RESUMEN
Mother-to-child transmission of HIV (MTCT) accounts for a significant proportion of new HIV infections in Peru. The purpose of this case-control study was to examine maternal and infant factors associated with MTCT in Peru from 2015 to 2016. For each biologically confirmed case infant, we randomly selected four birth year- and birth hospital-matched controls from five hospitals in Lima-Callao. Maternal and infant information were gathered from medical records. Simple conditional logistic regression was utilized to examine possible maternal and infant characteristics associated with MTCT. The rate of MTCT was 6.9% in 2015 and 2.7% in 2016. A total of 63 matched controls were identified for 18 cases. Protective factors included higher number of prenatal visits (odds ratio [OR]: 0.72; 95% confidence interval [CI]: 0.55-0.94, p = 0.012) and having more children (OR: 0.10, 95% CI: 0.01-0.79, p = 0.029). Risk factors included later maternal diagnosis (OR: 1.19; 95% CI: 1.06-1.34; p = 0.001) and greater viral load at the time of maternal diagnosis (OR: 1.05; 95% CI: 1.01-1.10; p = 0.022). Our study highlights the importance of targeting early and continued prenatal care as specific areas to target to prevent gaps in the HIV treatment cascade for pregnant HIV-infected women. These strategies can ensure early screening and initiation of antiretroviral therapy to reduce MTCT rates.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Continuidad de la Atención al Paciente , Infecciones por VIH/tratamiento farmacológico , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Adulto , Lactancia Materna , Estudios de Casos y Controles , Niño , Femenino , Humanos , Lactante , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Madres , Perú/epidemiología , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Mujeres Embarazadas , Atención Prenatal , Factores de Riesgo , Carga ViralRESUMEN
OBJECTIVE: To determine whether a diagnosis of otitis media in the first 5 years of childhood is associated with the development of pediatric inflammatory bowel disease (IBD). STUDY DESIGN: This was a nested case-control analysis of a population-based IBD database in Manitoba, Canada. A total of 294 children with IBD diagnosed between 1989 and 2008 were matched to 2377 controls, based on age, sex, and geographic region. The diagnosis of ottis media was based on physician claims. IBD status was determined based on a validated administrative database definition. Multivariate conditional logistic regression models were used to model the association between otitis media and IBD, adjusted for annual physician visits. RESULTS: Approximately 5% of the IBD cases and 12% of the controls did not have an otitis media diagnosis before that IBD case date. By age 5 years, 89% of the IBD cases had at least one diagnosis of otitis media, compared with 82% of the controls. In multivariate analyses, compared with cases and controls without an otitis media diagnosis, individuals with an otitis media diagnosis by age 5 years were 2.8-fold more likely to be an IBD case (95% CI, 1.5-5.2; P = .001). This association was detected in stratified models examining Crohn's disease and ulcerative colitis separately. CONCLUSION: Compared with controls, subjects diagnosed with IBD were more likely to have had at least one early childhood episode of otitis media before their diagnosis. We suspect that otitis media serves as a proxy measure of antibiotic use.