Rio de Janeiro, RJ, Brazil-Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Rio de Janeiro, Brazil.
Laboratório de Biologia Molecular, Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro-Rio de Janeiro, Rio de Janeiro, Brazil.
PLoS One. 2018 Jul 6;13(7):e0200168. doi: 10.1371/journal.pone.0200168. eCollection 2018.
Zika virus (ZIKV) was first isolated in Uganda in 1947. In Brazil, the first reported case of ZIKV infection was in May 2015. Additionally, dengue (DENV) is endemic and there has been a recent outbreak of chikungunya (CHIKV). Since the clinical manifestations of different arboviral infections (AI) can be similar, definitive diagnosis requires laboratory testing.
To determine the prevalence of ZIKV, DENV, and CHIKV infections in a Brazilian cohort of HIV-infected pregnant women, to assess clinical/immunological characteristics and pregnancy outcomes of women with evidence of recent AI.
Laboratory diagnosis of ZIKV, DENV and CHIKV infections utilized serological assays, RT-PCR and PRNT. The tests were performed at the first visit, 34-36 weeks of gestation and at any time if a woman had symptoms suggestive of AI. Mann-Whitney tests were used for comparison of medians, Chi-square or Fisher's to compare proportions; p< 0.05 was considered statistically significant. Poisson regression was used to analyze risk factors for central nervous system (CNS) malformations in the infant according to maternal symptomatology.
Of 219 HIV-infected pregnant women enrolled, 92% were DENV IgG+; 47(22%) had laboratory evidence of recent AI. Of these, 34 (72%) were ZIKV+, nine (19%) CHIKV+, and two (4%) DENV+. Symptoms consistent with AI were observed in 23 (10%) women, of whom 10 (43%) were ZIKV+, eight (35%) CHIKV+. No CNS abnormalities were observed among infants of DENV+ or CHIKV+ women; four infants with CNS abnormalities were born to ZIKV+ women (three symptomatic). Infants born to ZIKV+ women had a higher risk of CNS malformations if the mother was symptomatic (RR = 7.20), albeit not statistically significant (p = 0.066).
Among HIV-infected pregnant women with laboratory evidence of a recent AI, 72% were ZIKV-infected. In this cohort, CNS malformations occurred among infants born to both symptomatic and asymptomatic pregnant women with Zika infection.
寨卡病毒（ZIKV）于 1947 年在乌干达首次分离。在巴西，首例寨卡病毒感染报告于 2015 年 5 月。此外，登革热（DENV）流行，基孔肯雅热（CHIKV）也有暴发。由于不同虫媒病毒感染（AI）的临床表现可能相似，因此需要实验室检测进行明确诊断。
在巴西一组 HIV 感染孕妇中确定寨卡病毒、登革热病毒和基孔肯雅病毒感染的流行情况，评估有近期 AI 证据的孕妇的临床/免疫学特征和妊娠结局。
利用血清学检测、RT-PCR 和 PRNT 对寨卡病毒、登革热病毒和基孔肯雅病毒感染进行实验室诊断。检测在首次就诊时、妊娠 34-36 周以及如果孕妇出现疑似 AI 症状时进行。采用 Mann-Whitney 检验比较中位数，采用卡方或 Fisher 检验比较比例；p<0.05 为有统计学意义。采用泊松回归分析母亲症状与婴儿中枢神经系统（CNS）畸形的关系。
在 219 名 HIV 感染孕妇中，92%为 DENV IgG+；47 例（22%）有近期 AI 的实验室证据。其中，34 例（72%）为寨卡病毒阳性，9 例（19%）基孔肯雅病毒阳性，2 例（4%）登革热病毒阳性。23 例（10%）孕妇出现与 AI 一致的症状，其中 10 例（43%）为寨卡病毒阳性，8 例（35%）为基孔肯雅病毒阳性。登革热病毒或基孔肯雅病毒阳性孕妇的婴儿中未观察到 CNS 异常；4 例 CNS 异常的婴儿出生于寨卡病毒阳性孕妇（3 例有症状）。如果母亲有症状，寨卡病毒阳性孕妇的婴儿发生 CNS 畸形的风险更高（RR=7.20），但无统计学意义（p=0.066）。
在有近期 AI 实验室证据的 HIV 感染孕妇中，72%为寨卡病毒感染。在本队列中，有症状和无症状寨卡病毒感染孕妇所生婴儿均发生 CNS 畸形。
