Vertical Transmission of HIV-1 in the Metropolitan Area of Belo Horizonte, Brazil: 2006–2014

Abstract

Objective To revise HIV-1 vertical transmission (VT) rates in the metropolitan area of Belo Horizonte, Brazil, from January of 2006 to December of 2014.

Methods Descriptive study of a prospective cohort of HIV-1-infected pregnant women and their children, monitored by the Maternal and Child HIV/Aids Research Group of Research Group at Faculty of Medicine of Universidade Federal de Minas Gerais, Brazil.

Results The VT general rate was 1.9% (13/673; confidence interval [CI] 95%: 1.0–3.3). The extensive use of combined highly active antiretroviral therapy (HAART) (89.7%; 583/650) strongly impacted the reduction of VT during this period. Maternal viral load (VL) higher than 1,000 copies/mL showed significant association with VT (OR:6.6; CI 95%:1.3–33.3). Maternal breastfeeding was described in 10 cases in this cohort (1.5%; CI 95%: 0.7–2.7), but it was not associated with VT.

Conclusion The present cohort data were coherent with the low VT rate described in other global populations, and it was considerably lower in comparison to the results of the same cohort during the period of 1998–2005, when the VT rate was 6.2%. These data confirm the efficiency of the National Guidelines, and emphasize the importance of adopting the international recommended procedures for prevention of mother-to-child transmission (MTCT) of HIV.

Resumo

Objetivo Rever as taxas de transmissão vertical (TV) do HIV-1 na área metropolitana de Belo Horizonte, Brasil, de janeiro de 2006 a dezembro de 2014.

Métodos Estudo descritivo de uma coorte prospectiva de gestantes infectadas pelo HIV-1 e seus filhos, monitorados pelo Grupo de Pesquisa em HIV/Aids Materno-Infantil, da Faculdade de Medicina da Universidade Federal de Minas Gerais, Brasil.

Resultados A taxa geral de TV foi de 1,9% (13/673; intervalo de confiança [IC] 95%: 1,0–3,3). O uso extensivo de terapia antirretroviral combinada (TARVc) (89,7%; 583/650) impactou fortemente a redução de TV durante este período. Carga viral materna superior a 1.000 cópias/mL mostrou associação significante com TV (OR: 6,6; IC 95%:1,3–33,3). A amamentação materna foi descrita em 10 casos nesta coorte (1,5%; IC 95%: 0,7–2,7), mas não foi associada à TV.

Conclusão Os dados atuais da coorte foram coerentes com a baixa taxa de TV descrita em outras populações globais, e foi consideravelmente menor em comparação com os resultados da mesma coorte no período de 1998–2005, quando a taxa de TV foi de 6,2%. Esses dados confirmam a eficiência das Diretrizes Nacionais, e enfatizam a importância de adotar os procedimentos internacionais recomendados para a prevenção da transmissão do HIV da mãe para o filho.

Keywords

HIV infections - infectious disease vertical transmission - highly active antiretroviral therapy - infectious pregnancy complications

Palavras-Chave

infecções por HIV - transmissão vertical de doença infecciosa - terapia antirretroviral de alta atividade - complicações infecciosas na gravidez

Contributors

Melo V. H., Maia M. M. M., Correa Júnior M. D., Kakehasi F. M., Ferreira F. G. F., Andrade B. A. M., Scaramussa F. S., Ferreira F. A. M., Messias A. A. and Pinto J. A. declared to have contributed with the conception of the study, collection, and tabulation, critically reviewing intellectual, drafting of the manuscript and final approval of the version to be published.

• References

• 1 Ministry of Health. Secretariat of Health Surveillance. STD Department, Aids and Viral Hepatitis. Epidemiological Bulletin HIV/AIDS. 2015. http://www.aids.gov.br/pt-br/pub/2015/boletim-epidemiologico-hivaids-2015 . Accessed February 15, 2016
• 2 Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States . Rockville, MD: Department of Health & Human Services/AIDS Research Advisory Council (OARAC); 2015. https://aidsinfo.nih.gov/contentfiles/lvguidelines/PerinatalGL.pdf . Accessed February 15, 2016
• 3 Money D, Tulloch K, Boucoiran I, Caddy S. ; INFECTIOUS DISEASES COMMITTEE; SPECIAL CONTRIBUTORS. Guidelines for the care of pregnant women living with HIV and interventions to reduce perinatal transmission: executive summary. J Obstet Gynaecol Can 2014; 36 (08) 721-734 . Doi: 10.1016/S1701-2163(15)30515-6
• 4 Hughes B, Cu-Uvin S. Patient Information: HIV and Pregnancy (Beyond the Basics) . Dec 2015. http://www.uptodate.com/contents/hiv-and-pregnancy-beyond-the-basic . Accessed February 15, 2016
• 5 Anglemyer A, Rutherford GW, Horvath T, Baggaley RC, Egger M, Siegfried N. Antiretroviral therapy for prevention of HIV transmission in HIV-discordant couples. Cochrane Database Syst Rev 2013; (04) CD009153 . Doi: 10.1002/14651858.CD009153.pub3
• 6 Ministry of Health. Secretariat of Health Surveillance. STD Department, Aids and Viral Hepatitis. [Clinic Protocols and Therapeutic Guidelines for the HIV Vertical Transmission Prevention, Syphilis and Viral Hepatitis]. Brasília, DF: Ministry of Health; 2015. http://www.aids.gov.br/pt-br/pub/2015/protocolo-clinico-e-diretrizes-terapeuticas-para-prevencao-da-transmissao-vertical-de-hiv . Accessed February 15, 2016
• 7 Australian Government. The Department of Health. Clinical Practice Guidelines Antenatal Care. Module I: HIV . 2013. http://www.health.gov.au/internet/publications/publishing.nsf/Content/clinical-practice-guidelines-ac-mod1∼part-b∼maternal-health-screening∼hiv . Accessed February 26, 2016
• 8 Palasanthiran P, Starr M, Jones C, Giles M. Management of Perinatal Infections . Sidney: Australasian Society for Infectious Diseases; 2014. https://www.asid.net.au/documents/item/368 . Accessed February 26, 2016
• 9 Bitnun A, Brophy J, Samson L. , et al. Prevention of vertical HIV transmission and management of the HIV-exposed infant in Canada in 2014. Can J Infect Dis Med Microbiol 2014; 25 (02) 75-77
• 10 de Ruiter A, Taylor GP, Clayden P. , et al; British HIV Association. British HIV Association guidelines for the management of HIV infection in pregnant women 2012 (2014 interim review). HIV Med 2014; 15 (Suppl. 04) 1-77 . Doi: 10.1111/hiv.12185
• 11 Lundgren JD, Babiker AG, Gordin F. , et al; INSIGHT START Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med 2015; 373 (09) 795-807 . Doi: 10.1056/NEJMoa1506816
• 12 Cohen MS, Chen YQ, McCauley M. , et al; HPTN 052 Study Team. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 2011; 365 (06) 493-505 . Doi: 10.1056/NEJMoa1105243
• 13 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 (08) 973-981 . Doi: 10.1097/QAD.0b013e3282f9b67a
• 14 Warszawski J, Tubiana R, Le Chenadec J. , et al; ANRS French Perinatal Cohort. Mother-to-child HIV transmission despite antiretroviral therapy in the ANRS French Perinatal Cohort. AIDS 2008; 22 (02) 289-299 . Doi: 10.1097/QAD.0b013e3282f3d63c
• 15 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; Jun 2013. http://apps.who.int/iris/bitstream/10665/85321/1/9789241505727_eng.pdf . Accessed February 1, 2016
• 16 Centers for Disease Control and Prevention. 1994 Revised classification system for human immunodeficiency virus (HIV) infection in children under 13 years' age. MMWR Morb Mortal Wkly Rep 1994; 43: 1-10
• 17 Capurro H, Konichezky S, Fonseca D, Caldeyro-Barcia R. A simplified method for diagnosis of gestational age in the newborn infant. J Pediatr 1978; 93 (01) 120-122
• 18 Kakehasi FM, Pinto JA, Romanelli RMC. , et al. Determinants and trends in perinatal human immunodeficiency virus type 1 (HIV-1) transmission in the metropolitan area of Belo Horizonte, Brazil: 1998 - 2005. Mem Inst Oswaldo Cruz 2008; 103 (04) 351-357 . Doi: 10.1590/S0074-02762008000400007
• 19 World Health Organization. Mother-to-Child Transmission of HIV . Geneva: WHO; 2016. http://www.who.int/hiv/topics/mtct/en/ . Accessed February 15, 2016
• 20 Mofenson LM. Prevention in neglected subpopulations: prevention of mother-to-child transmission of HIV infection. Clin Infect Dis 2010; 50 (Suppl. 03) S130-S148 . Doi: 10.1086/651484
• 21 Torres SR, Luz AMH. [HIV+ pregnant woman and exposed children: epidemiological study on compulsory notification]. Rev Gaúcha Enferm 2007; 28 (04) 505-511
• 22 Rosa MC, Lobato RC, Gonçalves CV. , et al. Evaluation of factors associated with vertical HIV-1 transmission. J Pediatr (Rio J) 2015; 91 (06) 523-528 . Doi: 10.1016/j.jped.2014.12.005
• 23 Barral MFM, de Oliveira GR, Lobato RC, Mendoza-Sassi RA, Martínez AMP, Gonçalves CV. Risk factors of HIV-1 vertical transmission (VT) and the influence of antiretroviral therapy (ART) in pregnancy outcome. Rev Inst Med Trop São Paulo 2014; 56 (02) 133-138 . Doi: 10.1590/S0036-46652014000200008
• 24 Rodrigues STC, Vaz MJR, Barros SMO. Vertical transmission of HIV in the population treated at a reference center. Acta Paul Enferm 2013; 26: 158-164 . Doi: 10.1590/S0103-21002013000200009
• 25 Garcia PM, Kalish LA, Pitt J. , et al; Women and Infants Transmission Study Group. Maternal levels of plasma human immunodeficiency virus type 1 RNA and the risk of perinatal transmission. N Engl J Med 1999; 341 (06) 394-402 . Doi: 10.1056/NEJM199908053410602
• 26 Townsend CL, Byrne L, Cortina-Borja M. , et al. Earlier initiation of ART and further decline in mother-to-child HIV transmission rates, 2000-2011. AIDS 2014; 28 (07) 1049-1057 . Doi: 10.1097/QAD.0000000000000212
• 27 Read JS, Cohen RA, Hance LF. , et al; NISDI Perinatal/LILAC Study Group. Missed opportunities for prevention of mother-to-child transmission of HIV-1 in the NISDI Perinatal and LILAC cohorts. Int J Gynaecol Obstet 2012; 119 (01) 70-75 . Doi: 10.1016/j.ijgo.2012.05.026
• 28 Andiman W, Bryson Y, de Martino M. , et al; International Perinatal HIV Group. The mode of delivery and the risk of vertical transmission of human immunodeficiency virus type 1--a meta-analysis of 15 prospective cohort studies. N Engl J Med 1999; 340 (13) 977-987 . Doi: 10.1056/NEJM199904013401301
• 29 Mandelbrot L, Le Chenadec J, Berrebi A. , et al. Perinatal HIV-1 transmission: interaction between zidovudine prophylaxis and mode of delivery in the French Perinatal Cohort. JAMA 1998; 280 (01) 55-60 . Doi: 10.1001/jama.280.1.55
• 30 Boer K, England K, Godfried MH, Thorne C. ; European Collaborative Study. Mode of delivery in HIV-infected pregnant women and prevention of mother-to-child transmission: changing practices in Western Europe. HIV Med 2010; 11 (06) 368-378 . Doi: 10.1111/j.1468-1293.2009.00800.x
• 31 Senise J, Bonafé S, Castelo A. The management of HIV-infected pregnant women. Curr Opin Obstet Gynecol 2012; 24 (06) 395-401 . Doi: 10.1097/GCO.0b013e328359f11e
• 32 International Perinatal HIV Group. Duration of ruptured membranes and vertical transmission of HIV-1: a meta-analysis from 15 prospective cohort studies. AIDS 2001; 15 (03) 357-368
• 33 Cotter AM, Brookfield KF, Duthely LM, Gonzalez Quintero VH, Potter JE, O'Sullivan MJ. Duration of membrane rupture and risk of perinatal transmission of HIV-1 in the era of combination antiretroviral therapy. Am J Obstet Gynecol 2012; 207 (06) 482.e1-482.e5 . Doi: 10.1016/j.ajog.2012.10.862
• 34 Peters H, Byrne L, De Ruiter A. , et al. Duration of ruptured membranes and mother-to-child HIV transmission: a prospective population-based surveillance study. BJOG 2016; 123 (06) 975-981 . Doi: 10.1111/1471-0528.13442
• 35 Menezes Succi RC. Mother-to-child transmission of HIV in Brazil during the years 2000 and 2001: results of a multi-centric study. Cad Saude Publica 2007; 23 (Suppl. 03) S379-S389 . Doi: 10.1590/S0102-311×2007001500006