Increased Infant Human Immunodeficiency Virus-Type One Free Survival at One Year of Age in Sub-Saharan Africa With Maternal Use of Highly Active Antiretroviral Therapy During Breast-Feeding
Increased Infant Human Immunodeficiency Virus-Type One Free Survival at One Year of Age in Sub-Saharan Africa With Maternal Use of Highly Active Antiretroviral Therapy During Breast-Feeding
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DOI：
10.1097/inf.0b013e3181950c56
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发表时间：
2009-06-01
影响因子：
3.6
通讯作者：
Palombi, Leonardo
中科院分区：
文献类型：
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作者：
Marazzi, Maria Cristina;Nielsen-Saines, Karin;Palombi, Leonardo
背景：减少HIV-1母乳喂养传播仍然是撒哈拉以南非洲预防儿科感染的一个挑战。提供公式减少传播，但往往会增加儿童死亡率在此setting.Methods：一个前瞻性的观察队列研究的HIV-1暴露的婴儿的母亲接受产前和产后的医疗保健在药物资源增强艾滋病和营养不良中心在莫桑比克进行。接受医疗护理的HIV-1感染妇女的活产婴儿入组，在1、6和12个月大时使用分支DNA进行HIV-1检测。建议母亲们在6个月内只进行母乳喂养，并在出生前6个月内在产前和产后进行HAART治疗。CD 4细胞计数低于350/cmm的妇女在基线继续HAART infinitely.Results：341婴儿从出生后，313母婴对（92%）完成6个月，283（83%）完成12个月的后续行动。287名婴儿（84%）确诊为HIV-1，其中4名死亡。有9例HIV-1传播病例：1个月时341例中有4例（1.2%），6个月时313例中有2例（0.6%），12个月时276例中有2例（0.7%）（累积率：2.8%）。2名母亲（0.6%）和11名婴儿（3.2%）死亡。产妇和婴儿死亡率分别为10万分之587和1千分之33，而国家的死亡率分别为10万分之1千和1千分之101。HIV风险降低93%，12个月无HIV存活率为94%。结论：母亲使用HAART可显著降低晚期产后HIV-1传播，婴儿存活率高至12个月。
Background: Reduction of HIV-1 breast-feeding transmission remains a challenge for prevention of pediatric infections in Sub-Saharan Africa. Provision of formula decreases transmission but often increases child mortality in this setting.Methods: A prospective observational cohort study of HIV-1 exposed infants of mothers receiving pre and postnatal medical care at Drug Resource Enhancement Against AIDS and Malnutrition centers in Mozambique was conducted. Live-born infants of HIV-1-infected women receiving medical care were enrolled, HIV-1 testing was performed at 1, 6, and 12 months of age using branched DNA. Mothers were counseled to breast-feed exclusively for 6 months and were provided HAART antenatally mid postnatally for the first 6 months. Women with CD4 cell counts less than 350/cmm at baseline continued HAART indefinitely.Results: Of 341 infants followed from birth, 313 mother-infant pairs (92%) completed 6 months and 283 (83%) completed 12 months of follow-up. HIV-1 diagnosis was ascertained in 287 infants (84%) including 4 who died. There were 9 cases of HIV-1 transmission: 4 of 341 (1.2%) at 1 month, 2 of 313 (0.6%) at 6 months, and 2 of 276 (0.7%) at 12 months (cumulative rate: 2.8%). Two mothers (0.6%) and 11 infants (3.2%) died. Maternal and infant mortality rates were 587 of 100,000 and 33 of 1000, while country rates are 1000 of 100,000 and 101 of 1000. HIV risk reduction was 93% and HIV-free survival at 12 months was 94%.Conclusions: Late postnatal transmission of HIV-1 is significantly decreased by maternal use of HAART with high infant survival rates up to 12 months of age.