Background
Untreated syphilis during pregnancy is associated with spontaneous abortion, stillbirth, prematurity and infant mortality. Syphilis may facilitate HIV transmission, which is especially concerning in low and middle income countries where both diseases are common.
Methods
We performed an analysis of data available from NICHD/HPTN 040 (P1043), a study focused on the prevention of intrapartum HIV transmission to 1684 infants born to 1664 untreated HIV-infected women. The present analysis evaluates risk factors and outcomes associated with a syphilis diagnosis in this cohort of HIV-infected women and their infants.
Results
Approximately 10% (n=171) of women enrolled had serological evidence of syphilis without adequate treatment documented and 1.4% (n=24) infants were dually HIV and syphilis infected. Multivariate logistic analysis showed that compared to HIV-infected women, co-infected women were significantly more likely to self-identify as non-white (AOR 2.5, 95% CI 1.5-4.2), to consume alcohol during pregnancy (AOR 1.5, 95% CI 1.1-2.1) and to transmit HIV to their infants (AOR 2.1, 95% CI 1.3-3.4), with 88% of HIV infections being acquired in-utero. As compared to HIV infected or HIV exposed infants, co-infected infants were significantly more likely to be born to mothers with VDRL titers ≥1:16 (AOR 3, 95% CI 1.1-8.2) and higher viral loads (AOR 1.5 95% CI 1.1-1.9). Of 6 newborns with symptomatic syphilis, 2 expired shortly after birth, and 2 were HIV-infected.
Conclusion
Syphilis continues to be a common co-infection in HIV-infected women and can facilitate in utero transmission of HIV to infants. Most infants are asymptomatic at birth, but those with symptoms have high mortality rates.
The three indicators showed an almost maximum correlation with the reduction in cardiovascular mortality. Such relationship indicates the importance of improving quality of life to reduce cardiovascular mortality.
the decline in all-cause mortality resulted mainly from the decline in DCS mortality. In turn, the decline in DCS mortality was partly due to the reduction in CVD mortality, especially in the state of Rio de Janeiro.
BackgroundDiseases of the circulatory system (DCS) are the major cause of death in
Brazil and worldwide.ObjectiveTo correlate the compensated and adjusted mortality rates due to DCS in the
Rio de Janeiro State municipalities between 1979 and 2010 with the Human
Development Index (HDI) from 1970 onwards.MethodsPopulation and death data were obtained in DATASUS/MS database. Mortality
rates due to ischemic heart diseases (IHD), cerebrovascular diseases (CBVD)
and DCS adjusted by using the direct method and compensated for ill-defined
causes. The HDI data were obtained at the Brazilian Institute of Applied
Research in Economics. The mortality rates and HDI values were correlated by
estimating Pearson linear coefficients. The correlation coefficients between
the mortality rates of census years 1991, 2000 and 2010 and HDI data of
census years 1970, 1980 and 1991 were calculated with discrepancy of two
demographic censuses. The linear regression coefficients were estimated with
disease as the dependent variable and HDI as the independent variable.ResultsIn recent decades, there was a reduction in mortality due to DCS in all Rio
de Janeiro State municipalities, mainly because of the decline in mortality
due to CBVD, which was preceded by an elevation in HDI. There was a strong
correlation between the socioeconomic indicator and mortality rates.ConclusionThe HDI progression showed a strong correlation with the decline in mortality
due to DCS, signaling to the relevance of improvements in life
conditions.
BackgroundThe epidemiological profile of mortality in a population is important for the
institution of measures to improve health care and reduce mortalityObjectiveTo estimate mortality rates and the proportional mortality from
cardiovascular diseases and malformations of the circulatory system in
children and adolescents.MethodsThis is a descriptive study of mortality from cardiovascular diseases,
malformations of the circulatory system, from all causes, ill-defined causes
and external causes in children and adolescents in the state of Rio de
Janeiro from 1996 to 2012. Populations were obtained from the Brazilian
Institute of Geography and Statistics (Instituto Brasileiro de Geografia e
Estatística - IBGE) and deaths obtained from the Department of
Informatics of the Unified Health System (DATASUS)/Ministry of Health.ResultsThere were 115,728 deaths from all causes, 69,757 in males. The annual
mortality from cardiovascular diseases was 2.7/100,000 in men and
2.6/100,000 in women. The annual mortality from malformations of the
circulatory system was 7.5/100,000 in men and 6.6/100,000 in women. Among
the specific causes of circulatory diseases, cardiomyopathies had the
highest rates of annual proportional mortality, and from malformations of
the circulatory system, it occurred due to unspecified malformations of the
circulatory system, at all ages and in both genders.ConclusionMortality from malformations of the circulatory system was most striking in
the first years of life, while cardiovascular diseases were more relevant in
adolescents. Low access to prenatal diagnosis or at birth probably prevented
the proper treatment of malformations of the circulatory system.
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