Background. There are approximately 130 children per year who are born exposed to HIV-infected women in Uruguay. Although measures to prevent mother-to-child transmission (PMTCT) of HIV have been implemented years ago, it has not yet been possible to achieve sustained elimination of MTCT. An analysis of the national cohort of children exposed to HIV in Uruguay was conducted to evaluate the variables associated with MTCT.
Method. A cross-sectional study of live births HIV exposed between 2012 and 2016 in Uruguay.
Results. A total of 610 pregnancies resulted in 622 live births exposed to HIV. The overall MTCT rate was 2.7%: 5.3% in 2012, 1.6% in 2013, 3% in 2014, 1.8% in 2015, 1.6% in 2016. The women’s average age was 28 ± 7 years, CD4 count 508 ± 311 cells/µl. The median gestational age and interquartile range of the first pregnancy control was 12 (8-17) weeks, of HIV diagnosis was 17 (11-24) weeks in women without previous diagnosis and, of the start of HAART was 20 (14-27) weeks. The percentage of women with diagnosis of HIV prior to pregnancy and the HAART coverage was 60% and 48%, respectively. An improvement in these indicators was verified from 46.3% to 65.4% and from 27% to 67% between 2012 and 2016, respectively. (figure)
At 18-month follow-up, the MTCT rate was 0% in women with HAART prior to conception or initiating it before 14 weeks, 1% among who started HAART between 14 and 27 weeks, 3.8% among who started at gestational age greater than 27 weeks, and 19% among who did not receive HAART. The factors associated with MTCT in the univariate analysis were: poorly controlled pregnancy, HIV diagnosis late during pregnancy, seroconversion during pregnancy, do not receive any prophylaxis or start HAART late, breastfeeding, virological suppression, newborn without chemoprophylaxis. (table) There were no variables independently associated in the multivariate analysis.
Conclusions. The diagnosis of HIV and HAART coverage prior to pregnancy are the main factors in the PMTCT of HIV; so the achievement of 90-90-90 goals in HIV-infected women would make it possible to achieve the goal of eliminating perinatal HIV transmission.
