RESUMEN
Over the last 20 years, the incidence of vertical HIV transmission has decreased from 25%-42% to less than 1%. Although there are no signs of infection, the health of HIV-exposed uninfected (HEU) infants is notoriously affected during the first months of life, with opportunistic infections being the most common disease. Some studies have reported effects on the vertical transfer of antibodies, but little is known about the subclass distribution of these antibodies. We proposed to evaluate the total IgG concentration and its subclasses in HIV+ mothers and HEU pairs and to determine which maternal factors condition their levels. In this study, plasma from 69 HEU newborns, their mothers, and 71 control pairs was quantified via immunoassays for each IgG isotype. Furthermore, we followed the antibody profile of HEUs throughout the first year of life. We showed that mothers present an antibody profile characterized by high concentrations of IgG1 and IgG3 but reduced IgG2, and HEU infants are born with an IgG subclass profile similar to that of their maternal pair. Interestingly, this passively transferred profile could remain influenced even during their own antibody production in HEU infants, depending on maternal conditions such as CD4+ T-cell counts and maternal antiretroviral treatment. Our findings indicate that HEU infants exhibit an altered IgG subclass profile influenced by maternal factors, potentially contributing to their increased susceptibility to infections.
Asunto(s)
Infecciones por VIH , Lactante , Humanos , Recién Nacido , Inmunoglobulina G , Incidencia , Recuento de Linfocito CD4 , Transmisión Vertical de Enfermedad InfecciosaRESUMEN
Objetivo: identificar los factores que se relacionan con la falta de lectura en dos carteles diseñados para difundir pruebas de escrutinio que detectan el VIH en gestantes. Métodos: estudio descriptivo en gestantes ingresadas en un instituto de tercer nivel de atención. Se diseñaron y colocaron carteles de difusión sobre la aplicación gratuita de la prueba de escrutinio oral para detectar seropositividad al VIH en gestantes. Se analizaron variables sociodemográficas, religión, edad materna y trimestre de embarazo. Para evaluar la lectura o no del cartel se construyó y aplicó un cuestionario, previamente probado, donde se identificó el número de mujeres que declararon haber visto y leído los carteles así como sus datos sociodemográficos. Se aplicaron un total de 475 cuestionarios. Resultados: de las siete variables incluidas en el cuestionario, se encontró que la edad, la religión y el trimestre de embarazo al ingreso a la institución, tuvieron diferencias estadísticamente significativas en la frecuencia de no lectura del cartel. Conclusiones: es necesario generar alternativas comunicacionales enfocadas a aquellos grupos menos receptivos de la información a través de conocer los factores que influyen en la lectura o no de información. Las acciones de educación para la salud siguen formando parte fundamental en la toma de conciencia y modificación de conductas en la población, por lo que estas deben considerar y combinar no solo elementos educativos sino también psicológicos, culturales, comunicacionales y sociodemográficos con la finalidad de impactar de mejor manera el ámbito de la salud individual y social.
Objective: to identify the factors associated with unreading of two posters designed to spread screening tests that detect HIV in a pregnant woman. Methods: descriptive study conducted in hospitalized pregnant women in a tertiary care institution, in which posters were designed and placed to provide information on the free performance of oral screening test to detect HIV seropositivity in pregnant women. Sociodemographic variables, religion, maternal age and pregnancy trimester were analyzed. For evaluating whether the poster was read or not, a previously tested questionnaire was designed and applied to identify the number of women who reported having seen and read the signs and their basic demographic data. The total number of questionnaires was 475. Results: of the seven variables included in the questionnaire, it was found that age, religion and pregnancy trimester on admission to the institution had statistically significant differences in the frequency of unread poster. Conclusions: it is necessary to generate alternative communications targeted at those least receptive groups to information through knowing the factors that have an effect on reading or not of some information. Health education actions remain a fundamental part in raising awareness and in behavioral change in the population, so these should consider and combine not only educational elements but also psychological, cultural, communication and sociodemographic ones in order to have a better impact on the individual and social health.
RESUMEN
Introducción. Objetivos: revisar las recomendaciones internacionales e informar la experiencia que se tiene en el manejo y seguimiento de mujeres embarazadas infectadas por virus de inmunodeficiencia humana (VIH)/síndrome de inmunodeficiencia adquirida (SIDA) en el Instituto Nacional de Perinatología Isidro Espinosa de los Reyes (INPerIER). Métodos. Se presenta la experiencia clínica de 20 años (1988-2008) en el manejo de una cohorte de mujeres embarazadas infectadas por VIH atendidas en el INPerIER; con un enfoque a diferentes escenarios de mujeres embarazadas con VIH/SIDA y profilaxis antirretroviral, así como los avances para la atención de éstas. Resultados. El artículo describe el impacto que diversas estrategias a nivel mundial han tenido en los últimos 20 años para disminuir la transmisión perinatal del VIH y se documenta una tasa de transmisión de 0% a partir del año 1998 en la atención de las mujeres embarazadas infectadas por VIH en el INPerIER, lo cual, comparado a nivel mundial, muestra que el manejo es el óptimo. Conclusiones. Las intervenciones médicas para la detección, el inicio de la profilaxis antirretroviral y del tratamiento durante la gestación, han permitido disminuir la transmisión perinatal a menos de 2%.
Introduction. We undertook this study to review the international recommendations and report the experience at the Instituto Nacional de Perinatologia Isidro Espinosa de los Reyes (INPerIER) in the management of pregnant women with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). Methods. We reviewed medical records of 200 pregnant women with HIV/AIDS receiving care at INPerIER from 1988-2008 with specific focus on different scenarios of pregnant HIV/AIDS patients and different modes of antiretroviral prophylaxis. Treatment advances are also presented. Results. The impact of diverse worldwide strategies can serve to decrease perinatal transmission of HIV. We report our experience at INPerIER in demonstrating a decrease in the rate of vertical transmission between 1988 and 1998 to 0%. Conclusions. Early medical interventions with antiretroviral therapy has allowed us to reduce vertical transmission in pregnant women with HIV/AIDS to <2% over a 20-year period and to 0% since 1998.