Mother-to-child transmission of HIV in Brazil during the years 2000 and 2001: results of a multi-centric study

Abstract

The objective of this study was to assess mother-to-child transmission rates of HIV in Brazil during the years 2000 and 2001, and to identify the maternal and neonatal variables that were associated with this transmission. It was a cross-sectional, observational study with retrospective data obtained from patient medical records. The children were followed at 63 medical sites situated in five geographical macro-regions of the country (20 States and the Federal Capital). Children enrolled were those that were born of HIV-infected mothers and it was necessary for the mothers to present documented proof of HIV-infection before or during pregnancy, at time of delivery or in the first three months after delivery. There were 2,924 children enrolled and mother-to-child transmission rates of HIV were 8.6% (95%CI: 7.2-10.2) for the year 2000 and 7.1% (95%CI: 5.8-8.6) for the year 2001. The following variables were associated with lower mother-to-child transmission rates of HIV: elective cesarean section, diagnosis of mother's infection before or during pregnancy, access to HIV viral load and T CD4+ lymphocyte count during prenatal care, greater birth weight and avoidance of breastfeeding.

Determinants and trends in perinatal human immunodeficiency virus type 1 (HIV-1) transmission in the metropolitan area of Belo Horizonte, Brazil: 1998 - 2005

“…This decline is similar to what has been reported in other studies both in-country and internationally (João et al 2003, Wade et al 2004, Matida et al 2005, Succi 2007), demonstrating the effectiveness of strategies aimed at reducing mother to child transmission. Results from a multicenter observational study conducted in Latin America and Caribbean countries that included 770 mother-infant exposed to different ART regimens (Read et al 2007) also demonstrated a low (0.91%, 95%CI: 0.37 -1.86) HIV-1 mother to child transmission rate.…”

“…In the absence of interventions, the reported HIV-1 vertical transmission rate varies from 15 to 25% in Europe and the USA and extending to 40% in under-developed countries (WGMCT 1995). In Brazil, initial studies demonstrated a transmission rate of 16% (CI 95%: 13-20) (Tess et al 1998), but a significant decrease has been observed in recent years; a nation-wide study reported a transmission rate of 7.1% in 2001, but centers in Rio de Janeiro and São Paulo have described lower rates (3.57% between 1996 to 2001 and 2.4% in 2002, for each city respectively) (João et al 2003, Matida et al 2005, Succi 2007. Brazilian data reflect the progress achieved in the reduction of HIV-1 vertical transmission reported worldwide in centers where maternal antiretroviral therapy (ART) and breast milk replacement are available (Dorenbaum et al 2002, Wade et al 2004, Magder et al 2005, Newell et al 2007).…”

Prevalência de HIV em gestantes e transmissão vertical segundo perfil socioeconômico, Vitória, ES

“…17 Studies in other states in Brazil and in Vitória report rates from 0.42% to 0.50% 6,8,12,15 Nonetheless, prevalence in the current study is less than the 0.6% found in public maternity hospitals of Vitória by Miranda et al 13 The difference may be to the fact that these maternities attend pregnant women from other municipalities in the state.…”

“…17 Nonetheless, since the highest rates occur in pregnant women that do not undergo preventive interventions, which can reduce VT to less than 0.5%, 7 these levels are far from ideal.…”

“…7,b A study in 2009, with a representative sample of pregnant Brazilian women between ages 15 and 49 years, reported an HIV prevalence of 0.42% at delivery, which corresponds to 13 thousand infected women in 3 million annual pregnancies. 17 In Espírito Santo State (Southeastern Brazil), from 1985 to 2008, 329 AIDS cases were reported among children age less than 13 years, with VT responsible for 310 (94.2%) cases. c In the capital Vitória, a 2005 study reported a VT rate of 3.1%.…”