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PurposeTo evaluate the maternal and neonatal safety of vaginal delivery in women with HIV following the implementation of a national protocol in Italy.MethodsVaginal delivery was offered to all eligible women who presented antenatally at twelve participating clinical sites. Data collection and definition of outcomes followed the procedures of the National Program on Surveillance on Antiretroviral Treatment in Pregnancy. Pregnancy outcomes were compared according to the mode of delivery, classified as vaginal, elective cesarean (ECS) and non-elective cesarean section (NECS).ResultsAmong 580 women who delivered between January 2012 and September 2017, 142 (24.5%) had a vaginal delivery, 323 (55.7%) had an ECS and 115 (19.8%) had an NECS. The proportion of vaginal deliveries increased significantly over time, from 18.9% in 2012 to 35.3% in 2017 (p < 0.001). Women who delivered vaginally were younger, more commonly nulliparous, diagnosed with HIV during current pregnancy, and antiretroviral-naïve, but had a slightly longer duration of pregnancy, with significantly higher birthweight of newborns. NECS was associated with adverse pregnancy outcomes. The rate of HIV transmission was minimal (0.4%). There were no differences between vaginal and ECS about delivery complications, while NECS was more commonly associated with complications compared to ECS.ConclusionsVaginal delivery in HIV-infected women with suppressed viral load appears to be safe for mother and children. No cases of HIV transmission were observed. Despite an ongoing significant increase, the rate of vaginal delivery remains relatively low compared to other countries, and further progress is needed to promote this mode of delivery in clinical practice.

Objective. In our study we evaluated the frequency of three SNPs (−52 G A, −44 C G; −20 G A) in the 5′ UTR of DEFB-1 gene, in a cohort of 130 HIV-1 infected mothers and their children, collected by the Italian group SIGO in Obstetrics and Gynecology. Methods. The three SNPs (−52 G A, −44 C G; −20 G A) in the 5′ UTR of DEFB-1 gene were genotyped by direct sequencing of PCR products. Results. The C allele at position −44 was shown to be significantly different in both HIV-1 positive mothers and their children when compared to the healthy controls. The odds ratio for −44 C allele in children born to HIV-1 infected mothers is 7.09 (confidence interval 3.38-15.3) while the odds ratio for this allele in HIV-1 infected mothers is 6.42 (confidence interval 3.14-13.4). Conclusions. Our results evidence a high frequency of the −44 CC allele in HIV-1 infected mothers and their children with augmented potential risk of maternal fetal transmission. This potential vertical transmission risk has been successfully prevented by antiretroviral drug treatment and cesarian section of the HIV-1 positive mothers.

A dissertação aborda o tema da gestão da escola pública e dos desafios à construção da qualidade da educação escolar. Tem por objetivo conhecer condições de gestão da escola pública de ensino fundamental e suas repercussões na melhoria da qualidade da educação escolar. Com aportes das ciências sociais e do debate sociológico da educação (ANTUNES, 2006; AFONSO, 2010; 2012; AZEVEDO, 2001; 2011a; 2011b; FRIGOTTO, 2009; GENTILI, 1995; IANNI, 2004; OLIVEIRA, 2009; 2010), bem como do campo da administração da educação (AGUIAR, 2011; GRACINDO, 2009; OLIVEIRA, 2011; PARO, 1997; 2001; 2012; SANDER, 2005; 2007a; 2007b), centra a discussão em torno da gestão escolar e da qualidade da educação em diferentes projetos de sociedade, de modo a sinalizar a centralidade e entrecruzamentos dessas duas frentes nas políticas educacionais recentes. Para tanto, investe na recuperação de referenciais históricos da administração da educação no Brasil e da produção do conhecimento nesse campo, assim como no exame de ordenamentos legais atuais e na exploração de estudos da área da Educação que sinalizam o quadro de debates em torno do tema. Tomando por base pressupostos investigativos da vertente críticodialética e da pesquisa qualitativa, o delineamento da etapa empírica da pesquisa compreendeu dois momentos: a realização de sessões de grupos focais em um conjunto de oito escolas municipais de ensino fundamental, das quais participaram gestores escolares, professores e membros de equipes pedagógicas das escolas; e o acesso a uma base de dados e informações acerca de ações e estratégias traçadas pelas mesmas escolas visando à melhoria da qualidade da educação, cuja recolha foi operada no âmbito da pesquisa “Indicadores de qualidade do ensino fundamental na mesorregião do Oeste de Santa Catarina: estratégias e ações na rede municipal de ensino (2010-2014)”, vinculada ao Programa Observatório da Educação (Obeduc), da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes). Os resultados indicam que as percepções dos sujeitos acerca da qualidade, com maior ou menor ênfase, dão espaço a valores e a referenciais que pautam uma perspectiva de qualidade social da educação. No entanto, também indicam que as iniciativas das escolas no campo da gestão escolar são menos vigorosas quando comparadas às medidas julgadas necessárias à melhoria da qualidade da educação em suas escolas. Conclui, ainda que provisoriamente, que os caminhos adotados pelas escolas investigadas no campo da gestão escolar não evidenciam uma sintonia mais apurada com as visões de qualidade e as medidas prioritárias declaradas pelos sujeitos.

Objective. We investigated genetic polymorphisms of MBL2 gene, in a cohort of 90 italian HIV-1 pregnant seropositive women and their children in order to understand whether the MBL2 genotype of HIV-1 positive mothers might be related to their ability to transmit the virus to their children. Materials and methods. DNA was extracted from Iso Code Stix cards, and MBL2 genoptyping was performed by Melting Temperature Assay. Results. The frequency of the MBL2 0/0 homozygotes was higher in HIV-1 positive mothers than in healthy controls, the MBL2 0/0 genotype was more frequent in children born from HIV positive mothers than healthy subjects. Conclusions. We have confirmed the association of polymorphisms involving a gene of the innate immunity with an increased risk of being infected by HIV. These polymorphisms were also evidenced in children born from HIV + mothers, but the risk of infection was strongly reduced by cesarean delivery and by antiretroviral treatment.

Background. Very low rates of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) are achievable with use of highly active antiretroviral therapy (HAART). We examine risk factors for MTCT in the HAART era and describe infants who were vertically infected, despite exposure to prophylactic MTCT interventions. Methods. Of the 4525 mother-child pairs in this prospective cohort study, 1983 were enrolled during the period of January 1997 through May 2004. Factors examined included use of antiretroviral therapy during pregnancy, maternal CD4 cell count and HIV RNA level, mode of delivery, and gestational age in logistic regression analysis. Results. Receipt of antenatal antiretroviral therapy increased from 5% at the start of the HAART era to 92% in 2001–2003. The overall MTCT rate in this period was 2.87% (95% confidence interval [CI], 2.11%–3.81%), but it was 0.99% (95% CI, 0.32%–2.30%) during 2001–2003. In logistic regression analysis that included 885 mother-child pairs, MTCT risk was associated with high maternal viral load (adjusted odds ratio [AOR], 12.1; P = .003) and elective Caesarean section (AOR, 0.33; P = .04). Detection of maternal HIV RNA was significantly associated with antenatal use of antiretroviral therapy, CD4 cell count, and mode of delivery. Among 560 women with undetectable HIV RNA levels, elective Caesarean section was associated with a 90% reduction in MTCT risk (odds ratio, 0.10; 95% CI, 0.03–0.33), compared with vaginal delivery or emergency Caesarean section. Conclusions. Our results suggest that offering an elective Caesarean section delivery to all HIV-infected women, even in areas where HAART is available, is appropriate clinical management, especially for persons with detectable viral loads. Our results also suggest that previously identified risk factors remain important.

Background. There have been no clinical trials in resource-rich regions that have addressed the question of which highly active antiretroviral therapy (HAART) regimens are more effective for optimal viral response in antiretroviral-naive, human immunodeficiency virus (HIV)-infected pregnant women. Methods. Data on 240 HIV-1-infected women starting HAART during pregnancy who were enrolled in the prospective European Collaborative Study from 1997 through 2004 were analyzed. An interval-censored survival model was used to assess whether factors, including type of HAART regimen, race, region of birth, and baseline immunological and virological status, were associated with the duration of time necessary to suppress viral load below undetectable levels before delivery of a newborn. Results. Protease inhibitor-based HAART was initiated in 156 women (65%), 125 (80%) of whom received nelfinavir, and a nevirapine-based regimen was initiated in the remaining 84 women (35%). Undetectable viral loads were achieved by 73% of the women by the time of delivery. Relative hazards of time to achieving viral suppression were 1.54 (95% confidence interval, 1.05–2.26) for nevirapine-based HAART versus PI-based regimens and 1.90 (95% confidence interval, 1.16–3.12) for western African versus non-African women. The median duration of time from HAART initiation to achievement of an undetectable viral load was estimated to be 1.4 times greater in women receiving PI-based HAART, compared with women receiving nevirapine-based HAART. Baseline HIV RNA load was also a significant predictor of the rapidity of achieving viral suppression by delivery, but baseline immune status was not. Conclusions. In this study, nevirapine-based HAART (compared with PI [mainly nelfinavir]-based HAART), western African origin, and lower baseline viral load were associated with shorter time to achieving viral suppression.