Análise das ações de profilaxia da transmissão vertical do HIV no período de 2007 a 2018 no Núcleo Perinatal/HUPE/UERJ

Abstract

The progressive increase in the number of HIV cases among women and consequently of vertical transmission of HIV has been taking on great epidemiological importance, receiving special attention with the implementation of the Ministry of Health’s recommendations for the prophylaxis for vertical transmission of HIV (MTCT) and antiretroviral therapy in pregnant women (ART). Despite the efforts directed to the development of interventions related to these recommendations, data on the monitoring of the stages of interventions for the prophylaxis of MTCT are still scarce and suggest failures in the process. For this reason, the aim of this thesis is to evaluate the interventions adopted at the Perinatal Nucleus of UERJ (NP-UERJ) on the prophylaxis for vertical transmission of HIV. It is a retrospective cohort study. The population was composed of 323 HIV-positive mothers and their infants, assisted at the NP-UERJ, municipality of Rio de Janeiro, in the period 2007-2018. Data were collected from hospital registries of pregnant women and newborns. The variables used were data of pregnancy, birth, puerperium and follow-up of the newborn. Data were described through proportions, means, standard deviation, and medians. The level of significance was defined with p-value <0.05. The process of data entry and statistical analysis was carried out through the EPI-INFO 3.5.2 Computer Program. The median age was 27 years (14-44), with 12.7% (41) of adolescents. The majority (66.8%) came to know about the infection during the gestation: 39.4% in the current pregnancy and 27.4% in the previous pregnancy. The incidence of MTCT was of 2.7% (2/73) in 2007-2009, 1% (2/197) in 2010-2015, and there was no MTCT between 2016-2018. In all 4 cases of MTCT, the diagnosis of maternal infection by HIV occurred during the gestation. The viral load at the third trimester of gestation was >1,000 copies/mL or unknown in all mothers of positive infants and in 18.7% (42/225) of mothers with negative infants (p=0.003). The ART period of use was >4 weeks in 92.3% (264/286) of mothers with HIV-negative infants and 2 weeks in the HIV-positive group (p=0.004). One of the 4 infected infants and 2 of the negative infants did not use oral zidovudine (AZT) (p=0.04). There was no association between amniorrexis and MTCT (p=0.99), conjugal status (p=0.54), ethnicity (p=0.65), adolescence (p=0.42), way of delivery (p=0.99), beginning of pre-birth (p=0.44) or maternal comorbidities (p=0.48). The conclusion of the study points that the main factors associated with MTCT are high maternal viral load at the third trimester, the ART period of use, and the non-administration of zidovudina (AZT) on the newborn. The pre-birth assessment is crucially important for HIV diagnosis and early start of prophylaxis for MTCT, providing better perinatal outcomes