Características epidemiológicas e moleculares da infecção pelo vírus da imunodeficiência humana em gestantes no Estado do Piauí, Brasil

Abstract

It is estimated that, since its discovery in 1981 until the end of 2018, 74.9 million people have been infected with HIV and that 32 million people have died of AIDS-related illnesses since the beginning of the pandemic. Regardind infection in children (up to 13 years old), 84% of cases are due to vertical transmission. In this context, the present study aimed to identify the main epidemiological characteristics of HIV infection in pregnant women attended at a reference maternity hospital in Piauí, northeastern Brazil. This is a prospective study with the participation of 873 pregnant women attended at Maternidade Dona Evangelina Rosa (MDER), carried out between January 2016 and December 2017. For this purpose, samples were collected, epidemiological information and the diagnosis of HIV infection, carried out through anti-HIV-1/2 antibodies tests (Immunoblot HIV-1/2). In addition, syphilis diagnosis (VDRL and Rapid Treponemic Test), LTCD4 count (Flow Cytometry) and Viral Load (PCR-Real Time) counts were performed. Phylogenetic analysis allowed the comparison with other strains in the literature and the presence of resistance mutations. The data were analyzed using the statistical program Statistical Package for the Social Sciences 20.0 (SPSS). For comparative analysis, the chi-square test (2) was used, with a significance level 5% (p <0.05). Of the total participants, 17 samples tested positive for HIV and were genotyped to determine the subtypes. The prevalence of pregnant women with HIV was 1.95%, characterized as housewives, aged 12 to 35 years, heterosexual, with a partner, elementary school, residents of an urban area, own home, and family income of one to two minimum wages. It was found that 41.2% of pregnant womwn had between 0 and 6 consultations; 76% were in the 3rd trimester; 54.3% of deliveries were cesarean; 44.6% were primiparous and that 72.5% of newborns were over 2.5 kg. No statistical significance was observed in the correlations between the HIV-1 viral load and LTCD4 count parameters with the observed behavioral parameters. All HIV-1 seropositive samples were classified as subtype B (100%). DRM were detected for two samples, the PW 300 and PW 815 sequences. In the PW 300 sequence, the L90M mutation was found, while in the PW 815 sequence, L90M and K103N mutations were detected. L90M is a HIV-1 protease inhibitors (IP) resistance mutation classified as highly resistance to the drug nelfinavir and intermediate resistance to indinavir and saquinavir; the K103N mutation is associated with non-nucleoside inhibitors of HIV-1 reverse transcriptase (INNTR) and classified as highly resistant to nelfinavir and nevirapine. In the end, an flowchart for monitoring the health of pregnant women was developed to guide care and comprehensive care for HIV positive pregnant women in the State of Piauí. It is concluded that, in order to reduce the risk factors of the mother-child binomial and vertical HIV transmission, early diagnosis, quantification of viral load, genotyping and a correct decision in choosing the therapeutic scheme are of fundamental importance, thus avoiding the appearance of resistance strains.