Efficacy of Strategies to Reduce Mother-to-Child HIV-1 Transmission in Argentina, 1993–2000

Abstract

This study evaluated the success of a national program for the prevention of mother-to-child transmission (MTCT) of HIV-1 in 874 mother-infant pairs from Buenos Aires and surroundings. This population was referred to the National Reference Center for AIDS for diagnosis of neonatal infection during 1993-2000. The data revealed an increase in the use of antiretroviral therapy during pregnancy from 3.2% in 1993-1994 to 73.1% in 1999-2000 and in the use of cesarean delivery (reaching 54.8% in 1999-2000). However, the proportion of HIV-infected women who continued to breast-feed their children remained steady (around 12%). General improvement of the conditions for decreasing MTCT resulted in a significant decrease in the proportion of infected infants from 37.3% before 1995 to 10.7% in 1999-2000 and even 6.5% during 2001. Data on the time of diagnosis indicated that only 42.7% of the women knew about their HIV status before pregnancy, 44.8 knew during pregnancy, and 12.3% knew after the birth of their child. The main risk factor for HIV infection in the mothers was heterosexual contact (73%), and in the fathers, it was injection drug use (67%). These results point out the urgent need to develop additional strategies for prevention of MTCT of HIV-1 to generalize education, counseling, and testing of young women.

Mother-to-Child HIV Transmission in a Cohort of Pregnant Women Diagnosed by Rapid HIV Testing at Tijuana General Hospital, Baja California, Mexico

“…Two reports from Mexico City prior to the era of combination ART and other reports from Latin America found heterosexual transmission as the most frequent HIV-associated risk factor among pregnant women. [12][13][14][15] All women identified during prenatal care delivered by scheduled cesarean section, 53% in the absence of labor in contrast to 4% of women identified at the labor unit. Previous studies in Mexico have shown lower rates of cesarean section (25%) in women enrolled during pregnancy without specification of onset of labor.…”

“…12,13 Studies in Latin America have shown lower rates of elective cesarean section but 1 study in Argentina showed an increase in the use of elective cesarean section from 19% to 54% between 1993 and 2000. [14][15][16] Recently, a National Institute of Child Health and Human Development (NICHD) Perinatal Study conducted in Latin America found a similarly high cesarean section rate in their Mexican site at 61% among HIV-infected women enrolled during prenatal care. 17 In addition, the same study found a similar rate of preterm delivery at 9% as in our current study.…”

Infecção pelo HIV durante a gestação: estudo-Sentinela Parturiente, Brasil, 2002

“…10 Dentre os fatores associados à transmissão materno-infantil, destacam-se: a alta carga viral materna, a ruptura prolongada das membranas amnióticas, a presença de infecção sexualmente transmissível, o tipo de parto, a prematuridade e o uso de drogas. 4,8,15 Desde 1994, depois da divulgação do protocolo 076 do Aids Clinical Trial Group (PACTG 076), sabese que o uso da zidovudina (AZT) pela gestante infectada e pelo recém-nascido, durante as primeiras semanas de vida, pode reduzir em cerca de 70% o risco de a criança ser infectada, sendo considerado um dos principais avanços no conhecimento sobre a Aids. 5 Além disso, sabe-se, atualmente, que o uso de terapia anti-retroviral combinada, ou seja, a utilização simultânea de duas ou mais drogas anti-retrovirais, é capaz de reduzir significativamente a carga viral plasmática da mãe para níveis não detectáveis, reduzindo, assim, o risco de transmissão do HIV para o recém-nascido.…”

Epidemiology of HIV Vertical Transmission

“…Transmission from mother to child is the main route of infection among children, accounting for over 90% of children in infections [9]. Risk factors for mother to child transmission include high maternal viral load [10-12, advanced maternal immune deficiency [13], prolonged rupture of membranes [14] and the presence of sexually transmitted infection, type of delivery, prematurity and drug use [15][16][17]. Risk factors related to transmission of HIV through breast milk have been less studied, but transmission by this route was associated with either viral load as subclinical mastitis [18].…”