Hofer Cristina Barroso, Egger Matthias, Davies Mary-Ann, Frota Ana Cristina Cisne, de Oliveira Ricardo Hugo, Abreu Thalita Fernandes, Araújo Lúcia Evangelista, Witthlin Bernardo Bastos, Carvalho Alice Weber, Cordeiro Janaína Rivas, Lima Giulia Pasqualini, Keiser Olivia
Institute of Social and Preventive Medicine, Berne University, Berne, Switzerland.
Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Trop Med Int Health. 2017 Oct;22(10):1266-1274. doi: 10.1111/tmi.12925. Epub 2017 Aug 10.
To describe the cascade of care to HIV mother-to-child transmission (PMTCT) in a Rio de Janeiro reference paediatric clinic and evaluate the main factors possibly associated with HIV transmission.
Data on antenatal care (ANC), perinatal and neonatal assistance to HIV-infected and HIV-exposed but uninfected children assisted in the clinic from 1996 to 2013 were collected. The cascade of care was graphically demonstrated, and possible factors associated with HIV infection were described using regression models for bivariate and multivariate analysis. We imputed missing values of explanatory variables for the final model.
A total of 989 children were included in the analysis: 211 were HIV and 778 HEU. Graphically, the HIV PMTCT cascade of care improved from 1996/2000 to the later periods, but not from 2001/2006 to 2007/2013. The main factor independently associated with the HIV infection over time was breastfeeding. In the period 1996/2000, the lack of antiretroviral use during labour was associated HIV transmission. While in 2001/2007, other modes of delivery but elective Caesarean section, and lack of maternal antiretroviral use during ANC were associated with HIV transmission. In the last period, the main factor associated with transmission was the lack of maternal ANC.
The HIV PMTCT cascade improved over time, but HIV vertical transmission remains a problem, and better access to ANC is needed.
描述里约热内卢一家参考儿科诊所针对艾滋病毒母婴传播（PMTCT）的连续照护情况，并评估可能与艾滋病毒传播相关的主要因素。
收集了1996年至2013年在该诊所接受治疗的艾滋病毒感染儿童以及暴露于艾滋病毒但未感染儿童的产前护理（ANC）、围产期和新生儿护理数据。以图表形式展示了连续照护情况，并使用二元和多元分析的回归模型描述了与艾滋病毒感染相关的可能因素。我们对最终模型的解释变量缺失值进行了估算。
共有989名儿童纳入分析：211名感染艾滋病毒，778名暴露于艾滋病毒但未感染。从图表来看，艾滋病毒母婴传播连续照护情况从1996/2000年到后期有所改善，但从2001/2006年到2007/2013年没有改善。随着时间推移，与艾滋病毒感染独立相关的主要因素是母乳喂养。在1996/2000年期间，分娩时未使用抗逆转录病毒药物与艾滋病毒传播有关。而在2001/2007年，除择期剖宫产外的其他分娩方式以及产前护理期间母亲未使用抗逆转录病毒药物与艾滋病毒传播有关。在最后一个时期，与传播相关的主要因素是母亲未接受产前护理。
艾滋病毒母婴传播连续照护情况随时间有所改善，但艾滋病毒垂直传播仍然是一个问题，需要更好地获得产前护理。
