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Menegotto M, Magdaleno AM, da Silva CLO, Friedrich L, da Silva CH. Mother-to-Child HIV Transmission among Pregnant Women in a City with the Highest Rates of HIV in Brazil. Am J Perinatol 2022; 39:1418-1425. [PMID: 33477174 DOI: 10.1055/s-0040-1722605] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Most of the HIV pediatric infections are acquired through mother-to-child transmission (MTCT). Porto Alegre is a state capital of Brazil that had a HIV MTCT rate of 4.1% in 2013 and the highest rate of HIV-infected pregnant women in the country during 2018. Zidovudine and nevirapine have been used in Brazil for high-risk newborns since 2012. The aim of the study was to investigate HIV MTCT rate and the factors associated with HIV transmission at a hospital that is a reference center for HIV-infected mothers in Porto Alegre, after the introduction of this policy. STUDY DESIGN This retrospective cohort study included all HIV-exposed infants born between February 2013 and December 2016 at the Hospital de Clínicas de Porto Alegre. Student's t-test or Fisher's exact test was used to compare variables between HIV-infected and uninfected groups of newborns. Poisson's regression with robust variance was used to determine the factors associated with HIV MTCT. RESULTS A total of 375 newborns were exposed to HIV, with an outpatient loss of 14.4% (n = 54). The HIV MTCT rate was 2.18% (n = 7), with four infected during the intrauterine period. The risk factors for MTCT were no prenatal care (relative risk [RR] = 9.4; 95% confidence interval [CI]: 2.0-44.3), late maternal HIV diagnosis in the peripartum period (RR = 16.3; 95% CI: 3.6-73.0), syphilis infection during pregnancy (RR = 9.3; 95% CI: 2.1-40.3), maternal viral load >1,000 copies/mL in the third trimester or peripartum period (RR = 9.5; 95% CI: 1.7-50.5), and lack of or inappropriate antiretroviral therapy during pregnancy (RR = 8.2; 95% CI: 1.6-41.4). CONCLUSION MTCT rate was 2.18%. With the institution of two-drug prophylaxis for high-risk newborns, persistent cases HIV MTCT were predominantly found among women with absence of antenatal care, late HIV diagnosis, syphilis coinfection, high viral load, and inadequate ARV therapy during pregnancy. Although zidovudine and nevirapine were administered postnatally to high-risk newborns, this regimen could not prevent transplacental transmission. KEY POINTS · Most of the HIV pediatric infections are acquired through mother-to-child transmission.. · The study investigated HIV MTCT rate and the factors associated with HIV transmission in Brazil.. · HIV MTCT rate was 2.18% and most of them were infected during the intrauterine period..
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Affiliation(s)
- Mariana Menegotto
- Graduate Program in Child and Adolescent Health, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Amanda M Magdaleno
- Pediatrics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Carmem L O da Silva
- Pediatrics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,AIDS Assistance Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Luciana Friedrich
- AIDS Assistance Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Neonatology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Clécio H da Silva
- Graduate Program in Child and Adolescent Health, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Pediatrics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Zhao J, Chen Q, Fu C, Qin Q, Huang H, Feng Y, Wei Y, Li Y, Huang A, Xu Q, She S. Rate of the HIV Transmission and Associated Factors Among HIV-Exposed Infants in Guangxi, China: 2014-2019. AIDS Res Hum Retroviruses 2020; 36:647-655. [PMID: 32498619 DOI: 10.1089/aid.2020.0073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
This study aims to evaluate the epidemiological characteristics of mother-to-child transmission (MTCT) of HIV and identify the possible factors leading to infant HIV infection using a retrospective cohort study of early infant diagnosis (EID). Information on a total of 3,145 exposed infant-mother pairs was collected from the EID platform from July 2014 to December 2019. The MTCT rate was 2.1%. Spatial-temporal maps showed that rates varied by year and by region, with four districts (Baise, Guigang, Guilin, and Hechi) maintaining rates of >2.0% in 2019. The rate of antiretroviral therapy (ART) use was 94.4%, with a gradual increase in prescriptions of highly active ART (HAART) from 83.0% in 2014 to 92.4% in 2019. A majority of 99.5% of infants were receiving artificial feeding. Factors associated with MTCT were ART use (odds ratio [OR] = 0.065, confidence interval [95% CI] = 0.035-0.121) and artificial feeding (OR = 0.091, 95% CI = 0.018-0.452). HAART was more helpful in decreasing the risk of MTCT compared with monotherapy (OR = 0.115, 95% CI = 0.014-0.933). ART during the postpartum period correlated with an increased risk (OR = 11.579, 95% CI = 1.402-95.960) compared with use of ART during pregnancy. This study indicates that MTCT rate of HIV is decreasing meaningfully in Guangxi. Some areas still face challenges in elimination of MTCT and need further resources and interventions. Future program planning should take into consideration the fact that ART use-in particular the use of HAART or ART during pregnancy-and replacement feeding may contribute to the prevention of MTCT.
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Affiliation(s)
- Jiangyang Zhao
- Department of Clinical Laboratory, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Qiaopei Chen
- Department of Clinical Laboratory, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Chunyun Fu
- Department of Clinical Laboratory, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Qinghua Qin
- Department of Maternal Health, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Haifeng Huang
- Department of Clinical Laboratory, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yuanyuan Feng
- Department of Clinical Laboratory, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yuchen Wei
- Department of Clinical Laboratory, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yan Li
- Department of Clinical Laboratory, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Aidan Huang
- Department of Clinical Laboratory, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Qingqing Xu
- National HIV/HCV Reference Laboratory, National Center for AIDS/STD Control and Prevention, Beijing, China
| | - Shangyang She
- Department of Clinical Laboratory, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
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Lovero KL, de Oliveira TRD, Cosme EM, Cabrera NB, Guimarães MF, de Avelar JG, de Oliveira GRT, Salviato CDM, Douglass-Jaimes G, Cruz MLS, João EC, de Barros ACMW, Pone MVDS, Gomes IM, Riley LW, Cardoso CAA. Retrospective analysis of risk factors and gaps in prevention strategies for mother-to-child HIV transmission in Rio de Janeiro, Brazil. BMC Public Health 2018; 18:1110. [PMID: 30200914 PMCID: PMC6131771 DOI: 10.1186/s12889-018-6002-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 08/29/2018] [Indexed: 12/03/2022] Open
Abstract
Background Despite great progress made in methods to prevent mother-to-child transmission of HIV (MTCT), delivery and uptake of these measures remains a challenge in many countries. Although the Brazilian Ministry of Health aimed to eliminate MTCT by 2015, infection still occured in 15–24% of infants born to HIV-infected mothers. We sought to identify remaining factors that constrain MTCT elimination. Methods We conducted a retrospective, matched case-control study by reviewing hospital charts of infants born to HIV-infected mothers between 1997 and 2014 at three MTCT reference hospitals in the Rio de Janeiro metropolitan area. Cases were defined as HIV-exposed children with two positive HIV tests before 18 months of age; controls were defined as HIV-exposed children with two negative HIV tests before 18 months of age. We performed bivariate and MTCT cascade analyses to identify risk factors for MTCT and gaps in prevention services. Results We included 435 infants and their mothers (145 cases, 290 controls). Bivariate analyses of MTCT preventative care (PMTCT) indicated that cases were less likely to complete all individual measures in the antenatal, delivery, and postnatal period (p < 0.05). Assessing completion of the PMTCT cascade, the sequential steps of PMTCT interventions, we found inadequate retention in care among both cases and controls, and cases were significantly less likely than controls to continue receiving care throughout the cascade (p < 0.05). Motives for incompletion of PMTCT measures included infrastructural issues, such as HIV test results not being returned, but were most often due to lack of care-seeking. Over the course of the study period, PMTCT completion improved, although it remained below the 95% target for antenatal care, HIV testing, and antenatal ART set by the WHO. Adding concern, evaluation of co-infections indicated that case infants were also more likely to have congenital syphilis (OR: 4.29; 95% CI: 1.66 to 11.11). Conclusions While PMTCT coverage has improved over the years, completion of services remains insufficient. Along with interventions to promote care-seeking behaviour, increased infrastructural support for PMTCT services is needed to meet the HIV MTCT elimination goal in Brazil as well as address rising national rates of congenital syphilis.
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Affiliation(s)
- Kathryn Lynn Lovero
- Department of Psychiatry, Columbia College of Physicians and Surgeons / New York State Psychiatric Institute, 1051 Riverside Drive #24, New York, NY, 10032, USA.
| | - Thais Raquelly Dourado de Oliveira
- Departamento Materno-Infantil, Faculdade de Medicina, Universidade Federal Fluminense, Rua Marquês de Paraná 303, Niterói, Rio de Janeiro, 24.033-900, Brazil
| | - Estela Magalhães Cosme
- Departamento Materno-Infantil, Faculdade de Medicina, Universidade Federal Fluminense, Rua Marquês de Paraná 303, Niterói, Rio de Janeiro, 24.033-900, Brazil
| | - Natália Beatriz Cabrera
- Departamento Materno-Infantil, Faculdade de Medicina, Universidade Federal Fluminense, Rua Marquês de Paraná 303, Niterói, Rio de Janeiro, 24.033-900, Brazil
| | - Mariana Fernandes Guimarães
- Departamento Materno-Infantil, Faculdade de Medicina, Universidade Federal Fluminense, Rua Marquês de Paraná 303, Niterói, Rio de Janeiro, 24.033-900, Brazil
| | - Juliana Gregório de Avelar
- Departamento Materno-Infantil, Faculdade de Medicina, Universidade Federal Fluminense, Rua Marquês de Paraná 303, Niterói, Rio de Janeiro, 24.033-900, Brazil
| | - Giovanna Rodrigues Teixeira de Oliveira
- Departamento Materno-Infantil, Faculdade de Medicina, Universidade Federal Fluminense, Rua Marquês de Paraná 303, Niterói, Rio de Janeiro, 24.033-900, Brazil
| | - Camila de Morais Salviato
- Departamento Materno-Infantil, Faculdade de Medicina, Universidade Federal Fluminense, Rua Marquês de Paraná 303, Niterói, Rio de Janeiro, 24.033-900, Brazil
| | - Guillermo Douglass-Jaimes
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California Berkeley, 530E Li Ka Shing Center, Berkeley, CA, 94720, USA
| | - Maria Leticia Santos Cruz
- Serviço de Doenças Infecciosas e Parasitárias, Hospital Federal dos Servidores do Estado, Rua Sacadura Cabral 178, Rio de Janeiro, Rio de Janeiro, 20.221-903, Brazil
| | - Esaú Custódio João
- Serviço de Doenças Infecciosas e Parasitárias, Hospital Federal dos Servidores do Estado, Rua Sacadura Cabral 178, Rio de Janeiro, Rio de Janeiro, 20.221-903, Brazil
| | - Ana Cláudia Mamede Wiering de Barros
- Setor de Doenças Infecciosas Pediátricas, Departamento de Pediatria, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (FIOCRUZ), Avenida Rui Barbosa 716, Rio de Janeiro, Rio de Janeiro, 22.250-020, Brazil
| | - Marcos Vinicius da Silva Pone
- Setor de Doenças Infecciosas Pediátricas, Departamento de Pediatria, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (FIOCRUZ), Avenida Rui Barbosa 716, Rio de Janeiro, Rio de Janeiro, 22.250-020, Brazil
| | - Ivete Martins Gomes
- Setor de Doenças Sexualmente Transmissíveis, Hospital Geral de Nova Iguaçu, Avenida Henrique Duque Estrada Mayer 953, Nova Iguaçu, Rio de Janeiro, 26.050-210, Brazil
| | - Lee Woodland Riley
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California Berkeley, 530E Li Ka Shing Center, Berkeley, CA, 94720, USA
| | - Claudete Aparecida Araújo Cardoso
- Departamento Materno-Infantil, Faculdade de Medicina, Universidade Federal Fluminense, Rua Marquês de Paraná 303, Niterói, Rio de Janeiro, 24.033-900, Brazil
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