Pregnant women living with HIV and children exposed to HIV in Santa Catarina, epidemiological data from 2015 to 2021

Abstract

Vertical transmission is the transmission of an infection or disease from the mother to her fetus in the womb or newborn during childbirth. The main routes of contagion are pregnancy, childbirth and breastfeeding. To prevent transmission, all pregnant women should be investigated and monitored during the gestational period, at the time of delivery and in the puerperium. The follow-up of pregnant women in prenatal care includes the performance of several laboratory tests to identify the presence of infectious agents of vertical transmission, such as the Human Immunodeficiency Virus (HIV), guiding the treatment of the pregnant woman and avoiding infection of the fetus, also providing guidance on the possibilities of prevention. Considering the high number of HIV cases in the state of Santa Catarina, especially in the Alto Vale Itajaí region, the present study aims to present the epidemiological profile of HIV/AIDS indicators of the population of the state of Santa Catarina, specifically pregnant women and children exposed to HIV, in the period from 2015 to 2021. It is an epidemiological, retrospective, descriptive and analytical study of a historical series, also presenting information on the factors involved in vertical transmission of HIV and prevention strategies. The parameters evaluated in this study, collected from the Epidemiological Indicators Panel of the Department of Chronic Conditions Diseases and Sexually Transmitted Infections, were: number of children exposed to HIV, age of children exposed to HIV, number of HIV-infected pregnant women (GVHIV) and monitoring of these in relation to HIV viral load (CV) and CD4+ T lymphocyte count (CD4+) at the beginning of antiretroviral therapy. Although the systematization of the number of pregnant women with HIV and children exposed to the virus in the state of Santa Catarina shows annual differences in the period evaluated, the trend line referring to the number of GVHIV shows a small increase over the years, while the trend line for the number of children exposed to the virus reveals a slight decrease,  which can be elucidated by the expansion of the health team and the improvement in surveillance in the prevention of vertical transmission of HIV that has occurred over the years. The percentage of pregnant women with HIV VC lower than 50 copies/mL showed a gradual increase in the years evaluated, while the percentage with VC greater than 50 copies/mL showed a decrease. During the period evaluated in this study, less than 50% of the GVHIV had a CD4+ count and, among these, approximately 20% had CD4+ less than 350 cells/mm³ at the beginning of antiretroviral therapy. Failure to perform CD4+ counts may be related to an increase in the number of pregnant women with a VC of less than 50 copies/mL. Thus, CD4+ counts would be performed primarily in pregnant women with VC greater than 50 copies/mL and part of them with greater depletion of this cell type. In summary, this study shows the evolution of the treatment and follow-up offered to GVHIV and, consequently, to their children. It also reinforces the importance of prevention, diagnosis, treatment and prenatal follow-up strategies.