Costa Zelma B, Machado Gustavo C, Avelino Mariza M, Gomes Filho Clidenor, Macedo Filho Jose V, Minuzzi Ana L, Turchi Marilia D, Stefani Mariane M A, de Souza Wayner Vieira, Martelli Celina Mt
Institute of Tropical Medicine and Public Health, Federal University of Goiás, Goiás, Brazil.
BMC Infect Dis. 2009 Jul 27;9:116. doi: 10.1186/1471-2334-9-116.
Hepatitis C (HCV) and human immunodeficiency virus (HIV) infections are a major burden to public health worldwide. Routine antenatal HIV-1 screening to prevent maternal-infant transmission is universally recommended. Our objectives were to evaluate the prevalence of and potential risk factors for HCV and HIV infection among pregnant women who attended prenatal care under the coverage of public health in Central Brazil.
Screening and counselling for HIV and HCV infections was offered free of charge to all pregnant women attending antenatal clinic (ANC) in the public health system, in Goiania city (~1.1 million inhabitants) during 2004-2005. Initial screening was performed on a dried blood spot collected onto standard filter paper; positive or indeterminate results were confirmed by a second blood sample. HCV infection was defined as a positive or indeterminate sample (EIA test) and confirmed HCV-RNA technique. HIV infection was defined according to standard criteria. Factors associated with HIV and HCV infections were identified with logistic regression. The number needed to screen (NNS) to prevent one case of infant HIV infection was calculated using the Monte Carlo simulation method.
A total of 28,561 pregnant women were screened for HCV and HIV-1 in ANC. Mean maternal age was 23.9 years (SD = 5.6), with 45% of the women experiencing their first pregnancy. Prevalence of HCV infection was 0.15% (95% CI 0.11%-0.20%), and the risk increased with age (p < 0.01). The prevalence of anti-HIV infection was 0.09% (95% CI 0.06%-0.14%). Black women had a 4.9-fold (95% CI 1.42-16.95) greater risk of HIV-1 infection compared to non-black women. NNS to prevent one case of infant HIV infection ranged from 4,141 to 13,928.
The prevalence of HIV and HCV infections were low among pregnant women, with high acceptability rates in the opt-in strategy in primary care. Older maternal age was a risk factor for HCV and antenatal HCV testing does not fulfill the requirements for screening recommendation. The finding of higher risk of HIV-1 infection among black women despite being in consonance with the HIV-1 ethnic pattern in some American regions cannot be ruled out to be a surrogate marker of socio-economic condition.
丙型肝炎（HCV）和人类免疫缺陷病毒（HIV）感染是全球公共卫生的重大负担。普遍建议进行常规产前HIV-1筛查以预防母婴传播。我们的目标是评估巴西中部公共卫生覆盖范围内接受产前护理的孕妇中HCV和HIV感染的患病率及潜在危险因素。
2004 - 2005年期间，在戈亚尼亚市（约110万居民）的公共卫生系统中，为所有到产前诊所（ANC）就诊的孕妇免费提供HIV和HCV感染的筛查及咨询服务。初始筛查在采集于标准滤纸上的干血斑上进行；阳性或不确定结果通过第二份血样进行确认。HCV感染定义为样本（酶免疫测定试验）阳性或不确定且经HCV-RNA技术确认。HIV感染根据标准标准定义。通过逻辑回归确定与HIV和HCV感染相关的因素。使用蒙特卡罗模拟方法计算预防一例婴儿HIV感染所需的筛查人数（NNS）。
共有28,561名孕妇在ANC接受了HCV和HIV-1筛查。孕妇平均年龄为23.9岁（标准差 = 5.6），45%的妇女为首次怀孕。HCV感染患病率为0.15%（95%可信区间0.11% - 0.20%），且风险随年龄增加而升高（p < 0.01）。抗HIV感染患病率为0.09%（95%可信区间0.06% - 0.14%）。与非黑人女性相比，黑人女性感染HIV-1的风险高4.9倍（95%可信区间1.42 - 16.95）。预防一例婴儿HIV感染的NNS范围为4,141至13,928。
孕妇中HIV和HCV感染患病率较低，在初级保健的选择加入策略中接受率较高。产妇年龄较大是HCV的一个危险因素，产前HCV检测不符合筛查建议的要求。尽管黑人女性中HIV-1感染风险较高这一发现与美国一些地区的HIV-1种族模式一致，但不能排除其是社会经济状况的替代指标。
