Risk factors for late postnatal transmission of human immunodeficiency virus type 1 in sub-Saharan Africa
Risk factors for late postnatal transmission of human immunodeficiency virus type 1 in sub-Saharan Africa
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DOI：
10.1097/inf.0b013e31815b4960
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发表时间：
2008-03-01
影响因子：
3.6
通讯作者：
Read, Jennifer S.
中科院分区：
文献类型：
--
作者：
Chasela, Charles;Chen, Ying Qing;Read, Jennifer S.
背景资料：我们进行了二次数据分析的临床试验（HIVNET 024），以评估晚期产后传播（LPT）的人类免疫缺陷病毒1型（HIV-1）通过母乳喂养的危险因素。方法：有关活产，单胎婴儿的HIV-1感染的母亲进行了分析。出生后12个月内HIV-1传播的时间定义为：子宫内（出生时HIV-1 RNA结果阳性）、围产期/出生后早期（出生时结果阴性，4 - 6周访视时结果阳性）或LPT（4-6周访视时结果阴性，但此后直至12个月访视时检测结果阳性）。HIV-1-未感染的婴儿是那些阴性的HIV-1酶免疫测定结果在12个月的年龄，或阴性的HIV-1 RNA结果在整个follow-up.Results：2292 HIV-1感染的妇女，2052母亲/婴儿对符合纳入标准的婴儿。在1979名接受HIV-1检测的婴儿中，404名为HIV-1感染者，382名已知感染时间（LPT占传播的22%）。对LPT的进一步分析包括在4-6周访视时母乳喂养的婴儿（该访视时HIV-1结果为阴性），结果显示1317名婴儿中有6.9%在12个月大时通过LPT获得HIV-1感染。在调整后的analysis.Conclusions：在这个母乳喂养的人群中，6.9%的6周龄未感染的婴儿在12个月时获得HIV-1感染。制定干预措施以降低艾滋病毒1型感染者的LPT风险，并继续研究LPT的机制（以便制定更好的干预措施以减少这种传播）仍然至关重要。
Background: We conducted secondary data analyses of a clinical trial (HIVNET 024) to assess risk factors for late postnatal transmission (LPT) of human immunodeficiency virus type 1 (HIV-1) through breast-feeding.Methods: Data regarding live born, singleton infants of HIV-1infected mothers were analyzed. The timing of HIV-1 transmission through 12 months after birth was defined as: in utero (positive HIV-1 RNA results at birth), perinatal/early postnatal (negative results at birth, positive at 4-6 week visit), or LPT (negative results through the 4-6 week visit, but positive assays thereafter through the 12-month visit). HIV-1-uninfected infants were those with negative HIV-1 enzyme immunoassay results at 12 months of age, or infants with negative HIV-1 RNA results throughout follow-up.Results: Of 2292 HIV-1-infected enrolled women, 2052 mother/ infant pairs met inclusion criteria. Of 1979 infants with HIV- I tests, 404 were HIV-1-infected, and 382 had known timing of infection (LPT represented 22% of transmissions). Further analyses of LPT included infants who were breast-feeding at the 4-6 week visit (with negative HIV-1 results at that visit) revealed 6.9% of 1317 infants acquired HIV-1 infection through LPT by 12 months of age. More advanced maternal HIV-1 disease at enrollment (lower CD4(+) counts, higher plasma viral loads) were the factors associated with LPT in adjusted analyses.Conclusions: In this breast-feeding population, 6.9% of infants uninfected at 6 weeks of age acquired HIV-1 infection by 12 months. Making interventions to decrease the risk of LPT of HIV-1 available and continuing research regarding the mechanisms of LPT (so as to develop improved interventions to reduce such transmission) remain essential.