Trends in a Cohort of HIV-infected pregnant women in Rio de Janeiro, 1996-2004

Revista Brasileira de Epidemiologia

Guilherme Amaral Calvet²  Esaú Custódio João²  Karin Nielsen-saines²  Cynthia Braga Cunha²  Jacqueline Anita Menezes²  Marcos Machado D'ippolito¹  Maria Letícia Santos Cruz²  Ezequias Batista Martins²  Sônia Maria Santos Silva¹  Adriana Ferreira Medeiros²  Haroldo José Matos¹ 

[1] ,Hospital dos Servidores do Estado Department of Infectious Diseases Rio de Janeiro RJ ,Brazil

关键词: Mother-to-child HIV transmission;    Antiretroviral therapy pregnancy;    Cohort study Brazil;    HIV;    Transmissão materno-infantil do HIV;    Terapia anti-retroviral na gestação;    Estudo de coorte de gestantes;    HIV;    Aids;    Brasil;   

DOI  :  10.1590/S1415-790X2007000300004

来源: SciELO

【 摘 要 】

OBJECTIVE: To describe trends in sociodemographic, immunological and virological profiles and interventions to decrease the risk of mother-to-child HIV transmission. METHODS: Retrospective cohort study conducted at a tertiary institution in Rio de Janeiro, Brazil from January 1996 to December 2004. Analysis was performed by stratification in three time periods: 1996-1998 (P1), 1999-2001 (P2) and 2002-2004 (P3). RESULTS: In 9 years, 622 pregnancies occurred. Complications included: maternal mortality 0.3%, stillbirths 2.5%, miscarriages 0.6%, neonatal mortality 1.1%, prematurity 9.9%, low birth weight (LBW) 16.5%, congenital malformations 2.2%. The number of HIV-infected pregnant patients grew threefold over time reflecting increased prevalence of disease and patient identification. HIV diagnosis before pregnancy increased from 30% in P1 to 45% in P3. The proportion of pregnant women receiving highly active antiretroviral therapy increased from none (P1) to 88% (P3) with a significant trend towards women delivering at undetectable viral loads in later years despite a higher frequency of advanced disease. Scheduled cesarean deliveries increased from 35% in P1 to 48% in P3. Perinatal transmission rates were 2.4% with a decline from 3.5% in P1 to 1.6% in P3. Neonatal outcomes tended to remain constant or improve with time. A slight rise in LBW and congenital malformations were observed. CONCLUSIONS: During the observational period, HIV+ pregnant women presented with more advanced disease and lower socio-economic status. However, improved management of HIV-infected patients (associated with increased identification and increased availability of treatment) resulted into very low transmission rates similar to those of developed countries with overall improvement of patient outcomes.

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