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

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INTRODUCTION: The current epidemiological situation in Porto Alegre is worrying due to the high rates of vertical transmission of HIV, syphilis in pregnant women and congenital syphilis, making the evaluation of the prevalence of congenital syphilis in newborns exposed to HIV relevant. It is estimated that an analysis of the data found may lead to measures capable of assisting in the prevention of both infections. OBJECTIVES: To describe pregnancy coinfection HIV/syphilis data and the consequences to their newborns. METHODS: A retrospective cohort study of live births of HIV-positive mothers with and without gestational syphilis, born at Hospital de Clínicas of Porto Alegre from January 1st, 2013 to December 31th, 2017. RESULTS: A total of 440 newborns from HIV-positive mothers were divided into two groups: the first, with 392 infants of HIV-positive mothers without gestational syphilis, resulting in 3 HIV-infected infants (vertical transmission 0,7%); the second group, with 48 infants born from mothers with HIV/syphilis coinfection (prevalence of gestational syphilis 10,9%), with 64,6% needing hospitalization for congenital syphilis treatment, and 4 HIV-infected newborns (vertical transmission 8,3%). When compared the two groups, it was verified that this difference was statistically significant. CONCLUSIONS: The gestational and congenital syphilis prevalence in our hospital is alarming, and coinfection HIV/syphilis seems to be an independent risk factor to the vertical transmission of HIV.

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