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Title: Missed opportunities for prevention of mother-to-child transmission of HIV-1 in the NISDI Perinatal and LILAC cohorts
Authors: Read, Jennifer S.
Cohen, Rachel A.
Hance, Laura Freimanis
Machado, Elizabeth S.
Mussi-Pinhata, Marisa M.
Ceriotto, Mariana
Santos, Breno
Succi, Regina
Pilotto, Jose H.
Alarcon, Jorge O.
Kreitchmann, Regis
NISDI Perinatal/LILAC Study Group
Affilliation: Pediatric, Adolescent, and Maternal AIDS Branch, CRMC, NICHD, NIH, DHHS. Bethesda, USA.
Westat. Rockville, Maryland, USA.
Westat. Rockville, Maryland, USA.
Universidade Federal do Rio de Janeiro. Hospital Clementino Fraga. Serviço de Doenças Infecciosas. Rio de Janeiro, RJ, Brasil.
Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Ribeirão Preto, SP, Brasil.
Hospital Dra. Cecilia Grierson. Unidad de Enfermedades Infecciosas. Buenos Aires, Argentina.
Nossa Senhora da Conceição Hospital. Serviço de Doenças Infecciosas. Porto Alegre, Brasil.
Universidade Federal de São Paulo. Faculdade Paulista de Medicina. Departamento de Pediatria. São Paulo, Brasil.
Hospital Geral de Nova Iguaçu. HIV Family Care Clinic./ Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de AIDS e Imunologia Molecular. Rio de Janeiro, Brasil.
Universidad Nacional Mayor de San Marcos. D.A. Instituto Carrión de Medicina Tropical. Sección de Epidemiología. Lima, Perú.
Irmandade da Santa Casa de Misericordia de Porto Alegre. Porto Alegre, Brasil.
Abstract: OBJECTIVE: To evaluate cases of mother-to-child transmission of HIV-1 at multiple sites in Latin America and the Caribbean in terms of missed opportunities for prevention. METHODS: Pregnant women infected with HIV-1 were eligible for inclusion if they were enrolled in either the NISDI Perinatal or LILAC protocols by October 20, 2009, and had delivered a live infant with known HIV-1 infection status after March 1, 2006. RESULTS: Of 711 eligible mothers, 10 delivered infants infected with HIV-1. The transmission rate was 1.4% (95% CI, 0.7-2.6). Timing of transmission was in utero or intrapartum (n=5), intrapartum (n=2), intrapartum or early postnatal (n=1), and unknown (n=2). Possible missed opportunities for prevention included poor control of maternal viral load during pregnancy; late initiation of antiretrovirals during pregnancy; lack of cesarean delivery before labor and before rupture of membranes; late diagnosis of HIV-1 infection; lack of intrapartum antiretrovirals; and incomplete avoidance of breastfeeding. CONCLUSION: Early knowledge of HIV-1 infection status (ideally before or in early pregnancy) would aid timely initiation of antiretroviral treatment and strategies designed to prevent mother-to-child transmission. Use of antiretrovirals must be appropriately monitored in terms of adherence and drug resistance. If feasible, breastfeeding should be completely avoided. Presented in part at the XIX International AIDS Conference (Washington, DC; July 22-27, 2012); abstract WEPE163.
Keywords: HIV-1
Mother-to-child transmission
Issue Date: 2012
Citation: READ, J. S. et al. Missed opportunities for prevention of mother-to-child transmission of HIV-1 in the NISDI Perinatal and LILAC cohorts. International journal of gynaecology and obstetrics, v. 119, n. 1, p. 70-75, 2012.
Description: Presentes no NISDI Perinatal: Beatriz Grinsztejn; Valdiléa Veloso (Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil).
DOI: 10.1016/j.ijgo.2012.05.026
ISSN: 0020-7292
Copyright: open access
Appears in Collections:INI - Artigos de Periódicos

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