Prevención de la transmisión vertical del VIH-1 en un hospital público de complejidad terciaria de Buenos Aires, Argentina

objective: to describe characteristics of mother-child binomium (mcb), antiretroviral (arv) prophylaxis, time trends, and variables associated with vertical transmission of hiv-1 in a population assisted by a tertiary public hospital in argentina. methods: prospective descriptive study undertaken by the hospital cosme argerich s vertical transmission working group, buenos aires city, argentina 1998-2008. periods 1998-2003 vs. 2004-2008 were compared and variables associated with vertical transmission identified. results: of 357 mcb, 21.0% of the mothers had hcv coinfection and 68.0% cd4 < 500/μl. during pregnancy, 75.0% received arv: zidovudine (17.8%), zidovudinelamivudine (19.8%), zidovudine-lamivudine-nevirapine (41.9%), and zidovudinelamivudine-protease inhibitor (11.4%); 74.0% had viral load (vl) peripartum < 1 000 copies/ml. caesarean delivery: 58.0%. intrapartum zidovudine: 83.4%; 98.0% of infants received prophylaxis; zidovudine monotherapy was the most frequently used (73.0%). of neonates, 15.4% had low birthweight and 6.7% were premature. the global vertical transmission was 3.3% (10/302). comparing both periods, an increase in triple arv and vl < 1 000 copies/ml in peripartum and a decrease in the absence of maternal/neonatal prophylaxis and overall vt was observed. the vertical transmission for 2004-2008 was 1.3% vs. 6.3% in buenos aires city (official statistics). absence of maternal/intrapartum prophylaxis and prematurity were associated with vertical transmission (p < 0.01 and p = 0.01, respectively). conclusions: a decline in overall vertical transmission between the two periods was observed attributable to increased coverage of maternal/neonatal arv administration and increased use of triple therapy. the absence of maternal/intrapartum prophylaxis was the main factor associated with vertical transmission, emphasizing the need to improve accessibility of mcb to the local public health system.