[Prophylaxis of the vertical transmission of the human immunodeficiency virus (HIV) in the Czech Republic].
OBJECTIVE
To assess the efficacy of prophylactic measures intended to reduce vertical transmission of HIV infection and to evaluate the predictive value of demographic, immunological and virological factors for determination of the risk of HIV transmission to fetus and neonate.


METHODS
56 pregnancies of 53 HIV-positive women were included in this retrospective study. The women have been in the care of the AIDS Centre of the Dpt. of Infectious Diseases, University Hospital Na Bulovce over the past 15 years. Cellular immunity tests and HIV RNA viral load in all subjects were regularly determined. In line with our present knowledge and the patients compliance, we introduced prophylactic measures, which included the administration of antiretroviral agents, delivery by Caesarean section and breast-feeding avoidance. 58 children were born from these pregnancies and repeated blood tests were performed to detect the presence or absence of HIV RNA.


RESULTS
58 infants were born from 56 pregnancies-and 3 of them (5.17%) were infected with HIV. In two mothers, we diagnosed HIV positivity few hours before delivery; another woman was diagnosed early, however, the failure of treatment was due to her insufficient compliance. In addition, premature amniorrhoea was present in two women. Moreover, one of them presented with untreated syphilis. The other 55 children stayed uninfected. In six of them, however, prophylactic measures were not fully followed, mainly because the patients disregarded them.


CONCLUSIONS
The study fully confirms the high efficacy of prophylactic measures, which substantially reduce the risk of vertical transmission of HIV infection. Routine blood tests are necessary in all pregnant women by law. The failure of prophylaxis is in most cases due to inadequate compliance with the treatment. However, we cannot rule out the possible resistance to antiretroviral agents.
Rozsypal
Hanus
H
Department of Infectious Diseases, 1st Medicine Faculty of Charles University Prague, Czech Republic. rozsypalh@volny.cz
Stanková
Marie
M
Machala
Ladislav
L
Brucová
Marie
M
D018153:Czech Republic; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy / Q000635:transmission*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000628:therapy