Estimated incidence and genotypes of HIV-1 among pregnant women in central Brazil

• Published in: PloS one 2013-11, Vol.8 (11), p.e79189-e79189
• Main Authors: Costa, Zelma Bernardes, Stefani, Mariane Martins de Araujo, de Lima, Yanna Andressa Ramos, de Souza, Wayner Vieira, de Siqueira Filha, Noemia Teixeira, Turchi, Marilia Dalva, Borges, Walter Costa, Filho, Clidenor Gomes, Filho, Jose Vicente Macedo, Minuzzi, Ana Lucia, Martelli, Celina Maria Turchi
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; Age Factors; AIDS; AIDS Serodiagnosis - methods; Algorithms; Brazil - epidemiology; Child; Cross-Sectional Studies; DNA polymerases; Enzyme immunoassay; Enzyme-Linked Immunosorbent Assay; Enzymes; Estimates; Female; Genetic aspects; Genetic diversity; Genotype; Genotypes; Health care; Health surveillance; HIV; HIV infections; HIV Infections - blood; HIV Infections - diagnosis; HIV Infections - epidemiology; HIV patients; HIV tests; HIV-1 - classification; HIV-1 - genetics; Human immunodeficiency virus; Humans; Immunoassay; Incidence; Infection; Infections; Mass Screening - methods; Medical diagnosis; Medical research; Medicine; Mens health; Patients; Phylogeny; pol Gene Products, Human Immunodeficiency Virus - genetics; Polymerase chain reaction; Population; Pregnancy; Pregnancy Complications, Infectious - diagnosis; Pregnancy Complications, Infectious - epidemiology; Pregnancy Complications, Infectious - virology; Pregnant women; Prevalence; Proteases; Public health; Recombinants; Ribonucleic acid; RNA; RNA-directed DNA polymerase; Screening; Seroconversion; Studies; Subgroups; Viruses; Womens health; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0079189

To estimate the incidence of HIV-1 infection among pregnant women from central-western Brazil. Observational cross-sectional study. A total of 54,139 pregnant women received antenatal HIV screening from a network of public healthcare centers in 2011. The incidence of confirmed HIV-1 infection was estimated using the Serological Testing Algorithms for Recent HIV Seroconversion (STARHS) methodology and BED-capture enzyme immunoassay (BED-CEIA). The yearly incidence was calculated, and adjusted incidence rates were estimated. For a subgroup of patients, protease and partial reverse transcriptase regions were retrotranscribed from plasma HIV-1 RNA and sequenced after performing a nested polymerase chain reaction. Of the participants, 20% had a pregnancy before the age of 18 and approximately 40% were experiencing their first pregnancy. Of the 54,139 pregnant women screened, 86 had a confirmed HIV-1 diagnosis, yielding an overall prevalence of 1.59 cases per 1000 women (95% CI 1.27-1.96). A higher prevalence was detected in the older age groups, reflecting cumulative exposure to the virus over time. Among the infected pregnant women, 20% were considered recently infected according to the BED-CEIA. The estimated incidence of HIV infection was 0.61 per 1000 person-years (95% CI 0.33-0.89); the corrected incidence was 0.47 per 1000 person-years (95% CI 0.26-0.68). In a subgroup of patients, HIV-1 subtype C (16.7%) was the second most prevalent form after subtype B (66.7%); BF1 recombinants (11.1%) and one case of subtype F1 (5.5%) were also detected. This study highlights the potential for deriving incidence estimates from a large antenatal screening program for HIV. The rate of recent HIV-1 infection among women in their early reproductive years is a public health warning to implement preventive measures.