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Figueredo VSL, Monteiro DLM, Batista RFL, Gama MEA, Campos ASF, Pinto AGCF. Vertical transmission of HIV to neonates in a reference hospital in Northeastern Brazil from 2013 to 2017. Rev Inst Med Trop Sao Paulo 2023; 65:e34. [PMID: 37283409 DOI: 10.1590/s1678-9946202365034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/06/2023] [Indexed: 06/08/2023] Open
Abstract
The aim of this study was to estimate the rate of Mother-to-child Transmission (MTCT) of HIV to neonates in a reference university hospital in Sao Luis city, the capital of Maranhao State (MA), evaluating MTCT-associated factors. A retrospective cohort study based on data from the Notifiable Diseases Data System (SINAN) was carried out and included all HIV-exposed neonates notified from 2013 to 2017 by the university hospital. The study population comprised 725 HIV-exposed neonates, of whom 672 neonates were exposed and uninfected, and 53 were exposed and infected. The estimated rate of MTCT in the period of 2013 to 2017 was 7.3%. Most pregnant women were ≥ 20 years old (86.9%), reported ≥ 8 years of schooling (53.2%), reported full-time or independent paid work (46.9%) and were residents in other cities of the state (61.7%). Regarding healthcare, 86.3% received prenatal care, 74.6% received Antiretroviral Therapy (ART) as prophylaxis during pregnancy, 81.8% received ART prophylaxis during childbirth and 78.1% underwent cesarean section. Among the neonates, 92.8% received ART prophylaxis and 94.3% were not breastfed. Despite these variables, the 7.3% MTCT rate found in this study makes it clear that the interventions recommended by the Ministry of Health were not fully adopted.
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Affiliation(s)
- Vaneça Santos Leal Figueredo
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Universidade Federal do Maranhão, São Luís, Maranhão, Brazil
| | - Denise Leite Maia Monteiro
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Centro Universitário Serra dos Órgãos, Teresópolis, Rio de Janeiro, Brazil
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Bourguignon AM, Hartz Z, Moreira D. Avaliação de programas de atenção pósparto no Brasil: perfil bibliométrico da produção científica (2000-2019). SAÚDE EM DEBATE 2021. [DOI: 10.1590/0103-1104202113026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO A assistência puerperal constitui um componente da atenção à saúde das mulheres, contemplado em programas desenvolvidos no Brasil, que visam à melhoria dos indicadores de saúde materno-infantil. O estudo objetivou analisar o estado da arte dos estudos avaliativos sobre programas relacionados à atenção puerperal no Brasil, no período de 2000 a 2019. A pesquisa limitou-se à identificação e análise de artigos publicados em periódicos revisados por pares. A revisão foi realizada a partir de pesquisa dos descritores Avaliação, Programas e pós-parto nos portais da BVS, SciELO e Scopus, complementada pela verificação das referências citadas nos artigos para inclusão de estudos pertinentes. Ao total, foram identificados 42 artigos, os quais foram analisados segundo critérios previamente estabelecidos. Os resultados do perfil bibliométrico da produção intelectual identificaram: ausência de autores/centros de pesquisa especializados na interface Avaliação e Programas de atenção pós-parto, disparidades regionais na produção do conhecimento, maior quantidade de artigos sobre o Programa de Humanização no Pré-Natal e Nascimento e a Iniciativa Hospital Amigo da Criança, escassa utilização de referências teórico-metodológicas da área de avaliação. A discussão realizada procura contextualizar a produção científica analisada em relação à constituição do espaço da avaliação em saúde no Brasil.
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Affiliation(s)
| | - Zulmira Hartz
- Instituto de Higiene e Medicina Tropical (IHMT), Portugal
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Holzmann APF, Silva CSDOE, Soares JAS, Vogt SE, Alves CDR, Taminato M, Barbosa DA. Preventing vertical HIV virus transmission: hospital care assessment. Rev Bras Enferm 2020; 73:e20190491. [PMID: 32321146 DOI: 10.1590/0034-7167-2019-0491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/30/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES assess the implementation of actions to prevent vertical transmission of HIV. METHODS a retrospective cohort study conducted in two maternity hospitals in the city of Montes Claros, State of Minas Gerais. All women admitted for childbirth diagnosed with HIV and their respective newborns were included from 2014 to 2017. Data were collected from medical records and analyzed descriptively. RESULTS population consisted of 46 pairs of mothers and newborns. Management was considered inadequate in 30 cases of parturient/postpartum women (65.2%) and 14 cases of newborns (30.4%). The main reasons for inadequate maternal management were lack of pharmacological inhibition of lactation (53.3%) and counseling/consent for HIV testing (43.3%). For newborns, late onsetoffirst dose ofZidovudine (50.0%) and no prescriptionofNevirapine (28.6%). CONCLUSIONS important prevention opportunities were missed, pointing to the need for improved care.
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Affiliation(s)
| | | | | | | | | | - Mônica Taminato
- Universidade Federal de São Paulo. São Paulo, São Paulo, Brazil
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Guimarães MF, Lovero KL, de Avelar JG, Pires LL, de Oliveira GRT, Cosme EM, de Morais Salviato C, de Oliveira TRD, Cabrera NB, Cardoso CAA. Review of the missed opportunities for the prevention of vertical transmission of HIV in Brazil. Clinics (Sao Paulo) 2019; 74:e318. [PMID: 31531571 PMCID: PMC6735274 DOI: 10.6061/clinics/2019/e318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 06/17/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The present literature review aims to highlight gaps in the treatment of preventative mother-to-child HIV transmission and the risk factors in Brazil. METHODS Among the 425 articles identified in SciELO and PubMed searches, 59 articles published between 1994 and 2016 were selected for reading and data extraction, and 33 articles were included in the present review. RESULTS The rates of vertical HIV transmission described in the studies varied widely, from 1.8% to 27.8%, with a significant reduction over the years. However, recent rates were also found to be variable in different regions of Brazil, and despite the significant reduction in mother-to-child transmission, many gaps remain in prevention services. A failure to attend prenatal care is the main factor associated with the increased risk of vertical transmission of HIV, hindering early maternal diagnosis and the completion of preventative measures during the prenatal period and, often, the peripartum and postnatal periods. A small number of studies discussed the sociodemographic factors, including a low level of education for pregnant women and the inadequacies of health services, such as difficulties scheduling appointments and undertrained staff, associated with vertical transmission. As such, the current challenge is to better define the sociodemographic and infrastructural factors that increase the risk of mother-to-child transmission of HIV to provide the necessary investments to promote an earlier inclusion of these populations in prevention services. CONCLUSIONS This review may serve as a guide for future programs to focus efforts on the prevention of vertical HIV transmission.
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Affiliation(s)
| | - Kathryn Lynn Lovero
- Infectious Diseases, Berkeley School of Public Health, University of California, California, US
| | | | - Laís Lopes Pires
- Departamento Materno-Infantil, Faculdade de Medicina, Universidade Federal Fluminense, Niteroi, RJ, BR
| | | | - Estela Magalhães Cosme
- Departamento Materno-Infantil, Faculdade de Medicina, Universidade Federal Fluminense, Niteroi, RJ, BR
| | - Camila de Morais Salviato
- Departamento Materno-Infantil, Faculdade de Medicina, Universidade Federal Fluminense, Niteroi, RJ, BR
| | | | - Natália Beatriz Cabrera
- Departamento Materno-Infantil, Faculdade de Medicina, Universidade Federal Fluminense, Niteroi, RJ, BR
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Veroniki AA, Antony J, Straus SE, Ashoor HM, Finkelstein Y, Khan PA, Ghassemi M, Blondal E, Ivory JD, Hutton B, Gough K, Hemmelgarn BR, Lillie E, Vafaei A, Tricco AC. Comparative safety and effectiveness of perinatal antiretroviral therapies for HIV-infected women and their children: Systematic review and network meta-analysis including different study designs. PLoS One 2018; 13:e0198447. [PMID: 29912896 PMCID: PMC6005568 DOI: 10.1371/journal.pone.0198447] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 05/20/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Nearly all newly infected children acquire Human Immunodeficiency virus (HIV) via mother-to-child transmission (MTCT) during pregnancy, labour or breastfeeding from untreated HIV-positive mothers. Antiretroviral therapy (ART) is the standard care for pregnant women with HIV. However, evidence of ART effectiveness and harms in infants and children of HIV-positive pregnant women exposed to ART has been largely inconclusive. The aim of our systematic review and network meta-analysis (NMA) was to evaluate the comparative safety and effectiveness of ART drugs in children exposed to maternal HIV and ART (or no ART/placebo) across different study designs. METHODS We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (inception until December 7, 2015). Primary outcomes were any congenital malformations (CMs; safety), including overall major and minor CMs, and mother-to-child transmission (MTCT; effectiveness). Random-effects Bayesian pairwise meta-analyses and NMAs were conducted. After screening 6,468 citations and 1,373 full-text articles, 90 studies of various study designs and 90,563 patients were included. RESULTS The NMA on CMs (20 studies, 7,503 children, 16 drugs) found that none of the ART drugs examined here were associated with a significant increase in CMs. However, zidovudine administered with lamivudine and indinavir was associated with increased risk of preterm births, zidovudine administered with nevirapine was associated with increased risk of stillbirths, and lamivudine administered with stavudine and efavirenz was associated with increased risk of low birth weight. A NMA on MTCT (11 studies, 10,786 patients, 6 drugs) found that zidovudine administered once (odds ratio [OR] = 0.39, 95% credible interval [CrI]: 0.19-0.83) or twice (OR = 0.43, 95% CrI: 0.21-0.68) was associated with significantly reduced risk of MTCT. CONCLUSIONS Our findings suggest that ART drugs are not associated with an increased risk of CMs, yet some may increase adverse birth events. Some ART drugs (e.g., zidovudine) effectively reduce MTCT.
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Affiliation(s)
| | - Jesmin Antony
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Sharon E. Straus
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Huda M. Ashoor
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Yaron Finkelstein
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Paul A. Khan
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Marco Ghassemi
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Erik Blondal
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - John D. Ivory
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Brian Hutton
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Center for Practice Changing Research, The Ottawa Hospital–General Campus, Ottawa, Ontario, Canada
| | - Kevin Gough
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brenda R. Hemmelgarn
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Erin Lillie
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Afshin Vafaei
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Andrea C. Tricco
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Langendorf TF, Padoin SMDM, Paula CCD, Souza IEDO, Aldrighi JD. Prevention of vertical mother-to-child transmission of HIV: care and adhesion provided by couples. Rev Bras Enferm 2017; 69:275-81. [PMID: 27280563 DOI: 10.1590/0034-7167.2016690210i] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 10/09/2015] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: desvelar o movimento existencial do casal ao realizar a profilaxia da transmissão vertical do HIV. Método: investigação qualitativa, com abordagem fenomenológica de Martin Heidegger. Foi realizada entrevista fenomenológica com 14 participantes entre dezembro/2011 e fevereiro/2012 no ambulatório de um hospital universitário, Brasil. Foi desenvolvida análise compreensiva e interpretativa heideggeriana. Resultados: o casal compreende que seguiu a orientação dos profissionais de saúde conforme o que foi indicado. Ao não poder amamentar, a mulher não deixou de ser mãe, mas não foi uma vivência completa. Desvelaram-se os sentidos da ocupação do ser-casal em realizar o tratamento profilático e o da facticidade diante do fato de não amamentar. Conclusão: indica-se repensar o cuidado, propondo uma relação profissional que transcenda o impessoal que dita com o que o casal deve se ocupar, viabilizando sua participação de maneira ativa nas decisões e ações de cuidado.
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Affiliation(s)
- Tassiane Ferreira Langendorf
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Rio de Janeiro RJ , Brazil, Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery. Rio de Janeiro-RJ, Brasil., Universidade Federal do Rio de Janeiro
| | - Stela Maris de Mello Padoin
- Universidade Federal de Santa Maria, Programa de Pós-Graduação em Enfermagem, Santa Maria RS , Brazil, Universidade Federal de Santa Maria, Programa de Pós-Graduação em Enfermagem. Santa Maria-RS, Brasil., Universidade Federal de Santa Maria
| | - Cristiane Cardoso de Paula
- Universidade Federal de Santa Maria, Programa de Pós-Graduação em Enfermagem, Santa Maria RS , Brazil, Universidade Federal de Santa Maria, Programa de Pós-Graduação em Enfermagem. Santa Maria-RS, Brasil., Universidade Federal de Santa Maria
| | - Ivis Emília de Oliveira Souza
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Rio de Janeiro RJ , Brazil, Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery. Rio de Janeiro-RJ, Brasil., Universidade Federal do Rio de Janeiro
| | - Juliane Dias Aldrighi
- Universidade Federal do Paraná, Programa de Pós-Graduação em Enfermagem, Curitiba PR , Brazil, Universidade Federal do Paraná, Programa de Pós-Graduação em Enfermagem. Curitiba-PR, Brasil., Universidade Federal do Paraná
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Hoffmann IC, Santos WMD, Padoin SMDM, Barros SMOD. A five-year review of vertical HIV transmission in a specialized service: cross-sectional study. SAO PAULO MED J 2016; 134:508-512. [PMID: 28076637 DOI: 10.1590/1516-3180.2016.0139140616] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/14/2016] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE: Healthcare professionals need to instill the process of prevention, control and treatment of people infected with HIV into care practice. Through maintaining preventive treatment among HIV-infected pregnant women, it has been demonstrated that prophylactic antiretroviral therapy, scheduled cesarean section and the prohibition of breastfeeding significantly reduce vertical HIV transmission. This study aimed to assess the rates of vertical HIV transmission in a specialized service and identify the factors associated with it. DESIGN AND SETTING: Cross-sectional study developed at the University Hospital of Santa Maria (RS), Brazil. METHODS: A cross-sectional study was conducted on a sample of 198 notification forms and medical records of HIV-positive pregnant women and exposed children. RESULTS: The vertical transmission rate was 2.4%, and three children had been infected by vertical HIV transmission. The statistically significant risk factor was the use of injectable drugs. Delayed reporting of pregnancy, absence of antiretroviral therapy during pregnancy, lack of proper prenatal care, incapacity to perform viral load detection tests and CD4+ T cell counts and obstetric and maternal clinical complications were reported. CONCLUSIONS: The vertical transmission rate was high and the recommended intervention measures were not adopted in full. Adequate prophylactic measures need to be implemented in HIV-positive pregnant women prenatally and during the antenatal, delivery and postpartum periods.
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Affiliation(s)
- Izabel Cristina Hoffmann
- PhD. Nurse, University Hospital, Universidade Federal de Santa Maria (UFSM), Santa Maria (RS) Brazil
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Brandão MDN, Souza EDS, Brito RJVD, Guimarães CMMDS, Brandão MDFR, Cavalcante MCE. Challenges in preventing vertical HIV transmission in Petrolina, Pernambuco and Juazeiro, Bahia. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2016. [DOI: 10.1590/1806-93042016000300006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract Objectives: to measure vertical HIV transmission rate (TTV) and describe the adoption of prophylactic measurements (MP) in infected pregnant women and exposed children in the cities of Petrolina, PE and Juazeiro, BA. Methods: a cross-sectional study was carried out on 76 mothers and children from January 2006 to December 2010. Data were collected from reported forms and medical records from the referral services. The Ministry of Health recommendations was followed to characterize an infected child. It was appropriately considered to adopt the five MP distributed in three stages of care: pregnancy (antiretroviral therapy), intrapartum (intravenous azidotimidina and by delivery preference as a function of the maternal viral load) and post natal (azidotimidina taken orally by children and no breastfeeding). Results: 58 children investigated, five were HIV infected, revealing 8.6% of TTV. The MP was inadequate in 68.4% of the cases. Conclusions: high TTV of HIV and inadequate MP in most of the cases, the non-white patients and those who came from other cities received a lower proportion of adequate MP. Diagnostic failures and the three stages of care reflected on the TTV. Improve quick tests at pregnancy, integrate actions in cities, offer reproductive planning, maximize coverage of prenatal care and engage obstetric teams and Family Health are strategies to reduce TTV.
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Librelotto CS, Gräf T, Simon D, de Almeida SEM, Lunge VR. HIV-1 epidemiology and circulating subtypes in the countryside of South Brazil. Rev Soc Bras Med Trop 2016; 48:249-57. [PMID: 26108001 DOI: 10.1590/0037-8682-0083-2015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 05/20/2015] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Human immunodeficiency virus type 1 (HIV-1) has spread worldwide, with several subtypes and circulating recombinant forms. Brazil has an incidence of 20.5 HIV-1/acquired immunodeficiency syndrome (AIDS) patients per 100,000 inhabitants; however, the Southernmost State of Rio Grande do Sul (RS) has more than twice the number of HIV-1-infected people (41.3/100,000 inhabitants) and a different pattern of subtype frequencies, as previously reported in studies conducted in the capital (Porto Alegre) and its metropolitan region. This study examined HIV-1/AIDS epidemiological and molecular aspects in the countryside of Rio Grande do Sul. METHODS Socio-demographic, clinical and risk behavioral characteristics were obtained from HIV-1-positive adult patients using a structured questionnaire. HIV-1 subtypes were determined by nested-polymerase chain reaction (PCR) and sequencing of the pol and env genes. RESULTS The study sample included 149 (55% women) patients with a mean age of 41.8 ± 11.9 years. Most (73.8%) patients had a low education level and reported heterosexual practices as the most (91.9%) probable transmission route. HIV-1 subtypes were detected in 26 patients: 18 (69.2%) infected with subtype C, six (23.1%) infected with subtype B and two (7.7%) infected with BC recombinant forms. CONCLUSIONS These data highlight the increasing number of HIV-1 subtype C infections in the countryside of South Brazil.
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Affiliation(s)
- Carina Sperotto Librelotto
- Programa de Pós-Graduação em Biologia Celular e Molecular Aplicada à Saúde, Universidade Luterana do Brasil, Canoas, Rio Grande do Sul, Brazil
| | - Tiago Gräf
- Programa de Pós-Graduação em Biotecnologia e Biociências, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Daniel Simon
- Programa de Pós-Graduação em Biologia Celular e Molecular Aplicada à Saúde, Universidade Luterana do Brasil, Canoas, Rio Grande do Sul, Brazil
| | - Sabrina Esteves Matos de Almeida
- Centro de Desenvolvimento Técnico e Científico, Fundação Estadual de Produção e Pesquisa em Saúde, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vagner Ricardo Lunge
- Programa de Pós-Graduação em Biologia Celular e Molecular Aplicada à Saúde, Universidade Luterana do Brasil, Canoas, Rio Grande do Sul, Brazil
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Nóbrega I, Travassos AG, Haguihara T, Amorim F, Brites C. Short communication: Use of raltegravir in late-presenting HIV-infected pregnant women. AIDS Res Hum Retroviruses 2013; 29:1451-4. [PMID: 23731224 PMCID: PMC3809937 DOI: 10.1089/aid.2013.0059] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The risk of HIV-1 mother-to-child transmission (MTCT) is clearly correlated with the maternal HIV cell-free viral load (VL) at delivery. Preventing MTCT in late-presenting (after 28 weeks) HIV-infected pregnant women remains a clinical challenge, and ensuring a rapid decrease of maternal VL is an important preventive strategy. Raltegravir (RGV) has a higher first and second phase viral decay rate, has a high placental transfer, with a potential preloading effect for neonate, and demonstrates effective accumulation in cervicovaginal secretions. We report 14 cases in which RGV was used late in pregnancy for HIV-1 MTCT prophylaxis. All women were RGV naive and the prophylaxis regimens included RGV plus at least two other antiretroviral agents. At RGV initiation, the median gestational age was 36 weeks (range 34-38) and the median maternal plasma HIV-1 RNA viral load was 35,364 copies/ml (range 636-391,535). At delivery, the median gestational age was 38 weeks (range 37-40). The median exposure time to RGV was 17 days (range 7-32), with a mean maternal VL decay of 2.6 log. At delivery, seven women had undetectable (<50 copies/ml) VL, four had between 64 and 457 copies/ml, and in three VL was not available. All but one infant's HIV-RNA tests were negative at 1 and 3 months (one case of in utero MTCT). Raltegravir-containing antiretroviral regimens induced a rapid HIV-RNA decline in maternal VL at delivery, and were safe and effective in preventing MTCT for late-presenting, HIV-infected women.
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Affiliation(s)
- Isabella Nóbrega
- Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa, Salvador, BA, Brazil
| | - Ana Gabriela Travassos
- Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa, Salvador, BA, Brazil
| | - Tatiana Haguihara
- Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa, Salvador, BA, Brazil
| | - Fábio Amorim
- Maternidade de Referência Professor José Maria de Magalhães Neto, Salvador, BA, Brazil
| | - Carlos Brites
- Laboratório de Pesquisas em Infectologia, Universidade Federal da Bahia, Salvador, BA, Brazil
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