Mother-to-child Transmission of HIV From 1999 to 2011 in the Amazonas, Brazil: Risk Factors and Remaining Gaps in Prevention Strategies.
BACKGROUND
The purpose of the study was to estimate rates of mother-to-child transmission (MTCT) of HIV in the Amazonas, Brazil, and to identify the associated factors.


METHODS
This was a retrospective cohort study of 1210 children born to HIV-infected women between 1999 and 2011 and enrolled before age of 18 months in a reference HIV/AIDS pediatrics service in Manaus. We used multivariable logistic regression to assess the effect of maternal, obstetric and prophylactic interventions on MTCT of HIV.


RESULTS
Ten children were excluded because of undocumented maternal HIV status. Among 1200 children, 163 (13.6%) were lost to follow-up. We included in the analysis 1037 children with known HIV status. Of those, 68 children were HIV infected, resulting in a MTCT rate of 6.6% [95% confidence interval (CI): 5.3-8.3]. Among mothers, 76.1% had received antiretroviral therapy during pregnancy, 59.3% elective caesarean, and 9.7% were breastfed. Factors associated with lower odds of MTCT of HIV were antiretroviral therapy during pregnancy [odds ratio (OR): 0.26; 95% CI: 0.12-0.58], elective caesarean (OR: 0.48; 95% CI: 0.23-0.98) and with MTCT: being breastfed (OR: 4.56; 95% CI: 2.19-9.50). Transmission decreased from 7.5% in 2007-2008 to 3.2% in 2011, while breastfeeding decreased from 30.8% in 1999-2000 to 3.9% in 2011-2012.


CONCLUSIONS
The HIV rate of MTCT is still high in the Amazonas and challenges for its prevention prevail including lost to follow-up and gaps in critical strategies such as antiretroviral use during pregnancy. More efforts are needed to increase the number of women and babies who successfully complete the prevention of MTCT cascade and work toward elimination of MTCT of HIV.
From the *Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil; †Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; ‡TransLab., Department of Medical Sciences, Universitat de Girona, Catalunya, Spain; and §Departamento de DST, Aids e Hepatites Virais, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brazil.
Solange Dourado
SD
de Andrade
Meritxell
M
Sabidó
Wuelton
W
Marcelo Monteiro
Luiz
L
Canellas
Vania
V
Prazeres
Adele
A
Schwartz Benzaken
D000293:Adolescent; D000328:Adult; D000818:Animals; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D001942:Breast Feeding; D003140:Communicable Disease Control / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
D044966:Anti-Retroviral Agents