Carga viral durante a gestação como fator de risco para transmissão materno fetal do vírus da imunodeficiência humana
Arquivos
Data
2007
Autores
Senise, Jorge Figueiredo 
Orientadores
Castelo Filho, Adauto
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Determinar a relação entre carga viral durante a gestação e
transmissão materno fetal (TMF) do HIV.
Método: Estudo de Coorte retrolactivo que incluiu todas as gestantes atendidas
em dois centros do Brasil (Hospital Ipiranga e UNIFESP) de 1999 a dezembro
de 2006. A gestação foi dividida em três períodos, antes de 14 semanas, de 14
a 276/7 e a partir de 28 semanas. O período periparto também foi computado. A
maior carga viral em cada período foi considerada como carga viral de
exposição para cada gestante.
Resultados: Foram estudadas 613 gestantes, sendo que 63 foram excluídas
da análise devido abandono do pré-natal (33), abortamento (11), óbito fetal (10)
e falta de informação sobre carga viral ou tratamento anti-retroviral (9). Não
houve TMF do HIV nestas 9 mulheres excluídas. A taxa de TMF do HIV foi de
0,54%(3/550 IC 95% 0,11- 1,58%). Os recém nascidos não foram
amamentados. A mediana de carga viral a qual as gestantes ficaram expostas
no período anterior a 14ª. semana foi 10.000 cópias/ml(P25-75 990 – 54.900
cópias/ml), de 14 a 276/7 foi 7.900 cópias/ml(P25-75 547,75 – 42625 cópias/ml) e
a partir de 28 semanas menor que 400 cópias/ml(P25-75 < 400 – 4870
cópias/ml) A mediana de carga viral periparto foi menor que 400 cópias/ml P25-
75 <400 - <4000 cópias/ml) A TMF do HIV para gestantes expostas a mais de
1.000 cópias/ml durante as primeiras 14 semanas de gestação 0,49%(2/404; IC
95% 0,06 – 1,77), não foi diferente daquelas expostas a cargas virais menores
ou iguais a 1.000 cópias/ml foi 0%(0/134;) [p=1].De forma semelhante de 14 a
276/7 semanas a taxa de transmissão foi similar nos grupos, com carga viral
menor (0%; 0/151) e maior/igual (0,51% ; 2/392; IC 95% 0,06 – 1,84%) a 1.000
cópias/ml (p=1) A taxa de transmissão das mulheres expostas a cargas virais
iguais ou maiores que 1.000 cópias/ml a partir de 28 semanas e no periparto
foram 0,93% (2/214, p=0,51) e 2,44%(2/82, p=0,023) respectivamente.
Conclusões: A transmissão intra-útero do HIV parece não ser influenciada
pela carga viral durante as primeiras 28 semanas de gestação.
Objective: Determine the relation between VL during pregnancy and MTCT. Methods: Records of HIV-infected pregnant women in two centers in Brazil,(Hospital Ipiranga and UNIFESP) from 1999 to 2006 were analyzed. Three pregnancy periods were considered: earlier than 14 weeks; 14 to 276 /7 weeks; and 28 weeks of gestation or more. Peripartum HIV exposure was also computed. Exposure was the maximum viral load in each period. Results: 613 HIV-infected pregnant women were evaluated, but 63 were excluded. MTCT rate was 0,54% (3/550 - CI95 0.11-1.58%). Newborns were not breast-fed. Median viral load for the earlier-than-14-week period was 10,000 copies/mL (P25-75 990- 54,900 copies/mL), 7,900 copies/mL (P25-75 547,75-42,625 copies/mL) for the 14-to- 276 /7-week period, and lower than 400 copies/mL (P25-75 <400-4,870 copies/mL) after the 28-week period Peripartum median viral load was lower than 400 copies/mL (P25-75 <400-<400 copies/mL). MTCT in mothers with VL ≥1,000 copies/mL during the first 14 weeks (0.49%, 2/404) was not different from those with VL <1,000 copies/mL (0.0%, 0/134, p=1). Analogously, in the 14-to-276 /7-week period, MTCT was similar in groups with VL higher (0.51%, 2/392) or lower (0%, 0/151) than 1,000 copies/mL (p=1). Regarding VL >1,000 copies/mL at 28-weeks-or-later and at peripartum periods, MTCT rates were 0.93% (2/214, p = 0,15) and 2.4% (2/82, p = 0,023), respectively. Conclusions: Intrauterine transmission does not seem to be influenced by HIV viraemia during the first 28 weeks of pregnancy.
Objective: Determine the relation between VL during pregnancy and MTCT. Methods: Records of HIV-infected pregnant women in two centers in Brazil,(Hospital Ipiranga and UNIFESP) from 1999 to 2006 were analyzed. Three pregnancy periods were considered: earlier than 14 weeks; 14 to 276 /7 weeks; and 28 weeks of gestation or more. Peripartum HIV exposure was also computed. Exposure was the maximum viral load in each period. Results: 613 HIV-infected pregnant women were evaluated, but 63 were excluded. MTCT rate was 0,54% (3/550 - CI95 0.11-1.58%). Newborns were not breast-fed. Median viral load for the earlier-than-14-week period was 10,000 copies/mL (P25-75 990- 54,900 copies/mL), 7,900 copies/mL (P25-75 547,75-42,625 copies/mL) for the 14-to- 276 /7-week period, and lower than 400 copies/mL (P25-75 <400-4,870 copies/mL) after the 28-week period Peripartum median viral load was lower than 400 copies/mL (P25-75 <400-<400 copies/mL). MTCT in mothers with VL ≥1,000 copies/mL during the first 14 weeks (0.49%, 2/404) was not different from those with VL <1,000 copies/mL (0.0%, 0/134, p=1). Analogously, in the 14-to-276 /7-week period, MTCT was similar in groups with VL higher (0.51%, 2/392) or lower (0%, 0/151) than 1,000 copies/mL (p=1). Regarding VL >1,000 copies/mL at 28-weeks-or-later and at peripartum periods, MTCT rates were 0.93% (2/214, p = 0,15) and 2.4% (2/82, p = 0,023), respectively. Conclusions: Intrauterine transmission does not seem to be influenced by HIV viraemia during the first 28 weeks of pregnancy.
Descrição
Citação
SENISE, Jorge Figueiredo. Carga viral durante a gestação como fator de risco para transmissão materno fetal do vírus da imunodeficiência humana. 2007. 74 f. Tese (Doutorado em Ciências) – Escola Paulista de
Medicina, Universidade Federal de São Paulo, São Paulo, 2007.