Maria José Rodrigues Vaz

HIV-infected pregnant women have greater adherence with antiretroviral drugs than non-pregnant women

The objective of the study was to evaluate the influence of pregnancy on the level of adherence with antiretroviral (ARV) drugs, in a prospective cohort of 72 pregnant women and 79 non-pregnant women. Adherence was measured by pill counting and self-reporting. Women were deemed adherent if 95% or more of all ARV had been taken as prescribed, in two occasions. According to pill counting, 43.1 and 17.7% of pregnant and non-pregnant women, respectively, met the criteria of adherence (P = 0.001); in the postpartum, adherence declined to 20.6% (P = 0.002). In both groups, adherence rates by self-reporting were significantly higher as compared with pill counting (P = 0.001). In multivariate regression analysis, age >29 years (odds ratio [OR] 3.58, confidence interval [CI] 95% 0.10–0.75, P = 0.011), mean number of pills/day <6 (OR 2.53, CI 95% 1.07–6.01, P = 0.035), and being pregnant (OR 3.33, CI 95% 1.36–8.13, P = 0.008) were independently associated to greater adherence.

Short-term antiretroviral therapy to prevent mother-to-child transmission is safe and results in a sustained increase in CD4 T-cell counts in HIV-1-infected mothers.

Short‐term antiretroviral therapy (START) to prevent mother‐to‐child transmission (MTCT) is currently recommended for all HIV‐1‐infected pregnant women. The objective of this study was to assess the effect on CD4 cell counts and viral load dynamics the withdrawal of START after birth could generate.

Redução da transmissão vertical do HIV: desafio para a assistência de enfermagem

With the crescent rates of HIV infection within female population in reproductive age, we may observe a correspondent increase in congenital infections. Thus, the obstetric nurse must be updated to participate and to develop programs of pre-natal care for HIV pregnant women. The purpose of this study was to review the pre-natal follow-up of this population regarding nursing care. Authors did not intend to approach all aspects of this subject, especially considering that investigations extend the great improvements already achieved since the acknowledge of the disease.Com as crescentes taxas de infeccao pelo HIV na populacao feminina em idade fertil podemos observar um aumento correspondente de infeccoes congenitas. A enfermeira obstetra deve, portanto, estar atualizada para a participacao e desenvolvimento de programas de assistencia pre-natal as gestantes portadoras do HIV. Este trabalho tem como objetivo fornecer uma revisao sobre o acompanhamento pre-natal desta populacao para a assistencia de enfermagem. Nao se pretende esgotar o assunto, uma vez que pesquisas ampliam os enormes avancos ja ocorridos desde o reconhecimento da doenca.

HIV-1 viremia during the first 28 weeks of pregnancy is not associated with mother-to-child transmission

It is currently recommended that antiretroviral prophylaxis to prevent mother-to-child transmission (MTCT) of HIV be initiated at 14 weeks of gestation. However, the relevance of early-gestation HIV viral load level for intrauterine MTCT is unknown. The objective of this study was to determine the relationship between prenatal maternal viral load and intrauterine MTCT. Records of HIV-infected pregnant women in two centers in Brazil, from 1999 to 2004 were analyzed. Three pregnancy periods were considered: earlier than 14 weeks, 14 to 27 6/7 weeks, and 28 weeks of gestation or more. Peripartum HIV exposure was also computed. Maximum viral load in each period was the measure of HIV exposure. Four hundred fifty-seven HIV-infected pregnant women were evaluated, but 53 were excluded. The MTCT rate was 0.49% (2/404-95% confidence interval (CI95) = 0.14-1.79%). Newborns were not breast-fed. Median viral load for the earlier-than-14-week period was 9,900 copies/mL (P25-75 1,000-50,775 copies/mL), 8,350 copies/mL (P25-75 707-42,000 copies/mL) for the 14 to 27 6/7-week period, and 435 copies/mL (P25-75 90-7,775 copies/mL) after the 28-week period. The peripartum median viral load was 400 copies/mL (P25-75 80-500 copies/mL). MTCT in mothers with VL > 1,000 copies/mL during the first 14 weeks (0.67%, 2/298) was not different from those with VL =1,000 copies/mL (0.0%, 0/96, P=1). Analogously, in the 14 to 27 6/7-week period, MTCT was similar in groups with VL higher (0.68%, 2/292) or lower (0%, 0/106) than 1,000 copies/mL (P=1). Regarding VL >1,000 copies/mL at 28-weeks-or-later and at peripartum periods, MTCT rates were 1.15% (2/173, P = 0.18) and 2.8% (2/71, P = 0.03), respectively. Intrauterine transmission does not seem to be influenced by HIV viremia during the first 28 weeks of pregnancy.

A Randomized Controlled Trial to Assess Safety, Tolerability, and Antepartum Viral Load with Increased Lopinavir/Ritonavir Dosage in Pregnancy

HIV mother-to-child transmission (MTCT) is significantly reduced if antepartum viral load (apVL) is<50 copies/mL. Pharmacokinetic studies suggest increasing the dosage of lopinavir/ritonavir (LPV/r) in pregnancy. It is important to assess tolerance, safety, and rate of patients presenting a apVL<50 copies/mL when treating with increased dose of LPV/r during pregnancy. Confirmed HIV-infected pregnant women with a fetus at a gestational age of 14-33 weeks were randomly assigned to receive LPV/r 400/100 or 600/150 mg b.i.d. plus two nucleoside analogues (NRTIs). Treatment was discontinued in the case of alanine transaminase (ALT) of grade III elevation or higher, glucose, or triglycerides. Thirty-two women were randomized to the LPV/r 400/100 mg dose, and 31 women were randomized to the 600/150 mg dose. Overall, 9.4% of the women receiving the conventional dose, and 17.2% receiving the increased dose, discontinued treatment because of adverse events (p=0.29). The rates of gastrointestinal (GI) symptoms, laboratory abnormalities, preterm delivery, and low birth weight were similar in both groups. There were no cases of HIV MTCT. Among the women with a baseline VL>50 copies/mL assigned to the conventional dose group, 45% (95% confidence interval [CI] 62.5-27.5%) had a apVL>50 copies/mL compared with 10.5% (95% CI 21.6-0.6%) of those assigned to the increased dose group (p=0.01). There was no significant difference found for the patients with a baseline VL<50 copies/mL. In pregnant women with a baseline VL>50 copies/mL, it may be warranted to initiate LPV/r dosing at 600/150 mg, whereas the conventional dose is sufficient for pregnant women with a baseline VL<50 copies/mL.

Factores asociados a respuesta virológica en mujeres que usaron profilaxis antirretroviral de gran actividad para transmisión materno-fetal del virus de la inmunodeficiencia humana tipo 1

Introduccion El embarazo es una circunstancia unica en la infeccion por el virus de la inmunodeficiencia humana tipo 1 (VIH-1) que necesita respuesta virologica urgente al esquema antirretroviral debido a la influencia de la carga viral plasmatica (CVP) en la transmision materno-fetal (TMF). El objetivo del estudio es evaluar factores relacionados con el tiempo para obtener CVP Metodos Cohorte de gestantes infectadas por el VIH-1 controladas entre 2000 y 2005 con linfocitos CD4+ > 300/μl; uso de profilaxis antirretroviral de gran actividad durante, minimo, 4 semanas; interrupcion posparto de antirretrovirales y evaluaciones de laboratorio disponibles. Resultados Se analizaron 75 gestaciones. Los valores medianos iniciales fueron: CVP de 3,71 log10 copias/ml y 573 linfocitos CD4+/μl. En el 75% de los casos la profilaxis se inicio despues de 26,6 semanas de gestacion y duro hasta 11,7 semanas. El esquema profilactico cambio en 12 embarazos, 7 por toxicidad. El inhibidor de la protease fue parte de 33 profilaxis, 11 con lopinavir. La profilaxis resulto en CVP Conclusiones La profilaxis antirretroviral no deberia postergarse despues de 26-28 semanas de gestacion para alcanzar una CVP 100.000 copias/ml.

Behavioural Differences Between users seeking hiv-testing at the testing anD counseling center in the city of Montes c laros, state of Minas gerais

Introduction: the human immunodeficiency virus (HIV) epidemic is a global, dynamic and unstable phenomenon, whose form of occurrence depends on the individual and collective human behavior, among other factors. Objective: to identify the social and behavioral differences related to the risk of HIV infection, prevalence of HIV and the rate between genders in users of the Testing and Counseling Center (CTA) of the city of Montes Claros, Minas Gerais State. Methods: this is a cross-sectional study. The sample included 1,409 users’ records (716 men, 693 women) from the CTA of Montes Claros, from December 2007 to March 2009. For organization and statistical analysis, the Statistical Package for Social Sciences (SPSS) 15.0 was used and a significance level of 5% (p < 0,05) was considered. Results: significant differences (p < 0.05) between genders were found, indicating a higher percentage of singles (65.3%), drug users (73.5%) and those who have had three or more sexual partners (41.9%) during the past year among men. Men used condoms more regularly in fixed (20.1%) and eventual (44.4%) partners. HIV prevalence was of 2% and the rate between the genders was of 1:1. Conclusion: men were engaged in more risk behaviors for HIV, but women were infected in the same proportion. Prevention programs must consider social and cultural components to structure gender inequalities.

Reduction of HIV vertical transmission: a challenge for nursing care

With the crescent rates of HIV infection within female population in reproductive age, we may observe a correspondent increase in congenital infections. Thus, the obstetric nurse must be updated to participate and to develop programs of pre-natal care for HIV pregnant women. The purpose of this study was to review the pre-natal follow-up of this population regarding nursing care. Authors did not intend to approach all aspects of this subject, especially considering that investigations extend the great improvements already achieved since the acknowledge of the disease.Com as crescentes taxas de infeccao pelo HIV na populacao feminina em idade fertil podemos observar um aumento correspondente de infeccoes congenitas. A enfermeira obstetra deve, portanto, estar atualizada para a participacao e desenvolvimento de programas de assistencia pre-natal as gestantes portadoras do HIV. Este trabalho tem como objetivo fornecer uma revisao sobre o acompanhamento pre-natal desta populacao para a assistencia de enfermagem. Nao se pretende esgotar o assunto, uma vez que pesquisas ampliam os enormes avancos ja ocorridos desde o reconhecimento da doenca.

Reducción de la transmisión vertical del SIDA: desafio para la asistencia de enfermería

With the crescent rates of HIV infection within female population in reproductive age, we may observe a correspondent increase in congenital infections. Thus, the obstetric nurse must be updated to participate and to develop programs of pre-natal care for HIV pregnant women. The purpose of this study was to review the pre-natal follow-up of this population regarding nursing care. Authors did not intend to approach all aspects of this subject, especially considering that investigations extend the great improvements already achieved since the acknowledge of the disease.Com as crescentes taxas de infeccao pelo HIV na populacao feminina em idade fertil podemos observar um aumento correspondente de infeccoes congenitas. A enfermeira obstetra deve, portanto, estar atualizada para a participacao e desenvolvimento de programas de assistencia pre-natal as gestantes portadoras do HIV. Este trabalho tem como objetivo fornecer uma revisao sobre o acompanhamento pre-natal desta populacao para a assistencia de enfermagem. Nao se pretende esgotar o assunto, uma vez que pesquisas ampliam os enormes avancos ja ocorridos desde o reconhecimento da doenca.