Maternal-fetal microtransfusions and HIV-1 mother-to-child transmission in Malawi
Maternal-fetal microtransfusions and HIV-1 mother-to-child transmission in Malawi
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DOI：
10.1371/journal.pmed.0030010
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发表时间：
2006-01-01
期刊：
影响因子：
15.8
通讯作者：
Meshnick, SR
中科院分区：
文献类型：
--
作者：
Kwiek, JJ;Mwapasa, V;Meshnick, SR
研究背景HIV感染母亲所生婴儿中有25%到35%的婴儿感染了HIV-1。母婴传播(MTCT)的一个潜在途径可能是通过胎盘屏障的破坏(即母胎微量输血)。方法和发现胎盘碱性磷酸酶(PLAP)是一种130kD的母体酶，不能穿越完整的胎盘屏障。我们测量了脐静脉血中PLAP活性作为母婴微量输血的指标，并将其与HIV-1 IVITCT的风险联系起来。一项病例队列研究是从感染HIV-1的马拉维孕妇队列中随机挑选的149名妇女进行的；这些妇女作为36例宫内母婴传播和43例产中IVITCT的参考组。用免疫催化法测定脐带绒活性。采用实时定量聚合酶链式反应(Real-Time-PCR)检测婴儿HIV感染状况。脐带格子活动与HIV-1 IVITCT之间的关系通过使用广义估计方程的Logistic回归来衡量。在阴道分娩中，PLAY与IPMTCT相关(风险比，2.25/log(10)ng/ml PLAP；95%可信区间，0.95-5.32)，但与宫内MTCT无关。在调整了HIV-1RNA载量、绒毛膜羊膜炎和自我报告的发热的多变量模型中，脐带活动每增加一次，发生IPMTCT的风险几乎增加两倍(风险比，2.87；95%可信区间，1.05-7.83)。结论这些结果表明，在阴道分娩期间，胎盘微量输血是IPHIV-1 IVITCT的危险因素。未来需要进行研究，以确定增加微量输血风险的因素，以预防IPHIV-1 IVITCT。
Background Between 25% and 35% of infants born to HIV-infected mothers become HIV-1 infected. One potential route of mother-to-child transmission (MTCT) could be through a breakdown in the placental barrier (i.e., maternal-fetal microtransfusions).Methods and Findings Placental alkaline phosphatase (PLAP) is a 130-kD maternal enzyme that cannot cross the intact placental barrier. We measured PLAP activity in umbilical vein serum as an indicator of maternal-fetal microtransfusion, and related this to the risk of HIV-1 IVITCT. A case-cohort study was conducted of 149 women randomly selected from a cohort of HIV-1-infected pregnant Malawians; these women served as a reference group for 36 cases of in utero MTCT and 43 cases of intrapartum (IP) IVITCT. Cord PLAID activity was measured with an immunocatalytic assay. Infant HIV status was determined by real-time PCR. The association between cord PLAID activity and HIV-1 IVITCT was measured with logistic regression using generalized estimating equations. Among vaginal deliveries, PLAID was associated with IP MTCT (risk ratio, 2.25 per log(10) ng/ml PLAP; 95% confidence interval, 0.95-5.32) but not in utero MTCT. In a multivariable model adjusted for HIV-1 RNA load, choripamnionitis, and self-reported fever, the risk of IP MTCT almost tripled for every loglo increase in cord PLAP activity (risk ratio, 2.87; 95% confidence interval, 1.05-7.83).Conclusion These results suggest that during vaginal deliveries, placental microtransfusions are a risk factor for IP HIV-1 IVITCT. Future studies are needed to identify factors that increase the risk for microtransfusions in order to prevent IP HIV-1 IVITCT.