Transmissão vertical do HIV em um município da região metropolitana de Porto Alegre/RS: um estudo de caso-controle

Abstract

This dissertation aims to evaluate the vertical transmission (MT) of HIV and associated factors in exposed children living in the municipality of Viamão, between 2000 and 2023. We chose to carry out this topic due to the lack of studies that describe the situation of HIV MT in the municipality and the importance of this result for the implementation of contextualized measures that assist in the health care of exposed children. A case and control study was developed with data from the population of pregnant women and children exposed to HIV, using the National Disease Notification System (SINAN) database, HIV Pregnant database, with demographic variables of the pregnant woman, detection of infection of HIV, prenatal care and childbirth and information on the pregnant woman's anti-HIV test, use of antiretroviral therapy (ART) during pregnancy and childbirth, newborn exams and their evolution, including outcome. Missing information was investigated in the database of exposed children (SINAN Aids in children under 13 years of age) based on the variable mother's name, common to both banks as well as among adults reported as cases of HIV/Aids (SINAN HIV) . Information on CD4 and viral load in the pre-delivery period was obtained from the logistical control system for laboratory tests (SISCEL). Missing data on ART initiation were obtained from the Medication Logistics Control System (SICLOM) and number of prenatal consultations in the Live Birth Control System (SINASC). The cases were all pregnant women with children who acquired HIV infection during pregnancy, childbirth or breastfeeding in the municipality and period studied. Four controls were drawn using random numbers for each period, for each case, matched by year of diagnosis. STATA software was used for statistical analysis. A bivariate analysis was performed with the variables using Pearson's chi-square test and variables with p<0.2 in the bivariate analysis were included in the logistic regression model. In Pearson's chi-square test, the variables that showed statistical significance with HIV VT were use of prophylactic ART (p<0.01) and time of use of prophylactic ART (p<0.001). The results of the logistic regression showed that the duration of ART use during pregnancy remained associated with HIV VT, mainly at the expense of the category that did not use ART, where women who did not use ART are 7 times more likely to have HIV. outcome of TV to HIV in relation to those who used it. The age of the pregnant woman was associated in the model and shows that younger pregnant women are less likely to have the outcome of VT and HIV compared to pregnant women aged 40 or over. It was concluded that HIV VT is more likely to occur in pregnant women who did not adhere to ART during pregnancy, even with adherence to prenatal care, and demonstrates that quality prenatal care, with adequate structure and qualified professionals for the companionship and development of pregnancy is an important factor in changing the scenario found and reducing HIV VT rates.