Resultados maternos e perinatais de dez anos de assistência obstétrica a portadoras do vírus da imunodeficiência humana

Abstract

Objetivos: avaliar a transmissão vertical do vírus da imunodeficiência humana (HIV) e os fatores de risco associados à infecção perinatal. Métodos: estudo descritivo de 170 gestantes infectadas pelo HIV e seus 188 recém-nascidos, admitidas na Maternidade do Hospital das Clínicas da UFMG, no período de junho de 1994 a setembro de 2004. Foram analisados as características demográficas, o perfil sorológico e a via de parto das gestantes, assim como os resultados perinatais. As crianças foram acompanhadas por período de 18 meses após o nascimento. Os dados foram armazenados e analisados no Epi-Info, Versão 6.0. Estabeleceu-se intervalo de confiança a 95% (p<0,05). Resultados: o diagnóstico da infecção pelo HIV foi confirmado durante a gestação em 84 (45,4%) pacientes. A carga viral era inferior a 1000 cópias/mL em 60,4% das pacientes. O esquema predominante de uso dos anti-retrovirais foi a terapia tríplice (65,5%). Foi alta a taxa de cesariana: 79,5%. A taxa de prematuridade foi 18,2%. Entre os 188 recém-natos houve 184 (97,8%) nativivos e quatro (2,2%) mortes perinatais. Dos nascidos vivos, 97,8% receberam zidovudina após o nascimento. A taxa global de transmissão materno-fetal global foi 3,8%. As taxas de transmissão vertical do vírus, por período, foram: 60%, até 1996; 28%, entre 1996 e 1998; 0,68%, entre 1999 e 2004. Não foram encontrados fatores de risco significativamente associados à infecção perinatal pelo HIV, devido ao pequeno número de recém-nascidos infectados (n=6). Conclusão: houve grande redução da transmissão vertical do HIV no período analisado. A taxa atual de transmissão é zero, confirmando que, adotando-se medidas adequadas, pode-se prevenir a transmissão perinatal do vírus.

Clinical and epidemiological profile and reproductive outcome in hiv-infected pregnant women assisted at a university hospital maternity in vitória, brazil

“…Regarding TV cases, it was observed they all occurred with some factor associated with increased transmission (syphilis, without prenatal and without art). This rate is similar to that found in another location study (7) and in other Brazilian cities (10,15,29) , however was fewer than the Brazilian rate in 2001 (7.1%) and less than the rate of TV in the Southeast (7.0 %) (30) . In Brazil, the rates of HIV mother-to-child transmission had decreased in the last decade due implementation of the measures of the STD/Aids program (6) .…”

“…The considerable frequency of diagnosis of HIV infection during current pregnancy (33%) observed in this series is similar to that described in other studies in Brazil (6,7,9,(14)(15)(16) due to the practice of routine serological testing. In the study of Stefani (17) , it was observed that 70% of pregnant women had the diagnosis of HIV in pregnancy or childbirth.…”

“…When assessing the immune status of pregnant women in this study through the lymphocytes T CD4 count less than 200 cells/mm 3 , it was observed frequency of 10.8%, less than the proportion of 14.3% reported by Melo et al (15) ; and viral load <1,000/mm 3 was observed in 56.8% of cases, similar to the 60.4% found in the study of Melo et al (15) . This result is of great importance because in pregnant women with viral load less than 1,000 copies/mL and with more than 34 weeks the mode of delivery can be an obstetric indication.…”

“…The occurrence of fetal death was similar to that found in the study of Lee (9) and lower than the observed by Isaacs (25) , being greater than the proportion in the SINASC (22) . Several studies have reported lower prevalence of perinatal deaths than the observed in this study (15,28) . Regarding TV cases, it was observed they all occurred with some factor associated with increased transmission (syphilis, without prenatal and without art).…”

HIV Pregnant Women WItH more tHan one Pregnancy and tHe Use of antIretroVIral dUrIng Pre-natal care and cHIldbIrtH

“…Analyzing the quality of pre-natal assistance and the deliveries in public maternities provided for pregnant women, we identified a reality that is far from what is recommended by the Ministry of Health, showing how fragile the Programa Brasileiro de Redução da TV do HIV (Brazilian Program to Reduce the Transmission of HIV), regarding its organization, management and health service assessment (24) . There were a higher percentage of women who had a normal delivery (39.80%) than in other studies (20.5% to 27.3%) (15,25) . The definition of normal delivery is based on the results of the maternal viral load (less than 1.000 copies/mL), conducted after the 34 th week of pregnancy, and in association with an obstetric evaluation (6) .…”