ABSTRACT
Objetivos. Determinar la asociación entre VIH y complicaciones infecciosas (CI) después de una cesárea electiva. Materiales y métodos. Estudio de cohortes no concurrentes; se revisaron las historias clínicas de 237 cesáreas electivas en gestantes VIH reactivas atendidas en el Instituto Nacional Materno Perinatal de Perú, realizadas entre 2004 a 2012. Estas fueron pareadas por cirujano y fecha de cesárea con 237 gestantes VIH no reactivas. Se recogieron datos sociodemográficos, clínicos, características de la cesárea y relacionados a la infección por el VIH. Las CI se evaluaron según las recomendaciones del NHI Consensus Development Task Force. Se realizó el análisis bivariado con un nivel de significación del 5% y el cálculo del Odds Ratio (OR) con intervalo de confianza (IC) al 95%. Se construyó un modelo de regresión logística condicional. Resultados. El 13,9% de mujeres VIH positivas presentaron CI y 9,7% del grupo control (OR: 1,5 IC95% [0,9-2,7]); las expuestas (mujeres con VIH) tuvieron mayor probabilidad de tener una infección del tracto urinario (ITU) que las no expuestas (ORa: 4,5 IC95% [1,4-14,5]). Se encontró asociación entre CI y el tipo de incisión (ORa: 2,3 IC95% [1,1-4,5]) y el tiempo de hospitalización (6 frente a 3 días, p<0,001). Conclusiones. Las mujeres VIH positivas sin tratamiento antirretroviral tuvieron mayor riesgo de CI; aunque no se observó mayor riesgo global de CI en expuestas después de una cesárea electiva. El principal factor de riesgo asociado a una CI poscesárea electiva en mujeres VIH positivas fue el tipo de incisión.
Objectives: To determine the connection between HIV and infectious complications (IC) after an elective C-section. Materials and methods. A non-concurrent cohort study was conducted, in which the clinical records of 237 elective C-sections on HIV-positive pregnant women who gave birth at the Instituto Nacional Materno Perinatal (National Maternal Perinatal Institute) between 2004 and 2012 were revised. The records were matched by surgeon and C-section date, with 237 HIV-negative pregnant women. Socio-demographic and clinical data were collected, along with characteristics of the C-section and data related to the HIV infection. IC were evaluated according to the NIH Consensus Development Task Force. The descriptive analysis and the bivariate analysis were carried out with a significance level of 5% for the hypothesis tests and the calculation of the Odds Ratio (OR) with a confidence interval (CI) at 95%. A conditional logistic regression model was built. Results. IC were present in 13.9% of HIV-positive women and 9.7% of the control group (OR: 1.5 CI95% [0.9-2.7]); those who were exposed (women with HIV) were more likely to have a urinary tract infection (UTI) than those who were not exposed (ORa: 4.5 CI95% [1.4-14.5]). A connection was found between the IC and the type of incision (ORa: 2.3 CI95% [1.1-4.5]) and time of hospitalization (6 versus 3 days, p<0.001). Conclusions. Exposed women did not register a greater global risk of IC after an elective C-section; however, they were, indeed, more likely to get a UTI. Those HIV-positive women who were not receiving antiretroviral treatment were in greater risk of IC. The main risk factors associated with a post C-section IC in HIV-positive women were the type of incision, as well as the surgery time with the UTI.
Subject(s)
Adult , Female , Humans , Pregnancy , Cesarean Section , HIV Seropositivity/complications , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Urinary Tract Infections/epidemiology , Urinary Tract Infections/etiology , Cohort Studies , Elective Surgical ProceduresABSTRACT
Objetivos: Determinar los factores asociados a la no adherencia a TARGA en gestantes VIH positivas. Métodos: Se emplearon los datos de adherencia recogidos por el estudio NISDI Longitudinal Study in Latin American Countries (LILAC) sede Perú, de junio de 2008 a febrero de 2010, relacionados a información sociodemográfica, del embarazo, del VIH y adherencia en base al cuestionario del Adult AIDS Clinical Trials Group (AACTG) en mujeres VIH positivas durante la gestación, periparto y 6-12 semanas posparto. Definimos no adherencia como una pérdida de más del 5% de dosis en los últimos tres días. Se realizó análisis descriptivo y bivariado, con un nivel de significancia del 95%, se calcularon OR con sus IC al 95%. Resultados: Se estudió 44 pacientes. La edad promedio fue de 27.9±5.9 años. Al enrolamiento el 86.4% tomaba TARGA, aunque al momento del parto todas recibieron TARGA, siendo el 27.3% como profilaxis para la transmisión vertical. El 61.4% se encontraba en su primer esquema; el esquema más usado fue 2NRTI+2PI (56.8%) seguido de 2NRTI+1NNRTI (34%), con una mediana de dos pastillas/día y por un tiempo promedio de 12.5±16.6 meses. Durante la gestación la no adherencia fue de 7.3%, valor que aumentó a 21.2% en el periparto y 11.8% en el postparto. Los factores asociados a la no adherencia fueron un menor tiempo recibiendo ARV, tomar más de dos pastillas al día y un mayor tiempo de diagnóstico de VIH. Además, durante el embarazo el 34.1% de gestantes refería haber perdido alguna vez dosis de ARV, 27.3% durante el periparto y 23.5% durante el postparto. Entre las razones más frecuentes para haber perdido dosis estaban estar lejos de casa y cambio en la rutina (70%). Entre las mujeres que no habían perdido dosis el 11.1% reportó tener problemas para la toma de TARGA durante el embarazo, 4.2% al periparto y 11.5% en el posparto. Conclusiones: La no adherencia se incrementa de manera marcada en el periparto...
Objective: To assess the factors associated with non-adherence to HAART in HIV-positive pregnant women. Methods: We used data collected via the NISDI Longitudinal Study in Latin American Countries (LILAC) in Peru from June 2008 to February 2010, regarding sociodemographic information, pregnancy, HIV infection and treatment, as well as adherence based on the Adult AIDS Clinical Trials Group (AACTG) questionnaire in HIV-positive women during pregnancy, postdelivery hospital discharge (peripartum), and 6-12 weeks postpartum. We defined non-adherence as missing more than 5% of doses prescribed over the past 3 days. Statistical analysis consisted of descriptive and univariate analysis, considering significant a p value of 0.05, we calculated OR with 95% CI. Results: We included 44 women. Mean age was 27.9±5.9 years. At enrollment, 86.4% were on HAART, although at delivery 100% had received HAART; 27.3% of whom received HAART specifically for prevention of mother to child transmission (PMTCT). The majority (61.4%) were taking their initially prescribed HAART regimen; the most commonly prescribed was 2NRTI+2PI (56.8%) followed by 2NRTI+1NNRTI (34%), with a median of 2 tablets per day, for an average of 12.5±16.6 months. Using the cut off of 5% of doses missed during pregnancy, non-adherence was 7.3%, and increased in the peri- and postpartum to 21.2% and 11.8%, respectively. Factors associated with nonadherence were receiving ARV for less time; taking more than two pills a day and a longer time since HIV diagnosis. In addition 34.1% of pregnant women reported having ever missed a dose of ARV, 27.3% in the peripartum and 23.5% at the postpartum visit. Among the most common reasons cited for missing doses were ôbeing away from homeõ and ôa change in usual scheduleõ. Of the women who have not missed a dose, some reported having trouble taking the medications during pregnancy (11.1%), at birth (4.2%) and postpartum (11.5%)...