XVIII International AIDS Conference

Abstract

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Missed opportunities on HIV maternal to child transmission prevention in Rio de Janeiro, Brazil

C. Sepulveda1, T. Abreu2, R.H. Oliveira2, L. Evangelista2, A.C. Frota2, E.C. Santos1, P.V.d.S. Costa1, A.L. Favila1, S.A. Nogueira3, C.B. Hofer4

1Universidade Federal do Rio de Janeiro, Preventive Medicine, Rio de Janeiro, Brazil, 2Universidade Federal do Rio de Janeiro, Pediatrics, Rio de Janeiro, Brazil, 3Faculdade de Medicina de Petrópolis, Pediatrics, Petrópolis, Brazil, 4Universidade de Federal do Rio de Janeiro, Preventive Medicine - Infectious Diseases, Rio de Janeiro, Brazil

Background: In 1996, the Program for HIV Maternal to Child Transmission Prevention (MCTP) was launched in Rio de Janeiro. Its recommendations include that all pregnant women have HIV test offered, if infected they start antiretroviral therapy (ART), use IV zidovudine (ZDV) during labor and the infant receive oral ZDV for 6 weeks. Despite of it all, Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG) HIV Clinic, a pediatric state reference center, is still receiving a considerable number of HIV-infected infants and children. The aim of this study is to evaluate the HIV MCTP main gaps in Rio de Janeiro.
Methods: This is a case control study of the prospectively collected data from prenatal care of all HIV vertically exposed and infected children born from1996 to 2007, followed at IPPMG. HIV vertically infected children were defined as cases and the non-infected, but HIV vertically exposed children as controls. Bivariate analysis were performed with Student T and Chi-square tests. Variables with p-value< 0.15 were inserted in a logistic regression analysis, and period of birth 1996-2000 or 2001-2007 was forced in the model.
Results: 185 cases and 822 controls were followed. The variables independently associated with HIV vertical infection were younger maternal age (OR=0.79, 95%CI= 0.78-0.87, per year), use of ART during pregnancy (OR=0.16, 95%CI= 0.05-0.57), and breastfeeding (OR=12.15, 95%CI= 4.20-35.14).
Conclusions: Factors associated with a best prenatal care (use of ART), as well as perinatal care (avoid breastfeeding) must be improved in Rio de Janeiro, even adjusting for year of birth. Even adjusting for several prenatal and perinatal care factors, younger maternal age was a risk for HIV vertical transmission, and must be studied with other maternal characteristics.


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