Prevention of mother-to-child HIV transmission is an emerging public health challenge. In Brazil, preventive prophylaxis with AZT during pregnancy, at delivery, and for newborns was introduced in 1996, with a marked reduction in transmission (less than 5.0% nationwide). Since 1999 the Municipal STD/AIDS Program in Campos dos Goytacazes, Rio de Janeiro State (population = 416,441) has acted in the prevention of vertical transmission. In 2001/2003, there was a moderately increased implementation (from 28.0% to 36.0%) of HIV screening services during pregnancy, and more pregnant women were knowledgeable about vertical HIV transmission. Remaining challenges are to expand HIV screening to pregnant women at large and to effectively introduce rapid diagnostic tests for HIV in the delivery room. Such actions are expected to change the current situation, in which only 6.8% of infected children under observation had access to prophylaxis for vertical HIV transmission.

Prevention of mother-to-child transmission of HIV and Toxoplasma dual infections in the immunocompromised patient remains a healthcare challenge. We report a case of congenital toxoplasmosis resulting from reactivation of latent infection in a severely immunodepressed HIV-infected pregnant woman, who had poor adherence to therapy; this case illustrates the difficulties encountered in management of such a rare condition.

We report on the adverse reactions to the Bacillus Calmette-Guérin (BCG) vaccine in BCG-vaccinated children. We examined children exposed to the vertical transmission of human immunodeficiency virus (HIV) (n = 141), who participated in a prevention program of vertical transmission, and HIV-infected children (n = 66) in a setting endemic for HIV and tuberculosis (TB) in Brazil from August 2000 to February 2008. No cases of disseminated BCG disease occurred in either group of children. While no cases of regional BCG disease were noted in exposed/uninfected children, the rate of regional BCG disease in HIV-infected children was 4.5% (3/66); the three events occurred in <1-year-old children (3/17; 17.6%). One case was associated with severe immunodepression before highly active antiretroviral therapy (HAART). Two cases were manifestations of immune reconstitution inflammatory syndrome (IRIS). Among the HIV-infected children, the accrued benefits of potentially preventing severe TB outweighed the risks associated with the use of the BCG vaccine.

A amamentação ao seio em tempos de pandemia pelo vírus HIV deve ser uma atitude acima de tudo responsável. Todo esforço deve ser feito para a definição do estado materno em relação à infecção pelo HIV. Nos países em que existe a possibilidade de garantia do leite artificial, o aleitamento artificial deve ser indicado pelos profissionais de saúde, com orientações bem detalhadas sobre o seu correto preparo. Nos casos de infecção materna pelo HIV comprovada ou suspeitada, o leite materno deve ser sempre contraindicado, até que se exclua o diagnóstico. Todas as condutas diferentes da acima referida devem ser veementemente repudiadas.