Successful prevention of HIV transmission from mother to infant in Brazil using a multidisciplinary team approach

objectives: to determine the hiv vertical transmission rate (vtr) and associated risk factors by use of zidovudine and infant care education in brazil. methods: since 1995, a prospective cohort of hiv infected pregnant women has been followed at the federal university of rio de janeiro. a multidisciplinary team was established to implement the best available strategy to prevent maternal-infant hiv transmission. patients with aids or low cd4 and high viral load received anti-retroviral drugs in addition to zidovudine. children were considered infected if they had 2 positive pcr-rna tests between 1 and 4 months of age, or were hiv antibody positive after 18 months. education regarding infant treatment and use of formula instead of breast feeding was provided. results: between 1995 and august, 2000, hiv status was determined for 145 infants. compliance with intra-partum treatment, infant treatment and use of formula was 88.2%. intra-partum zidovudine treatment was completed in 134/145 (92.6%) of patients; 88.1% had rupture of membranes < 4 hours; 85.4% of mothers were asymptomatic. the mean cd4 count was 428.4 cells and mean viral load 39,050 copies. hiv vertical transmission rate was 4/145 (2.75%; ci: 0.1%-5.4%). the only risk factor significantly associated with transmission was a failure to use zidovudine intra-partum in 2 of the 4 mothers (50% versus 6.4% in non-transmitting mothers). a trend toward low cd4 and high viral load at entry, and rupture of membranes > 4 hours were associated with increased hiv transmission. conclusion: hiv vertical transmission in brazil was reduced to a level similar to other countries with the most effective prevention programs using a multidisciplinary team approach. a high level of compliance for use of anti-retroviral drugs, the provision of health education to mothers, and use of formula for all exposed infants.