[Trends of HIV mother-to-child transmission in Catalonia, Spain, between 1987 and 2003]. / Evolución de la transmisión vertical del VIH en Cataluña durante el período 1987-2003.

BACKGROUND AND OBJECTIVE: To describe and to analyze the evolution of the mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV), the clinical and epidemiological characteristics and the use of antiretrovirals (ARV) in the HIV infected pregnant women and their new-borns alive between 1987 and 2003 in Catalonia. MATERIAL AND METHOD: The available clinical-epidemiological and treatment data were obtained from 4 reference hospitals that take care of most of the children born to HIV infected mothers in Catalonia. Two of the hospitals had a data base designed to the follow up of their patients, whereas in the other 2 data were gathered by reviewing clinical registries. For the analysis, 3 periods, based on the recommendations of treatment ARV during pregnancy, were settled down: 1987-1993; 1994-1996, and 1997-2003. RESULTS: 1,105 mother-infant pairs were studied. HIV MTCT was reduced from 20.4% to 3.5% from first to third period of study (p < 0.001). The median age of the mothers increased from 24.6 to 30.5 years of age (p < 0.001). The proportion of women infected by sexual transmission increased from 17.2% to 58.8% (p < 0.001), whereas that of parenteral transmission decreased from the 79.2% to 43.5% (p < 0.001). In the last period, 74.1% of mother-child pairs received complete ARV prophylaxis regimens and 21.6% partial ones. The rate of elective caesarean-section went up from 32.2% to 58.2% (p < 0.001). CONCLUSIONS: The rates of MTCT in our setting have followed the same trend as in other countries of our surroundings. The observed changes reflect the variations in the characteristics of the epidemic in the general population. The implementation of the recommendations on ARV prophylaxis has begun early and it has extended progressively without getting to be total. Additional strategies for the universal coverage of the screening test during pregnancy are still needed.

Evolución de la transmisión vertical del VIH en Cataluña durante el período 1987-2003 / Trends of HIV mother-to-child transmission in Catalonia, Spain, between 1987 and 2003

FUNDAMENTO Y OBJETIVO: Describir y analizar la evolución de la transmisión vertical (TV) del virusde la inmunodeficiencia humana (VIH), las características clinicoepidemiológicas y el uso deantirretrovirales (ARV) en las gestantes infectadas por el VIH y sus recién nacidos vivos entre1987 y 2003 en Cataluña.MATERIAL Y MÉTODO: Se obtuvieron los datos clinicoepidemiológicos y de tratamiento disponiblesde los 4 hospitales de referencia que más hijos de madres infectadas atienden en Cataluña.Dos de ellos disponían de una base de datos propia, diseñada para el seguimiento de sus pacientes,mientras que en los otros 2 los datos se recogieron mediante revisión de historias clínicas.Para el análisis se establecieron 3 períodos en función de las recomendaciones de tratamientoARV durante el embarazo: 1987-1993; 1994-1996, y 1997-2003.RESULTADOS: Se estudió a 1.105 parejas madres-hijo. La tasa de TV se redujo del 20,4 al 3,5% entreel primer y el tercer períodos de estudio (p < 0,001). La mediana de edad de las madres se incrementódesde los 24,6 a los 30,5 años (p < 0,001). La proporción de mujeres infectadas por transmisiónsexual pasó del 17,2 al 58,8% (p < 0,001), mientras que la de transmisión parenteral pasó del 79,2al 43,5% (p < 0,001). En el último período un 74,1% de parejas madre-hijo recibió profilaxis ARVcompleta y un 21,6% parcial. Las cesáreas programadas pasaron del 32,2 al 58,2% (p < 0,001).CONCLUSIONES: Las tasas de TV en nuestro medio han seguido la misma tendencia que en otrospaíses de nuestro entorno. Los cambios observados reflejan las variaciones en las característicasde la epidemia en la población general. La adopción de las recomendaciones de la profilaxisARV se ha iniciado con prontitud y se ha extendido progresivamente sin llegar a ser total. Sonaún necesarias estrategias para la universalización de la prueba de cribado durante el embarazo

BACKGROUND AND OBJECTIVE: To describe and to analyze the evolution of the mother-to-child transmission(MTCT) of the human immunodeficiency virus (HIV), the clinical and epidemiologicalcharacteristics and the use of antiretrovirals (ARV) in the HIV infected pregnant women andtheir new-borns alive between 1987 and 2003 in Catalonia.MATERIAL AND METHOD: The available clinical-epidemiological and treatment data were obtainedfrom 4 reference hospitals that take care of most of the children born to HIV infected mothersin Catalonia. Two of the hospitals had a data base designed to the follow up of their patients,whereas in the other 2 data were gathered by reviewing clinical registries. For the analysis, 3periods, based on the recommendations of treatment ARV during pregnancy, were settleddown: 1987-1993; 1994-1996, and 1997-2003.RESULTS: 1,105 mother-infant pairs were studied. HIV MTCT was reduced from 20.4% to 3.5%from first to third period of study (p < 0.001). The median age of the mothers increased from24.6 to 30.5 years of age (p < 0.001). The proportion of women infected by sexual transmissionincreased from 17.2% to 58.8% (p < 0.001), whereas that of parenteral transmission decreasedfrom the 79.2% to 43.5% (p < 0.001). In the last period, 74.1% of mother-child pairs receivedcomplete ARV prophylaxis regimens and 21.6% partial ones. The rate of elective caesarean-sectionwent up from 32.2% to 58.2% (p < 0.001).CONCLUSIONS: The rates of MTCT in our setting have followed the same trend as in other countriesof our surroundings. The observed changes reflect the variations in the characteristics of the epidemicin the general population. The implementation of the recommendations on ARV prophylaxishas begun early and it has extended progressively without getting to be total. Additional strategiesfor the universal coverage of the screening test during pregnancy are still needed