Potential risk factors for vertical HIV‐1 transmission in Catalonia, Spain: the protective role of Cesarean section
Potential risk factors for vertical HIV‐1 transmission in Catalonia, Spain: the protective role of Cesarean section
复制标题
西班牙加泰罗尼亚 HIV-1 垂直传播的潜在危险因素：剖腹产的保护作用
DOI：
--
复制
发表时间：
1997
期刊：
影响因子：
--
通讯作者：
J. Casabona
中科院分区：
文献类型：
--
作者：
A. Maguire;E. Sànchez;C. Fortuny;J. Casabona
目的：探讨某些潜在危险因素在HIV-1垂直传播中的作用。设计：对1987年至1992年加泰罗尼亚（西班牙东北部）HIV-1感染妇女所生婴儿进行前瞻性登记。方法：共有599名婴儿，出生在加泰罗尼亚医院的520名妇女被确定为在妊娠期间或分娩时感染HIV-1，包括在内。记录了分娩方式、出生体重、胎龄和母乳喂养以及母亲年龄、HIV-1感染途径、临床分期和p24抗原血症等数据。根据美国疾病控制和预防中心的标准，确定了489名（82%）婴儿的HIV-1感染状况。计算风险估计值和比值比（OR），并进行logistic回归。结果：总的垂直传播率为18.6%（95%可信区间，15.2-22.0%）。多变量分析显示，剖腹产与较低的垂直传播率（OR = 0.3; P = 0.001），是母亲通过注射毒品感染HIV-1（OR = 0.44; P = 0.02）。母乳喂养（OR = 6.9; P = 0.001）、极低出生体重（< 1500 g; OR = 6.3; P = 0.001）和p24抗原血症（OR = 4.6; P = 0.04）均与风险增加相关。剖腹产婴儿的艾滋病毒1型粗传播率为6%，而阴道分娩婴儿的艾滋病毒1型粗传播率为21%。阴道分娩的人群归因风险为61.7%。结论：研究结果表明，在没有齐多夫定预防的情况下，剖宫产具有保护作用。然而，目前的研究应针对抗逆转录病毒药物和剖腹产可能对母婴艾滋病毒-1感染产生的单独和综合影响。
Objective:To evaluate the roles of certain potential risk factors on the vertical transmission of HIV-1. Design:Prospective registry of infants born to HIV-1-infected women in Catalonia (north-east Spain) from 1987 to 1992. Methods:A total of 599 infants, born in Catalan hospitals to 520 women who were identified as being HIV-1-infected during gestation or at delivery, were included. Data on mode of delivery, birth weight, gestational age and breast-feeding as well as the mother's age, her route of HIV-1 infection, clinical stage and p24 antigenaemia, were recorded. HIV-1 infection status of 489 (82%) of the infants was determined according to the criteria of the US Centers for Disease Control and Prevention. Risk estimates and odds ratio (OR) were calculated and logistic regression was performed. Results:The overall rate of vertical transmission was 18.6% (95% confidence interval, 15.2–22.0%). Multivariate analyses revealed that Cesarean section was associated with a lower rate of vertical transmission (OR = 0.3; P = 0.001), as was maternal HIV-1 infection via injecting drug use (OR = 0.44; P = 0.02). Breast-feeding (OR = 6.9; P = 0.001), very low birth weight (< 1500 g; OR = 6.3; P = 0.001) and p24 antigenaemia (OR = 4.6; P = 0.04) were all related to increased risk. The crude rate of HIV-1 transmission was 6% among Cesarean births compared with 21% for infants born via vaginal deliveries. The population-attributable risk for vaginal deliveries was 61.7%. Conclusions:The results show a protective effect of Cesarean section in the absence of zidovudine prophylaxis. However, current research should be directed towards the individual and combined effects that antiretroviral agents and Cesarean section may have on mother-to-child HIV-1 infection.