TRANSMISSÃO VERTICAL DO VÍRUS HIV: avaliação do processo e resultados da assistência a mães portadoras do vírus HIV e seus recém-nascidos

Abstract

Introduction: The vertical transmission is considered the main way of HIV infection in children. The equivalent to 65% of ali cases occur during the labor and delivery, 35% remains occur in uterus and by breastfeeding. Nowadays, the rate of HIV vertical transmission is about 20%, however, lots of publications in literature shows a reduction for levels between zero and 2% with the introduction of antiretroviral therapy in pregnancy and delivery, elective cesarean section, AZT use for newborn and avoiding breastfeeding. Objectives: To evaluate the process of delivery assistance of the HIV-infected women and their newborns at the Maternity of the Hospital Universitário, Unidade Materno Infantil of the Universidade Federal do Maranhão in São Luís. The prevalence of vertical transmission and loss to follow or interruption of monitoring. Method: Retrospective study of 178 HIV-infected pregnant women, admitted in the HUMI UFMA for management of delivery from 2002 to 2008. Results: Among the HIV-infected women 40 (22.47%) had rapid HIV test, 47 (26.40%) Elisa test during prenatal assistance and the remains patients 91 (51.12%) had the diagnosis before pregnancy. About TARV, 125 (70.22%) had it during prenatal care, only AZT for 84 (67.20%) and, 174 (97.0%), the AZT during labor assistance or intrapartum. The remain equivalent to 04 (2.25%), did not receive any prophylactic care. About the serum Viral Lecture (VL) and CD4, just 18 (10,11%) did the procedure; 02 (11.11%) had VL below < 1000 copies and 18 (88,89%) had VL more than > 1000 copies/ml. About the percentage of women in labor, with amniorrexe and breastfeeding interruption was respectively 102 (57.30%); 23 (12.98); 175 (98.31%), considering the labor and the amniorrexe for more than 4 hours 73 (71.57%); 19 (82.61%). AII newborns and neonates received AZT - oral solution and no one was breastfed. About HIV-positive newborns and the follow up loss respectively 11 (6.18%); 65 (36.62%). The serum conversion appeared among RNS of women with labor that lasted more than 4 hours and those who had rapid test for diagnosis during labor e, 10 (90.91%). In attention to the way of delivering, Normal or cesarean section the percentages were equivalents around 50%. Conclusion: The level of assistance of HIV-infected pregnant women according to the "Nascer Maternidade Project" guidelines was ineffective in 7 years at the Hospital Maternity under study. Due to lack of organization, individual and social vulnerability of most of these population of HIV-infected women, had a negative influence over the actions or prophylactic measures for the control of vertical transmission at the maternity under study.