Factors associated with mother-to-child transmission of the human immunodeficiency virus in Pernambuco, Brazil, 2000-2009

Objective To identify risk factors associated with mother-to-child transmission of HIV in the Brazilian state of Pernambuco. Methods Retrospective cohort study with 1200 HIV-exposed children born in Pernambuco, registered up to the age of 2months in a public programme to prevent vertical transmission. Univariate and multivariate logistic regression analyses were conducted for maternal and peripartum characteristics and prophylactic interventions, to identify risk factors for mother-to-child transmission of HIV. Results The transmission rate was 9.16% (95% CI: 7.410.9). The following risk factors were independently associated with transmission: non-use of antiretroviral during pregnancy (OR: 7.8; 95% CI: 4.115); vaginal delivery (OR: 2.02; 95% CI: 1.23.4); prematurity (OR: 2.5; 95% CI: 1.34.7); and breastfeeding (OR: 2.6; 95% CI: 1.44.6). Conclusions This mother-to-child transmission rate is unacceptably high, as prophylactic interventions such as antiretroviral therapy and infant feeding formula are free of charge. Absence of antiretroviral therapy during pregnancy was the main risk factor. Therefore, early identification of exposed mothers and initiating prophylactic interventions are the main challenges for controlling transmission.