Diversity of risk of mother-to-child HIV-1 transmission according to feeding practices, CD4 cell count, and haemoglobin concentration in a South African cohort
Diversity of risk of mother-to-child HIV-1 transmission according to feeding practices, CD4 cell count, and haemoglobin concentration in a South African cohort
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DOI：
10.1111/j.1365-3156.2008.02004.x
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发表时间：
2008-03-01
影响因子：
3.3
通讯作者：
Coutsoudis, A.
中科院分区：
文献类型：
--
作者：
Tournoud, M.;Ecochard, R.;Coutsoudis, A.
目的估计分娩期和产后HIV-1母婴传播的概率，根据各种喂养方式（配方奶粉喂养，纯母乳喂养，或混合喂养）和其他母亲和婴儿covariates.METHODS我们使用的推广时间模型扩展到多个曝光研究感染的概率归因于每个传播场合。从德班（南非）出生的HIV-1阳性的未经治疗的母亲在1995年和1998年之间的551名婴儿的血液样本进行了连续测试，直到15 months.RESULTS归因于在子宫内和产时传播的感染的概率为21.88%（18.71-25.20），并没有显着相关的喂养的做法。纯母乳喂养6个月的产后传播感染概率为-0.7%（0-2.5），而混合喂养6个月的产后传播感染概率为-6.15%（3.16-9.57）。母亲CD 4细胞计数和孕龄是分娩时传播概率的显着预测因子，而母亲CD 4细胞计数和母亲血红蛋白浓度是产后传播probability.CONCLUSION有关适当的婴儿喂养的做法的决策应考虑到产后传播风险的差异之间的纯和混合喂养。混合喂养应避免母亲免疫状态差，血红蛋白浓度低。
OBJECTIVE To estimate the probabilities of intrapartum and postpartum HIV-1 mother-to-child-transmission according to various feeding practices (formula feeding, exclusive breastfeeding, or mixed-feeding) and to other mother and infant covariates.METHODS We used the promotion time model extended to multiple exposures to study the probability of infection attributable to each transmission occasion. Blood samples from 551 infants from Durban (South Africa) born to HIV-1 positive untreated mothers between 1995 and 1998 were sequentially tested until 15 months.RESULTS The probability of infection attributable to in utero and intrapartum transmission was 21.88% (18.71-25.20) and was not significantly associated with the feeding practice. The probability of infection attributable to postnatal transmission through exclusive breastfeeding was negligible -0.7% (0-2.5) for 6 months of exclusive breastfeeding-- in comparison with that observed with mixed-feeding -6.15% (3.16-9.57) for 6 months of mixed-feeding. Maternal CD4 cell count and gestational age were significant predictors of intrapartum transmission probability while maternal CD4 cell count and maternal haemoglobin concentration were significant predictors of postpartum transmission probability.CONCLUSION Decisions about appropriate infant feeding practices should take into account the difference in postpartum transmission risk between exclusive and mixed-feeding. Mixed-feeding should be all the more avoided that mothers have poor immunological statuses and low haemoglobin concentrations.