HIV-1 mother-to-child transmission and drug resistance among Brazilian pregnant women with high access to diagnosis and prophylactic measures

Alcântara, Keila Correia de; Lins, Janaína Bacelar Accioli; Albuquerque, Maly de; Aires, Letícia Mara; Cardoso, Ludimila Paula Vaz; Minuzzi, Ana Lúcia; Stefani, Mariane M. A.

doi:10.1016/j.jcv.2012.01.011

Cited by 25 publications

(26 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A previous regional study investigating different subpopulations reported a low rate of subtype C among infected patients [58]. However, recent molecular epidemiology studies have shown a significant increase in rates of HIV-1 subtype C among pregnant women living in small interior cities in central western Brazil [13]. …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Estimated Incidence and Genotypes of HIV-1 among Pregnant Women in Central Brazil

et al. 2013

View full text Add to dashboard Cite

ObjectiveTo estimate the incidence of HIV-1 infection among pregnant women from central-western Brazil.DesignObservational cross-sectional study.MethodsA total of 54,139 pregnant women received antenatal HIV screening from a network of public healthcare centers in 2011. The incidence of confirmed HIV-1 infection was estimated using the Serological Testing Algorithms for Recent HIV Seroconversion (STARHS) methodology and BED-capture enzyme immunoassay (BED-CEIA). The yearly incidence was calculated, and adjusted incidence rates were estimated. For a subgroup of patients, protease and partial reverse transcriptase regions were retrotranscribed from plasma HIV-1 RNA and sequenced after performing a nested polymerase chain reaction.ResultsOf the participants, 20% had a pregnancy before the age of 18 and approximately 40% were experiencing their first pregnancy. Of the 54,139 pregnant women screened, 86 had a confirmed HIV-1 diagnosis, yielding an overall prevalence of 1.59 cases per 1000 women (95% CI 1.27–1.96). A higher prevalence was detected in the older age groups, reflecting cumulative exposure to the virus over time. Among the infected pregnant women, 20% were considered recently infected according to the BED-CEIA. The estimated incidence of HIV infection was 0.61 per 1000 person-years (95% CI 0.33-0.89); the corrected incidence was 0.47 per 1000 person-years (95% CI 0.26-0.68). In a subgroup of patients, HIV-1 subtype C (16.7%) was the second most prevalent form after subtype B (66.7%); BF1 recombinants (11.1%) and one case of subtype F1 (5.5%) were also detected.ConclusionThis study highlights the potential for deriving incidence estimates from a large antenatal screening program for HIV. The rate of recent HIV-1 infection among women in their early reproductive years is a public health warning to implement preventive measures.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Among pregnant women, recent molecular data from central Brazil have shown an unexpectedly high prevalence of subtype C viruses, which are strongly related to those circulating in southern/southeastern Brazil [13]. …”

Section: Introductionmentioning

confidence: 99%

Estimated Incidence and Genotypes of HIV-1 among Pregnant Women in Central Brazil

et al. 2013

View full text Add to dashboard Cite

show abstract

“…New PR/RT subtype C sequences were obtained from 32 individuals from RJ selected from a larger cohort of about 3,000 HIV-infected patients followed at outpatient clinics from the Public Health System distributed throughout the state that underwent HIV genotyping tests at the Laboratory of AIDS and Molecular Immunology (FIOCRUZ) between 2002 and 2011, as previously described [20]. The HIV-1 subtype C pol sequences from RJ were combined with sequences from SP ( n = 18), GO ( n = 16), MT ( n = 4) and MS ( n = 4) available at the Los Álamos HIV Sequence Database ( www.hiv.lanl.gov ) and described elsewhere [10,14,15,16,17,18,21,22,23,24], and with a dataset of sequences isolated in the south region (RS = 55, SC = 41 and PR = 39) described in detail in a previous study [25]. The study was approved by the Instituto Oswaldo Cruz - Ethics Committee.…”

Section: Methodsmentioning

confidence: 99%

Tracing the Origin and Northward Dissemination Dynamics of HIV-1 Subtype C in Brazil

et al. 2013

View full text Add to dashboard Cite

Previous studies indicate that the HIV-1 subtype C epidemic in southern Brazil was initiated by the introduction of a single founder strain probably originating from east Africa. However, the exact country of origin of such a founder strain as well as the origin of the subtype C viruses detected outside the Brazilian southern region remains unknown. HIV-1 subtype C pol sequences isolated in the southern, southeastern and central-western Brazilian regions (n = 209) were compared with a large number (n ~ 2,000) of subtype C pol sequences of African origin. Maximum-likelihood analyses revealed that most HIV-1 subtype C Brazilian sequences branched in a single monophyletic clade (CBR-I), nested within a larger monophyletic lineage characteristic of east Africa. Bayesian analyses indicate that the CBR-I clade most probably originated in Burundi and was introduced into the Paraná state (southern region) around the middle 1970s, after which it rapidly disseminated to neighboring regions. The states of Paraná and Santa Catarina have been the most important hubs of subtype C dissemination, and routine travel and spatial accessibility seems to have been the major driving forces of this process. Five additional introductions of HIV-1 subtype C strains probably originated in eastern (n = 2), southern (n = 2) and central (n = 1) African countries were detected in the Rio de Janeiro state (southeastern region). These results indicate a continuous influx of HIV-1 subtype C strains of African origin into Brazil and also unveil the existence of unrecognized transmission networks linking this country to east Africa.

show abstract

“…The estimated vertical transmission rate was 6.8% in 2004, with a range from 13.4% in the North region to 4.3% in the Midwest region [10]. Local studies conducted in the Southeast region [11-14] have reported vertical transmission rates closer to 3%, while rates of less than or equal to 2% have been found in the Midwest and South regions [15-17]. In contrast, in the North and Northeast regions and in the state of São Paulo, local studies have found vertical transmission rates of 9.9% [18], 9.2% [19] and 6.0% [20], respectively.…”

Section: Introductionmentioning

confidence: 99%

Prenatal testing and prevalence of HIV infection during pregnancy: data from the “Birth in Brazil” study, a national hospital-based study

Domingues

Szwarcwald²,

Souza³

et al. 2015

BMC Infect Dis

View full text Add to dashboard Cite

BackgroundThe rate of vertical HIV transmission has decreased in Brazil, but regional inequalities suggest problems in implementing control measures during pregnancy and delivery. The aims of this study were to ascertain the coverage of HIV testing during prenatal care and estimate the prevalence of HIV infection during pregnancy in Brazil.MethodsThis was a national hospital-based study of 23,894 women that was conducted in 2011–2012. The data came from interviews with mothers during postpartum hospitalization, from hospital medical files and from prenatal cards. All the pregnant women with reactive serological results for HIV infection marked on their cards or with diagnoses of HIV infection during the hospital stay for delivery were considered cases of HIV infection. Univariate and multivariable logistic regression were performed to investigate factors associated with the prevalence of HIV infection and with performing at least one HIV test during pregnancy.ResultsAmong participating women, the coverage of testing for HIV infection was 81.7% among those who presented with prenatal card and the prevalence of HIV infection among pregnant women was 0.4% (95% CI: 0.32-0.51%). In the adjusted analysis, there was higher coverage of testing among women living in the South and Southeast regions; of women aged 35 years and over; with greater schooling levels; who self-reported as white; with prenatal care provided in private services; with an early start to prenatal care; and with an adequate number of consultations, defined as a minimum of six for a term pregnancy. In the adjusted analyses there was a greater odds ratio of HIV infection among women living in the South region, aged 35 years and over, with schooling of less than 8 years, who self-reported race as black, without a partner, with syphilis coinfection and who were attended by public services.ConclusionsThe prevalence of HIV infection among pregnant women in Brazil remains below 1% and the coverage of testing for HIV infection is over 80%. However, the regional and social inequalities in access to healthcare services and the missed opportunities for diagnoses of HIV infection indicate the importance of strengthening HIV infection control programs during pregnancy.

show abstract

HIV-1 mother-to-child transmission and drug resistance among Brazilian pregnant women with high access to diagnosis and prophylactic measures

Abstract: In this study delayed disclosure of diagnosis, partial/no preventive measures, drug resistance among asymptomatic women under prophylaxis and MTCT in low viremic mothers raise concerns. The expansion of subtype C infection corroborates surveillance of HIV-1 diversity in this region.

Cited by 25 publications

References 34 publications

Estimated Incidence and Genotypes of HIV-1 among Pregnant Women in Central Brazil

Estimated Incidence and Genotypes of HIV-1 among Pregnant Women in Central Brazil

Tracing the Origin and Northward Dissemination Dynamics of HIV-1 Subtype C in Brazil

Prenatal testing and prevalence of HIV infection during pregnancy: data from the “Birth in Brazil” study, a national hospital-based study

Contact Info

Product

Resources

About