Correlates of Mother-to-Child Transmission of HIV in the United States and Puerto Rico
Correlates of Mother-to-Child Transmission of HIV in the United States and Puerto Rico
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DOI：
10.1542/peds.2010-3691
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发表时间：
2012-01-01
期刊：
影响因子：
8
通讯作者：
Nesheim, Steven
中科院分区：
文献类型：
--
作者：
Whitmore, Suzanne K.;Taylor, Allan W.;Nesheim, Steven
目的：本研究的目的是检查美国15个司法管辖区2005年至2008年出生年份的人口统计学、行为和临床变量与母婴艾滋病毒传播之间的关系。方法：本研究使用增强围产期监测系统对生育活婴的艾滋病毒感染妇女的数据。多变量逻辑回归用于评估与母婴传播相关的变量。结果：8054例新生儿中，有179例（2.2%）被诊断为HIV感染。一半的新生儿至少有一次错过预防机会：74.3%的感染婴儿和52.1%的未感染婴儿。在7757对有足够数据进行分析的母婴中，接受晚期检测或未接受产前抗逆转录病毒药物治疗的妇女生育艾滋病毒感染婴儿的几率更高（比值比分别为2.5[95%置信区间（CI）： 1.5-4.0]和3.5 [95% CI: 2.0-6.4]）。母乳喂养的母亲的几率是不母乳喂养的母亲的4.6倍（95% CI: 2.2-9.8）。CD4计数为每微升500个细胞的女性调整后的几率。滥用药物的妇女的几率是不滥用药物的妇女的两倍（95% CI: 1.4-2.9）。结论：艾滋病毒感染妇女检测较晚、未使用抗逆转录病毒药物、滥用药物、母乳喂养或CD4细胞计数较低的婴儿感染艾滋病毒的几率较高。在美国，早期艾滋病毒诊断、药物滥用治疗、避免母乳喂养和使用产前抗逆转录病毒药物的增加对消除围产期艾滋病毒感染至关重要。儿科2012;129: e74-e81
OBJECTIVE: The goal of this study was to examine associations between demographic, behavioral, and clinical variables and mother-to-child HIV transmission in 15 US jurisdictions for birth years 2005 through 2008.METHODS: The study used Enhanced Perinatal Surveillance system data for HIV-infected women who gave birth to live infants. Multivariable logistic regression was used to assess variables associated with mother-to-child transmission.RESULTS: Among 8054 births, 179 infants (2.2%) were diagnosed with HIV infection. Half of the births had at least 1 missed prevention opportunity: 74.3% of infected infants, 52.1% of uninfected infants. Among 7757 mother-infant pairs with sufficient data for analysis, the odds of having an HIV-infected infant were higher for women who received late testing or no prenatal antiretroviral medications (odds ratio: 2.5 [95% confidence interval (CI): 1.5-4.0] and 3.5 [95% CI: 2.0-6.4], respectively). The odds for mothers who breastfed were 4.6 times (95% CI: 2.2-9.8) the odds for those who did not breastfeed. The adjusted odds for women with CD4 counts = 500 cells per microliter. The odds for women who abused substances were twice (95% CI: 1.4-2.9) those for women who did not.CONCLUSIONS: The odds of having an HIV-infected infant were higher among HIV-infected women who were tested late, had no antiretroviral medications, abused substances, breastfed, or had lower CD4 cell counts. Increases in earlier HIV diagnosis, substance abuse treatment, avoidance of breastfeeding, and use of prenatal antiretroviral medications are critical in eliminating perinatal HIV infections in the United States. Pediatrics 2012; 129: e74-e81