Evaluation of factors associated with vertical HIV-1 transmission

Rosa, Matheus Costa da; Lobato, Rubens Caurio; Gonçalves, Carla Vitola; Silva, Naylê Maria Oliveira da; Barral, Maria Fernanda Martínez; Martinez, Ana Maria Barral de; Hora, Vanusa Pousada da

doi:10.1016/j.jped.2014.12.005

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Sumário

• J. Pediatr. (Rio J.) 91 (6) • Nov-Dec 2015 • https://doi.org/10.1016/j.jped.2014.12.005 copy

Evaluation of factors associated with vertical HIV-1 transmission^☆ ☆ Please cite this article as: da Rosa MC, Lobato RC, Gonc¸alves CV, da Silva NM, Barral MF, de Martinez AM, et al. Evaluation of factorsassociated with vertical HIV-1 transmission. J Pediatr (Rio J). 2015;91:523-8.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To compare the prevalence and factors associated with vertical transmission of human immunodeficiency virus 1 (HIV-1) among pregnant women treated in the periods of 1998-2004 and 2005-2011 in a reference service for the care of HIV-infected patients in southern Brazil.

Methods

This was a descriptive and analytical study that used the databases of laboratories from the CD4 and STDs/AIDS Viral Load National Laboratory Network of the Brazilian Ministry of Health. HIV-1-infected pregnant women were selected after an active search for clinical information and obstetric and neonatal data from their medical records between the years of 1998 and 2011.

Results

102 pregnant women were analyzed between 1998 and 2004 and 251 in the period between 2005 and 2011, totaling 353 children born to pregnant women with HIV-1. It was observed that the vertical transmission rate was 11.8% between 1998 and 2004 and 3.2% between 2005 and 2011 (p < 0.001). The increased use of antiretroviral drugs (p = 0.02), the decrease in viral load (p < 0.001), and time of membrane rupture lower than 4 h (p < 0.001) were associated with the decrease of vertical transmission factors when comparing the two periods.

Conclusion

It was observed a decrease in the rate of vertical transmission in recent years. According to the studied variables, is suggested that the risk factors for vertical transmission of HIV-1 were absence of antiretroviral therapy, high viral load in the pregnant women, and membrane rupture time >4 h.

KEYWORDS
Human immunodeficiency virus type 1; Vertical infection transmission; Pregnant woman

	Membrane rupture time								p-value
Period	n		> 4h	%		< 4h	%		< 0,001
1998-2004	102		81	79,4		21	20,6
2005-2011	251		27	10,8		224	89,2
Total	353		108	30,6		245	69,4
	Delivery mode								0,67
	n		Cesarean	%		Normal	%
1998-2004	102		39	38,2		63	61,7
2005-2011	251		90	35,8		161	64,8
Total	353		129	36,5		224	63,5
	Mother-to-child transmission								< 0,001
	n		HIV +	%		HIV -	%
1998-2004	102		12	11,8		90	88,2
2005-2011	251		8	3,2		243	96,8
Total	353		20	5,7		333	94,3
	Antiretroviral therapy during pregnancy								0,02
	n		Incomplete	%		Complete	%
1998-2004	102		40	39,3		62	60,7
2005-2011	251		67	26,7		184	73,3
Total	353		107	30,3		246	69,7
	T CD4+ cell count
	n	cell 0-199		%	cell 200-499	%	cell > 500		%
1998-2004	95	18		18,9	50	52,6	27		28,4
2005-2011	251	13		5,2	94	37,5	144		57,3
Valor de P		< 0,001			< 0,001		1.00
	Maternal viral load --- Log¹⁰
	n	0-2,99	%	3,0-3,99	%	4,0-4,99	%	≥	%
1998-2004	95	27	28,4	23	24,2	35	36,8	10	10,5
2005-2011	251	173	68,9	49	19,5	26	10,3	3	1,2
Valor de p			< 0,001		0,37		< 0,001		< 0,001
	Newborn gender								0,68
	n		Male	%		Female	%
1998-2004	102		54	52,9		48	47,1
2005-2011	251		127	50,5		124	49,5
Total	353		181	51,3		172	48,7

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E-mail: jped@jped.com.br

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[1] * Corresponding author. E-mail: dahoravp@gmail.com (V.P. da Hora).

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Evaluation of factors associated with vertical HIV-1 transmission☆ ☆ Please cite this article as: da Rosa MC, Lobato RC, Gonc¸alves CV, da Silva NM, Barral MF, de Martinez AM, et al. Evaluation of factorsassociated with vertical HIV-1 transmission. J Pediatr (Rio J). 2015;91:523-8.

Abstract

Objective

Methods

Results

Conclusion

Evaluation of factors associated with vertical HIV-1 transmission^☆ ☆ Please cite this article as: da Rosa MC, Lobato RC, Gonc¸alves CV, da Silva NM, Barral MF, de Martinez AM, et al. Evaluation of factorsassociated with vertical HIV-1 transmission. J Pediatr (Rio J). 2015;91:523-8.