Vertical transmission of the HIV in women who are users of the Pereira Rossell Hospital Center, Uruguay 2012-2014. Results of the application of the Zidovudine - Nevirapine combined protocol in Uruguayan children
Abstract
Introduction:
controlled pregnancy and interruption of breastfeeding are strategies used to reduce vertical transmission of the immunodeficiency virus (HIV). Neonates are subject to prophylactic treatment of zidovudine or combination therapy with zidovudine and nevirapine based on the mother-to-child transmission risk.
Objective:
to describe mother-to-child transmission from 2012 to 2014 at the Pereira Rossell Hospital Center, its relationship with the maternal viral load and the observation of the AZT-NVP prophylactic treatment recommended for neonates.
Method:
descriptive study, at the Obstetric Pediatrix HIV-Aids Reference Center from September 1, 2012 until December, 31, 2014. The newborns to mother with detectable or undetectable viral loads at the time of delivery. Administration of zidovudine-nevirapine was recorded. Vertical transmission was defined.
Results:
162 women were included in the study, 86 of them with a detectable or unknown viral load and 76 women with a detectable load. The first group gave birth to 88 children and the second one to 76. Global mother-to-child transmission rate was 4.9%, 9% in the first group and 0% in the second one. The association between mother-to-child transmission and maternal load was recorded (P<0.05). Administration of AZT-NVP was indicated in 45.5% of children. Intrauterine mother-to child transmission was 5 for the 8 infected children. As to the other three children: 2 received AZT and another one received no prophylactic therapy.
Discussion and conclusions:
fifty per cent of the women’s pregnancies were not dully controlled. Average mother-to-child transmission was 4.9%. Out of the 8 infected cases, 5 happened in the uterus, only an early diagnosis and treatment would have prevented it from happening. The AZT-NVP protocol is not applied in the right way. Its application on the other 3 children may have avoided the infection.
References
(1) Connor EM, Sperling RS, Gelber R, Kiselev P, Scott G, O'Sullivan MJ, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. N Engl J Med 1994; 331(18):1173-80. Disponible en: http://www.nejm.org/doi/pdf/10.1056/NEJM199411033311801. Consulta: abril 2017.
(2) McGowan JP, Crane M, Wiznia AA, Blum S. Combination antiretroviral therapy in human immunodeficiency virus-infected pregnant women. Obstet Gynecol 1999; 94(5 Pt 1):641-6.
(3) Cooper ER, Charurat M, Mofenson L, Hanson IC, Pitt J, Diaz C, et al. Combination antiretroviral strategies for the treatment of pregnant HIV-1-infected women and prevention of perinatal HIV-1 transmission. J Acquir Immune Defic Syndr 2002; 29(5):484-94.
(4) European Collaborative Study. Mother-to-child transmission of HIV infection in the era of highly active antiretroviral therapy. Clin Infect Dis 2005; 40(3):458-65. Disponible en: https://academic.oup.com/cid/article-lookup/doi/10.1086/427287. Consulta : abril 2017.
(5) Tubiana R, Le Chenadec J, Rouzioux C, Mandelbrot L, Hamrene K, Dollfus C, et al. Factors associated with mother-to-child transmission of HIV-1 despite a maternal viral load <500 copies/ml at delivery: a case-control study nested in the French perinatal cohort (EPF-ANRS CO1). Clin Infect Dis 2010; 50(4):585-96.
(6) Office of AIDS Research Advisory Council. Panel on Treatment of Pregnant Women with HIV Infection and Prevention of Perinatal Transmission. Recommendations for use of antiretroviral drugs in pregnant women with HIV infection and interventions to reduce perinatal HIV transmission in the United States. Rockville, MD: Aidsinfo, 2017. Disponible en: https://aidsinfo.nih.gov/contentfiles/lvguidelines/PerinatalGL.pdf. Consulta : abril 2017.
(7) Uruguay. Ministerio de Salud Pública. Dirección General de la Salud. Departamento de Programación Estratégica en Salud. Área Salud Sexual y Reproductiva. Programa Nacional ITS-VIH/Sida. Infección por virus de la Inmunodeficiencia Humana (VIH): pautas para diagnóstico, monitorización y tratamiento antirretroviral. Actualización 2014. Disponible en: http://www.msp.gub.uy/sites/default/files/Pautas%20VIH%20para%20Diagnostico%20y%20tratamiento%20antiretroviral%20adultos-mujeres-ni%C3%B1os%202014.pdf. Consulta: abril 2017.
(8) Townsend CL, Cortina-Borja M, Peckham CS, de Ruiter A, Lyall H, Tookey PA. Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000-2006. AIDS 2008; 22(8):973-81.
(9) España. Ministerio de Sanidad, Servicios Sociales e Igualdad. Secretaría del Plan Nacional sobre el Sida. Sociedad Española de Ginecología y Obstetricia. Sociedad Española de Infectología Pediátrica. Grupo de Estudio de Sida. Documento de consenso para el seguimiento de la infección por el vih en relación con la reproducción, embarazo, parto y profilaxis de la transmisión vertical del niño expuesto. Madrid: MSSSI, 2013.
(10) Administración de los Servicios de Salud del Estado. Hospital de la Mujer Dra. Paulina Luisi. Clínicas ginecotológicas A y C. Centro Hospitalario Pereira Rossell. Departamento Obstétrico. Departamento de Emergencia. Departamento de Neonatología. Servicio de Recién Nacidos. Indicadores del Hospital de la Mujer: informe de gestión de maternidad 2013. Montevideo: ASSE, 2013.
(11) Uruguay. Ministerio de Salud Pública. Día mundial del VIH/SIDA: 1º de diciembre de 2015. Informe Epidemiológico VIH/SIDA en Uruguay. Montevideo: MSP, 2015. Disponible en: http://www.msp.gub.uy/sites/default/files/Informe%20epidemiologico%20VIH%202015%20Uruguay_0.pdf. Consulta: abril 2017.
(12) Gray GE, Urban M, Chersich MF, Bolton C, van Niekerk R, Violari A, et al. A randomized trial of two postexposure prophylaxis regimens to reduce mother-to-child HIV-1 transmission in infants of untreated mothers. AIDS 2005; 19(12):1289-97.
(13) Nielsen-Saines K, Watts DH, Veloso VG, Bryson YJ, Joao EC, Pilotto JH, et al. Three postpartum antiretroviral regimens to prevent intrapartum HIV infection. N Engl J Med 2012; 366(25):2368-79. Disponible en: http://www.nejm.org/doi/pdf/10.1056/NEJMoa1108275. Consulta: abril 2017.
(14) Pedroso C, Queiroz AT, Alcântara LC, Drexler JF, Diaz RS, Weyll N, et al. High prevalence of primary antiretroviral resistance among HIV-1-infected adults and children in Bahia, a northeast state of Brazil. J Acquir Immune Defic Syndr 2007; 45(2):251-3.
(15) Eshleman SH, Hoover DR, Hudelson SE, Chen S, Fiscus SA, Piwowar-Manning E, et al. Development of nevirapine resistance in infants is reduced by use of infant-only single-dose nevirapine plus zidovudine postexposure prophylaxis for the prevention of mother-to-child transmission of HIV-1. J Infect Dis 2006; 193(4):479-81.
(16) Mirochnick M, Nielsen-Saines K, Pilotto JH, Pinto J, Jiménez E, Veloso VG, et al. Nevirapine concentrations in newborns receiving an extended prophylactic regimen. J Acquir Immune Defic Syndr 2008; 47(3):334-7.
(17) World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. Geneva : WHO, 2013. Disponible en: http://www.who.int/hiv/pub/guidelines/arv2013/download/en/. Consulta: abril 2017.
(18) Office of AIDS Research Advisory Council. Panel on Antiretroviral Therapy and Medical Management of HIV-Infected Children. Guidelines for the use of antiretroviral agents in pediatric HIV infection. Rockville, MD: Aidsinfo, 2017. Disponible en: http://aidsinfo.nih.gov/contentfiles/lvguidelines/pediatricguidelines.pdf. Consulta: abril 2017.
(19) Organización Panamericana de la Salud. Guía práctica para la ejecución de la estrategia y plan de acción para la eliminación de la transmisión materno infantil del VIH y de la sífilis congénita en las Américas. Washington, DC: OPS, 2014.
(20) Uruguay. Ministerio de Salud Pública, Dirección General de la Salud. Área de Salud Sexual y Reproductiva. Programa Nacional ITS-VIH/Sida. Guía clínica para la eliminación de la sífilis congénita y transmisión vertical del VIH: Uruguay 2013. Montevideo: MSP, 2013.
(21) Ord. Nº 567. Ref. 001-3-3771/201: test rápidos VIH 2014. Disponible en: http://www.msp.gub.uy/sites/default/files/archivos_adjuntos/Ordenanza%20test%20rapidos%20vih%202014.pdf. Consulta: abril 2017.
(22) Rosa MC, Lobato RC, Gonçalves CV, Silva NM, Barral MF, Martinez AM, et al. Evaluation of factors associated with vertical HIV-1 transmission. J Pediatr (Rio J) 2015; 91(6):523-8.
(23) Patricio FR, Rutherford GW, Barreto JH, Rodamilans C, Badaró R. Effectiveness of the prevention of mother-to-child HIV transmission in Bahia, Brazil. Braz J Infect Dis 2015; 19(5):538-42.
(24) Camacho-González AF, Kingbo MH, Boylan A, Eckard AR, Chahroudi A, Chakraborty R. Missed opportunities for prevention of mother-to-child transmission in the United States. AIDS 2015; 29(12):1511-5.
(25) Newell ML. Mechanisms and timing of mother-to-child transmission of HIV-1. AIDS 1998; 12(8):831-7.
(26) Uruguay. Ministerio de Salud Pública, Dirección General de la Salud. Áreas Programáticas Salud Sexual y Salud Reproductiva, Salud de la Mujer, ITS-VIH/Sida. Guía clínica para la eliminación de la sífilis congénita y transmisión vertical del VIH. 2 ed. Montevideo: MSP, 2015.
(27) Cecchini D, Rodríguez C, Nieto C, Astarita V, Giesolauro R, Martínez M. Prevención de la transmisión vertical del VIH-1 en un hospital público de complejidad terciaria de Buenos Aires, Argentina. Rev Panam Salud Pública 2011; 30(3):189-95.
(28) Laurido M. Resistencia del VIH-1 a los antirretrovirales: guía práctica. Buenos Aires: Journal, 2011.
(29) Mirochnick M, Clarke DF, Dorenbaum A. Nevirapine: pharmacokinetic considerations in children and pregnant women. Clin Pharmacokinet 2000; 39(4):281-93.
