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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 [UNIFESP]
Pilotto, Jose H.
Alarcon, Jorge O.
Kreitchmann, Regis
NISDI Perinatal LILAC Study Grp
Universidade Federal do Rio de Janeiro (UFRJ)
Universidade de São Paulo (USP)
Dr Cecilia Grierson Hosp
Nossa Senhora da Conceicao Hosp
Universidade Federal de São Paulo (UNIFESP)
Hosp Geral Nova Iguacu
Lab AIDS & Mol Immunol IOC Fiocruz
Irmandade Santa Casa de Misericordia Porto Alegre
Keywords: HIV-1
Mother-to-child transmission
Issue Date: 1-Oct-2012
Publisher: Elsevier B.V.
Citation: International Journal of Gynecology & Obstetrics. Clare: Elsevier B.V., v. 119, n. 1, p. 70-75, 2012.
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. (c) 2012 Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics.
ISSN: 0020-7292
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