Trends in the management and outcome of HIV-1-infected women and their infants in the NISDI Perinatal and LILAC cohorts, 2002-2009

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2013-07-01
Autores
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.
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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.
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International Journal of Gynecology & Obstetrics. Clare: Elsevier B.V., v. 122, n. 1, p. 37-43, 2013.