distribution of risk factors, and careful consideration must be taken in studying cognitive decline in this group.