Effectiveness of the prevention of mother-to-child HIV transmission in Bahia, Brazil.

INTRODUCTION: Antiretroviral therapy and prophylaxis during the antepartum, intrapartum and postpartum periods, cesarean delivery and avoidance of breast milk significantly reduce vertical transmission of HIV. OBJECTIVE: To evaluate the effectiveness prevention of mother-to-child transmission of HIV and determine the rate of vertical transmission in a public sexually transmitted infection and HIV referral center in Salvador, Bahia, in the period immediately prior to the initiation of universal antiretroviral therapy in pregnant women. METHODS: Cross-sectional study using data collected from medical records of children born to HIV infected mothers in Bahia from 2005 to 2008 who were referred to the Reference Center for Diagnosis and Research of Sexually Transmitted Diseases and HIV/AIDS for care. RESULTS: Of 232 HIV-exposed infants, 19 (8.2%) had confirmed HIV infection. One hundred eighty-eight (81%) mothers received antenatal care, 120 (52%) antepartum antiretroviral therapy or prophylaxis, and 168 (72%) intrapartum zidovudine. Two hundred twenty-three (96%) infants received zidovudine. In multivariable models, the combination of intrapartum and postpartum antiretroviral prophylaxis was associated with decreased adjusted odds of mother-to-child transmission. CONCLUSIONS: Low levels of antenatal screening and access to prevention of mother-to-child transmission were significant limitations in the cascade of prevention of mother-to-child transmission at our center in this period.

Prevalence of and risk factors for late diagnosis of HIV infection in Brazilian infants and children.

INTRODUCTION: Late human immunodeficiency virus (HIV) diagnosis is an important cause of HIV-related morbidity and mortality in infants and children. METHODS: This retrospective cohort study of HIV-infected children diagnosed in Sergipe, in northeastern Brazil, between 2002 and 2011 aimed to determine the prevalence of and risk factors for late HIV diagnosis. RESULTS: Of 55 infants and children with confirmed infection, 42 (76.5%) were diagnosed at ≥ 12 months old. No antiretroviral prophylaxis during delivery (OR 5.48, 95% CI 1.11-32.34) was associated with late diagnosis. CONCLUSIONS: More than 75% of cases were diagnosed late. Efforts are needed to improve early HIV diagnosis in infants.

Response to the complete hepatitis B vaccine regimen in infants under 12 months of age: a case series.

OBJECTIVES: Describing rates of seroconversion and its associated factors in a series of Brazilian infants following the final dose of the vaccine at 6 months of age. METHODS: Peripheral blood samples were collected after the third dose of the vaccine for the detection of anti-hepatitis B surface antibodies among infants of 7-12 months of age. We measured the association between seroconversion and birthweight, gestational age, time since administration of the vaccine in the maternity hospital and whether or not testing for hepatitis B surface antigen had been performed during pregnancy. RESULTS: We examined 40 infants. The mean birthweight was 2787g (standard deviation=853g) and mean gestational age was 37.5 (standard deviation=3.08) weeks. The proportion that seroconverted was non-significantly higher in infants who weighed ≥2000g at birth (96.7%) than in those with birthweights <2000g (80%, p=0.149). There was no difference between the infants who were born at <37 weeks of gestational age and those born at ≥37 weeks (p<0.178) neither between seroconversion and the time of application of the first dose of the vaccine after delivery (p=0.202). CONCLUSION: The proportion of infants who seroconverted was similar to that found in other Brazilian studies. There were no differences in the proportion seroconverting by age at first immunization.

Oral manifestations of HIV infection in patients receiving highly active antiretroviral therapy (HAART) in Bahia, Brazil.

OBJECTIVES: We investigated the oral manifestations of HIV-infected patients in Salvador, Brazil, and their relationship to immunologic, sociodemographic, and therapeutic factors. METHODS: This was a cross-sectional study that used data from adult patients' medical records in the dentistry service of the AIDS Reference Center in Salvador, Brazil. We reviewed the patients' records to collect information concerning oral health status and data on socioeconomic status, immunologic status, and treatment. RESULTS: A total of 993 patients were included in the study, of whom 473 (47.6 percent) were male. Approximately 5.5 percent of the patients presented with any oral lesions. Oral lesions were the most common in the patients with fewer than 350 CD4+ T lymphocytes (8.4 percent) and with viral loads greater than 10,000 copies (8.3 percent). CONCLUSIONS: Our study shows that lesions are more common in patients with advanced immune suppression and low level of schooling. Oral candidiasis and angular chelitis were the most common lesions seen.