Posadas-Robledo FJ

Language: Spanish
References: 19
Page: 374-382
PDF size: 347.37 Kb.

ABSTRACT

Objective: To assess whether neonates taken by elective cesarean from mothers infected with the Human Immunodeficiency Virus (HIV) have a lower frequency of positivity in a rapid test at birth than those born vaginally.
Materials and Methods: Retrospective, observational, descriptive study. We reviewed the cases of women with reactive HIV test during pregnancy, who received prophylactic therapy with antiretroviral during the years 2014-2016. The cases are analyzed with reactive test at birth and results are compared between delivery and caesarean section.
Results: In this studio, we analyzed 1,261 births, 1,245 women underwent caesarean section and 16 vaginal births. We observed 103 cases of babies with reactive HIV test at birth. Of these, 87 were born by caesarean section and 16 by vaginal delivery. 7% of births by caesarean section and 100% of those born by vaginal delivery, recorded reactive HIV test. The pregnant woman with HIV, who underwent elective cesarean section, showed a relative risk (RR) of .07 with a 95% confidence index (95% CI 0.06-0.09). The risk that a newborn by elective cesarean section present a reactive HIV test was between 6 and 9%.
Conclusions: Elective cesarean reduces the risk of a reactive HIV test in the newborn. 93% of neonates obtained by caesarean section were tested negative for HIV. All neonates obtained vaginally presented a rapid test reactive to HIV even with suppressed viral load. The woman with HIV should ideally have undetectable viral load at birth. When it does not meet this requirement, it is suggested to consider the practice of an elective cesarean section as an absolute indication.

REFERENCES

1. UNAIDS. Guía de inicio rápido para Spectrum, 2018. http:// www.unaids.org.

2. WHO. Global guidance on Criteria and processes for validation: Elimination of Mother-To child Transmission of HIV and syphilis. 2th ed, 2017. http://www.paho.org/hq/index. php?option=com_docman&task=doc_details&gid=44224 &Itemid=270&lang=en

3. Plazola-Camacho NG, Ortiz-Ibarra FJ. Veinte años de experiencia en el manejo de la mujer embarazada infectada por VIH-SIDA en el Instituto Nacional de Perinatología. Bol. Med. Hosp. Infant. Mex. 2009;66:350-363 http://www. scielo.org.mx/pdf/bmim/v66n4/v66n4a9.pdf

4. Townsend CL, Byrne L, Cortina-Borja M, et al. Earlier initiation of ART and further decline in mother-to-child HIV transmission rates, 2000-2011. AIDS. 2014;28:1049-57. https://journals.lww.com/aidsonline/pages/articleviewer. aspx?year=2014&issue=04240&article=00014&type=A bstract

5. López-Cervantes M, Castro-Borbonio MV, Pérez-Enríquez O, Rojas-Russell M. Causales críticas de la trasmisión vertical del VIH y sífilis congénita en México. Una perspectiva basada en estudios. Ciudad de México, 2014. www.censida. salud.gob.mx/descargas/biblioteca/CausalesTVVIHySC.pdf

6. Organización Panamericana de la Salud. Eliminación de la trasmisión materno-infantil del VIH y la sífilis en las Américas 2016. http://iris.paho.org/xmlui/bitstream/han dle/123456789/34074/9789275319550-spa.pdf.

7. CENSIDA. Programa de Acción Específico. Respuesta al VIH, Sida e ITS 2013-2018. México: Centro Nacional para la Prevención y el Control del VIH-SIDA, 2013. https:// www.gob.mx/censida/documentos/programa-de-accionespecifico- respuesta-al-vih-sida-e-its-2013-2018-100599.

8. Posadas-Robledo FJ, Uribe-Zúñiga P, Bravo-García E. VIH perinatal y sífilis congénita en México. Rev. Universitarios Potosinos 2017;218:16-21. http://www.uaslp.mx/Comunicacion- Social/Paginas/Divulgacion/Revista/UPcatorce/ Universitarios-Potosinos-218.aspx

9. Cerda J, Vera C, Rada G. Medicina basada en evidencias. Rev. Méd. Chile 2013 oct;141(10). https:// scielo.conicyt.cl/scielo.php?script=sci_arttext&pid =S0034-98872013001000014

10. Sociedad Andaluza de Medicina Intensiva y Unidades Coronarias. Consulta en línea abril 20q8. http://www.samiuc.es/ estadisticas-variables-binarias/medidas-de-comparacion/ riesgo-relativo-rr/.

11. INEGI. Natalidad. http://www.beta.inegi.org.mx/proyectos/ registros/vitales/natalidad/default.html.

12. Foster C, Pace MC, Kaye S. Early antiretroviral therapy reduces HIV DNA following perinatal HIV infection. AIDS. 2017;31 August (13):1847-51. https://journals.lww.com/ aidsonline/Abstract/2017/08240/Early_antiretroviral_therapy_ reduces_HIV_DNA.9.aspx

13. López-Cervantes M. Causales críticas asociadas a la trasmisión vertical del VIH y sífilis congénita. UNAM, CENSIDA, UPEIS, 2014. http://www.censida.salud.gob.mx/descargas/ biblioteca/CausalesTVVIHySC.pdf.

14. CONASIDA. Guía de manejo de antirretrovirales en personas con VIH. https://www.gob.mx/cms/uploads/attachment/ file/286302/Gu_a_ARV_2017.pdf.

15. OMS. Declaración de la OMS sobre tasas de cesárea. http://apps.who.int/iris/bitstream/handle/10665/161444/ WHO_RHR_15.02_spa.pdf;jsessionid=1D6C515C95F521A A8241DACE83803A4C?sequence=1.

16. Briand N, Jasseron C, Sibiude J, et al. Cesarean section for HIV-infected women in the combination antiretroviral therapies era, 2000-2010. Am J Obstet Gynecol 2013;209:335. e1-12. https://www.ncbi.nlm.nih.gov/pubmed/23791563.

17. de Vincenzi I. Triple antiretroviral compared with zidovudine and single-dose nevirapine prophylaxis during pregnancy and breastfeeding for prevention of mother-to-child transmission of HIV-1 (Kesho Bora study): a randomised controlled trial. Lancet Infect Dis. 2011;11:171-80. http:// www.thelancet.com/pdfs/journals/laninf/PIIS1473- 3099(10)70288-7.pdf

18. Centro para el Control y la Prevención de Enfermedades (CDC). Transmisión ocupacional del VIH y prevención entre los trabajadores de la salud. https://www.cdc.gov/hiv/ spanish/group/other/occupational.html.

19. Elizondo-Mayer-Serra C. El derecho a la protección de la salud. Salud Pública Mex 2007;49:144-155. https://www. scielosp.org/article/ssm/content/raw/?resource_ssm_ path=/media/assets/spm/v49n2/a10v49n2.pdf