Márcia Maria Ferrairo Janini Dal Fabbro

Infecção pelo HTLV 1/2: atuação no pré-natal como estratégia de controle da doença no Estado de Mato Grosso do Sul

In this study, the prevalence of HTLV 1/2 infection among pregnant women in the State of Mato Grosso do Sul was estimated by means of the ELISA, Western Blot and PCR techniques, in blood samples collected by peripheral venous puncture. 116,689 pregnant women were examined and 153 were diagnosed as presenting HTLV 1/2 infection, with prevalence of 0.13%. Among these 153 pregnant women, 133 (86.9%) had type 1 and 20 (11.1%) had type 2; 73.2% were black, brown or indigenous; about 90% performed domestic activities; and 75.8% (116/153) had been to school for seven years or less. The 153 pregnant women had 172 pregnancies during the study period and 164 pregnancies were followed. Out of pregnancies that were followed, 6.7% (11/164) evolved to abortion, 26.8% (41/153) reported previous abortions and 31.7% (13/41) had had more than two abortions. Comorbidities were found in 17% (26/153), among whom 3.3% (5/153) had HIV (p<0.000002). The authors emphasize the importance of identifying pregnant women with HTLV 1/2 infection, as a strategy for disease control and prevention.

Prospective study on the prevention of vertical transmission of HIV in Campo Grande, Mato Grosso do Sul, Brazil, from 1996 to 2001

This prospective study, involving 76 pregnant women infected with HIV, paired with their 79 exposed infants, was carried out between May 1996 and October 2001, at the Reference Department for Pregnant Women Infected with HIV in Campo Grande, Mato Grosso do Sul. The mean age of the pregnant women was 24 years; 88% (67/76) apparently were infected due to sexual practices; 88% (67/76) were housewives; 823% (63/76) graduated from junior high school; 14.5% (11/76) reported co-infection with Hepatitis C, 9.2% with Syphilis; 51% (39/76) learned the diagnosis during prenatal care; 67% (51/76) reported HIV clinical symptomatology and 9.2% (7/76) reported opportunistic infections. Elective cesareans were performed in 57% (43/76). The mean gestational age at delivery was 38 weeks and we found 12.5% (10/80) pronatis; 97% (74/76) had a ruptured membrane time after less than four hours and one child (1.3%) was nursed. ACTG 076 Protocol (AIDS Clinical Trial Group 076) was used in 80% (61/76) of the pregnant women, with 100% adherence; 62% (38/61) used zidovudine plus another antiretroviral in the gestation; 92% (73/79) of the infants used zidovudine after the birth and 19% (14/73) used zidovudine and lamivudine. The transmission rate in this study was 2.5%.

Introduction of the dengue virus type 4 in the State of Mato Grosso do Sul, Brazil

We report on the first isolation of dengue virus serotype 4 (DENV-4) in the State of Mato Grosso do Sul, Brazil, in February, 2012. The cases were isolated in the city of Campo Grande, the state capital, and presented the classic signs and symptoms of dengue fever. DENV-4 was primarily identified through viral isolation in C6/36 clone lineage of Aedes albopictus cells; followed by indirect immunofluorescence, using type-specific monoclonal antibodies. The results were subsequently confirmed by Nested RT-PCR tests. The first description of the introduction of DENV-4 in a state whose population is susceptible to this serotype and the circulation of three other serotypes in the area is cause for concern due to the increased possibility of severe and lethal cases of the disease, and of huge epidemics.

Cobertura da testagem sorológica e prevalência da infecção pelo HIV entre gestantes do Estado de Mato Grosso do Sul, Brasil, 1999 a 2003

Summary The purpose of this research is to show the impact that the Pregnancy Protection Programme hash on the number of women tested for HIV in the prenatal period during the first year of the programme compared to previous years. The methods used were collection of a blood sample (obtained by finger prick) on five discs of filter paper (S&5903). Initial ELISA testing was done, followed by confirmatory tests: ELISA, Western-Blot and PCR-test in a separate sample of blood collected by venous puncture. Those submitted from pregnant women for HIV-testing included: 496/41,859 (1.18%) pregnant in 1999, 6.448/41,270(16.01%) in 2000, 6,627/39,629 (16.72%) in 2001, 11,330/39,731(28.51%) in 2002, and 32,512/39,183 (83.00%) in 2003. The coverage reached was also due to the facility and practicality of collecting material in the public health services, rural and indigenous populations using filter-paper, which has contributed to the increase of HIV-infected women, who were diagnosed making prevention, prophylactic and therapeutic procedures possible, reducing HIV vertical transmission, and consequently the maternal and infant morbidity and mortality for AIDS.

Non-polarized cytokine profile of a long-term non-progressor HIV infected patient

The HIV-1 initial viral infection may present diverse clinical and laboratory course and lead to rapid, intermediate, or long-term progression. Among the group of non-progressors, the elite controllers are those who control the infection most effectively, in the absence of antiretroviral therapy (ART). In this paper, the TH1, TH2 and TH17 cytokines profiles are described, as well as clinical and laboratory aspects of an HIV-infected patient with undetectable viral load without antiretroviral therapy. Production of IL-6, IL-10, TNF-α, IFN-γ, and IL-17 was detected; in contrast IL-4 was identified. Host-related factors could help explain such a level of infection control, namely the differentiated modulation of the cellular immune response and a non-polarized cytokine response of the TH1 and TH2 profiles.

High vertical HIV transmission rate in the Midwest region of Brazil

OBJECTIVES To estimate vertical HIV transmission rate in a capital city of the Midwest region of Brazil and describe the factors related to transmission. METHODS A descriptive epidemiological study based on the analysis of secondary data from the Notifiable Diseases Information System (SINAN). The analysis considered all HIV-infected pregnant women with delivery in Campo Grande-MS in the years 2007-2013 and their HIV-exposed infants. RESULTS A total of 218 births of 176 HIV-infected pregnant women were identified during the study period, of which 187 infants were exposed and uninfected, 19 seroconverted, and 12 were still inconclusive in July 2015. Therefore, the overall vertical HIV transmission rate in the period was 8.7%. Most (71.6%) of HIV-infected pregnant women were less than 30 years at delivery, housewives (63.6%) and studied up to primary level (61.9%). Prenatal information was described in 75.3% of the notification forms and approximately 80% of pregnant women received antiretroviral prophylaxis. Among infants, 86.2% received prophylaxis, but little more than half received it during the whole period recommended by the Brazilian Ministry of Health. Among the exposed children, 11.3% were breastfed. CONCLUSION The vertical HIV transmission rate has increased over the years and the recommended interventions have not been fully adopted. HIV-infected pregnant women need adequate prophylactic measures in prenatal, intrapartum and postpartum, requiring greater integration among health professionals.

Missed opportunities for prevention of perinatal HIV infection

The increment of HIV transmission involving the female population of childbearing age favors HIV vertical transmission.1 Programs for the prevention of mother-to-child-transmission (PMTCT) of HIV are part of the solution to eliminate new pediatric HIV infections and that can reduce the risk of MTCT to fewer than 2%.2 Herein we report missed opportunities for preventing perinatal HIV infection abstracted from medical records of a cohort of patients. Vertically HIV-infected infants followed up from birth or from the time of diagnosis receiving care at the referral services of Campo Grande city, in Midwest Brazil, between 1993 and 2014 were included. Patients who died during the study period were excluded from the analysis due to insufficient information in the medical records. One hundred forty-one patients were identified until 2014, 99 were eligible for inclusion and 42 died during the study period. Most of the children were diagnosed owing to their parents’ HIV diagnoses (p < 0.001), including one patient diagnosed at 127 months old. One teenager was diagnosed at 144 months because of the death his older brother. Seventy-six mothers (96.2%) had not received ARV prophylaxis during pregnancy, while 74 (92.5%) had not used prophylaxis during labor, including two women who had received ARVT during pregnancy. Moreover, 91 (91.9%) children had not received prophylaxis ARV. Although 66.0% of HIV infections in the women had been diagnosed before delivery (Table 1), 82.4% of the newborns were breastfed. Despite lack of ARV prophylaxis, most of the patients (52.5%) were between 16 and 24 years old in 2014. Since 1997, voluntary prenatal HIV testing ought to be offered in Brazil. The fact that 43% of the children in this cohort were born before 1997 contributed to the majority of pregnant women having been diagnosed after delivery. On the other hand, 57% of the children were born after 1997 and their HIV-infected mothers could have been diagnosed during pregnancy. Furthermore, women who were receiving ARVT during pregnancy and did not use prophylaxis during labor, as well as women who were aware of their HIV status before pregnancy and had not undergone Cesarean delivery raises the Table 1 – Characteristics of HIV-positive mothers of infants infected by vertical transmission, Campo Grande, Brazil.

Introdução do vírus dengue sorotipo 4 no Estado de Mato Grosso do Sul, Brasil

We report on the first isolation of dengue virus serotype 4 (DENV-4) in the State of Mato Grosso do Sul, Brazil, in February, 2012. The cases were isolated in the city of Campo Grande, the state capital, and presented the classic signs and symptoms of dengue fever. DENV-4 was primarily identified through viral isolation in C6/36 clone lineage of Aedes albopictus cells; followed by indirect immunofluorescence, using type-specific monoclonal antibodies. The results were subsequently confirmed by Nested RT-PCR tests. The first description of the introduction of DENV-4 in a state whose population is susceptible to this serotype and the circulation of three other serotypes in the area is cause for concern due to the increased possibility of severe and lethal cases of the disease, and of huge epidemics.

Introducción del serotipo de virus dengue 4 en el Estado de Mato Grosso do Sul, Brasil

We report on the first isolation of dengue virus serotype 4 (DENV-4) in the State of Mato Grosso do Sul, Brazil, in February, 2012. The cases were isolated in the city of Campo Grande, the state capital, and presented the classic signs and symptoms of dengue fever. DENV-4 was primarily identified through viral isolation in C6/36 clone lineage of Aedes albopictus cells; followed by indirect immunofluorescence, using type-specific monoclonal antibodies. The results were subsequently confirmed by Nested RT-PCR tests. The first description of the introduction of DENV-4 in a state whose population is susceptible to this serotype and the circulation of three other serotypes in the area is cause for concern due to the increased possibility of severe and lethal cases of the disease, and of huge epidemics.