Lost chances to avoid mother-to-child transmission of HIV; Uruguay 2005-2007
Abstract
Despite Uruguay having a STD/HIV National Program under the Ministry of Health, health care services seemingly approachable, and antiretroviral drugs free for those in the public sub-sector, HIV vertical transmission figures are unacceptably high.
Objective: to analyze the existence of lost opportunities that would have avoided infection.
Method: the study examined the clinical records of infected children born between January 1, 2005 and December 31, 2007.
The following variables were analyzed: time of diagnosis, pregnancy follow-up, medication received, form of childbirth, antiretrovirals during birth and for the newborn, breastfeeding. Likewise, psychological condition of mothers was studied, whenever possible.
Results: during this period, 264 children were born of HIV-infected mothers; 13 were infected (vertical transmission 4.9%).
Out of 13 women, 11 of them had no prenatal follow-up, and thus were not administered antiretrovirals; two of them were not administered AZT during birth in spite of diagnosis made through a quick test upon delivery; and four newborns were not administered AZT and were breastfed.
Mothers were under vulnerable social, economic and cultural conditions, since many of them were on their own, took drugs, had psychological problems and evidenced little education. Six of them worked in prostitution.
Two of them died during the child’s first year of life. Two of the fathers were in prison and one of them died in jail.
Conclusions: policies that appeal to pregnant women in the lower economic sectors need to be drafted. The quick test must be carried out systematically in pregnancies with poor prenatal follow-up. Health professionals must be more committed to this condition, almost completely avoidable for children.
References
(2) Cohan D. Perinatal HIV: special considerations. Top HIV Med 2003; 11: 200-13.
(3) Chavez A, Álvarez A, Wu E, Peña A, Vizueta E. Evolución de la transmisión vertical de la infección por el VIH en Chile. Rev Chil Infect 2007; 24(5): 368-71.
(4) González I, Díaz-Jidy M, Berdasquera D, Toledo ME. Pérez J. Infección por VIH en Cuba por transmisión vertical. Reporte de nueve casos fatales en 10 años. Rev Chil Infect 2008; 25(1): 41-8.
(5) Sarubbi M, Vázquez L, Zárate M, Rodríguez G, Canete V, Luppino C, et al. Results of 2 years experience with an HIV vertical transmission prevention program (AMAPES). Int J Infect Dis 2004, 8(Supl.1): S210.
(6) Quian J, Picón T, Rodríguez I, Gutiérrez S, González A, Nin M, et al. Evaluación de la quimioprofilaxis con zidovudine a la mujer embarazada VIH positiva y su hijo. Arch Pediatr Urug 1999; 70(1): 5-10.
(7) Turchi M, da Silva Duarte L, Turchi C. Mother-to-child transmission: risk factors and missed opportunities for prevention among pregnant women attending health sevices in Goiânia, Goias State, Brazil. Cad Sáude Pública 2007; 23 Sup.3: S390-S401.
(8) Risk factors for mother-to-child transmission of HIV-1. European Collaborative Study. Lancet 1992; 339: 1007-2.
(9) Sperling R, Shapiro D, Coombs R, Todd J, Herman S, McSherry G, et al. Maternal viral load, zidovudine treatment, and the risk of transmission of HIV type 1 from mother to infant. N Engl J Med 1996; 335(22): 1621-9.
(10) Mayaux M, Dussaix E, Isopet J, Rekacewicz C, Mandelbrot L, Ciraru N, et al. Maternal virus load during pregnancy and mother-to-child transmission of HIV type 1: the French perinatal cohort studies. J Infect Dis 1997; 175: 172-5.
(11) Elective caesarean-section versus vaginal delivery in prevention of vertical HIV-1 transmission: a randomised clinical trial. The European Mode of Delivery Collaboration. Lancet 1999; 353: 1035-9.
(12) Maternal viral load and vertical transmission of HIV-1: an important factor but not the only one. The European Collaborative Study. AIDS 1999; 13: 1377-85.
(13) Connor EM, Sperling R, Gelfer R, Kiselev P, Scott G, O’Sullivan MJ. Reduction of maternal-infant transmission of HIV-type 1 with zidovudine treatment. N Engl J Med 1994; 331: 1173-80.
(14) Quian J, Visconti A, Gutiérrez S, Galli A, Maturo M, Galeano V, et al. Detección de infección VIH a través de test rápido en mujeres embarazadas: una estrategia exitosa para disminuir la transmisión vertical. Rev Chil Infect 2005; 22(4): 321-6.
(15) Uruguay. Ministerio de Salud Pública. Infección por virus de la inmunodeficiencia humana (VIH-SIDA). Guías para diagnóstico, tratamiento antirretroviral y monitorización adultos y embarazadas. Montevideo: OPS/OMS, 2006. Dsiponibe en: http://www.msp.gub.uy/andocasociado.aspx?432,15993. [Consulta: 28 abril 2008].
(16) Quian J, Gutiérrez S, Visconti A, Sicco G, Telechea D, Nin M, et al. Primeros 1000 hijos de madres VIH positivas en el Uruguay; análisis de las distintas intervenciones realizadas durante los 15 años de un centro nacional de referencia. Saludarte 2007; 5(2): 156-72.
(17) Sistema Informático Perinatal (SIP). Centro Hospitalario Pereira Rossell. Ministerio de Salud Pública. Uruguay. 2007
(18) Turchi M, da Silva Duarte L, Turchi C. Mother-to-child transmission of HIV: risk factors and missed opportunities for prevention among pregnant women attending health services in Goiâna, Goias State, Brazil. Cad Sáude Pública 2007; 23 Sup: S390-S401.
(19) Pérez C. Estrategias de Prevención del VIH/SIDA. Revista Quark Ciencia Medicina Comunicación y Cultura 2002; 24. XIV Conferencia Internacional de SIDA. Barcelona.
(20) Stringer E, Chi B, Chintu N, Creek T, Ekouevi D, Coetzee D, et al. Monitoring effectiveness of programmes to prevent mother-to-child HIV transmission in lower-income countries. Bull World Health Organ 2008; 86: 57-62.
(21) Coll O, Fiore S, Floridia M, Giaquinto C, Grosch-Wörner I, Guiliano M, et al. Pregnancy and HIV infection: a European consensus on management. AIDS 2002; 16(Suppl 2); S1-S18.
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