title: Maternal risk factors for HIV infection in infants in northeastern Brazil.
abstract: BACKGROUND
  While the rate of vertically transmitted HIV infection has fallen in most regions of Brazil, there have been no similar decreases in northern and northeastern Brazil.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the risk factors associated with vertical transmission in the state of Sergipe in northeastern Brazil.
  
  
  METHODS
  This was a retrospective cohort study. We recorded clinic and registry data for all HIV-infected pregnant women and exposed children diagnosed in Sergipe from 1990 to 2011.
  
  
  RESULTS
  We identified 538 deliveries and 561 HIV-exposed infants (23 sets of twins). One hundred one (18.9%) infants were HIV-infected. In the multivariate analysis, infant antiretroviral prophylaxis was a significant protective factor (adjusted odds ratio (aOR) 0.07, 95% confidence interval (CI) 0.01-0.41, p=0.003). Breastfeeding was marginally associated with an increased odds of perinatal transmission (aOR 4.52, 95% CI 0.78-26.17, p = 0.092). The attributable risk percentage for breastfeeding over the study period was 91.0%. Transmission decreased from 91 per 100 live births before 1997 to 2 per 100 in 2011 following the adoption of the prevention protocol.
  
  
  CONCLUSIONS
  Transmission declined over the study period. The screening of pregnant women and timely initiation of prophylaxis and therapy are issues that require further attention.
authors.affiliation: Department of Nursing, Federal University of Sergipe, Aracaju, Sergipe, Brazil. Electronic address: ligiadolce@gmail.com.
authors.forename: Lígia M D
authors.initials: LM
authors.lastname: de Lemos
authors.forename: Joseph
authors.initials: J
authors.lastname: Lippi
authors.forename: George W
authors.initials: GW
authors.lastname: Rutherford
authors.forename: Gabriella S
authors.initials: GS
authors.lastname: Duarte
authors.forename: Nágyla G R
authors.initials: NG
authors.lastname: Martins
authors.forename: Victor S
authors.initials: VS
authors.lastname: Santos
authors.forename: Ricardo Q
authors.initials: RQ
authors.lastname: Gurgel
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001724:Birth Weight; D001938:Brazil / Q000453:epidemiology; D001942:Breast Feeding; D005260:Female; D015658:HIV Infections / Q000401:mortality / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D008431:Maternal-Fetal Exchange; D008875:Middle Aged; D015999:Multivariate Analysis; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: Breastfeeding; HIV; Pregnancy; Vertical infectious disease transmission