Updated:20/05/2022 11:48h
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This is demonstrated by a study led by a team from the Infectious Diseases area of the CIBER (CIBERINFEC) and the Gregorio Marañón Health Research Institute (IiSGM), carried out within the framework of the Pediatric Network for the Prevention, Early Detection and Treatment of HIV in children (PLANTAIDS) of the Ibero-American Program of Science and Technology for Development (CYTED), which has published the journal BMC Infectious Diseases.
Although significant prevention efforts have achieved a reduction in mother-to-child transmission of HIV (MTCT) globally, new cases of pediatric HIV infections still occur. Early diagnosis of new infections is essential to initiate adequate antiretroviral treatment to prevent infant morbidity and mortality related to infection.
IMT can occur at three times: during pregnancy, childbirth, the puerperium, and during lactation. Prevention of transmission at these stages is crucial. In this sense, the main interventions are antiretroviral therapy during pregnancy and in the neonatal period, caesarean section before delivery and rupture of the membranes, in case of detectable viral load; and the contraindication of breastfeeding for women living with HIV.
Efforts are being made in Latin America to prevent pediatric HIV, but it is still far from the elimination of mother-to-child transmission of HIV proposed by the World Health Organization (WHO) as one of the Millennium Development Goals. The WHO estimated that, in 2010, 21,000 pregnant women were HIV positive in Latin America, and only 10,600 (50.5%) received antiretroviral therapy; in that year, 3,400 children under the age of 15 were diagnosed with HIV. In 2017, a similar number of seropositive women were counted, of whom 15,300 (72.9%) were receiving this therapy. The number of new pediatric HIV diagnoses decreased to 2,400 (29%), mainly due to the implementation of measures to prevent mother-to-child transmission.
The objective of this research was to describe the cases of mother-to-child transmission of HIV in reference hospitals in Latin America and to analyze possible failures in preventive strategies for mother-to-child transmission and diagnostic delay, in order to continue advancing in the improvement of these parameters. For this, a multicenter and descriptive study of cases of IMT diagnosed during 2018 in 13 reference hospitals in 8 countries (Costa Rica, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua and Panama) was designed. The work included data from 81 children with HIV.
The results revealed that less than 3% of the women knew their HIV diagnosis before pregnancy, of which only one had received antiretroviral treatment prior to pregnancy. More than 80% of them were diagnosed after childbirth, 8.7% during pregnancy and 2.9% at delivery itself.
At the time of diagnosis, almost half of the children (49.3%) had an advanced stage of the disease. The younger the children at diagnosis, the fewer previous hospitalizations, and better immunovirologic status were found in children whose mothers knew their HIV status at delivery, compared with mothers who did not.
“Although the transmission of HIV from mother to child in Latin America has decreased in recent years, our series shows that there are still cases that indicate failures in prevention, being a critical point to improve earlier diagnosis of pregnant women” , says Marisa Navarro, one of the coordinators of this study. “Half of the boys and girls were diagnosed in an advanced stage of the disease and the delay in maternal diagnosis led to a worse clinical and immunological prognosis for these minors,” she stresses.
“This study can serve to try to improve on the missed opportunities that prevent HIV infections in children; an improvement that goes through a universal screening of HIV infection in pregnancy, which in these countries globally does not exceed 50%, and the treatment of HIV in pregnant women, in addition to the monitoring of newborns exposed to HIV”, concludes.
Pediatric Network for the Prevention, Early Detection and Treatment of HIV
This work is one of the activities carried out by the «Pediatric Network for the Prevention, Early Detection and Treatment of HIV in children» (PLANTAIDS) of the Ibero-American Program of Science and Technology for Development (CYTED). The PLANTAIDS network brings together researchers from 9 Latin American countries (Nicaragua, Guatemala, Mexico, Honduras, Costa Rica, Panama, Ecuador, Venezuela, El Salvador), who, with the support of the Spanish pediatric HIV network CoRISpe, the The Italo Latin American Institute (IiLA), the PENTA network and the ESTHER Program of the Spanish Ministry of Health are working to advance the prevention, early diagnosis and treatment of pediatric HIV in Latin America.
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