ABSTRACT 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.

ABSTRACT 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.

Relatamos o primeiro isolamento do vírus dengue sorotipo 4 (DENV-4) no Estado de Mato Grosso do Sul, Brasil, em fevereiro de 2012. Os casos foram isolados na cidade de Campo Grande, capital do estado, e apresentaram sinais e sintomas clássicos da febre do dengue. O DENV-4 foi primeiramente identificado por isolamento viral em clone C6/36 linhagem de células de Aedes albopictus seguido por imunofluorescência indireta, utilizando anticorpos monoclonais tipo-específicos. Os resutlados foram posteriormente confirmados por testes de Nested RT-PCR. A descrição de sua introdução pela primeira vez neste estado, com população suscetível a este sorotipo e onde já circularam os outros três sorotipos é muito preocupante, pois aumenta a possibilidade de ocorrer formas graves e letais desta doença, assim como possibilita a ocorrência de grandes epidemias.

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.

Informe del primer aislamiento del serotipo del virus dengue 4 (DENV-4) en el Estado de Mato Grosso do Sul, Brasil, en febrero de 2012. Los casos fueron aislados en la ciudad de Campo Grande, capital del estado, y que presentan signos y síntomas de fiebre de dengue clásico. El DENV-4 se identificó principalmente a través de aislamiento viral en C6/36 con linaje de células de Aedes albopictus; seguido por inmunofluorescencia indirecta, utilizando anticuerpos monoclonales específicos de tipo. Después, fueron confirmados por pruebas de RT-PCR anidada. La descripción de la introducción del DENV-4 por primera vez en este estado, asociado a una población susceptible a este serotipo, y también la circulación de los otros tres serotipos en la zona es muy preocupante. La razón de esta preocupación es la mayor posibilidad de que se produzcan casos severos y letales de la enfermedad, así como, la aparición de grandes epidemias.

Relatamos o primeiro isolamento do vírus dengue sorotipo 4 (DENV-4) no Estado de Mato Grosso do Sul, Brasil, em fevereiro de 2012. Os casos foram isolados na cidade de Campo Grande, capital do estado, e apresentaram sinais e sintomas clássicos da febre do dengue. O DENV-4 foi primeiramente identificado por isolamento viral em clone C6/36 linhagem de células de Aedes albopictus seguido por imunofluorescência indireta, utilizando anticorpos monoclonais tipo-específicos. Os resutlados foram posteriormente confirmados por testes de Nested RT-PCR. A descrição de sua introdução pela primeira vez neste estado, com população suscetível a este sorotipo e onde já circularam os outros três sorotipos é muito preocupante, pois aumenta a possibilidade de ocorrer formas graves e letais desta doença, assim como possibilita a ocorrência de grandes epidemias.

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.

Informe del primer aislamiento del serotipo del virus dengue 4 (DENV-4) en el Estado de Mato Grosso do Sul, Brasil, en febrero de 2012. Los casos fueron aislados en la ciudad de Campo Grande, capital del estado, y que presentan signos y síntomas de fiebre de dengue clásico. El DENV-4 se identificó principalmente a través de aislamiento viral en C6/36 con linaje de células de Aedes albopictus; seguido por inmunofluorescencia indirecta, utilizando anticuerpos monoclonales específicos de tipo. Después, fueron confirmados por pruebas de RT-PCR anidada. La descripción de la introducción del DENV-4 por primera vez en este estado, asociado a una población susceptible a este serotipo, y también la circulación de los otros tres serotipos en la zona es muy preocupante. La razón de esta preocupación es la mayor posibilidad de que se produzcan casos severos y letales de la enfermedad, así como, la aparición de grandes epidemias.

Neste estudo, foi estimada a prevalência da infecção pelo HTLV 1/2 em gestantes no Estado de Mato Grosso do Sul, por meio das técnicas ELISA, Western Blot e PCR, em amostras de sangue obtidas por punção venosa periférica. Foram examinadas 116.689 gestantes, sendo diagnosticadas 153 infectadas pelo HTLV 1/2, com prevalência de 0,13%. Deste total, 133 (86,9%) eram do tipo 1 e 20 (11,1%) do tipo 2. Das 153 gestantes, 73,2% eram negras, pardas ou índias, cerca de 90% tinham atividades domésticas e 75,8% (116/153) tinham 7 anos ou menos de escolaridade. As 153 gestantes tiveram 172 gestações, durante o período do estudo, sendo que 164 tiveram acompanhamento. Das gestações acompanhadas, 6,7% (11/164) evoluíram para aborto, 26,8% (41/153) gestantes relataram abortos anteriores, sendo que 31,7% (13/41) apresentaram mais de dois abortos. Co-morbidades foram detectadas em 17% (26/153) sendo 3,3% (5/153) com HIV (p<0,000002). Os autores enfatizam a importância da identificação das gestantes infectadas pelo HTLV1/2 na estratégia de controle e prevenção da doença.

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.

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%.