Maternal syphilis infection is associated with increased risk of mother-to-child transmission of HIV in Malawi
Maternal syphilis infection is associated with increased risk of mother-to-child transmission of HIV in Malawi
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DOI：
10.1097/01.aids.0000244206.41500.27
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发表时间：
2006-09-11
期刊：
影响因子：
3.8
通讯作者：
Meshnick, Steven R.
中科院分区：
文献类型：
--
作者：
Mwapasa, Victor;Rogerson, Stephen J.;Meshnick, Steven R.
目的：确定孕产妇梅毒与 HIV 母婴传播 (MTCT) 之间的关联。设计：前瞻性队列研究。方法：对伊丽莎白女王中心医院（马拉维）入院的妊娠晚期孕妇进行 HIV 筛查（通过 HIV 快速检测）和梅毒（通过快速血浆回潮试验和梅毒螺旋体血凝试验）。根据 HIVNET 012 方案，感染 HIV 的妇女及其婴儿接受奈韦拉平治疗。他们在产后 6 周和 12 周进行了随访。通过 DNA PCR 诊断婴儿 HIV 感染。结果：在纳入的 1155 名 HIV 感染妇女中，1147 人有梅毒检测结果，其中 92 人（8.0%）感染。只有 751 名艾滋病毒呈阳性的妇女生下了在出生时接受艾滋病毒检测的活单胎婴儿。其中，65 例 (8.7%) 感染了 HIV，表明子宫内 (IU) HIV 母婴传播。在 686 名出生时艾滋病毒呈阴性的婴儿中，有 507 名得到了成功的随访。其中，89 例 (17.6%) 感染了 HIV，表明产时/产后 (IP/PP) HIV 母婴传播。调整孕产妇 log(10) HIV-1 病毒载量和低出生体重 (LBW) 后，孕产妇梅毒与 IU HIV 母婴传播相关[调整后相对风险 (ARR)，2.77； 95% CI，1.40-5.46]。此外，在调整近期发烧、乳腺感染、LBW和母亲标志HIV-1病毒载量后，母亲梅毒与IP/PP HIV MTCT相关（ARR，2.74；95% CI，1.58-4.74）。结论：母亲梅毒与IU和IP/PP HIV MTCT相关。怀孕期间孕产妇梅毒的筛查和早期治疗可能会减少儿童艾滋病毒感染。 (c) 2006 年利平科特·威廉姆斯和威尔金斯。
Objective: To determine the association between maternal syphilis and HIV mother-to-child transmission (MTCT).Design: Prospective cohort study.Methods: Pregnant women admitted at Queen Elizabeth Central Hospital (Malawi) in late third trimester were screened for HIV (by HIV rapid tests) and syphilis (by rapid plasma regain test and Treponema pallidum hemagglutination assay). HIV-infected women and their infants received nevirapine, according to the HIVNET 012 protocol. They were followed up at 6 and 12 weeks postpartum. Infant HIV infection was diagnosed by DNA PCR.Findings: Of the 1155 HIV-infected women enrolled, 1147 had syphilis test results, of whom 92 (8.0%) were infected. Only 751 HIV-positive women delivered live singleton infants who were tested for HIV at birth. Of these, 65 (8.7%) were HIV-infected, suggesting in utero (IU) HIV MTCT. Of the 686 infants who were HIV-negative at birth, 507 were successfully followed up. Of these, 89 (17.6%) became HIV-infected, suggesting intrapartum/postpartum (IP/PP) HIV MTCT. Maternal syphilis was associated with IU HIV MTCT, after adjusting for maternal log(10) HIV-1 viral load and low birth weight (LBW) [adjusted relative risk (ARR), 2.77; 95% CI, 1.40-5.46]. Furthermore, maternal syphilis was associated with IP/PP HIV MTCT (ARR, 2.74; 95% CI, 1.58-4.74), after adjusting for recent fever, breast infection, LBW and maternal logo HIV-1 viral load.Conclusion: Maternal syphilis is associated with IU and IP/PP HIV MTCT. Screening and early treatment of maternal syphilis during pregnancy may reduce pediatric HIV infections. (c) 2006 Lippincott Williams & Wilkins.