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Mother-to-Child transmission of HIV and prophylactic treatment


Author: Luca Lucia
Degree:doctor of medicine
Speciality: 14.00.10 - Infections Diseases
Year:2008
Scientific adviser: Victor Pântea
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific consultant: Constantin Spînu
doctor habilitat, professor, National Center of Public Health
Institution:
Scientific council:

Status

The thesis was presented on the 6 February, 2008
Approved by NCAA on the 17 April, 2008

Abstract

Adobe PDF document0.32 Mb / in romanian

Thesis

CZU [616.98:578.7+618.2]-084

Adobe PDF document 0.69 Mb / in romanian
139 pages


Keywords

ВИЧ-инфекция, СПИД, передача ВИЧ-инфекции от матери к ребенку, антиретровирусное лечение, иммунологические методы, цитометрический поток, вирусологические методы, PCR, бессимптомная инфекция, симптоматическая инфекция, сероположительный, сероотрицательный, CD4, РНК ВИЧ, ELISA

Summary

This paper represents a comprehensive research of Mother-to-Child transmission of HIV and infection prophylaxis by using the antiretroviral treatment, focusing on clinical, epidemiological, immunological and virologic peculiarities of HIV infection in pregnant women; on clinical, immunological and virologic aspects in children born by HIV-positive mothers; and on the effectiveness of antiretroviral treatment to prevent Mother-to-Child transmission of HIV. The research sample comprised 163 pregnant women with HIV infection (stage A and stage B) and the newborns of these women; out of 163 pregnant women 130 benefited from prophylactic ARV treatment, while 33 pregnant women and their newborns did not. The pregnant women have been examined through clinical, epidemiological, immunological and virologic methods. The main route of infection of pregnant women included in the Study was the sexual way (94.48%).

Any clinical manifestations of HIV infection has not been identified in 98 HIV-positive pregnant women, Stage A. In 32 pregnant women, HIV-positive, Stage B, the clinical symptomatology has been manifested through: hyperemia of buccal cavity mucous, which has a dry and glossy aspect, with whitish and creamy sediments, which could be easily detached, appearance of an unpleasant taste; frequent urinations, burning pain in the process of urination; vaginal whitish and creamy eliminations, genital pruritus, sensation of pain in the form of burn at the level of genitals. The level of CD4 cells higher than 500 cells/mm3, stage A, was identified in 50% of pregnant women, while the level of such cells after giving birth was identified in 48.98% of pregnant women; the same indicator for stage B was 43.75% and 46.88%, accordingly. Before the commencement of the ARV therapy with prophylactic purpose, the viral load recorded in 118 pregnant women (90,76%) reached levels higher than 1000 copies/ml.

130 pregnant women got ARV treatment with prophylactic purpose starting with the 28-th week of pregnancy. The schemes of ARV treatment have been selected depending on the clinical and para-clinical data and in conformity with the WHO recommendations and with the National Protocols for providing care and treatment for HIV and AIDS developed and approved in 2003. As a result of the ARV treatment the viral load in 124 pregnant women (95.38%) decreased and reached a non-detectable level (<400 copies/ml). Of pregnant women who were not treated with ARV 32 (97%) pregnant women were infected sexually and only 1 (3%) pregnant woman due to injectable drugs. The clinical sign in pregnant women, who did not benefited from prophylactic ARV treatment, has been observed in 10 (30,3%) pregnant women through: hyperemia of buccal cavity mucous, which had a dry and glossy aspect, with whitish and creamy sediments, which could be easily detached, appearance of an unpleasant taste; frequent urinations, burning pain in the process of urination; vaginal whitish and creamy eliminations, genital pruritus, sensation of pain in the form of burn at the level of genitals. 16 (48.49%) pregnant women had the number of CD4 more than 500 cells/mm3. The viral load was higher than 50,000 copies/ml also in 16 pregnant women.

33 pregnant women with HIV infection who did not benefit from ARV prophylactic treatment transmitted the infection to their infants in 14 (42.4%) cases. Thanks to the provision of ARV therapy perinatal transmission of HIV infection has been recorded in two (1.54%) newborns.