Decrease of the vertical transmission of HIV/AIDS in Cuba, January 1986 - September 2009
Pedro Kourí Institute, Medical Care Department, Ciudad de la Habana, Cuba
Background: Since 1986, a controlled program has been established in the primary health care system in order to reduce HIV vertical transmission in Cuba.
Methods: The usual approach since 2008, applied to every HIV+ pregnant woman who decides to keep her pregnancy, is to administer HAART independently of her immunological status, from week 14 to the time when the caesarean section is carried out (week 38). Breastfeeding is strongly discouraged. The newborn child receives ZDV (2mg/Kg/dose) every 6 hours for the first 6 weeks. The children are followed-up at the IPK outpatient office, where their HIV infection status is determined. Infected children are treated with antiretrovirals according to the presence of opportunistic diseases, CD4 cell count and viral load. Quantification of CD4 is determined by flow cytometry, using a FACScan cytometer. Quantification of viral RNA levels is made with the Nuclisens system from Biomerieux.
Results: Of all the seropositive cases (11725) reported for the country, 2267 seropositive women have been reported between January 1st, 1986 and September 2009 (19.3%). Three hundred fifty four seropositive women (15,6%) have given birth 382 children (23 women have delivered twice and 5 women have delivered twins); of the 382 children, 36 (9,4%) are HIV+, 34 (94,4%) have been classified as AIDS patients, 23 (63,8%) are under treatment with HAART ; 2 (5,5%) are asymptomatic and 11 (30,5 %) have died. No infection has been shown in 274 children (71, 2%) by PCR and Western Blot, and 72 (18, 8%) are still under study.
Conclusions: The Program for Prevention and Control of HIV Vertical Transmission is effective since the number of infected children is low, similar to the figures reported for developed countries.
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