Vertical transmission of HIV to neonates in a reference hospital in Northeastern Brazil from 2013 to 2017

Figueredo, Vaneça Santos Leal; Monteiro, Denise Leite Maia; Batista, Rosângela Fernandes Lucena; Gama, Mônica Elinor Alves; Campos, Aline Santos Furtado; Pinto, Adna Gesarone Carvalho Ferreira

doi:10.1590/S1678-9946202365034

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ORIGINAL ARTICLE • Rev. Inst. Med. trop. S. Paulo 65 • 2023 • https://doi.org/10.1590/S1678-9946202365034 copy

Vertical transmission of HIV to neonates in a reference hospital in Northeastern Brazil from 2013 to 2017

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The aim of this study was to estimate the rate of Mother-to-child Transmission (MTCT) of HIV to neonates in a reference university hospital in Sao Luis city, the capital of Maranhao State (MA), evaluating MTCT-associated factors. A retrospective cohort study based on data from the Notifiable Diseases Data System (SINAN) was carried out and included all HIV-exposed neonates notified from 2013 to 2017 by the university hospital. The study population comprised 725 HIV-exposed neonates, of whom 672 neonates were exposed and uninfected, and 53 were exposed and infected. The estimated rate of MTCT in the period of 2013 to 2017 was 7.3%. Most pregnant women were ≥ 20 years old (86.9%), reported ≥ 8 years of schooling (53.2%), reported full-time or independent paid work (46.9%) and were residents in other cities of the state (61.7%). Regarding healthcare, 86.3% received prenatal care, 74.6% received Antiretroviral Therapy (ART) as prophylaxis during pregnancy, 81.8% received ART prophylaxis during childbirth and 78.1% underwent cesarean section. Among the neonates, 92.8% received ART prophylaxis and 94.3% were not breastfed. Despite these variables, the 7.3% MTCT rate found in this study makes it clear that the interventions recommended by the Ministry of Health were not fully adopted.

Vertical transmission of infectious diseases; Infectious complications in pregnancy; HIV infections; Incidence

CHARACTERISTICS	General		HIV vertical transmission				p-value*

			Negative (n = 672)		Positive (n = 53)

	n	(%)	n	(%)	n	(%)
Maternal age group							0.385
< 20 years	95	13.10	86	12.80	9	16.98
≥ 20 years	630	86.90	586	87.20	44	83.02
Maternal schooling							0.039
< 8 years	339	46.76	307	45.68	32	60.38
≥ 8 years	386	53.24	365	54.32	21	39.62
Maternal ethnicity							0.024
Black**	672	92.69	627	93.30	45	84.91
Non-black**	53	7.31	45	6.70	8	15.09
Maternal occupation							0.863
Works (full-time or independent paid work)	340	46.90	317	47.17	23	43.40
Does not work	318	43.86	293	43.60	25	47.17
Student	67	9.24	62	9.23	5	9.43
Municipality of residence							0.118
Sao Luis	278	38.34	263	39.14	15	28.30
Other municipalities	447	61.66	409	60.86	38	71.70
Prenatal care							< 0.001
Yes	626	86.34	606	90.18	20	37.74
No	99	13.66	66	9.82	33	62.26
Prenatal prophylaxis							< 0.001
Yes	541	74.62	530	78.87	11	20.75
No	184	25.38	142	21.13	42	79.25
Mode of delivery							< 0.001
Cesarean	566	78.07	540	80.36	26	49.06
Vaginal	159	21.93	132	19.64	27	50.94
Prophylaxis at childbirth							< 0.001
Yes	593	81.79	572	85,12	21	39.62
No	132	18.21	100	14,88	32	60.38
Prophylaxis in the neonate							< 0.001
Yes	673	92.83	646	96.13	27	50.94
No	52	7.17	26	3.87	26	49.06
Prophylaxis duration in the neonate							< 0.001
Adequate	675	93.10	649	96.58	26	49.06
Inadequate	50	6.90	23	3.42	27	50.94
Maternal breastfeeding							< 0.001
No	684	94.34	650	96.73	34	64.15
Yes	41	5.66	22	3.27	19	35.85

VARIABLES	Unadjusted		p-value	Adjusted		p-value

	PR*	CI ∞ (95%)		PR*	CI*** (95%)
Maternal age group			0.383			0.796
> 20 years		1			1
≤ 20 years	0.73	0.37 – 1.46		0.90	0.43 – 1.90
Maternal schooling			0.042			0.048
< 8 years		1			1
≥ 8 years	1.73	1.02 – 2.95		1.72	1.00 – 2.96
Maternal occupation			0.863
Works (full-time or independent paid work)		1			1	0.679
Does not work	1.16	0.67 – 2.00		1.27	0.73 – 2.22
Student	1.10	0.43 – 2.80		1.23	0.43 – 3.51
Maternal ethnicity			0.023			0.017
Non-black**		1			1
Black**	0.44	0.22 – 0.89		0.42	0.21 – 0.86
Municipality of residence			0.124			0.159
Sao Luis		1			1
Other municipalities	1.57	0.88 – 2.81		1.53	0.84 – 2.77

VARIABLES	Unadjusted		p-value	Adjusted		p-value

	PR*	CI ∞ (95%)		PR*	CI** (95%)
Prenatal care			< 0.001			< 0.001
Yes		1			1
No	10.43	6.24 – 17.43		4.00	2.35 – 6.81
Prenatal prophylaxis			< 0.001			< 0.001
Yes		1			1
No	11.22	5.90 – 21.35		5.44	2.74 – 10.79

VARIABLES	Unadjusted		p-value	Adjusted		p-value

	PR*	CI ∞ (95 %)		PR*	CI** (95 %)
Mode of delivery			< 0.001			0.798
Cesarean		1			1
Vaginal	3.69	2.22 – 6.15		0.92	0.48 – 1.73
Intravenous ART prophylaxis at labor and delivery			< 0.001			0.042
Yes		1			1
No	6.84	4.08– 11.48		2.73	1.03 – 7.22
Prophylaxis in the neonate			< 0.001			0.002
Yes		1			1
No	12.46	7.87 – 19.72		0.18	0.06 – 0.53
Prophylaxis duration in the neonate			< 0.001			< 0.001
Adequate		1			1
Inadequate	14.01	8.88 – 22.11		32.65	21.60 – 49.36
Maternal breastfeeding			< 0.001			0.620
No		1			1
Yes	9.32	5.85 – 14.84		1.22	0.55 – 2.70

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[1] Correspondence to: Vaneça Santos Leal Figueredo Universidade Federal do Maranhão, Rua Bela Aurora, 8, CEP 65064320, São Luís MA, Brazil Tel: +55 98 98156670 E-mail: vanecafigueredo9@gmail.com