Mother-to-child transmission of HIV infection in the era of highly active antiretroviral therapy
Mother-to-child transmission of HIV infection in the era of highly active antiretroviral therapy
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DOI：
10.1086/427287
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发表时间：
2005-02-01
影响因子：
11.8
通讯作者：
Horban, A
中科院分区：
文献类型：
--
作者：
Giaquinto, C;Ruga, E;Horban, A
背景。通过使用高效抗逆转录病毒疗法（HAART），可以实现极低的母婴传播率（MTCT）。我们研究了HAART时代MTCT的危险因素，并描述了尽管接受了预防性MTCT干预，但仍垂直感染的婴儿。在这项前瞻性队列研究的4525对母子中，1983对在1997年1月至2004年5月期间登记。在logistic回归分析中，检查的因素包括妊娠期间抗逆转录病毒治疗的使用、母体CD4细胞计数和HIV RNA水平、分娩方式和胎龄。产前抗逆转录病毒治疗的接受率从HAART时代开始时的5%增加到2001 - 2003年的92%。这一时期的总MTCT率为2.87%(95%可信区间[CI]， 2.11% ~ 3.81%)，而2001 ~ 2003年的MTCT率为0.99% （95% CI, 0.32% ~ 2.30%）。在包括885对母子的logistic回归分析中，MTCT风险与高母体病毒载量（调整优势比[AOR]， 12.1;）和择期剖宫产（AOR, 0.33;）相关。母体HIV RNA的检测与产前抗逆转录病毒治疗的使用、CD4细胞计数和分娩方式显著相关。在560名HIV RNA水平检测不到的妇女中，与阴道分娩或紧急剖宫产相比，选择性剖宫产与MTCT风险降低90%相关（优势比0.10;95% CI, 0.03 - 0.33）。我们的研究结果表明，为所有感染艾滋病毒的妇女提供选择性剖腹产分娩是适当的临床管理，即使在有HAART的地区也是如此，特别是对于可检测到病毒载量的人。我们的研究结果还表明，先前确定的风险因素仍然很重要。
Background. Very low rates of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) are achievable with use of highly active antiretroviral therapy (HAART). We examine risk factors for MTCT in the HAART era and describe infants who were vertically infected, despite exposure to prophylactic MTCT interventions.Methods. Of the 4525 mother-child pairs in this prospective cohort study, 1983 were enrolled during the period of January 1997 through May 2004. Factors examined included use of antiretroviral therapy during pregnancy, maternal CD4 cell count and HIV RNA level, mode of delivery, and gestational age in logistic regression analysis.Results. Receipt of antenatal antiretroviral therapy increased from 5% at the start of the HAART era to 92% in 2001 - 2003. The overall MTCT rate in this period was 2.87% ( 95% confidence interval [CI], 2.11% - 3.81%), but it was 0.99% ( 95% CI, 0.32% - 2.30%) during 2001 - 2003. In logistic regression analysis that included 885 mother-child pairs, MTCT risk was associated with high maternal viral load (adjusted odds ratio [AOR], 12.1;)and elective Caesarean section (AOR, 0.33;). Detection of maternal HIV RNA was significantly Pp. 003 Pp. 04 associated with antenatal use of antiretroviral therapy, CD4 cell count, and mode of delivery. Among 560 women with undetectable HIV RNA levels, elective Caesarean section was associated with a 90% reduction in MTCT risk (odds ratio, 0.10; 95% CI, 0.03 - 0.33), compared with vaginal delivery or emergency Caesarean section.Conclusions. Our results suggest that offering an elective Caesarean section delivery to all HIV-infected women, even in areas where HAART is available, is appropriate clinical management, especially for persons with detectable viral loads. Our results also suggest that previously identified risk factors remain important.