Lower mother-to-child HIV-1 transmission in boys is independent of type of delivery and antiretroviral prophylaxis - The Italian Register for HIV Infection in Children
Lower mother-to-child HIV-1 transmission in boys is independent of type of delivery and antiretroviral prophylaxis - The Italian Register for HIV Infection in Children
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DOI：
10.1097/01.qai.0000164247.49098.0e
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发表时间：
2005-12-01
影响因子：
3.6
通讯作者：
de Martino, M
中科院分区：
文献类型：
--
作者：
Galli, L;Puliti, D;de Martino, M
婴儿性别与艾滋病毒-1母婴传播率（MTCT）之间的关系在意大利艾滋病毒感染儿童登记册登记的4151名儿童（2166名男孩和1985名女孩）的前瞻性队列中进行了评估。采用Logistic回归模型分别估计1985-1995年和1996-2001年期间可能影响MTCT的因素的粗优势比（ORs）、调整优势比（AORs）和95% ci。为了评估特定亚组中按性别划分的MTCT率，按分娩方式和抗逆转录病毒预防进行了单独的逻辑回归模型。在1985-1995年出生的儿童中，15.5%的男孩（95% Cl: 13.6-17.7）和17.9%的女孩（95% Cl: 15.7-20.3）受到感染（P = 0.1181）。1995年后，男孩感染比例（3.1% [95% CI: 2.0 ~ 4.4]; AOR: 0.43 [95% Cl: 0.26 ~ 0.71], P = 0.0008）低于女孩（AOR: 6.3%, 95% CI: 4.8 ~ 8.1）。男孩较低的AOR独立于择期剖宫产（AOR: 0.31, 95% Cl: 0.14-0.71）；除了选择性剖宫产（AOR: 0.38, 95% Cl: 0.19-0.78）和抗逆转录病毒预防(齐多夫定单药治疗（AOR: 0.11, 95% CI: 0.03-0.38）；无（AOR: 0.43, 95% CI: 0.21-0.90）。当对母亲进行联合治疗时，未观察到差异（AOR: 1.14, 95% CI: 0.30-4.32），但由于该组儿童感染率极低，结果可能存在偏差。在1995年以后出生的儿童中，感染艾滋病毒1的男孩比例较低。可能涉及性别固有因素（而不是分娩类型或产妇抗逆转录病毒预防），因为男孩的感染风险较低，不受干预措施的影响。一种可能的解释是，在受感染的胎儿中，更多的女孩存活到怀孕结束，并可能利用预防战略的好处。
The relationship between infant's gender and rate of HIV-1 mother-to-child transmission (MTCT) was evaluated in a prospective cohort of 4151 children (2166 boys and 1985 girls) born to HIV-1-infected mothers enrolled in the Italian Register for HIV Infection in Children. Logistic regression models were performed to estimate crude odds ratios (ORs) and adjusted odds ratios (AORs) and 95% CIs for factors potentially influencing MTCT separately for the period 1985-1995 and the period 1996-2001. To evaluate rates of MTCT by gender in specific subgroups, separate logistic regression models by mode of delivery and antiretroviral prophylaxis were performed. Among children born in 1985-1995, 15.5% boys (95% Cl: 13.6-17.7) and 17.9% girls (95% Cl: 15.7-20.3) were infected (P = 0.1181). After 1995, a lower proportion of boys (3.1% [95% CI: 2.0-4.4]; AOR: 0.43 [95% Cl: 0.26-0.71], P = 0.0008) than girls (AOR: 6.3%, 95% CI: 4.8-8.1) was infected. Lower AORs for boys persisted independently of elective cesarean delivery (AOR: 0.31, 95% Cl: 0.14-0.71); other than elective cesarean (AOR: 0.38, 95% Cl: 0.19-0.78) and antiretroviral prophylaxis (zidovudine monotherapy (AOR: 0.11, 95% CI: 0.03-0.38); none (AOR: 0.43, 95% CI: 0.21-0.90). No difference was observed when combined therapy in the mother was administered (AOR: 1.14, 95% CI: 0.30-4.32), but results were likely to be biased by the very low rate of infected children in this group. A lower proportion of HIV-1-infected boys in children born after 1995 was found. Factor(s) intrinsic to gender (rather than type of delivery or maternal antiretroviral prophylaxis) may be involved, because the risk of infection in boys was lower independent of interventions. A possible explanation is that, among infected fetuses, more girls survive up to the end of pregnancy and may take advantage of the benefits of preventive strategies.