Preval??ncia de infec????es sexualmente transmiss??veis em gestantes infectadas pelo HIV acompanhadas em Centro de Refer??ncia em Salvador, Bahia

Avaliar a preval??ncia de infec????es sexualmente transmiss??veis (IST) em gestantes infectadas pelo HIV e estimar os fatores de riscos associados acompanhadas no ambulat??rio de pr??-natal no Centro Estadual Especializado em Diagn??stico, Assist??ncia e Pesquisa (CEDAP), em Salvador, Bahia. Metodologia: Este ?? um estudo transversal, realizado no per??odo de 01 de outubro de 2010 a 30 de setembro de 2011.Foram convidadas a participar as gestantes que procuraram atendimento no ambulat??rio de pr??-natal do CEDAP. Foram exclu??das as pacientes que utilizaram antibi??ticos h?? menos de 30 dias, apresentaram complica????es obst??tricas na primeira consulta como amea??a de abortamento, de parto prematuro e ruptura prematura de membranas. As participantes foram entrevistadas em rela????o ?? hist??ria s??cio-epidemiol??gica e cl??nica e testadas para HBsAg,anti HCV,anti HTLV I/II,VDRL,captura h??brida para Chlamydia trachomatis,cultura para Neisseria gonorrhoeae,Mycoplasma hominis e Ureaplasma urealyticum,citologia onc??tica para pesquisa de HPV.Obtidas contagens de Linf??citos TCD4 + e carga viral do HIV em amostra sangu??nea. Nossa principal vari??vel de desfecho foi a presen??a de qualquer IST. Resultados: Eram eleg??veis 76 gestantes, destas 63 (82,9%) participaram do estudo. A m??dia de idade das pacientes foi de 28,2 anos (16 - 40 anos), e de 19 semanas de idade gestacional ao chegar ao servi??o.Foi feito o diagn??stico de pelo menos uma das IST estudadas al??m do HIV em 23/63 (36,5%) das pacientes.A freq????ncia dos diagn??sticos foi HPV (15,0%), Chlamydia trachomatis (11,1%), s??filis (9,5%), hepatite C (8,1%), HTLV I/II(3,4%), hepatite B (3,2%), Mycoplasma hominis (2,1%) e Ureaplasma urealyticum (2,1%).N??o houve diagn??stico de Neisseria gonorrhoeae.N??o foi encontrada associa????o entre as vari??veis s??cio-epidemiol??gicas e a presen??a de IST nas gestantes estudadas.A contagem de linf??citos T CD4<500 cels/mm3 (p= 0,047) e carga viral>1000 c??pias (p=0,027) foram associadas ?? presen??a de IST.Discuss??o: A presen??a de IST em gestantes infectadas pelo HIV ?? freq??ente. Devido a n??o exist??ncia de associa????o com vari??veis s??cio-epidemiol??gicas recomenda-se que todas as gestantes infectadas pelo HIV devem ser investigadas. A associa????o com baixa imunidade e carga viral aumentada sugere dificuldade de acesso ao acompanhamento adequado. ?? necess??ria triagem precoce de IST no cuidado da gestante infectada pelo HIV para evitar um maior preju??zo do sistema imunol??gico e diminuir a transmiss??o vertical destas infec????esTo evaluate the prevalence of sexually transmitted infections (STI) in HIV infected pregnant women and to estimate the risk factors associated in HIV infected pregnant women followed at the prenatal care in the State Center Specializing in Diagnosis, Care and Research (CEDAP), in Salvador, Bahia. Methodology: This is a cross-sectional study conducted from 1 October 2010 to 30 September 2011. The women who sought prenatal care at CEDAP were invited to participate in the study. We excluded patients who used antibiotics for less than 30 days, had obstetric complications in the first visit such threatened abortion, premature labor and premature rupture of membranes. Participants were interviewed regarding socio-epidemiological and clinical history and tested for HBsAg, anti HCV, anti HTLV I/II, VDRL, Chlamydia trachomatis Hybrid capture, Neisseria gonorrhoeae, Mycoplasma hominis and Ureaplasma urealyticum culture, Pap smear to detect HPV. CD4+ lymphocytes counts and HIV viral load obtained in blood sample. Our main outcome variable was the presence of any STI. Results: Of 76 eligible women, 63 (82.9%) participated. The mean age of patients was 28.2 years (16-40 years), and gestational age on arrival in the service was 19 weeks. The diagnosis of at least one of sexually transmitted infections other than HIV studied in 23/63 (36.5%) patients. The frequency of diagnoses was HPV (15.0%), Chlamydia trachomatis (11.1%), syphilis (9.5%), hepatitis C (8.1%), HTLV I / II (3.4%), hepatitis B (3.2%), Mycoplasma hominis (2.1%) and Ureaplasma urealyticum (2.1%). There was no diagnosis of Neisseria gonorrhoeae. No association was found between socio-demographic variables and the presence of STIs in pregnant women studied. The CD4 T lymphocyte count below 500 cells/mm3 (p = 0.047) and viral load> 1000 copies (p = 0.027) was associated with the presence of STI. Discussion: STI are frequent in pregnant women infected with HIV. Therefore, the lack of socio-epidemiologic association recommends that all HIV pregnant women should be investigated. The association with low immunity and viral load suggests increased difficulty of access to appropriate monitoring. Thus, it is necessary in early screening for STI care of pregnant women infected with HIV to prevent further damage to the immune system and to decrease the transmission of these infections