Determinação da carga viral em líquido amniótico, no momento doparto, de gestantes infectadas pelo vírus da imunodeficiência humana

Abstract

Objectives: evaluate possibility to HIV detection in amniotic fluid, collected at delivery, in HIV positive pregnant and to compare viral load in this fluid with the maternal and newborn child blood samples. Methods: we enrolled 40 HIV- 1 positive women with healthy, singleton pregnancies and newborn child. All of then were submitted to elective cesarean section. The bDNA was used to determinated of maternal and child plasma viral load. Blood samples were collected after delivery. The amniotic fluid was obtained during surgery and was stored at 70º C. The NASBA (Nucleic Acid Sequence-Based Amplification) NucliSens easyMAG (Biomérieux) was used for quantification of amniotic fluidviral load. The viral load in maternal and child blood and amniotic samples were compared. Results: the median age of women was 28,5 years. The median of prenatal visits was 8 during pregnancy. 13 (32,5%) patient began pre-natal in first trimester and 17 (42,5%) began in second trimester. Maternal plasma viral load after delivery range <50 to 99.882 copies/ml. CD4 lymphocyte count, at the same time, was: 5 (13,9%) < 200 cels/mm3, 16 (44,5%) 200 to 499 cels/mm3 and 15 (41,6%) > 500 cels/mm3. Newborn infant characteristics were: eigth (20%) infants had weight less than 2500g and 3 (7,5%) were preterm (less than 37 weeks). One child had plasma viral load positive at delivery, but it became negative after 2 month. 38 children were HIV negative after 3 month. Three samples amniotic fluid viral load were positive. In the two samples viral load was repeated and one sample remained positive. All of mothers with amniotic fluid viral load positive had plasma viral load undetectable during pregnancy and after delivery. The mother of the childwho had viral load positive after birth also had plasma viral load undetectable after delivery. Conclusion: HIV-1 RNA was detectable in amniotic fluid but we wouldnt identify co-relation with mother and child plasma viral load.