Factors associated with vertical HIV transmission during two different time periods: the impact of zidovudine use on clinical practice at a Brazilian reference centre

• Published in: International journal of STD & AIDS Vol. 14; no. 12; pp. 818 - 825
• Main Authors: MUSSI-PINHATA, M. M, KATO, Cristina M, DUARTE, G, PASCHOINI, M. C, BETTIOL, H, QUINTANA, S. M
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.12.2003; Royal Society of Medicine Press; Sage Publications Ltd
• Subjects: Adolescent; Adult; Anti-HIV Agents - therapeutic use; Biological and medical sciences; Brazil; Breast Feeding; Cohort Studies; Female; Fetal Membranes, Premature Rupture - complications; HIV Infections - drug therapy; HIV Infections - transmission; Human immunodeficiency virus; Human viral diseases; Humans; Infectious Disease Transmission, Vertical - prevention & control; Infectious Disease Transmission, Vertical - statistics & numerical data; Infectious diseases; Logistic Models; Medical sciences; Multivariate Analysis; Pregnancy; Pregnancy Complications, Infectious - drug therapy; Pregnancy Complications, Infectious - virology; Retrospective Studies; Rh Isoimmunization; Rh-Hr Blood-Group System; Substance Abuse, Intravenous - complications; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Zidovudine - therapeutic use; South America; Brazil; America; vertical disease transmission; Brazil; risk factors; zidovudine; HIV; RNA-directed DNA polymerase; Maternal diseases; Reverse transcriptase inhibitor; Antiviral; Pyrimidine nucleoside; Human; Immunopathology; Enzyme; Transferases; Use; Enzyme inhibitor; Retroviridae; AIDS; Immune deficiency; Lentivirus; Infection; Virus; Nucleotidyltransferases; Sexually transmitted disease; Dideoxynucleoside; Viral disease; Risk factor; Vertical transmission; Nucleosidic analog; Human immunodeficiency virus; Zidovudine
• ISSN: 0956-4624; 1758-1052
• DOI: 10.1258/095646203322556156

Vertical HIV transmission rates and associated factors among mother-infant pairs cared for at a Brazilian reference centre from 1988 to 1993 (period 1), and from 1996 to 1999 (period 2) were evaluated. A total of 150 and 239 infants born to HIV+ mothers were enrolled at birth during these periods. No zidovudine prophylaxis was available in period 1. In period 2, 92.4% of the infants were exposed to zidovudine (54% started at delivery or in the post-natal period). During period 1, 25 of 129 infants were found to be infected (19.4%; 95% confidence interval [CI]=13-27) vs 20 of 232 (8.6%; 95% CI=5-13) during period 2 (P <0.01). After controlling for co-variables, this decline was due to zidovudine prophylaxis, either with complete (odds ratio [OR]=0.24; 95% CI=0.08-0.70) or incomplete (OR=0.37; 95% CI=0.17-0.81) regimens. Premature rupture of membranes (OR =3.2) and rhesus-negative blood type of the infant (OR=2.6) facilitated transmission. Although confirming the protective effect of zidovudine prophylaxis, alternative approaches aimed at pregnant women identified late are needed for this population.