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Exposure timing is critical in terms of safety, as teratogenic risk is highest very early in pregnancy, before most women recognise they are pregnant.
To determine if a birth defect is associated with a drug or simply reflects the baseline population rate of a defect, the number of required exposures will vary based on the defect population prevalence. Data on birth defects with ARV exposure will be discussed. In addition to birth defects, some data suggest that preconception use of ARVs may be associated with adverse pregnancy outcome such as preterm delivery, low birthweight or stillbirth, and that there may be differences between ARV regimens in such effects; examples will be discussed.
There are unique developmental, cognitive, biologic, psychosocial and societal factors that contribute to the challenges encountered in optimising care and outcomes for adolescents and young adults. This population has lower rates of diagnosis, engagement and ultimately viral suppression, which threaten to derail the gains in HIV treatment and care for this population. Furthermore, our systems of care, often fragmented for this evolving population, can worsen outcomes.
This whirlwind lecture will discuss the worldwide landscape of adolescents, review the current epidemiology of HIV in this population, assess the factors that contribute to risk and management challenges, analyse systems of care and their impact on outcomes including transition to adult care , highlight promising models and interventions, and areas of need for research to optimise outcomes for this key, growing population.
Strategies for prevention among individuals with HIV infection include HPV vaccination, cervical cancer and anal cancer screening programmes, and early initiation of antiretroviral therapy ART. However, more definitive evidence is needed.