Determinants and trends in perinatal human immunodeficiency virus type 1 (HIV-1) transmission in the metropolitan area of Belo Horizonte, Brazil: 1998 - 2005

Significant decrease in human immunodeficiency virus type 1 (HIV-1) vertical transmission has been observed worldwide in centers where interventions such as antiretroviral therapy (ART), elective cesarean section, and avoidance of breastfeeding have been implemented. This prospective cohort study aimed to assess the determinants of and the temporal trends in HIV-1 vertical transmission in the metropolitan area of Belo Horizonte, Brazil from January 1998 to December 2005. The rate of HIV-1 vertical transmission decreased from 20 percent in 1998 to 3 percent in 2005. This decline was associated with increased use of more complex ART regimens during pregnancy. Multivariate analysis restricted to clinical variables demonstrated that non ART, neonatal respiratory distress/sepsis and breastfeeding were independently associated with HIV-1 vertical transmission. When laboratory parameters were included in the model, high maternal viral load and non maternal ART were associated with HIV-1 vertical transmission. The results from this study confirm the impact of ART in the reduction of HIV-1 vertical transmission and indicate the need for improvement in the care and monitoring of mother and infant pairs affected by HIV-1.

Perfil das gestantes infectadas pelo HIV atendidas em pré-natal de alto risco de referência de Belo Horizonte / Profile of HIV-infected pregnant women at a reference prenatal care service in Belo Horizonte

OBJETIVOS: identificar gestantes infectadas pelo HIV em centro de referência e investigar características refe-rentes à infecção e paridade. MÉTODOS: estudo transversal, que abrangeu toda a população de gestantes infectadas pelo HIV assistidas no Pré-Natal de Alto Risco do Hospital das Clínicas da Universidade Federal de Minas Gerais, em 2004. Foram coletados dados demográficos, epidemiologia da infecção pelo HIV e história obstétrica. Para análise estatística foi utilizado o SPSS 12.0. RESULTADOS: foram identificadas 85 mulheres com média de idade de 29,1 anos e 90 gestações. Em 55 gestações (61,1 por cento), as mulheres tinham conhecimento prévio da infecção. Sessenta e quatro (71,1 por cento) informavam união estável. Provavelmente, todas adquiriram o HIV em relações heterossexuais. Cinqüenta e quatro (60 por cento) tiveram o diagnóstico durante alguma gravidez. A média global de gestações foi 3,5, sendo 1,71 após o diagnóstico. Pacientes com diagnóstico prévio apresentaram maior média de gestações, em relação àquelas com diagnóstico na gestação estudada (p = 0,002). Oitenta e seis gestantes usaram anti-retroviral, sendo 56,7 por cento por indicação terapêutica. Não foram verificados casos de transmissão vertical. CONCLUSÕES: novas gestações em mulheres infectadas pelo HIV não são raras, apesar dos recursos de contracepção oferecidos. Assim, outras investigações são necessárias para a identificar suas dificuldades não abordadas durante a assistência médica de rotina.

OBJECTIVES: identify HIV infected pregnant women in a referral center and investigate characteristics related to infection and parity. METHODS: a cross-sectional study comprising all HIV infected women treated at the High Risk Prenatal Care in the Hospital das Clínicas da Universidade Federal de Minas Gerais, in 2004. Demographic data, HIV epidemiology infection and obstetrical history were collected. For statistical analysis SPSS 12.0 was used. RESULTS: eighty five women median aged 29.1 and 90 pregnancies were followed-up. In 55 pregnancies (61.1 percent) women had prior information of the infection. Sixty four (71.1 percent) informed they lived together. Probably they all acquired HIV in heterosexual relations. Fifty four (60 percent) were diagnosed during one of the pregnancies. The global pregnancies median was 3.5, and 1.71 following diagnosis. Patients with prior diagnosis had a higher pregnancy median as compared to those who were diagnosed during their pregnancies (p = 0.002). Eighty six pregnant women made use of anti-retroviral medication, 56.7 percent through therapeutic indication. No vertical transmission cases were determined. CONCLUSIONS: new pregnancies in HIV infected women are not rare notwithstanding contraceptive resources offered. Therefore, further investigations are necessary to identify what difficulties not previously approached they have during routine medical assistance.

A experiência de adolescer com aids / The experience of carryng adolescents of virus HIV

Trata-se de estudo qualitativo com abordagem dentro do método sociológico, fundamentada nas teorias do interacionismo (SIMMEL, 1991; GOFFMAN; 1999; PETITAT, 1998). A pesquisa teve por objetivo compreender as experiências de adolescentes portadores do vírus HIV infectados por transmissão vertical...