[Pregnancy and postpartum control in HIV infected women]. / Control de embarazo y postparto en mujeres infectadas por HIV.

Pregnancy and postpartum control in HIV infected women. We present data from a retrospective observational descriptive study with the objective of evaluating characteristics of HIV-infected pregnant women, analyze the level of control of pregnancy and assess adherence to treatment and loss of follow up after delivery. We analyzed reported data of 104 pregnancies, 32.7% of them under 25 years old. The diagnosis was performed as part of pregnancy control in 36.5% of women. TARV started before 24 weeks of pregnancy in 70% of them and a regimen with 2 nucleos(t)ides and 1 ritonavir potenciated protease inhibitor (PIr) was prescribed in 84.5%. Elective c-section was the most frequent mode of delivery. The viral load after 32 weeks of pregnancy was available in 82.7%, being less than 1000 cop/ml in 78 (75%), less than 200 cop/ml in 70 (67.3%) and not available in 18 (17.3%) of cases. We observed a considered high rate of adherence failure and loss of follow up after delivery. Reported data should alert programs on the need to implement strategies to promote early pregnancy control and increase adherence and retention in care, especially in the postpartum period.

[Perception of risk of HIV infection and knowledge about the use of antiretrovirals in prevention]. / Percepción de riesgo de infección por HIV y conocimiento sobre uso de antirretrovirales en prevención.

INTRODUCTION: Combined prevention (CP) is considered the key strategy against the HIV epidemic. The objective of the study was to evaluate the perception of risk of HIV infection and the knowledge about the use of antiretrovirals (ARV) for prevention, among patients who attend a Sexually Transmitted Infections (STI) clinic. METHODS: A survey on personal data and perception of risk of HIV infection, knowledge about post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP), was administered to patients at the time of applying doses of penicillin for the treatment of syphilis, or when taking a blood sample for STI diagnosis, between May and December, 2022. RESULTS: 100 persons were surveyed: 43 were under 25 years of age, 67 reported male sex-gender and 33 females. Thirty of 91 (33%) perceived they had had some risk of infection in their lives, 19 of them in the last year; 77/96 (80%) stated that they had no knowledge about PEP, and 82/100, about PrEP. Only 22 out of 100 responded that antiretrovirals could provide benefit in preventing HIV; 26 (60%) of the 43 patients <25 years of age, and 18 of the 57 ≥ 25 years (31.6%) responded they have had two or more sexual partners in the last year. No statistically significant differences were observed related to gender and age group. DISCUSSION: The low perception of infection risk and knowledge about the use of antiretrovirals in HIV prevention, show the existing difficulties for the implementation of combined prevention (PEP-PrEP) in this population.

Introducción: La prevención combinada (PC) se considera la estrategia clave frente a la epidemia de HIV. El objetivo del estudio fue evaluar la percepción de riesgo de infección por HIV y el conocimiento sobre uso de antirretrovirales (ARV) para prevención, entre pacientes que concurren a un consultorio de Infecciones de Transmisión Sexual (ITS). Métodos: Una encuesta sobre datos personales y percepción de riesgo de infección por HIV, conocimiento sobre profilaxis posterior a la exposición (PEP) y previa a la exposición (PrEP), fue administrada a pacientes al momento de aplicar dosis de penicilina para tratamiento de sífilis, o de extraer muestra de sangre para diagnóstico de ITS, entre mayo y diciembre, 2022. Resultados: De 100 personas encuestadas, 43 eran menores de 25 años, 67 reportaron sexo-género masculino y 33 femenino. Treinta de 91, (33%), percibían haber tenido en su vida algún riesgo de infección, 19 de ellas en el último año; 77/96 (80%) manifestaron no tener conocimiento sobre PEP, y 82/100, sobre PrEP. Solo 22% respondió que los antirretrovirales podrían brindar beneficio para prevenir el HIV; 26 (60%) de los 43 menores de 25 años, y 18 de los 57 ≥ 25 años (31.6%) respondieron haber tenido dos o más parejas sexuales el último año. No se observaron diferencias estadísticamente significativas, relacionadas con género y grupo etario. Discusión: La baja percepción de riesgo de infección y del conocimiento sobre uso de antirretrovirales para prevención de HIV, evidencian las dificultades existentes en la implementación de prevención combinada (PEPPrEP) en esta población.

Maternal antiretroviral drugs during pregnancy and infant low birth weight and preterm birth.

OBJECTIVE: To determine the relationship between maternal antiretroviral regimens during pregnancy and adverse infant outcomes [low birth weight (LBW) and preterm birth]. The a priori hypothesis was that protease inhibitor (PI)-containing regimens are associated with an increased risk of LBW and preterm birth. DESIGN: Prospective cohort study of HIV-1-infected women and their infants (NISDI Perinatal Study). METHODS: Data were analysed from 681 women receiving at least one antiretroviral drug [in order of increasing complexity: one or two nucleoside reverse transcriptase inhibitors (1-2 NRTI), two NRTI plus one non-nucleoside reverse transcriptase inhibitor (NNRTI) (HAART/NNRTI), or two NRTI plus one PI (HAART/PI)] for at least 28 days during pregnancy, and who delivered live born, singleton infants with known birth weight and gestational age by 1 March 2005. Multivariable logistic regression modeling was used to assess the relationship of maternal ART with LBW and with preterm birth, adjusting for covariates. RESULTS: The incidence of LBW and preterm birth, respectively, was 9.6% and 7.4% (1-2 NRTI), 7.4% and 5.8% (HAART/NNRTI), and 16.7% and 10.6% (HAART/PI). There was no statistically significant increased risk of LBW [adjusted odds ratio (AOR), 1.5; 95% confidence interval (95% CI), 0.7-3.2] or preterm birth (AOR, 1.1; 95% CI, 0.5-2.8) among women who received HAART/PI compared with women receiving 1-2 NRTI. CONCLUSIONS: Among a population of HIV-1-infected women in Latin America and the Caribbean, maternal receipt of PI-containing ART regimens during pregnancy was not associated with a statistically significant increase in risk of LBW or preterm birth.

Profilaxis pre-exposición para la prevención de infección por VIH (PrEP) en mujeres de áreas vulnerables del conurbano de Buenos Aires / Pre-exposure prophylaxis for the prevention of HIV infection (PrEP) in women from vulnerable areas of the suburbs of Buenos Aires

Se describen una serie de casos desarrollados en la región oeste del conurbano bonaerense, en los cuales se presentaron situaciones de alto riesgo de infección por VIH, de modo de poder analizar y explorar el potencial uso de PrEP en mujeres como parte de la estrategia combinada de prevención. Si bien la eficacia de la PrEP está adecuadamente documentada, su implementación se encuentra demorada en la región. Las mujeres no parecen estar dentro de las poblaciones consideradas clave y por lo tanto son alejadas de esas estrategias. Incorporar el uso de PrEP en mujeres jóvenes con riesgo de infección puede contribuir al logro de los objetivos de control de la epidemia y evitar la transmisión vertical del VIH. La falta de un adecuado conocimiento y la baja percepción del riesgo de infección se describen como barreras para una implementación exito

A series of cases developed in the western region of Buenos Aires, in which there were situations of high risk of HIV infection, are described in order to analyze and explore the potential use of PrEP in women as part of the combined prevention strategy. Although the effectiveness of PrEP is well documented, its implementation is delayed in the region. Women do not seem to be within the considered key populations and therefore far from those strategies. Incorporating the use of PrEP in young women at risk of infection can contribute to the achievement of the objectives of epidemic control and avoid vertical transmission of HIV. The lack of adequate knowledge and the low perception of the risk of infection are described as barriers to a successful implementation. Keywords:

Control de embarazo y postparto en mujeres infectadas por HIV / Pregnancy and postpartum control in HIV infected women

Presentamos los datos de un estudio descriptivo observacional retrospectivo realizado con el objetivo de evaluar las características de las mujeres embarazadas infectadas por HIV, analizar el nivel de control del embarazo y evaluar la adherencia al tratamiento y las pérdidas de seguimiento posterior al parto. Analizamos los datos informados de 104 embarazos, 32.7% de mujeres menores de 25 años. El diagnóstico se realizó durante el control del embarazo en 36.5% de ellos. La terapia antirretroviral (TARV) se inició antes de la semana 24 en 70% de los embarazos. El régimen utilizado incluyó 2 nucleós(t)idos + 1 inhibidor de la proteasa potenciado con ritonavir (IPr) en 84.5% de los casos. La cesárea electiva fue el modo mas frecuente de parto. La carga viral luego de la semana 32 de embarazo estaba disponible en el 82.7% de las pacientes siendo menor a 1000 copias/ml en 78 (75%) y menor a 200 en 70 (67.3%), no hallándose disponible en 18 (17.3%) de los casos. Observamos una alta frecuencia de fallos de adherencia y pérdidas de seguimiento posteriores al parto. Los datos comunicados deben alertar a los programas y centro de atención sobre la necesidad de implementar estrategias que promuevan el control temprano del embarazo e incrementen la adherencia y la retención en cuidado, especialmente en el período posterior al parto.

We present data from a retrospective observational descriptive study with the objective of evaluating characteristics of HIV-infected pregnant women, analyze the level of control of pregnancy and assess adherence to treatment and loss of follow up after delivery. We analyzed reported data of 104 pregnancies, 32.7% of them under 25 years old. The diagnosis was performed as part of pregnancy control in 36.5% of women. TARV started before 24 weeks of pregnancy in 70% of them and a regimen with 2 nucleos(t)ides and 1 ritonavir potenciated protease inhibitor (PIr) was prescribed in 84.5%. Elective c-section was the most frequent mode of delivery. The viral load after 32 weeks of pregnancy was available in 82.7%, being less than 1000 cop/ml in 78 (75%), less than 200 cop/ml in 70 (67.3%) and not available in 18 (17.3%) of cases. We observed a considered high rate of adherence failure and loss of follow up after delivery. Reported data should alert programs on the need to implement strategies to promote early pregnancy control and increase adherence and retention in care, especially in the postpartum period.

Enfermedad avanzada al diagnóstico de infección por VIH en el Conurbano de Buenos Aires / Advanced disease at HIV diagnosis in the surrounding area of the city of Buenos Aires

Objetivos: Analizar las características de la población y determinar frecuente de infección por VIH. Método: Se realizó un estudio analítico descriptivo de corte transversal mediante análisis retrospectivo de los datos reportados en dos cohortes de seguimiento de pacientes de dos hospitales de la región oeste del Conurbano de Buenos Aires.Resultados: Analizamos las HC de 211 pacientes. Sexo femenino 108 (51,2 %), masculino 102 (48,3 %) y transgénero 1 (0,5 %). El modo primario de trans-misión se describió como heterosexual en el 89 % de los pacientes. El recuento de CD4 fue menor a 200 cel/ml en 60,2 % de los pacientes y menor a 350 cel/ml en el 77 %. Al momento de diagnóstico de infección presentaban un evento marcador de sida 65 pacientes (30 %) y se hallaban sintomáticos 86 (40,8 %). Ser de sexo masculino (OR 3,1 IC95 % 1,7-5,6), presentar edad de 45 años o superior (OR 4.0 IC95 % 2,1-7,8), y estar desempleado o con empleo informal (OR 3,3 IC95 % 1,8-5,9) se asociaron estadísticamente a EA tanto en el análisis bivariado como en el multivariado mientras que haber ingresado al nivel secundario de educación se asoció con baja posibilidad sólo en el bivariado. Conclusiones: Observamos una elevada frecuencia de EA en la población estudiada caracterizada como asociada desde el punto de vista estadístico al sexo masculino, la falta de empleo y la edad superior a los 45 años. La situación de los hombres referidos asi-mismo como heterosexuales debería ser especialmente estudiada

Objectives: To analyze characteristics of the population and determine frequency and possible associated factors with advanced disease (AD) at the time of diagnosis of HIV infection.Method: A cross-sectional descriptive study was carried out. Retrospective analysis of the reported data in two patient follow-up cohorts of two hospitals of the western region of Buenos Aires.Results: We analyzed HCs from 211 patients. Female gender 108 (51.2%), male 102 (48.3%) and transgender 1 (0.5%). The primary mode of transmission was described as heterosexual in 89% of patients. The CD4 count was less than 200 cells / ml in 60.2% of patients and less than 350 cells / ml in 77%. At the time of diagnosis of infection, 65 patients (30%) had an AIDS event and were symptomatic 86 (40.8%). Male sex (OR 3.1 IC95% 1.7-5.6), age of 45 years or above (OR 4.0 IC95% 2.1-7.8), and to be unemployed or with informal employment (OR 3.3 IC95% 1.8-5.9) were statistically associated to EA in both the bivariate and multivariate analyzes, while have begun the secondary level of education was associated with a low probability only in the bivariate. Conclusions: We observed a high frequency of AD in the studied population. characterized as statistically associated to male sex, lack of employment and age above 45 years. The situation of men referred as heterosexual should be specially evaluated