Oportunidades perdidas para evitar latransmisión materno-infantil del virus de la inmunodeficiencia humana; Uruguay 2005-2007 / Lost chances to avoid mother-to-child transmission of HIV; Uruguay 2005-2007

Introducción: a pesar de que Uruguay tiene un Programa Nacional de ITS.SIDA en el Ministerio de Salud Pública, que los servicios de salud son aparentemente accesibles a la población y que los antirretrovirales (ARV) son gratuitos para los tributarios del sub sectorpúblico, las cifras de transmisión vertical del VIH son inaceptablemente elevadas. Objetivo: analizar la existencia de oportunidades perdidas que hubieran evitado la infección.Material y método: análisis de las historias clínicas de los niños infectados nacidos en el período 1° de enero de 2005 al 31 de diciembre de 2007.Se analizaron las siguientes variables: momento del diagnóstico, control de embarazo, medicación recibida, vía de finalización, ARV durante el nacimiento y al recién nacido, amamantamiento. Se estudiaron, cuando fue posible, las condiciones psicológicas de las madres.Resultados: en ese período nacieron 264 hijos de madres infectadas con VIH; 13 resultaron infectados (transmisión vertical 4,9%). De las 13 mujeres, 11 no controlaron su embarazo, por lo que no recibieron ARV, dos no recibieron zidovudina (AZT) durante el nacimiento a pesar del diagnóstico por test rápido enel parto, y cuatro recién nacidos no recibieron AZT y amamantaron. Las condiciones sociales, económicas y culturales de las madres fueron de vulnerabilidad, ya que muchas de ellas estaban solas, consumían drogas, tenían problemas psicológicos y su cultura era escasa. Seis ejercían la prostitución.Dos murieron durante el primer año de vida de los niños. Dos de los padres estaban presos y uno de ellos murió en la cárcel. Conclusiones: es necesario implementar políticas que logren captar a las mujeres embarazadas pertenecientes a los estratos más humildes de la población. El test rápido debe realizarse en forma sistemática en los embarazos mal controlados. El equipo de salud debe estar más comprometido con esta enfermedad, casi totalmente evitable para los niños.

Despite Uruguay having a STD/HIV National Program under the Ministry of Health, health care services seemingly approachable, and antiretroviral drugs free for those in the public sub-sector, HIV vertical transmission figures are unacceptably high. Objective: to analyze the existence of lost opportunities that would have avoided infection. Method: the study examined the clinical records of infected children born between January 1, 2005 and December 31, 2007. The following variables were analyzed: time of diagnosis, pregnancy follow-up, medication received, form ofchildbirth, antiretrovirals during birth and for the newborn, breastfeeding. Likewise, psychological condition ofmothers was studied, whenever possible.Results: during this period, 264 children were born of HIV-infected mothers; 13 were infected (vertical transmission4.9%). Out of 13 women, 11 of them had no prenatal followup, and thus were not administered antiretrovirals; two ofthem were not administered AZT during birth in spite of diagnosis made through a quick test upon delivery; and four newborns were not administered AZT and were breastfed. Mothers were under vulnerable social, economic andcultural conditions, since many of them were on their own, took drugs, had psychological problems and evidencedlittle education. Six of them worked in prostitution. Two of them died during the childÆs first year of life. Two of the fathers were in prison and one of them died in jail. Conclusions: policies that appeal to pregnant women in the lower economic sectors need to be drafted. Thequick test must be carried out systematically in pregnancies with poor prenatal follow-up. Health professionals must be more committed to this condition, almost completely avoidable for children.

Apesar da existência de um Programa Nacional de DTS.SIDA do Ministério de Saúde Pública do Uruguai, de serviços de saúde aparentemente acessíveis à população e que os medicamentos anti-retrovirais (ARV) são gratuitos para as pessoas que utilizam o sub-setor público de atenção de saúde, as cifras de transmissão vertical de VIH são altas e inaceitáveis. Objetivo: analisar a existência de oportunidades perdidasque poderiam evitar a infecção.Material e método: análise dos prontuários de paciente das crianças infectadas nascidas no período 1° dejaneiro de 2005 a 31 de dezembro de 2007. As seguintes variáveis foram analisadas: momento do diagnóstico, controle da gravidez, medicamentosrecebidos, via de terminação, ARV durante o nascimento ao recém-nascido, aleitamento. Quando foi possível, ascondições psicológicas da mãe foram estudadas. Resultados: no período estudado nasceram 264 filhos de mães infectadas com VIH; 13 foram infectados(transmissão vertical 4.9%). Das 13 mulheres, 11 não controlaram sua gravidez, por tanto não receberam medicamentos ARV, os recémnascidosnão receberam zidovudina (AZT) durante o nascimento apesar do diagnóstico por teste rápido no parto, e quatro recém- nascidos não receberam AZT e foram amamentados. As condições sociais, econômicas e culturais das mãesforam de vulnerabilidade, pois muitas estavam sozinhas, eram consumidoras de drogas, apresentavam problemas psicológicos e tinham pouca cultura. Seis exerciam a prostituição. Duas morreram durante o primeiro ano de vida das crianças. Dois pais estavam presos e um deles morreu na prisão.Conclusões: é necessário implementar políticas que captem as gestantes dos estratos mais humildes da população. O teste rápido deve ser realizado de forma sistemática nas mulheres que não controlaram sua gestação. A equipe de saúde deve estar mais comprometida com essa patologia, praticamente evitável para as crianças.

Impact of universal varicella vaccination on 1-year-olds in Uruguay: 1997-2005.

OBJECTIVE: Varicella vaccination was introduced at the end of 1999 into the Uruguayan immunisation schedule for children aged 12 months. Varilrix (Oka strain; GlaxoSmithKline Biologicals) has been the only vaccine used since then and coverage has been estimated to exceed 90% since the start of the universal varicella vaccination programme. We assessed the impact of the Uruguayan varicella vaccination programme during 2005, 6 years after its introduction. METHODS: Information on hospitalisations was collected from the main paediatric referral hospital and information on medical consultations for varicella was collected from two private health insurance systems in Montevideo. The proportion of hospitalisations due to varicella and the proportion of ambulatory visits for varicella since the introduction of the vaccine were compared between 1999 and 2005 and 1997 and 1999 in the following age groups: <1 year, 1-4 years, 5-9 years and 10-14 years. RESULTS: By 2005, the proportion of hospitalisations due to varicella among children, was reduced by 81% overall and by 63%, 94%, 73% and 62% in the <1, 1-4, 5-9 and 10-14 years age groups, respectively. The incidence of ambulatory visits for varicella among children was reduced by 87% overall and by 80%, 97%, 81% and 65% in the <1, 1-4, 5-9 and 10-14 years age groups, respectively. CONCLUSIONS: The burden of varicella has decreased substantially in Uruguayan children since the introduction of the varicella vaccination, including those groups outside the recommended vaccination age. It is expected to decrease further as more cohorts of children are vaccinated and herd immunity increases.

Expression of prostate specific membrane antigen (PSMA) in prostatic adenocarcinoma and prostatic intraepithelial neoplasia.

The prostatic membrane antigen (PSMA) is a protein that is expressed in the prostatic epithelium. We studied the expression of PSMA in a series of 55 patients with different stages of prostate cancer and we compared the PSMA staining in prostate cancer cells, in high-grade prostatic intraepithelial neoplasia (PIN) and in histologically benign prostatic epithelium for the same specimen. For this purpose archival paraffin-embedded specimens were studied by immunohistochemistry with a monoclonal antibody 7E11-C5.3 against PSMA using the streptavidin-biotin method. The mean percentage of PSMA immunoreactivity was 56.67% in prostate cancer (CaP) cells, and 48.6% in PIN cells, which was significantly higher than benign-appearing prostatic epithelium (5.72%) (for each pair, p<0.001). PSMA expression was greater in CaP with a higher Gleason score (p=0.01), but no relationship was found with serum PSA value. We conclude that PSMA overexpression is detected in high-grade PIN and is associated with a higher Gleason score of prostate cancer. It is a potential marker for studying carcinogenesis and progression of prostate cancer.

Frequency, Type and Associated Diseases of Bacteria and Virus in The Oropharynx of Children Born to Human Immunodeficiency Virus-Infected Mothers.

HIV-infected children are more likely than other children to develop pneumonia, which in these children is often recurrent or persistent. The main reservoir of the major pathogens is the nasopharynx, but to date no data has been published on the frequency and biologic characteristics of S.pneumoniae, H.influenzae and respiratory viruses found in the upper respiratory tract of children born to human immunodeficiency virus-infected mothers. To document these aspects, 105 children was monitored by pharyngeal swab (PS) and nasopahryngeal aspirates (NPA) who attended an outpatient clinic for HIV-infection evaluation. Bacterial identification was performed by standard procedures. Serotype, biotype and beta-lactamase production was investigated in H.influenzae isolates. S.pneumoniae serotypes were recognized by "quellung" and the susceptibility to 4 antibiotics was assessed. Respiratory syncytial viruses, parainfluenza, influenza A and B, and adenoviruses were diagnosed by indirect immunofluorescence and/or viral isolation in cell cultures. Twenty-nine children were identified as infected by HIV as a result of maternal-child transmission. Seventy children born to HIV-positive mothers but who were not HIV-infected served as controls. Of 269 PS, 110 110 S. pneumoniae and 92 H.influenzae were identified. Also 31 viruses were detected in 188 NPA. After stratifying by age no differences were observed in the frequency of bacterial colonization or in the presence of viruses in the upper respiratory tract of the two groups. Some biologic characteristics of the agents were noteworthy such as the frequency of colonization by S.pneumoniae serotype 14, the predominance of H.influenzae biotype I and the high frequency of viruses in NPA of asymptomatic children. Of note, although colonization frequencies were similar, children presenting with acute respiratory illness (ARI) were more likely to have bacteria isolated if they also had HIV-infection than if they were HIV-negative. It is concluded that HIV-infection in infants as a result of maternal virus transmission have a similar frequency of bacteria and virus colonization of their respiratory tract, but a higher frequency of ARI and perhaps a higher frequency of types of bacteria with special characteristics.