HIV and syphilis coinfection in pregnancy and vertical HIV transmission: a study based on epidemiological surveillance data/Coinfeccao HIV/sifilis na gestacao e transmissao vertical do HIV: um estudo a partir de dados da vigilancia epidemiologica

• Published in: Revista panamericana de salud pública Vol. 40; no. 6; p. 435
• Main Authors: Acosta, Lisiane M.W, Goncalves, Tonantzin Ribeiro, Barcellos, Nemora Tregnago
• Format: Journal Article
• Language: Portuguese
• Published: Pan American Health Organization 01.12.2016
• Subjects: Brasil
• ISSN: 1020-4989; 1680-5348

Objective. To estimate the rate of HIV and syphilis coinfection among pregnant women living in Porto Alegre, Brazil, as well as the association of coinfection with vertical HIV transmission and socioeconomic variables. Method. This analytical retrospective cross-sectional study employed data from the regular epidemiological surveillance system for the period from 2010 to 2013. Data were obtained regarding pregnant women with HIV and exposed children, syphilis in pregnancy, and congenital syphilis. Results. The study population included 1 500 HIV-positive women with deliveries from 2010 to 2013. Of these, 155 (10.3%) were also infected with syphilis, corresponding to an HIV and syphilis coinfection rate of 10.2% ([+ or -] 1.5%). The coinfected group had lower education levels, higher prevalence of black women, and greater HIV exposure related to drug use by the woman or a partner. Coinfected women had more delayed HIV diagnosis (for example, during childbirth) and greater prevalence of lacking prenatal care (44%). Crude analysis showed an association between vertical HIV transmission and HIV and syphilis co-infection (PR = 2.1; 95%CI: 1.21-3.74; P = 0.01) that persisted in the adjusted analysis. Conclusion. A profile of increased vulnerability was identified among pregnant women with HIV and syphilis coinfection. A positive impact of the treatment to reduce congenital syphilis and eliminate vertical transmission of HIV depends on enhanced access to qualified health care. Key words Infectious disease transmission, vertical; coinfection; HIV and syphilis; Brazil. Objetivo. Estimar a taxa de coinfeccao do HIV/sifilis nas gestantes de Porto Alegre, estado do Rio Grande do Sul, e sua associacao com a transmissao vertical do HIV e variaveis socioeconomicas. Metodo. Neste estudo transversal retrospectivo analitico, foram utilizados dados do sistema de vigilancia epidemiologica de gestantes portadoras do HIV e criancas expostas e dados da sifilis na gestacao e da sifilis congenita no periodo de 2010 a 2013. Resultados. A populacao do estudo incluiu 1 500 gestantes positivas para HIV com partos no periodo de 2010 a 2013. Dessas, 155 (10,3%) tambem eram infectadas por sifilis, correspondendo a uma taxa de coinfeccao HIV/sifilis de 10,2% ([+ or -] 1,5%). Foi encontrada menor escolaridade no grupo de gestantes coinfectadas, bem como maior prevalencia de mulheres negras e maior exposicao ao HIV relacionada ao uso de drogas pelo parceiro e pela gestante. Gestantes com coinfeccao HIV/sifilis tiveram diagnostico do HIV em momentos mais tardios, como no parto, alem de maior prevalencia de nao realizacao de pre-natal (44%). Na analise bruta foi identificada associacao da transmissao vertical do HIV com a presenca de coinfeccao HIV/sifilis (razao de prevalencia = 2,1; IC95%: 1,21 a 3,74; P = 0,01), a qual se manteve na analise ajustada. Conclusao. Um perfil de maior vulnerabilidade foi evidenciado no grupo de gestantes coinfectadas por HIV/sifilis, enfatizando a importancia de melhorar o acesso a atendimento qualificado a saude para impacto positivo do tratamento na reducao da sifilis congenita e na eliminacao da transmissao vertical do HIV. Palavras-chave Transmissao vertical de doenca infecciosa; coinfeccao; HIV; sifilis; Brasil.