Mother-to-child transmission of HIV in the Southern Region of Santa Catarina, from 2005 to 2015: analysis of risk factors to seroconversion in newborns

Oliveira, Karen Waleska Kniphoff de; Oliveira, Suzana Kniphoff de; Barranco, Ana Beatriz Sanches; Hoffmann, Tamara; Duarte, Camila Soares; Nazário, Rayane Felippe; Marcon, Chaiana Esmeraldino Mendes; Schuelter-Trevisol, Fabiana

doi:10.1590/1806-93042018000300002

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 18 (3) • Jul-Sep 2018 • https://doi.org/10.1590/1806-93042018000300002 copy

Mother-to-child transmission of HIV in the Southern Region of Santa Catarina, from 2005 to 2015: analysis of risk factors to seroconversion in newborns

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to analyze both frequency and risk factors for seroconversion among newborns of HIV-positive mothers to HIV.

Methods:

a cohort study was conducted with children residing in Southern Region of Santa Catarina. Secondary data from the notification files and medical records of newborn's mothers of infected infants were used. The participants were all the newborns from 2005 to 2015 that were exposed to HIV through vertical transmission and attended a municipal health care center.

Results:

there were 104 cases of infant exposure to HIV. Seroconversion was confirmed in three cases, two of them died of AIDS during the study period. Breastfeeding (PR= 32.7; CI95%= 10.7-99.5; p= 0.002) and non-use of antiretroviral drugs during pregnancy (PR=18.2; CI95%= 2.0-163.0; p= 0.008) were risk factors for HIV seroconversion.

Conclusions:

seroconversion rates among neonates in Southern Region of Santa Catarina were similar to the national average. Seroconversion was associated with non-use of antiretroviral therapy during pregnancy and breastfeeding.

Key words:
HIV infections; Infectious disease transmission; vertical; Seroconversion

Maternal characteristics	N	%
Age (years)
16-20	10	9.6
21-25	11	10.6
26-30	12	11.5
31-40	19	18.3
No information	52	50.0
Skin color
White	75	72.1
Non-white	21	20.2
No information	8	7.7
Education (years of schooling)
0-8	76	73.1
> 8	23	22.1
No information	5	4.8
Place of residence
Tubarão	51	49.0
Nearby towns	48	46.2
Other towns in Santa Catarina	5	4.8
Residence area
Urban/peri-urban	82	78.8
Rural	13	12.5
No information	9	8.7
Occupation
Studant	2	1.9
Housewife	54	51.9
Employed	11	10.6
Self-employed	6	5.8
Unemployed	1	1.0
No information	30	28.8
Pregnancy date
On ARV during pregnancy
Yes	85	81.7
No	14	13.5
No information	5	4.8
On ARV during labor
Yes	95	91.3
No	5	4.8
No information	4	3.9
Type of delivery
Vaginal	17	16.3
Cesarean section	83	79.8
No information	4	3.9

Newborn characteristics	N	%
Gender
Male	52	50.0
Female	51	49.0
No information	1	1.0
Skin color
White	53	51.0
Non-white	16	15.4
No information	35	33.6
Prophylaxis with oral antiretroviral medications
Yes	93	89.4
No	5	4.8
No information	6	5.8
Duration of ARV regimen (weeks)
<3	16	15.4
3-5	1	1.0
6	51	49.0
No use	2	1.9
No information	34	32.7
Breastfeeding
Yes	2	1.9
No	98	94.2
No information	4	3.9
Cross-feeding
Yes	1	1.0
No	99	95.1
No information	4	3.9
Evolution
Infected	3	2.9
Not infected	77	74.0
Lost to follow-up	14	13.5
Transferred out to other regions	7	6.7
HIV-related deaths	2	1.9
Death due to other causes	1	1.0

Variables	Case 1	Case 2	Case 3	Case 4	Case 5
Maternal CD4 count (cels/mm³)^† † Last record available during pregnancy.	349	354	389	307	185
Maternal viral load (copies/mL)^† † Last record available during pregnancy.	29,841	13,603	150	95,279	220,359
Antiretroviral therapy during pregnancy	No	No	No	Yes	No
Antiretroviral therapy during labor	No	Yes	Yes	Yes	No
Type of delivery	Vaginal	Cesarean	Cesarean	Cesarean	Vaginal
Breastfeeding	Yes	No	No	Yes	No
Oral prophylaxis (in weeks)	2-5	< 3	< 3	< 3	< 3
Outcome	Infected	Infected	Infected	Deceased	Deceased

Variables	Seroconversion				p ^* * Two-tailed Fisher's exact test.	Relative Risk
	Present		Absent			(CI95%)
	n	%	n	%
ARV therapy during pregnancy (n=99)					0.008	18.2 (2.0-163.0)
No	3	75.0	11	11.6
Yes	1	25.0	84	88.4
ARV therapy during labor (n=100)					0.188	6.3 (0.8-50.5)
No	1	25.0	4	4.2
Yes	3	75,0	92	95.8
Type of delivery (n=100)					0.199	3.3 (0.6-18.0)
Vaginal	2	40.0	15	15.8
Cesarean section	3	60.0	80	84.2
Breastfeeding (n=100)					0.002	32.7 (10.7-99.5)
Yes	2	40.0	0	-
No	3	60.0	95	100.0
ARV therapy in infants (n=80)					0.235	4.7 (0.6-34.3)
No	1	20.0	4	4.3
Yes	4	80.0	89	95.7

Notification year	Notified cases (n)	Life births (n)	Seroconversion
Notification year	Notified cases (n)	Life births (n)	n	%	Rate/1.000 life births
2005	15	4,005	1	6.7	0.2
2006	9	4,098	-	-	-
2007	9	3,984	-	-	-
2008	9	4,292	1	11.1	0.2
2009	7	4,097	-	-	-
2010	11	4,216	-	-	-
2011	7	3,827	-	-	-
2012	5	4,493	1	20.0	0.2
2013	12	4,575	2	16.6	0.4
2014	9	4,177	-	-	-
2015	11	4,834	-	-	-
Total	104	46,598	5	4.8	0.1

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