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Master's Dissertation
DOI
https://doi.org/10.11606/D.17.2004.tde-10102006-102046
Document
Author
Full name
Adriana Nunes Fernandes da Silva
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2004
Supervisor
Committee
Passos, Afonso Dinis Costa (President)
Cervi, Maria Célia
Pereira, Maria José Bistafa
Title in Portuguese
Estudo evolutivo das crianças expostas ao HIV e notificadas pelo núcleo de vigilância epidemiológica do HCFMRP-USP
Keywords in Portuguese
AIDS
AIDS infantil
transmissão vertical
Abstract in Portuguese
Esta pesquisa teve como objetivo avaliar a evolução de crianças nascidas de mães positivas para o HIV ou com AIDS no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, durante o período compreendido entre 1986 e 2001. Foram levantadas informações relativas a profilaxia pré-natal e da criança ao nascer, assim como à reversão sorológica, soropositividade e sobrevida. Dos 680 participantes, 67 (9,8%) se infectaram, 520 (76,5%) não se infectaram e 93 (13,7%) ficaram sem informação devido ao abandono de seguimento. Profilaxia durante a gestação ocorreu em 144 mulheres com o uso de uma droga (21,2%) e em 77 com a utilização de duas ou mais drogas (11,3%), não tendo se verificado em 459 gestantes (67,5%). Entre os recém nascidos, 205 (30,1%) receberam apenas AZT, 134 (19,7%) foram medicados com AZT+SMX/TMP e 341 (50,1%) não foram tratados. Ocorreu óbito de 39 crianças (5,7%), com 559 (82,2%) tendo permanecido vivas e 82 (12,0%) cuja informação foi perdida. O percentual de óbito foi consideravelmente mais elevado entre os que não receberam profilaxia (9,7%), em relação aos que receberam apenas AZT (2,9%). Não se verificou nenhuma morte entre as 134 crianças em uso AZT+SMX/TMP. As proporções de óbitos variaram de acordo com o tempo, atingindo 9,5% no período pré-profilaxia (1986/1995) e caindo para 2,7% entre os anos de 1996 e 2001. Entre os 67 indivíduos infectados pelo HIV foram verificadas 22 mortes (33,8%), valor muito superior ao encontrado entre os 520 não infectados, nos quais ocorreram apenas 4 óbitos (0,8%). Os tempos medianos de reversão sorológica foram iguais a 589 dias para os nascidos de 1986 a 1995, e 451 dias, para os que nasceram no período 1996 a 2001. As curvas de sobrevivência demonstraram o evidente favorecimento dos indivíduos que foram submetidos a algum tipo de profilaxia, indicando que a intervenção terapêutica trouxe ganhos inquestionáveis para os recém nascidos de gestantes positivas para o HIV ou com AIDS.
Title in English
Evolutive study of children exposed to HIV and notified by the Nucleus of Epidemiological Surveillance of HCFMRP-USP
Keywords in English
AIDS
infantile AIDS
vertical transmission
Abstract in English
The objective of the present study was to evaluate the evolution of children born to HIV-positive mothers or mothers with AIDS at the University Hospital, Faculty of Medicine of Ribeirão Preto, during the period from 1986 to 2001. Information was obtained about prenatal prophylaxis and infant prophylaxis at birth, and about serologic reversal, seropositivity and survival. Of the 680 participants, 67 (9.8%) were infected, 520 (76.5%) were not infected, and no information was available for 93 (13.7%) infants who were lost to follow-up. Prophylaxis during pregnancy occurred in 144 women with the use of mono prophylaxis (21.2%) and in 77 with the use of two or more drugs (11.3%), and 459 (67.5%) received no prophylaxis. Among the newborns, 205 (30.1%) received only AZT, 134 (19.7%) were medicated with AZT+SMX/TMP, and 341 (50.1%) had not carried trough prophylaxis. Thirty-nine children died (5.7%), 559 (82.2%) continued to live, and for 82 (120%) the information was lost. The death rate was considerably more elevated among the children who did not receive prophylaxis (9.7%) compared to those who received only AZT (2.9%). No death occurred among the 134 children had prophylaxis with AZT+SMX/TMP. Death rates varied according to time, reaching 9.5% during the preprophylaxis period (1986/1995) and falling to 2.7% between 1996 and 2001 Twenty-two deaths occurred among the 67 HIV-infected individuals (33.8%), a much higher value than detected among the 520 non-infected individuals (4 deaths, 0.8%). The median times for serological reversal were 589 days for the infants born between 1986 and 1995 and 451 days for those born from 1996 to 2001. The survival curves demonstrated an evident favoring of individuals submitted to some type of prophylaxis, indicating that therapeutic intervention has brought unquestionable gains for infants born to HIV-positive mothers or mothers with AIDS.
 
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Publishing Date
2006-10-16
 
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