Cecchini Diego, Martinez Marina, Astarita Viviana, Nieto Claudia, Giesolauro Rafael, Rodriguez Claudia
Grupo de Trabajo en Prevención de la Transmisión Vertical del VIH-1, Hospital General de Agudos Dr Cosme Argerich, Buenos Aires, Argentina.
Rev Panam Salud Publica. 2011 Sep;30(3):189-95. doi: 10.1590/s1020-49892011000900001.
To describe characteristics of mother-child binomium (MCB), antiretroviral (ARV) prophylaxis, time trends, and variables associated with vertical transmission of HIV-1 in a population assisted by a tertiary public hospital in Argentina.
Prospective descriptive study undertaken by the Hospital Cosme Argerich s Vertical Transmission Working Group, Buenos Aires city, Argentina 1998-2008. Periods 1998-2003 vs. 2004-2008 were compared and variables associated with vertical transmission identified.
Of 357 MCB, 21.0% of the mothers had HCV coinfection and 68.0% CD4 < 500/µL. During pregnancy, 75.0% received ARV: zidovudine (17.8%), zidovudinelamivudine (19.8%), zidovudine-lamivudine-nevirapine (41.9%), and zidovudinelamivudine-protease inhibitor (11.4%); 74.0% had viral load (VL) peripartum < 1 000 copies/mL. Caesarean delivery: 58.0%. Intrapartum zidovudine: 83.4%; 98.0% of infants received prophylaxis; zidovudine monotherapy was the most frequently used (73.0%). Of neonates, 15.4% had low birthweight and 6.7% were premature. The global vertical transmission was 3.3% (10/302). Comparing both periods, an increase in triple ARV and VL < 1 000 copies/mL in peripartum and a decrease in the absence of maternal/neonatal prophylaxis and overall VT was observed. The vertical transmission for 2004-2008 was 1.3% vs. 6.3% in Buenos Aires city (official statistics). Absence of maternal/intrapartum prophylaxis and prematurity were associated with vertical transmission (P < 0.01 and P = 0.01, respectively).
A decline in overall vertical transmission between the two periods was observed attributable to increased coverage of maternal/neonatal ARV administration and increased use of triple therapy. The absence of maternal/intrapartum prophylaxis was the main factor associated with vertical transmission, emphasizing the need to improve accessibility of MCB to the local public health system.
描述阿根廷一家三级公立医院所服务人群中母婴二元组（MCB）的特征、抗逆转录病毒（ARV）预防措施、时间趋势以及与HIV-1垂直传播相关的变量。
阿根廷布宜诺斯艾利斯市科斯梅·阿杰里奇医院垂直传播工作组于1998 - 2008年进行的前瞻性描述性研究。比较了1998 - 2003年和2004 - 2008年两个时间段，并确定了与垂直传播相关的变量。
在357对母婴二元组中，21.0%的母亲合并丙型肝炎病毒感染，68.0%的母亲CD4细胞计数<500/µL。孕期，75.0%的母亲接受了抗逆转录病毒治疗：齐多夫定（17.8%）、齐多夫定 - 拉米夫定（19.8%）、齐多夫定 - 拉米夫定 - 奈韦拉平（41.9%）以及齐多夫定 - 拉米夫定 - 蛋白酶抑制剂（11.4%）；74.0%的母亲分娩时病毒载量（VL）<1000拷贝/mL。剖宫产率：58.0%。产时使用齐多夫定的比例：83.4%；98.0%的婴儿接受了预防治疗；齐多夫定单药治疗是最常用的（73.0%）。新生儿中，15.4%出生体重低，6.7%早产。总体垂直传播率为3.3%（10/302）。比较两个时间段，发现三联抗逆转录病毒治疗的使用增加，分娩时病毒载量<1000拷贝/mL的情况增多，而未进行母婴预防治疗的情况以及总体垂直传播率下降。2004 - 2008年布宜诺斯艾利斯市的垂直传播率为1.3%，而官方统计数据为6.3%。未进行母婴/产时预防治疗以及早产与垂直传播相关（分别为P<0.01和P = 0.01）。
观察到两个时间段总体垂直传播率下降，这归因于母婴/新生儿抗逆转录病毒治疗覆盖率的增加以及三联疗法使用的增多。未进行母婴/产时预防治疗是与垂直传播相关的主要因素，强调需要提高母婴二元组获得当地公共卫生系统服务的可及性。
