Navegando por Palavras-chave "Mother-to-child transmission"

Agora exibindo 1 - 2 de 2
  • Nenhuma Miniatura disponível
    Item
    Somente Metadadados
    Missed opportunities for prevention of mother-to-child transmission of HIV-1 in the NISDI Perinatal and LILAC cohorts
    (Elsevier B.V., 2012-10-01) 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; NICHD; WESTAT Corp; 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; UNMSM; Irmandade Santa Casa de Misericordia Porto Alegre
    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.
  • Nenhuma Miniatura disponível
    Item
    Somente Metadadados
    Trends in the management and outcome of HIV-1-infected women and their infants in the NISDI Perinatal and LILAC cohorts, 2002-2009
    (Elsevier B.V., 2013-07-01) Stoszek, Sonia K.; Duarte, Geraldo; Hance, Laura Freimanis; Pinto, Jorge; Gouvea, Maria I.; Cohen, Rachel A.; Santos, Breno; Teles, Elizabete; Succi, Regina [UNIFESP]; Alarcon, Jorge O.; Read, Jennifer S.; NISDI Perinatal LILAC Study Grp; WESTAT Corp; Universidade de São Paulo (USP); Universidade Federal de Minas Gerais (UFMG); Hosp Servidores Estado Saude; Hosp Nossa Senhora da Conceicao; Hosp Femina; Universidade Federal de São Paulo (UNIFESP); Univ Nacl Mayor San Marcos; Eunice Kennedy Shriver Natl Inst Child Hlth & Hum; US Dept HHS
    Objective: To describe temporal management and outcome trends among HIV-1-infected pregnant women and their infants enrolled in the NISDI Perinatal and LILAC cohorts. Methods: A prospective cohort of 1548 HIV-1-infected pregnant women and their 1481 singleton live-born infants was analyzed. Participants were enrolled at 24 Latin American and Caribbean sites and followed-up for at least 6 months postpartum. Variables were compared by 2-year enrollment periods from September 27, 2002, to June 30, 2009, using logistic and linear regression modeling. Results: Antiretroviral (ARV) use during pregnancy remained high (99.0%). ARVs became increasingly used for treatment (P < 0.001). Regimens containing 2 nucleoside reverse transcriptase inhibitors plus a protease inhibitor became more common in later years (P < 0.001). the proportion of women with viral loads below 1000 copies/mL at hospital discharge after delivery (HD) increased over time (P = 0.0031). Median CD4 lymphocyte counts also rose at HD, from 441 cell/mm(3) to 515 cells/mm(3) (P < 0.05). Elective cesarean deliveries increased from 30.5% to 42.0% (P = 0.018). Most infants received ARV prophylaxis (99.7%). Few infants were breastfed (0.5%) or became infected with HIV-1 (1.2%). Conclusion: the results indicate that national HIV-1 treatment and transmission prevention policies are effective among patients with healthcare access in the region. (c) 2013 Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics.