Evolución de la transmisión vertical del VIH en Cataluña durante el período 1987-2003

Abstract

To describe and to analyze the evolution of the mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV), the clinical and epidemiological characteristics and the use of antiretrovirals (ARV) in the HIV infected pregnant women and their new-borns alive between 1987 and 2003 in Catalonia. The available clinical-epidemiological and treatment data were obtained from 4 reference hospitals that take care of most of the children born to HIV infected mothers in Catalonia. Two of the hospitals had a data base designed to the follow up of their patients, whereas in the other 2 data were gathered by reviewing clinical registries. For the analysis, 3 periods, based on the recommendations of treatment ARV during pregnancy, were settled down: 1987-1993; 1994-1996, and 1997-2003. 1,105 mother-infant pairs were studied. HIV MTCT was reduced from 20.4% to 3.5% from first to third period of study (p < 0.001). The median age of the mothers increased from 24.6 to 30.5 years of age (p < 0.001). The proportion of women infected by sexual transmission increased from 17.2% to 58.8% (p < 0.001), whereas that of parenteral transmission decreased from the 79.2% to 43.5% (p < 0.001). In the last period, 74.1% of mother-child pairs received complete ARV prophylaxis regimens and 21.6% partial ones. The rate of elective caesarean-section went up from 32.2% to 58.2% (p < 0.001). The rates of MTCT in our setting have followed the same trend as in other countries of our surroundings. The observed changes reflect the variations in the characteristics of the epidemic in the general population. The implementation of the recommendations on ARV prophylaxis has begun early and it has extended progressively without getting to be total. Additional strategies for the universal coverage of the screening test during pregnancy are still needed.