Evolução histórica da transmissão vertical do HIV em Estado do nordeste brasileiro : 1990-2011

• Ano de defesa: 2013
• Autor(a) principal: Lemos, Lígia Mara Dolce de
• Orientador(a): Gurgel, Ricardo Queiroz
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Sergipe
• Programa de Pós-Graduação: Pós-Graduação em Ciências da Saúde
• País: BR
• Palavras-chave em Português: Transmissão Vertical de Doença Infecciosa; HIV; Crianças; Antirretrovirais; Sobrevida; Diagnóstico Tardio
• Palavras-chave em Inglês: Infectious Disease Transmission, Vertical; HIV; Child; Antiretroviral; Survival; Late diagnosis
• Área do conhecimento CNPq: CNPQ::CIENCIAS DA SAUDE
• Link de acesso: https://ri.ufs.br/handle/riufs/3586

Introduction: the mother-to-child transmission is the main route of acquisition of HIV in children and the progressive increase of the epidemic in women of reproductive age significantly influences the epidemic in childhood. With the results of prophylaxis with antiretroviral, the possibility of transmission decreased considerably, but is still an important public health problem. Objective: to describe the time series of the clinical, epidemiological and laboratory of children born from mothers HIV positive or with AIDS in Sergipe and followed at referral center for STD / AIDS from January 1990 to December 2011. Methods: this is a retrospective cohort study. We recorded clinic and registry data from all HIV-infected pregnant women and exposed children from: notification system disorders (SINAN), file reference center for HIV / AIDS (CEMAR), referral maternity, system laboratory (SISCEL) and mortality system (SIM). The analyses were differentiated according to five specific objectives. At first, it was analyzed using the protocol AIDS clinical trial group (ACTG 076) in reference maternity HIV / AIDS for the period 1994-2010. We included HIV positive mothers from July 1994 to April 2010. In the second objective we did a prevalence survey to estimate the number of HIV positive pregnant using the capture-recapture method in the state of Sergipe in the period 1990-2011. The third was a retrospective cohort study to evaluate the risk factors associated with vertical transmission and the rate of mother to child transmission in Sergipe in the period 1990-2010. The fourth objective trends observed mortality in a cohort of children infected with HIV in the period 1993-2011. The fifth and last observed prevalence and risk factors for late diagnosis of HIV in infants exposed vertical transmission. Results: we identified 561 HIV-exposed children in the study period. Of these, 467 (83.24%) performed diagnostic test for HIV and 101 (18%) were infected by the virus. Of these, 467 (83.24) performed diagnostic test for HIV, 101 (18%) were infected, and 61 (10.8%) were still under investigation. In multivariate analysis of maternal factors for HIV infection in children, antiretroviral prophylaxis in children was a protective factor (aOR 0:07, 95% CI 0:01 to 0:41, p=0.003). Breastfeeding was marginally associated with increased chance of transmission (adjusted Odds Ratio [aOR] 4.52, CI 95% 0.78-0.17, p=0.092). The risk for breastfeeding over the study period was 91.0%, and transmission decreased from 91 per 100 live births before 1997 to 2 per 100 in 2011 following adoption of the prevention protocol. Of the 101 infected, twentyone children died with a median age at 4.3 years (IQR, 1.5-5.6 ears). In multivariable analysis, after adjusting for current treatment, the risk of death was 57% lower for children born after 2001 compared to those born before (adjusted relative risk [ARR] 0.43,IC95% 0.20-0.96, p <0.005). Lack of prenatal care (p=0.09) and breastfeeding (p=0.07) were marginally associated with late diagnosis. Was observed using the ACTG 076 was fully (during pregnancy, during delivery and after childbirth) utilized in only 31.8% of the participants. We estimate the population of HIV-seropositive pregnant women in the State of Sergipe between 2000 and 2010, using the capture-recapture method (CRC), that there were in total 1110 HIV seropositive pregnant women; therefore, 381 (34.3%) women were not captured by any of the three official systems registrations. Conclusion: the vertical transmission declined over the study period. Nevertheless, capitation of pregnant women and early initiations of preventive measures need to improve as soon as early HIV diagnosis in children for these populations to enjoy the benefit of the prophylactic and therapeutic/prophylactics measures including no infection, longer survival and better quality of life.