Evaluación inicial del programa de prevención de la transmisión materno-infantil de la infección por el virus de la inmunodeficiencia humana en Guinea Ecuatorial / Initial evaluation of a programme to prevent mother-to-child transmission of human immunodeficiency virus infection in Equatorial Guinea

INTRODUCCIÓN: La prevalencia de la infección por el virus de la inmunodeficiencia humana (VIH) en gestantes en Guinea Ecuatorial (GE) es alta (7,3%). En 2008 se actualizó el protocolo de prevención de transmisión vertical (PTMH) de VIH para adaptarlo a las guías de la OMS vigentes. El objetivo de nuestro trabajo es describir las características y la evolución de los niños expuestos al VIH tras la introducción del protocolo. MÉTODOS: Estudio descriptivo retrospectivo de los hijos de madres con infección por VIH, en el Hospital Regional y Centro de Salud María Rafols en Bata (GE) seguidos desde junio de 2008 hasta noviembre de 2011. El diagnóstico de infección por VIH en los niños se basó en el protocolo de test rápidos serológicos. RESULTADOS: Se incluyeron 103 niños, y de ellos 47 eran varones. Un total de 53 pacientes (51%) completaron el seguimiento. Catorce niños (26%) fueron diagnosticados de infección por VIH (11 por diagnóstico presuntivo, 3 por persistencia de anticuerpos después de los 18 meses de vida). Seis niños (12%) fallecieron antes de un diagnóstico definitivo. El 52% de las madres recibieron tratamiento antirretroviral (TAR) durante el embarazo. La transmisión vertical en los niños cuyas madres recibieron TAR fue del 16% (3/19), frente al 43% (10/23) en los niños cuyas madres no lo recibieron (p = 0,05), y del 8% (1/13) en los niños cuyas madres recibieron TAR y el niño profilaxis posnatal (p < 0,05). CONCLUSIONES: En nuestra cohorte el cumplimiento del protocolo de PTMH ha sido todavía muy bajo. El tratamiento antirretroviral en mujeres embarazadas disminuyó la tasa de transmisión vertical, pero esta aún sigue siendo muy alta. Una elevada proporción de niños se perdieron durante el seguimiento, así que es prioritario desarrollar estrategias para evitarlo, así como medidas de diagnóstico virológico precoz

Background: The prevalence of human immunodeficiency virus (HIV)-iBACKGROUND: The prevalence of human immunodeficiency virus (HIV)-infected pregnant women in Equatorial Guinea (EG) has been reported as 7.3%. In 2008 an updated version of the PMTCT protocol was accepted according to the current WHO guidelines. The aim of this study was to describe the characteristics and outcome of children exposed to HIV after the introduction of the protocol. METHODS: A retrospective review was conducted on the clinical characteristics of the infants born to HIV-infected mothers in the Hospital Regional de Bata and Primary Health Care Centre Maria Rafols in Bata (EG) between June 2008 and November 2011. The diagnosis of HIV infection in children was based on rapid serology tests. RESULTS: A total of 103 children were included, of which 47 were males. Fifty three patients (51%) completed the follow-up (51%). Fourteen children (26%) were diagnosed with HIV infection (11 presumptive diagnosis, 3 due to persistence of antibodies at 18 months). Six children (12%) died before a definitive diagnosis. Just over than half (52%) of mothers received antiretroviral therapy (ART) during pregnancy. The transmission rate in children whose mothers received ART was 16% (3/19), compared with 43% (10/23) in children whose mothers did not receive it. Only one child was infected (8%) when the mother received ART, and child received postnatal prophylaxis. CONCLUSIONS: The PMTCT protocol compliance was still very low. Antiretroviral therapy in pregnant women decreased the rate of vertical transmission, but the rate still remains very high. Many children were lost to follow-up. Strategies to prevent loss to follow-up and methods for earlier virological diagnostic are needed

[Initial evaluation of a programme to prevent mother-to-child transmission of human immunodeficiency virus infection in Equatorial Guinea]. / Evaluación inicial del programa de prevención de la transmisión materno-infantil de la infección por el virus de la inmunodeficiencia humana en Guinea Ecuatorial.

BACKGROUND: The prevalence of human immunodeficiency virus (HIV)-infected pregnant women in Equatorial Guinea (EG) has been reported as 7.3%. In 2008 an updated version of the PMTCT protocol was accepted according to the current WHO guidelines. The aim of this study was to describe the characteristics and outcome of children exposed to HIV after the introduction of the protocol. METHODS: A retrospective review was conducted on the clinical characteristics of the infants born to HIV-infected mothers in the Hospital Regional de Bata and Primary Health Care Centre Maria Rafols in Bata (EG) between June 2008 and November 2011. The diagnosis of HIV infection in children was based on rapid serology tests. RESULTS: A total of 103 children were included, of which 47 were males. Fifty three patients (51%) completed the follow-up (51%). Fourteen children (26%) were diagnosed with HIV infection (11 presumptive diagnosis, 3 due to persistence of antibodies at 18 months). Six children (12%) died before a definitive diagnosis. Just over than half (52%) of mothers received antiretroviral therapy (ART) during pregnancy. The transmission rate in children whose mothers received ART was 16% (3/19), compared with 43% (10/23) in children whose mothers did not receive it. Only one child was infected (8%) when the mother received ART, and child received postnatal prophylaxis. CONCLUSIONS: The PMTCT protocol compliance was still very low. Antiretroviral therapy in pregnant women decreased the rate of vertical transmission, but the rate still remains very high. Many children were lost to follow-up. Strategies to prevent loss to follow-up and methods for earlier virological diagnostic are needed.