Efecto de la información de los controles prenatales en la trasmisión del virus del vih en recién nacidos. Estudio realizado en el Hospital Abel Gilbert Pontón período 2013 mediante charlas en Unidades Educativas
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2015
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Medicina
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La gran mayoría de los casos nuevos en pediatría son consecuencia de transmisión perinatal. La transmisión puede ocurrir in útero (30-40%) durante el nacimiento (6070%) o en el período de post parto a través de la leche materna. Un niño es considerado infectado in útero, si los exámenes virológicos (VIH PCR DNA – RNA o cultivo) son positivos en las primeras 48 horas de vida. Debido al riesgo de contaminación con sangre materna, no se debe usar la sangre de cordón para estudio virológico. El niño infectado in útero, generalmente, tiene una evolución hacia síntomas de la infección más tempranamente que el niño que ha adquirido la infección en el intraparto. La patogénesis de la infección en útero no está bien comprendida, pero parece ser secundaria al paso del virus en forma transplacentaria en presencia de corioamnionitis o infección ascendente en pacientes con ruptura prematura de membranas especialmente de más de 4 horas de duración. (Martínez-Aguilar et al., 2008) La identificación temprana de la mujer infectada con VIH es crucial para evitar la transmisión perinatal. Se deberán establecer leyes universales, obligatorias, para que los médicos que atienden gestantes les ofrezcan consejería sobre la conveniencia de efectuarse voluntariamente la prueba (Elisa) durante el embarazo. (Berdasquera Corcho et al., 2001)
El tratamiento antirretroviral de una mujer embarazada abarca dos aspectos: el tratamiento de la infección por VIH en la mujer adulta y la prevención de la infección en el neonato. (Berdasquera Corcho et al., 2001)
La decisión de iniciar la terapéutica debe individualizarse y abarcar aspectos como la concentración de RNA de HIV-1 en plasma y el número de linfocitos CD4(+) T, así como la historia clínica del paciente. (Baquero-Artigao, 2009)
El manejo según el criterio clínico se elige de acuerdo a los escenarios si existe madres que no hayan estado en tratamiento TARGA y que si se debe interrumpir el embarazo e inclusive se toma en cuenta su positividad al virus durante el trabajo de parto se observa que el manejo con AZT es el pilar para los esquemas que se manejan siempre y cuando sean bien tolerados ni presenten sus efectos secundarios ya dichos anteriormente.
The vast majority of new cases in children result from perinatal transmission. Transmission can occur in utero (30-40%) at birth (60-70%) or in the postpartum period through breast milk. A child is considered infected in utero if virologic tests (HIV DNA PCR - RNA or culture) are positive in the first 48 hours of life. Because of the risk of contamination with maternal blood, do not use the cord blood for virological study. The infected child in utero generally has an evolution towards infection symptoms earlier than the child who has acquired intrapartum infection. The pathogenesis of infection in the uterus is not well understood, but appears to be secondary to the passage of the virus in the form in the presence of chorioamnionitis transplacental or ascending infection in patients with premature rupture of membranes especially of more than 4 hours. (Martinez-Aguilar et al., 2008) Early identification of women infected with HIV is crucial to prevent perinatal transmission. It should establish universal, mandatory laws, so that doctors caring expectant offer them counseling on the advisability of voluntarily performed the test (Elisa) during pregnancy. (Berdasquera Cork et al., 2001) Antiretroviral treatment of a pregnant woman has two aspects: the treatment of HIV infection in adult women and prevention of infection in the neonate. (Berdasquera Cork et al., 2001) The decision to initiate therapy should be individualized and include aspects such as the concentration of HIV-1 RNA in plasma and the number of CD4 (+) T, and the patient's history. (Baquero-Artigao, 2009) Management based on clinical judgment is chosen according to the stage if mothers who have not been on HAART and whether to terminate the pregnancy and even taking into account the positive to the virus during labor is observed that the AZT management is the mainstay for the schemes always handled as they are not well tolerated and those previously submit side effects.
The vast majority of new cases in children result from perinatal transmission. Transmission can occur in utero (30-40%) at birth (60-70%) or in the postpartum period through breast milk. A child is considered infected in utero if virologic tests (HIV DNA PCR - RNA or culture) are positive in the first 48 hours of life. Because of the risk of contamination with maternal blood, do not use the cord blood for virological study. The infected child in utero generally has an evolution towards infection symptoms earlier than the child who has acquired intrapartum infection. The pathogenesis of infection in the uterus is not well understood, but appears to be secondary to the passage of the virus in the form in the presence of chorioamnionitis transplacental or ascending infection in patients with premature rupture of membranes especially of more than 4 hours. (Martinez-Aguilar et al., 2008) Early identification of women infected with HIV is crucial to prevent perinatal transmission. It should establish universal, mandatory laws, so that doctors caring expectant offer them counseling on the advisability of voluntarily performed the test (Elisa) during pregnancy. (Berdasquera Cork et al., 2001) Antiretroviral treatment of a pregnant woman has two aspects: the treatment of HIV infection in adult women and prevention of infection in the neonate. (Berdasquera Cork et al., 2001) The decision to initiate therapy should be individualized and include aspects such as the concentration of HIV-1 RNA in plasma and the number of CD4 (+) T, and the patient's history. (Baquero-Artigao, 2009) Management based on clinical judgment is chosen according to the stage if mothers who have not been on HAART and whether to terminate the pregnancy and even taking into account the positive to the virus during labor is observed that the AZT management is the mainstay for the schemes always handled as they are not well tolerated and those previously submit side effects.
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Virus de inmunodeficiencia humana, Hospital de Especialidades Guayaquil Dr. Abel Gilbert Pontón, Cantón Guayaquil, Ecuador, Recién nacido, Atención prenatal, Transmisión vertical de enfermedad infecciosa, Programas educativos