Mother-to-child transmission of human immunodeficiency virus in aten years period

Abstract

Objectivesto evaluate mother-to-child transmission (MTCT) rates and related factors in HIV-infected pregnant women from a tertiary hospital between 2000 and 2009.Subjects and methodcohort of 452 HIV-infected pregnant women and their newborns. Data was collected from recorded files and undiagnosed children were enrolled for investigation. Statistical analysis: qui-square test, Fisher exact test, Student t test, Mann-Whitney test, ANOVA, risk ratio and confidence intervals.ResultsMTCT occurred in 3.74%. The study population displayed a mean age of 27 years; 86.5% were found to have acquired HIV through sexual contact; 55% were aware of the diagnosis prior to the pregnancy; 62% were not using HAART. Mean CD4 cell-count was 474 cells/ml and 70.3% had undetectable viral loads in the third trimester. HAART included nevirapine in 35% of cases and protease inhibitors in 55%; Zidovudine monotherapy was used in 7.3%. Mean gestational age at delivery was 37.2 weeks and in 92% by caesarian section; 97.2% received intravenous zidovudine. Use of AZT to newborn occurred in 100% of them. Factors identified as associated to MTCT were: low CD4 cell counts, elevated viral loads, maternal AIDS, shorter periods receiving HAART, other conditions (anemia, IUGR (intra uterine growth restriction), oligohydramnium), coinfecctions (CMV and toxoplasmosis) and the occurrence of labor. Use of HAART for longer periods, caesarian and oral zidovudine for the newborns were associated with a decreased risk. Poor adhesion to treatment was present in 13 of the 15 cases of transmission; in 7, coinfecctions were diagnosed (CMV and toxoplasmosis).ConclusionUse of HAART and caesarian delivery are protective factors for mother-to-child transmission of HIV. Maternal coinfecctions and other conditions were risk factors for MTCT.

Mother to Child HIV Transmission and Its Predictors among HIV-Exposed Infants: A Retrospective Follow-Up Study in Southwest Ethiopia

“…A low CD4 count is an indicator of high viral load. Although, maternal HIV viral load and CD4 counts were not systematically recorded in this study, other studies [19,20] had reported similar findings, indicating mothers with CD4 count less than 200 cells/µl and high viral load (an indication of late AIDS stage) were three to five times more likely to transmit HIV to their exposed infants [9,19,21].…”

Prenatal testing and prevalence of HIV infection during pregnancy: data from the “Birth in Brazil” study, a national hospital-based study

“…The decline in mortality due to AIDS in Brazil since the 2000s [3], with increasing survival among HIV-infected individuals [46,47], is one possible explanation. The high proportion of pregnant women with diagnoses of HIV infection prior to the current pregnancy, which has been reported in several national studies [11,13,14,18,19], suggests that women who have been infected for longer periods are becoming pregnant, which may also explain the increase in prevalence with age.…”

“…The estimated vertical transmission rate was 6.8% in 2004, with a range from 13.4% in the North region to 4.3% in the Midwest region [10]. Local studies conducted in the Southeast region [11-14] have reported vertical transmission rates closer to 3%, while rates of less than or equal to 2% have been found in the Midwest and South regions [15-17]. In contrast, in the North and Northeast regions and in the state of São Paulo, local studies have found vertical transmission rates of 9.9% [18], 9.2% [19] and 6.0% [20], respectively.…”

Risk factors for human immunodeficiency virus infection among Brazilian blood donors: a multicentre case–control study using audio computer‐assisted structured interviews

“…Risk factors for HIV infection in the general population of Brazil have been evaluated in several studies . Sexual transmission is the cause of the majority of HIV/AIDS cases in Brazil, with almost half of infections attributable to unprotected sex among men who have sex with other men (MSM).…”