Título:	Transmissão vertical e mortalidade em crianças vivendo com HIV nascidas no Brasil, no período de 2010 a 2020
Autor(es):	Beber, Andréa Mônica Brandão
Orientador(es):	Benzaken, Adele Schwartz
Coorientador(es):	Díaz Bermúdez, Ximena Pamela
Assunto:	Mortalidade infantil HIV Transmissão vertical de doenças infecciosas Saúde materno-infantil
Data de publicação:	27-Jun-2026
Data de defesa:	23-Fev-2026
Referência:	BEBER, Andréa Mônica Brandão. Transmissão vertical e mortalidade em crianças vivendo com HIV nascidas no Brasil, no período de 2010 a 2020. 2026. 150 f., il. Tese (Doutorado em Saúde Coletiva) — Universidade de Brasília, Brasília, 2025.
Abstract:	Introduction: Vertical transmission of HIV (VT-HIV) remains the main route of infection among children, despite the expansion of global prevention policies and the high coverage of antiretroviral therapy among pregnant women. In Brazil, although advances have significantly reduced the incidence of pediatric infection, gaps in maternal and child surveillance and monitoring persist. This thesis analyzed gaps in the identification of VT-HIV cases, in the monitoring of the mother–child dyad, and in the factors associated with mortality among children living with HIV born in Brazil between 2010 and 2020. Methods: The study was structured in three stages. The first consisted of a narrative literature review examining the evolution of public health policies aimed at eliminating VT-HIV over the past four decades. The subsequent stages included retrospective cohort studies of mother–child dyads living with HIV, based on deterministic and probabilistic linkage between the national consolidated HIV database and the Siscel, Siclom, and Sinan-Gestante HIV databases. Statistical analyses were conducted using R software (version 4.3.3), applying chi-square and Mann–Whitney tests, multiple logistic and Cox regression models, as well as Kaplan–Meier survival curves and the log-rank test to estimate survival up to ten years after birth. Results: The review of 45 technical documents and scientific articles published between 1985 and 2025 highlighted advances in the Brazilian response to VT-HIV. Driven by the incorporation of scientific innovations into the Unified Health System and by the implementation of strategic programs in maternal and child health, these initiatives contributed to the reduction of pediatric AIDS cases and to the country’s international certification for the elimination of VT-HIV as a public health problem. In the cohort study, 88,162 children were identified; after applying eligibility criteria, 3,829 (4.3%) children living with HIV born in Brazil between 2010 and 2020 were included. Of these, only 2,144 (56.0%) were classified as VT-HIV cases, 1,445 (37.7%) were reclassified from the “unknown” category, and 240 (6.3%) were identified exclusively in laboratory databases. A total of 2,105 mother–child dyads (55.0%) were identified. Maternal diagnosis occurred before pregnancy in 32% of cases, during pregnancy in 24%, at delivery in 15%, and after delivery in 29%. Among children with a recorded HIV viral load, 57.1% were born to women diagnosed before delivery. Viral load testing within 60 days of life was more frequent among children born to women diagnosed before delivery (78.3%), whereas testing after 180 days was concentrated among those born to women diagnosed after delivery (55.4%). A similar pattern was observed for initiation of antiretroviral therapy. A total of 229 deaths were recorded (case-fatality rate: 6.0%), with a median age at death of six months (IQR 4–17). The risk of death was higher among children with moderate (aOR=2.44; 95% CI 1.43–4.17) and severe immunosuppression (aOR=3.80; 95% CI 2.23–6.48) and among those born in the North Region (aOR=2.32; 95% CI 1.09–4.95). Children with access to treatment had a 50% reduction in the risk of death (aOR=0.50; 95% CI 0.31–0.81); those diagnosed after 24 months had a 67% reduction (aOR=0.33; 95% CI 0.14–0.78); and children with an initial viral load below 10,000 copies/mL had an approximately 46% reduction in risk (aOR=0.54; 95% CI 0.42–0.78). Conclusion: National initiatives contributed to Brazil achieving the international target for the elimination of VT-HIV. Despite this milestone, the integration of national surveillance and information systems revealed weaknesses in interoperability, record classification, and the continuum of care, with direct implications for epidemiological surveillance. Strengthening an integrated, continuous, and equity-oriented response is essential to sustain the elimination of vertical HIV transmission in Brazil.
Unidade Acadêmica:	Faculdade de Ciências da Saúde (FS)
Informações adicionais:	Tese (doutorado) — Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva, 2026.
Programa de pós-graduação:	Programa de Pós-Graduação em Saúde Coletiva
Agência financiadora:	Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Aparece nas coleções:	Teses, dissertações e produtos pós-doutorado

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