BACKGROUND: A high-coverage public health prenatal program (70,000 women/year) from central western Brazil/Goias State has represented a unique opportunity for the early diagnosis of HIV-1 and implementation of strategies to prevent mother-to-child transmission (MTCT). OBJECTIVES: To investigate MTCT among a prospective cohort of HIV-1 infected mothers/exposed infants. STUDY DESIGN: 142 mothers/their 149 infants (2008-2010) were investigated regarding maternal viral load, CD4(+)cell counts, HIV-1 pol sequences; infants' HIV-1 RNA tests (30/120 days), sequential anti-HIV-1/2 serology. HIV-1 subtypes were assigned by REGA. Transmitted drug resistance was identified by the Calibrated Population Resistance tool, secondary resistance by Stanford HIV-1 Drug Resistance/International AIDS Society databases. RESULTS: Mothers (median age=24 years; 25/142 adolescents) were diagnosed during prenatal care (2008-2010) or previously (1994-2007). Recent cases were younger, mostly asymptomatic. Undetectable viremia and MTCT prophylaxis predominated in formerly diagnosed mothers. Recent cases had higher subtype C prevalence. One naive patient had transmitted resistance; ten antiretroviral-experienced patients had secondary resistance: 6 from MTCT prophylaxis, 4 under HAART. Late disclosure of diagnosis, vaginal delivery, breastfeeding, lack of oral zidovudine were observed in the three MTCT cases (3/149; 2.01%). Two of three infected infants harbored subtype C; infected infants/mothers did not have drug resistance mutations. Two of the transmitting-mothers had viremia <1000 copies/ml. Among exposed-uninfected infants the median time to seroreversion was 12 months. CONCLUSIONS: In this study delayed disclosure of diagnosis, partial/no preventive measures, drug resistance among asymptomatic women under prophylaxis and MTCT in low viremic mothers raise concerns. The expansion of subtype C infection corroborates surveillance of HIV-1 diversity in this region.
BACKGROUND: A high-coverage public health prenatal program (70,000 women/year) from central western Brazil/Goias State has represented a unique opportunity for the early diagnosis of HIV-1 and implementation of strategies to prevent mother-to-child transmission (MTCT). OBJECTIVES: To investigate MTCT among a prospective cohort of HIV-1 infected mothers/exposed infants. STUDY DESIGN: 142 mothers/their 149 infants (2008-2010) were investigated regarding maternal viral load, CD4(+)cell counts, HIV-1 pol sequences; infants' HIV-1 RNA tests (30/120 days), sequential anti-HIV-1/2 serology. HIV-1 subtypes were assigned by REGA. Transmitted drug resistance was identified by the Calibrated Population Resistance tool, secondary resistance by Stanford HIV-1 Drug Resistance/International AIDS Society databases. RESULTS: Mothers (median age=24 years; 25/142 adolescents) were diagnosed during prenatal care (2008-2010) or previously (1994-2007). Recent cases were younger, mostly asymptomatic. Undetectable viremia and MTCT prophylaxis predominated in formerly diagnosed mothers. Recent cases had higher subtype C prevalence. One naive patient had transmitted resistance; ten antiretroviral-experienced patients had secondary resistance: 6 from MTCT prophylaxis, 4 under HAART. Late disclosure of diagnosis, vaginal delivery, breastfeeding, lack of oral zidovudine were observed in the three MTCT cases (3/149; 2.01%). Two of three infected infants harbored subtype C; infected infants/mothers did not have drug resistance mutations. Two of the transmitting-mothers had viremia <1000 copies/ml. Among exposed-uninfected infants the median time to seroreversion was 12 months. CONCLUSIONS: In this study delayed disclosure of diagnosis, partial/no preventive measures, drug resistance among asymptomatic women under prophylaxis and MTCT in low viremic mothers raise concerns. The expansion of subtype C infection corroborates surveillance of HIV-1 diversity in this region.
Authors: Zelma Bernades da Costa; Yanna Andressa Ramos de Lima; Celina Maria Turchi Martelli; Mariane Martins de Araújo Stefani Journal: AIDS Patient Care STDS Date: 2013-08 Impact factor: 5.078
Authors: Rodrigo Cerda; Freddy Perez; Rosa Maria S M Domingues; Paula M Luz; Beatriz Grinsztejn; Valdilea G Veloso; Sonja Caffe; Jordan A Francke; Kenneth A Freedberg; Andrea L Ciaranello Journal: Open Forum Infect Dis Date: 2015-05-22 Impact factor: 3.835
Authors: Sabri Saeed Sanabani; Rodrigo Pessôa; Ana Carolina Soares de Oliveira; Vanessa Pouza Martinez; Maria Teresa Maidana Giret; Regina Célia de Menezes Succi; Karina Carvalho; Claudia Satiko Tomiyama; Douglas F Nixon; Ester Cerdeira Sabino; Esper Georges Kallas Journal: PLoS One Date: 2013-05-07 Impact factor: 3.240
Authors: Edson Delatorre; José C Couto-Fernandez; Monick Lindenmayer Guimarães; Ludimila Paula Vaz Cardoso; Keila Correia de Alcantara; Mariane Martins de Araújo Stefani; Hector Romero; Caio C M Freire; Atila Iamarino; Paolo M de A Zanotto; Mariza G Morgado; Gonzalo Bello Journal: PLoS One Date: 2013-09-12 Impact factor: 3.240