Missed Opportunities for Prevention of Mother-to-Child Transmission of Human Immunodeficiency Virus Type 1 in Latin America and the Caribbean: The Nisdi Perinatal Study

D’Ippolito, Marcos Machado; Read, Jennifer S.; Korelitz, James; João, Esaú; Mussi-Pinhata, Marisa Márcia; Rocha, Neiva

doi:10.1097/inf.0b013e3180618bd6

Cited by 17 publications

(9 citation statements)

References 6 publications

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“…The results of the present study are consistent with previous studies of MTCT of HIV-1 conducted over the past 8 years in Europe [8,9], the USA [10,11], Africa [12], and Latin America and the Caribbean [2,13]. These studies identified various missed opportunities for prevention of infection, which included late or no HIV-1 testing [10–12]; late or no initiation of prenatal care or maternal antiretrovirals [2,8,10,11]; limited or no use of maternal antiretroviral regimens [2,9,11,13]; poor control of maternal VL during pregnancy [2]; and lack of ECD [2,11].…”

Section: Discussionsupporting

confidence: 92%

“…These studies identified various missed opportunities for prevention of infection, which included late or no HIV-1 testing [10–12]; late or no initiation of prenatal care or maternal antiretrovirals [2,8,10,11]; limited or no use of maternal antiretroviral regimens [2,9,11,13]; poor control of maternal VL during pregnancy [2]; and lack of ECD [2,11]. …”

Section: Discussionmentioning

confidence: 99%

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Missed opportunities for prevention of mother‐to‐child transmission of HIV‐1 in the NISDI Perinatal and LILAC cohorts

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Cohen

Hance

et al. 2012

Intl J Gynecology & Obste

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Objective To evaluate cases of mother-to-child transmission of HIV-1 at multiple sites in Latin America and the Caribbean in terms of missed opportunities for prevention. Methods Pregnant women infected with HIV-1 were eligible for inclusion if they were enrolled in either the NISDI Perinatal or LILAC protocols by October 20, 2009, and had delivered a live infant with known HIV-1 infection status after March 1, 2006. Results Of 711 eligible mothers, 10 delivered infants infected with HIV-1. The transmission rate was 1.4% (95% CI, 0.7–2.6). Timing of transmission was in utero or intrapartum (n=5), intrapartum (n=2), intrapartum or early postnatal (n=1), and unknown (n=2). Possible missed opportunities for prevention included poor control of maternal viral load during pregnancy; late initiation of antiretrovirals during pregnancy; lack of cesarean delivery before labor and before rupture of membranes; late diagnosis of HIV-1 infection; lack of intrapartum antiretrovirals; and incomplete avoidance of breastfeeding. Conclusion Early knowledge of HIV-1 infection status (ideally before or in early pregnancy) would aid timely initiation of antiretroviral treatment and strategies designed to prevent mother-to-child transmission. Use of antiretrovirals must be appropriately monitored in terms of adherence and drug resistance. If feasible, breastfeeding should be completely avoided.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Missed opportunities for prevention of mother‐to‐child transmission of HIV‐1 in the NISDI Perinatal and LILAC cohorts

Read

Cohen

Hance

et al. 2012

Intl J Gynecology & Obste

Self Cite

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“…Approximately 90% of the AIDS cases among children (<13 years old) are attributable to mother-to-child-transmission (MTCT). Although the rate of vertical transmission has been declining, the implementation of antenatal HIV screening and timely management of infected pregnant women varies across the country due to disparities of health care access, suggesting missed opportunities for prevention [22-24]. …”

Section: Introductionmentioning

confidence: 99%

Prevalence and risk factors for Hepatitis C and HIV-1 infections among pregnant women in Central Brazil

et al. 2009

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BackgroundHepatitis C (HCV) and human immunodeficiency virus (HIV) infections are a major burden to public health worldwide. Routine antenatal HIV-1 screening to prevent maternal-infant transmission is universally recommended. Our objectives were to evaluate the prevalence of and potential risk factors for HCV and HIV infection among pregnant women who attended prenatal care under the coverage of public health in Central Brazil.MethodsScreening and counselling for HIV and HCV infections was offered free of charge to all pregnant women attending antenatal clinic (ANC) in the public health system, in Goiania city (~1.1 million inhabitants) during 2004–2005. Initial screening was performed on a dried blood spot collected onto standard filter paper; positive or indeterminate results were confirmed by a second blood sample. HCV infection was defined as a positive or indeterminate sample (EIA test) and confirmed HCV-RNA technique. HIV infection was defined according to standard criteria. Factors associated with HIV and HCV infections were identified with logistic regression. The number needed to screen (NNS) to prevent one case of infant HIV infection was calculated using the Monte Carlo simulation method.ResultsA total of 28,561 pregnant women were screened for HCV and HIV-1 in ANC. Mean maternal age was 23.9 years (SD = 5.6), with 45% of the women experiencing their first pregnancy. Prevalence of HCV infection was 0.15% (95% CI 0.11%–0.20%), and the risk increased with age (p < 0.01). The prevalence of anti-HIV infection was 0.09% (95% CI 0.06%–0.14%). Black women had a 4.9-fold (95% CI 1.42–16.95) greater risk of HIV-1 infection compared to non-black women. NNS to prevent one case of infant HIV infection ranged from 4,141 to 13,928.ConclusionThe prevalence of HIV and HCV infections were low among pregnant women, with high acceptability rates in the opt-in strategy in primary care. Older maternal age was a risk factor for HCV and antenatal HCV testing does not fulfill the requirements for screening recommendation. The finding of higher risk of HIV-1 infection among black women despite being in consonance with the HIV-1 ethnic pattern in some American regions cannot be ruled out to be a surrogate marker of socio-economic condition.

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“…Published reports regarding missed opportunities for prevention of mother-to-child transmission of HIV from Latin America and the Caribbean (21, 22) Europe (23) and the U.S. (24) found late initiation of prenatal antiretroviral therapy, poor control of viral load, late HIV diagnosis and lack of elective cesarean delivery as common factors resulting in mother-to-child transmission. These findings are similar in our case series.…”

Section: Discussionmentioning

confidence: 99%