Amaç
Without specific interventions, the rate of HIV MTCT was estimated at 15-20% in Europe and USA, and 25-40% in African populations. As a combination of antiretroviral therapy, elective C- section delivery and refraining from breastfeeding can substantially reduce the rate of MTCT, universal HIV testing of mothers to be is recommended. To monitor practices and outcome Public Health Department of Campania Region of Southern Italy implemented since 1997 a Register of infants exposed in utero to HIV.
Yöntem
All the live infants from seropositive delivering women entered a standardized work-up for prevention and diagnosis of MTCT and side- effects control. Risk factors for MTCT were carefully assessed near birth based on medical records and structured interview of mothers and personal gynecologist.
Bulgular
In the study period 108 infants were recruited; four of them were infected. Maternal categoıy was Al in 51, A2 in 35, Bl in 2, B2 in 5, B3 in 4, Cl in 1, C2 in 3, and C3 in 7. The 67% of the maternal infection were diagnosed before becoming pregnant and the 18% were diagnosed during gestation, while 15% of them were accomplished after delivery, based on the presence of risk factors such as a HIV positive partner and/or injecting drug abuse. A positive trend (X2 <0.001) over time was found in the number of infant reported in the register and in the proportion child exposed to antiretroviral therapy either as monotherapy (41%) either as multitherapy (30%), in utero and postnatally (70%) either only postnatally (19%). C- section was carried out in 79% of the mothers and formula feeding was adopted in 90% of the infants. The most of breast fed infants passed to formula feeding within 2 or 3 days of life. One infant died at 7 days of live because of severe hearth disease. No serious side effects were found but mild anemia and prematurity (in 30% of the mothers submitted to multitherapy). At least one parent was immigrant from high prevalence locals such as sub- Saharan Africa and East Europe countries in 42 (39%) of the exposed infants and in 2/4 (50%) of the infected infants.
Sonuç
Campania region is considered a relatively protect geographic area, as estimates on 1997 were 3 to 5 exposed newborn on 70,000 birth rate, based on HIV antibody prevalence on newborn cards collected for other newborn screenings. Unpublished local data point out 45% of delivering women recorded an HIV test. Our data suggest there is an increasing number of infected women who become pregnant, an increasing number of infants exposed to ART in ulero or in early life. Property of interventions against HIV MTCT is increasing; furthermore there are opportunities to improve outcome by encouraging early in pregnaney testing especially in immigrants from epidemic areas. Low transmission rate suggests the rate of MTCT can be substantially reduced in our population even in advanced disease.
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