Estimated Incidence and Genotypes of HIV-1 among Pregnant Women in Central Brazil

Abstract

ObjectiveTo estimate the incidence of HIV-1 infection among pregnant women from central-western Brazil.DesignObservational cross-sectional study.MethodsA total of 54,139 pregnant women received antenatal HIV screening from a network of public healthcare centers in 2011. The incidence of confirmed HIV-1 infection was estimated using the Serological Testing Algorithms for Recent HIV Seroconversion (STARHS) methodology and BED-capture enzyme immunoassay (BED-CEIA). The yearly incidence was calculated, and adjusted incidence rates were estimated. For a subgroup of patients, protease and partial reverse transcriptase regions were retrotranscribed from plasma HIV-1 RNA and sequenced after performing a nested polymerase chain reaction.ResultsOf the participants, 20% had a pregnancy before the age of 18 and approximately 40% were experiencing their first pregnancy. Of the 54,139 pregnant women screened, 86 had a confirmed HIV-1 diagnosis, yielding an overall prevalence of 1.59 cases per 1000 women (95% CI 1.27–1.96). A higher prevalence was detected in the older age groups, reflecting cumulative exposure to the virus over time. Among the infected pregnant women, 20% were considered recently infected according to the BED-CEIA. The estimated incidence of HIV infection was 0.61 per 1000 person-years (95% CI 0.33-0.89); the corrected incidence was 0.47 per 1000 person-years (95% CI 0.26-0.68). In a subgroup of patients, HIV-1 subtype C (16.7%) was the second most prevalent form after subtype B (66.7%); BF1 recombinants (11.1%) and one case of subtype F1 (5.5%) were also detected.ConclusionThis study highlights the potential for deriving incidence estimates from a large antenatal screening program for HIV. The rate of recent HIV-1 infection among women in their early reproductive years is a public health warning to implement preventive measures.

HIV-1 incidence among people seeking voluntary counseling and testing centers, including pregnant women, in Pernambuco State, Northeast Brazil

“…Higher incidence estimates were observed in Rio de Janeiro (0.41%; 95%CI: 0.11-0.72) and Rio Grande do Sul (1.93%; 95%CI: 0.88-2.97) 1 . A HIV-1 incidence estimate of 0.61 per 1,000 persons-years was found in Central Brazil, smaller than our estimates 13 .…”

HIV-1 infection and pregnancy in young women in Brazil: socioeconomic and drug resistance profiles in a cross-sectional study

“…1 In the Central Western region, adolescents represented 26% of 54 139 pregnant women screened for HIV-1 infection during antenatal care. 4 Compared to adults, younger HIV-1 infected patients had lower attendance in specialised clinical care, higher HIV-1 sequelae and difficulties in initiation and adherence to highly active antiretroviral therapy (HAART). 5 6 Therefore, HIV infection and pregnancy association in young women raises a concern as long-term exposure to HAART started at early age, and low adherence may lead to increased selection of drug-resistant viruses.…”

“…Prevalence of HIV-1 infection in this population has been recently estimated as 1.59/1000 (95% CI 1.27% to 1.96%). 4 In this context, this study aimed to describe in antiretroviral (ARV)-naïve and ARV-exposed young pregnant Brazilian women infected with HIV - 1: socioeconomic variables, transmitted and secondary ARV resistance mutation profiles and pregnancy outcomes, such as MTCT.…”

High rate of HIV infection in voluntary, first time, young male donors at HEMOAM, a reference blood bank in the Brazilian Amazon: 1992–2012 historical series

“…Therefore, HIV‐infected women are probably under‐represented within this blood donor population from HEMOAM. However, differently from the beginning of the epidemic, heterosexual transmission affecting mainly women is now the major route of infection, accounting for 57% of newly reported AIDS cases and has been well documented in Brazil . A study from the 1990s in the USA did not show impact of heterosexual transmission on blood safety .…”