Missed opportunities for prevention of mother-to-child transmission of human immunodeficiency virus type 1 in Latin America and the Caribbean: the NISDI perinatal study.

Cases of mother-to-child transmission (MTCT) of human immunodeficiency virus type 1 (HIV-1) in a prospective cohort study in Latin America and the Caribbean were analyzed. Eight of 820 eligible infants became infected [transmission rate, 0.98% (95% CI = 0.45-1.96%)]. Five cases (62%) represented missed opportunities for prevention of MTCT of HIV-1, suggesting the need for ongoing training and education of clinicians regarding prevention of MTCT of HIV-1.

[Brain tumors and pregnancy]. / Tumor cerebral e gravidez.

BACKGROUND: Despite not being a common fact, the occurrence of brain tumors during pregnancy poses a risk to both the mother and infant. AIM: To identify the best medical procedure to be followed for a pregnant patient harboring a brain tumor. METHOD: The records of 6 patients with brain tumors, diagnosed during pregnancy were examined. RESULTS: Several types of brain tumors have been associated with pregnancy, but the meningioma is, by far, the most frequent. It seems that pregnancy aggravates the clinical course of intracranial tumors. There were no operative mortality in these series. In 2 patients the labor occurred before the craniotomy and in others, the delivery occurred after the surgery. CONCLUSION: The best moment to recommend the craniotomy and the neurosurgical removal of the tumor will depend of the mothers neurological condition, the tumor histological type as well as the gestational age.

Nevirapine toxicity in a cohort of HIV-1-infected pregnant women.

OBJECTIVE: The purpose of this study was to complete an evaluation of nevirapine (NVP) toxicity in a cohort of HIV+ pregnant women. STUDY DESIGN: This was a retrospective study of 611 women followed from January 1996 to December 2003. All women who used NVP for > 7 days were included. Multivariate logistic regression was used to test independent association of CD4 and hepatitis C virus (HCV) infection related to the outcome of toxic effects of NVP. RESULTS: One hundred ninety-seven women were exposed to NVP for > 7 days, and toxicity occurred in 11 (5.6%), leading to drug discontinuation in 7 patients. One case of Stevens-Johnson syndrome occurred. No serious liver toxicity occurred except for 1 grade 4 cholestasis. Median CD4 was 344 in women without toxicities and 298 in women with toxicities. HCV was the only significant factor associated to toxicity by logistic regression (odds ratio [OR] 15.61, P = .001). CONCLUSION: NVP toxicities occurred in a very small fraction of patients and were not associated with fatalities.

Vertical transmission of HIV in Rio de Janeiro, Brazil.

A cohort of 297 HIV-infected pregnant women was followed from January 1996 to December 2001. The overall transmission rate was 3.57% and remained constant over time. Low birth-weight was independently associated with a higher risk of vertical transmission (P=0.0072), whereas a longer duration of antiretroviral drugs during pregnancy was independently associated with a lower risk of transmission (P=0.0084). Further decreases in transmission should be obtained by initiating prophylaxis earlier in pregnancy.

Trends in a Cohort of HIV-infected pregnant women in Rio de Janeiro, 1996-2004

OBJECTIVE: To describe trends in sociodemographic, immunological and virological profiles and interventions to decrease the risk of mother-to-child HIV transmission. METHODS: Retrospective cohort study conducted at a tertiary institution in Rio de Janeiro, Brazil from January 1996 to December 2004. Analysis was performed by stratification in three time periods: 1996-1998 (P1), 1999-2001 (P2) and 2002-2004 (P3). RESULTS: In 9 years, 622 pregnancies occurred. Complications included: maternal mortality 0.3 percent, stillbirths 2.5 percent, miscarriages 0.6 percent, neonatal mortality 1.1 percent, prematurity 9.9 percent, low birth weight (LBW) 16.5 percent, congenital malformations 2.2 percent. The number of HIV-infected pregnant patients grew threefold over time reflecting increased prevalence of disease and patient identification. HIV diagnosis before pregnancy increased from 30 percent in P1 to 45 percent in P3. The proportion of pregnant women receiving highly active antiretroviral therapy increased from none (P1) to 88 percent (P3) with a significant trend towards women delivering at undetectable viral loads in later years despite a higher frequency of advanced disease. Scheduled cesarean deliveries increased from 35 percent in P1 to 48 percent in P3. Perinatal transmission rates were 2.4 percent with a decline from 3.5 percent in P1 to 1.6 percent in P3. Neonatal outcomes tended to remain constant or improve with time. A slight rise in LBW and congenital malformations were observed. CONCLUSIONS: During the observational period, HIV+ pregnant women presented with more advanced disease and lower socio-economic status. However, improved management of HIV-infected patients (associated with increased identification and increased availability of treatment) resulted into very low transmission rates similar to those of developed countries with overall improvement of patient outcomes.

OBJETIVOS: Descrever as tendências temporais nas características sociodemográficas, imunológicas e virológicas e as das condutas utilizadas para reduzir o risco da transmissão mãe-filho do HIV. MÉTODOS: Estudo de coorte retrospectivo em uma instituição de saúde terciária no Rio de Janeiro de janeiro de 1996 a dezembro de 2004. A análise utilizou a estratificação em três períodos de tempo: 1996-1998 (P1), 1999-2001 (P2) e 2002-2004 (P3). RESULTADOS: Em 9 anos, 622 gestações foram acompanhadas. As complicações foram: mortalidade materna 0,3 por cento, natimortos 2,5 por cento, abortos 0,6 por cento, mortalidade neonatal 1,1 por cento, prematuridade 9,9 por cento, baixo peso ao nascer (BPN) 16,5 por cento, malformações congênitas 2,2 por cento. O número de gestantes HIV positivo triplicou ao longo do tempo, refletindo o aumento da prevalência da doença e a melhor identificação das pacientes. O diagnóstico da infecção pelo HIV antes da gestação aumentou de 30 por cento em P1 para 45 por cento em P3. A proporção de gestantes recebendo o tratamento combinado potente aumentou de zero em P1 para 88 por cento em P3 com uma tendência significativa a ter uma carga viral abaixo do limite de detecção no parto nos últimos anos apesar de uma maior proporção de pacientes com doença mais avançada. O índice de cesarianas eletivas aumentou de 35 por cento em P1 para 48 por cento em P3. A taxa de transmissão perinatal global foi de 2,4 por cento caindo de 3,5 por cento em P1 para 1,6 por cento em P3. Os desfechos neonatais tenderam a permanecer constantes ou a melhorar ao longo do tempo. Um discreto aumento dos índices de BPN e de malformações congênitas foi observado. CONCLUSÕES: Ao longo do período de estudo aumentou a proporção de gestantes HIV positivo com doença mais avançada e com padrão socioeconômico mais baixo. Por outro lado, a melhora da abordagem terapêutica dos pacientes infectados pelo HIV, associada a uma maior detecção de casos e maior acesso...