Prevalência da infecção por HTLV-1/2 em gestantes da área metropolitana do Rio de Janeiro e relato dos desfechos obstétricos das infectadas

Abstract

HTLV-1/2 are oncogenic retroviruses transmitted by sexual contact, blood products and from mother to child, particularly through breastfeeding. Around 10% of infected people develop severe and disabling diseases. Data on prevalence of HTLV-1/2 in pregnant women are scarce and heterogeneous in Brazil. There were no published data on the seroprevalence of these viruses in pregnant women in Rio de Janeiro, nor Brazilian researches addressing the effects of infection on obstetric outcomes. The aim is to estimate the prevalence of HTLV-1/2 infection in pregnant women in the metropolitan area of Rio de Janeiro and report pregnancy outcomes of carrier mothers to increase understanding about the impact of the infection on pregnancy. This is a cross-sectional study conducted with 1204 women who delivered at UERJ s perinatal unit and at Hospital Estadual da Mãe, between November 2012 and May 2013. Blood was collected for HTLV-1/2 screening and a structured questionnaire with sociodemographic, sexual and reproductive items was administered at the admission for delivery. Samples were screened by chemiluminescent microparticle immunoassay (CMIA) and positive ones were confirmed by Western blot (WB). Data on past obstetric history, comorbidities and pregnancy outcomes were obtained through the review of medical records. Epi-info and Excel softwares were used for building the database and performing statistical analysis. Eight women had confirmed HTLV-1/2 infection (7 HTLV-1, 1 HTLV-2), equivalent to a prevalence rate of 0.66. The mean age of the population was 24.9 years and most of them reported being non-Caucasian (70%), in a stable relationship (73.8%), having less than ten years of formal education (57%) and a monthly family income of up to two minimum wages. There were no statistically significant differences between HTLV-1/2 positive and negative patients. In seropositive women there were two cases of coinfection with sexually transmitted diseases, one with syphilis and one with HPV. Three infected women (3/8) reported previous adverse pregnancy outcomes. There were four (4/8) adverse outcomes in the current pregnancy (2 premature ruptures of membranes, 1 pre-eclampsia, 1 fetal demise). Two urgent c-sections were performed (2/8). All liveborn infants were delivered at term and were appropriate weight for gestational age (GA). The stillborn was preterm and small for GA. The HTLV-1/2 prevalence found in the study population was substantial. The profile of infected and non-infected patients was similar. Since there is currently no treatment or immunization for HTLV-1/2, counselling of carrier mothers is the only way to stop vertical transmission. Hence, knowledge about local prevalence is fundamental to guide public health policies on antenatal screening and management. Better understanding about the impact of the infection on pregnancy may help to identify issues to be addressed by future research.