人类免疫缺陷病毒急性感染对母乳传播影响的研究

目的了解母亲在产后输血感染HIV导致的母乳传播及其影响因素,为阻断HIV的母婴传播提供依据。方法以116名产后输血感染HIV的母亲及接受其哺乳的118名子女为研究对象,回顾性调查母乳传播率;分析母亲分娩年龄、子女性别、母亲合并感染HCV、哺乳持续时间、以及母亲哺乳期的乳腺疾病对母乳传播的影响,并探讨HIV母乳传播的危险因素;分析未作抗病毒治疗的情况下,母亲及其子女的生存期。结果 118名接受产后输血感染HIV母亲哺乳的子女,43名HIV阳性,母乳传播率为36.4%。78名母亲和27名HIV阳性子女感染的HIV均为B’亚型;母亲分娩年龄是否大于平均年龄、子女性别、母亲是否感染HCV、母乳喂养时间是否超过12个月均未增加HIV母乳传播率;乳腺疾病增加HIV母乳传播;乳腺疾病及母乳喂养时间是HIV母乳传播的危险因素;母亲的平均生存期为11.8年,HIV阳性子女的平均生存期为12.0年,两者差异无统计学意义(χ2=0.426,P=0.514)。结论母亲在产后输血感染HIV造成的HIV母乳传播率较高,乳腺疾病及母乳喂养时间长促进HIV的母乳传播,通过母乳喂养感染HIV的儿童生存期与其母亲相比差异...     

2000-2011年邢台市儿童HIV感染状况调查

目的掌握邢台市儿童HIV感染状况。方法对2000-2011年邢台市检出的109例具有母婴传播危险因素HIV阳性育龄妇女及其所生的155例子女进行流行病学调查,并采集血样进行HIV抗体检测。结果 155例子女中,检出儿童HIV感染者48例。母婴传播感染率为30.1%(48/155)。155例中有母乳喂养史119例,检出HIV感染43例,母乳喂养感染率为36.1%(43/119)。存在单纯母乳喂养因素和宫内、分娩、母乳3个因素的感染率分别为36.8%(32/87)、34.4%(11/32);人工喂养感染率为13.9%(5/36)。存在母乳喂养因素的母婴传播组HIV感染率36.1%(43/119)显著高于人工喂养的母婴传播组13.9%(5/36)。儿童HIV感染者年龄以6~12岁为主,占83.3%;感染者主要分布在沙河市40例,占83.3%;母乳喂养为主要感染途径,占感染者总数的89.6%(43/48);母乳喂养时间较长,平均2周岁;导致艾滋病儿童死亡直接原因分别为多器官功能衰竭、呼吸衰竭、脑水肿。结论母乳喂养是邢台市儿童感染HIV的主要途径。     

艾滋病病毒在有偿献血员家庭子代传播的回顾性研究

【目的】　研究艾滋病病毒通过父亲或母亲传播给子代的发生率及其影响因素。　【方法】　通过对中国中部地区某行政村有偿献血员家庭进行HIV筛查和回顾性问卷调查 ,根据有偿献血员献血地点、时间和子女的出生时间确定研究对象。　【结果】　共有 3 2个家庭 46名儿童符合入选标准 ,其中父亲HIV阳性而母亲阴性家庭 17个 ,儿童 2 5名 ,子代HIV感染发生率为 0 ;父亲HIV阴性而母亲阳性家庭 7个 ,儿童 12名 ,子代HIV感染率为16.67%;父母亲均为HIV阳性的家庭 8个 ,儿童 9名 ,子代感染率为 44 .44 %;父亲HIV阴性而母亲阳性的家庭与父母均为HIV阳性家庭的子代感染率差异无显著性 ,合并后子代HIV感染为 2 8.5 7%;HIV阳性儿童母亲HIV感染至怀孕前的时间显著少于HIV阴性儿童的母亲 ;有 3名HIV阳性儿童的感染发生在母乳喂养期。　【结论】　未见到HIV“父婴传播”存在 ,“母婴传播”概率为 2 8.75 %,母乳喂养是HIV母婴传播的一条重要途径     

艾滋病母乳传播的影响因素及阻断措施

艾滋病病毒(HIV)母婴传播是儿童感染HIV的最主要途径,其传播率为13%~42%,母乳喂养的传播率约占母婴传播率的40%。影响HIV母乳传播的因素主要包括母亲、婴儿和母乳持续时间3方面因素,预防HIV母乳传播的主要措施包括:预防育龄妇女HIV感染、给HIV感染的母亲采用高效抗逆转录病毒疗法、给婴儿服用预防性药物、选择合适的婴儿喂养方式、加热母乳或巴氏消毒。     

TTV母婴传播途径随访研究

目的 :了解输血传播病毒 (TTV)在孕产妇血清、乳汁及新生儿脐血中的感染情况 ,探讨其在母婴间的传播途径及生后 1年期间的带菌情况。方法 :应用套式 PCR对 40 0例正常孕产妇分娩前的血清及其新生儿的脐血血清标本、产妇的乳汁配对进行 TTV DNA检测 ,对阳性的母亲及其新生儿进行 6个月、 12个月随访 ,对 TTV DNA成对阳性的母血、母乳及其婴儿的血进行克隆和序列测定 ,比较分析母婴 TTV感染株之间核苷酸的序列同源性。结果 :62例孕妇血清、 4例新生儿脐血清、 2 0例母乳检测出 TTV DNA,孕母 TTV感染率 15.5% (62 / 4 0 0 ) ,出生时母婴 TTV传播率 6.5% (4/ 62 ) ,阳性母亲乳汁 TTV DNA检出率 3 2 .2 % (2 0 / 62 ) ,经 6个月、 12个月随访孕母血 TTV DNA阳性的 42对母乳喂养的母婴 ,母血清 TTV DNA阳性率分别为2 1.3 % (9/ 4 2 )、 82 .1% (2 3 / 2 8) ,婴儿血清 TTV DNA阳性率分别为 40 .5% (17/ 4 2 )、 2 8.5% (8/ 2 8)。配对比较母婴间 TTV感染株序列同源性为 97.4%～ 99.8%。结论 :TTV可经非血液途径传播 ,TTV感染可自然转阴 ,并存在健康携带者     

徐州市铜山区艾滋病母婴垂直传播流行病学分析

目的:探讨艾滋病母婴垂直传播及母乳喂养在艾滋病垂直传播中的危险性。方法:对铜山区1998年～2008年29例因受血感染艾滋病母亲感染期间生育史和所生儿童HIV感染状况做回顾性调查。结果:29例HIV阳性母亲所生33例婴幼儿中有6例感染HIV,垂直传播发生率为18.18%,其中18例是产后输血感染HIV,其所生育的18例活产婴幼儿有2例感染HIV,单纯因母乳喂养造成的垂直传播发生率为11.11%。结论:徐州铜山地区HIV母婴垂直传播的发生率接近于发达国家报道水平。单纯母乳喂养因素造成的垂直传播发生率低于有关报道。     

乙型肝炎病毒母婴传播的相关风险因素调查

目的探讨乙型肝炎病毒(HBV)母婴传播的相关风险因素,为HBV母婴传播的防治提供参考。方法选取2018年1月—2019年12月在甘肃省妇幼保健院分娩的224例乙肝表面抗原(HBsAg)阳性的产妇及其分娩新生儿224例,观察HBV母婴传播宫内感染结果,调查相关风险因素。结果 46例新生儿脐带血HBV DNA阳性,阳性率为20.54%,6个月后11例婴儿诊断为HBV母婴传播宫内感染,感染率为4.91%;单因素分析产妇年龄、分娩孕周、分娩方式、妊娠合并症或并发症与HBV母婴传播宫内感染无关,HBeAg与HBV DNA定量不同时HBV母婴传播宫内感染率不同,差异有统计学意义。新生儿性别、出生体重、1 min Apgar评分、喂养方式与HBV母婴传播宫内感染无关;非条件多因素logistic回归分析显示产妇HBeAg阳性、产妇HBV DNA定量106500copies/mL和脐带血HBV DNA定量106500copies/mL是HBV母婴传播宫内感染的相关风险因素。结论产妇HBeAg阳性及HBV DNA定量高水平、脐带血HBV DNA定量高水平是HBV母婴传播的高风险因素,产妇年龄、分娩孕周、分娩方式、妊娠合并症或并发症、新生儿性别、出生体重、1 min Apgar评分和喂养方式作为风险因素影响HBV母婴传播的证据不足。     

乙型肝炎病毒母婴传播易患因素分析

目的:探讨乙型肝炎病毒(HBV)携带母亲的新生儿母婴感染的易患因素。方法:回顾性分析HBs Ag阳性孕妇及其子女,结合住院病历及随访调查,记录母亲分娩方式、哺乳方式、儿童疫苗接种等资料,并对母亲和子女采血检测HBV血清学标志。结果:250例随访儿童中,238例出生24 h内接种了第1针乙肝疫苗,179例24 h内注射了乙肝免疫球蛋白(HBIG);儿童HBs Ag阳性4例,阳性率1.6%。其中HBe Ag阳性母亲48例的子女HBs Ag阳性4例,阳性率为8.3%明显高于孕期HBe Ag阴性母亲的子女HBs Ag阳性率为0.0%(P<0.01)。经剖宫产和阴道分娩的子女HBs Ag阳性率分别为2.1%(3/140)和0.9%(1/110)(P>0.05),人工喂养儿童HBs Ag阳性率4.8%(4/83)高于母乳喂养(P<0.05),可能与人工喂养组母亲HBe Ag阳性率53.0%(44/83)明显高于母乳喂养组2.4%(4/167)有关(P<0.01)。结论:母亲HBe Ag阳性是发生HBV母婴传播的危险因素,新生儿正规免疫预防后剖宫产和人工喂养并不降低HBV母婴感染的风险。因此,不能将剖宫产分娩作为减少HBV母婴传播的手段,并应该鼓励HBs Ag阳性产妇进行母乳喂养。     

TTV母婴传播途径随访研究

目的了解输血传播病毒(TTV)在孕产妇血清、乳汁及新生儿脐血中的感染情况,探讨其在母婴间的传播途径及生后1年期间的带菌情况.方法应用套式PCR对400例正常孕产妇分娩前的血清及其新生儿的脐血血清标本、产妇的乳汁配对进行TTV DNA检测,对阳性的母亲及其新生儿进行6个月、12个月随访,对TTV DNA成对阳性的母血、母乳及其婴儿的血进行克隆和序列测定,比较分析母婴TTV感染株之间核苷酸的序列同源性.结果62例孕妇血清、4例新生儿脐血清、20例母乳检测出TTV DNA,孕母TTV感染率15.5%(62/400),出生时母婴TTV传播率6.5%(4/62),阳性母亲乳汁TTV DNA检出率32.2%(20/62),经6个月、12个月随访孕母血TTV DNA阳性的42对母乳喂养的母婴,母血清TTV DNA阳性率分别为21.3%(9/42)、82.1%(23/28),婴儿血清TTV DNA阳性率分别为40.5%(17/42)、28.5%(8/28).配对比较母婴间TTV感染株序列同源性为97.4%～99.8%.结论TTV可经非血液途径传播,TTV感染可自然转阴,并存在健康携带者.     

母乳喂养与艾滋病毒的母婴传播

艾滋病毒(HIV)以每天5000名新感染者的速度传播,目前全世界已有1000万成人和100万儿童感染 HIV,估计至2000年将有4000万 HIV 感染者。HIV 感染者中3/4为异性性接触传播所致,妇女感染例数骤增且80%为育龄妇女,儿童 HIV 感染中80%为母婴传播,足见阻断母婴传播在控制艾滋病(AIDS)流行中具有十分重要的意义。可靠资料证实母乳可作为 HIV 母婴传播的媒介,本文简要综述母乳喂养在 HIV母婴传播中的意义、发生机理、影响因素和预防策略等方面的研究现状。     

我国部分地区2005-2007年艾滋病母婴传播水平变化趋势

目的 了解我国部分艾滋病高发地区艾滋病母婴传播水甲变化趋势.方法 自2005年1月至2009年6月在我国艾滋病相对高发的15个县(区)开展相关调查研究,对2005年1月至2007年12月期间人类免疫缺陷病毒(HIV)感染产妇分娩所生婴幼儿进行追踪随访至产后18个月,收集的儿童死亡及确定HIV感染等相关资料.结果 调查研究期间,研究地区HIV感染孕产妇所生满18月龄儿童共644名.其中,随访至满18月龄及以上的婴幼儿550名,44名儿童失访,50例死亡.550名满18月龄及以上的婴幼儿中确定HIV感染53例.2005-2007年母婴传播水半分别为13.19%(24/182)、8.90%(17/191)和6.78%(12/177),呈逐年下降趋势(X~2=4.23,P<0.05).根据判定死于艾滋病儿童的数据对随访满18月龄的HIV感染孕产妇所生儿童的HIV感染水平进行校正,2005-2007年的母婴传播率分别校正为16.74%、12.98%、9.52%,亦逐年降低(X~2=4.69,P<0.05).结论 长期、有效的预防艾滋病母婴传播干预措施可使艾滋病母婴传播水平逐年降低;采用死亡儿童数据对母婴传播率进行校正,才能正确评价预防艾滋病母婴传播措施的效果.     

Transmission of HIV-1 in the Breast-Feeding Process

Current laboratory techniques cannot distinguish the mode of vertical transmission (intrauterine, intrapartum, or postnatal) of human immunodeficiency virus type 1 (HIV-1) from mother to infant. The ability to transmit HIV-1 via breastfeeding has been established in 24 case reports, primarily involving mothers who seroconvert after delivery. Whether breast-feeding adds a notable additional risk of HIV-1 infection to the risk from pregnancy is controversial. The importance of the duration and intensity of breast-feeding in modulating the outcome of HIV transmission via breast milk also remains unclear. Factors in breast milk may play important roles in an infant's susceptibility to infection with HIV and in the expression of the virus. Pasteurization and storage enhance the intrinsic, antiviral properties of human milk. Banked human milk is pasteurized to destroy the HIV-1 virus but retains properties that may be helpful to infants of HIV-1-positive mothers in developed countries where breastfeeding is not recommended. For infants in populations where the infant mortality rate is high, the risk of death associated with HIV infection acquired via breast milk is lower than the risk associated with not being breast-fed. J Am Diet Assoc. 1996; 96:267-274.     

Reducing childhood mortality in poor countries: Antenatal and perinatal strategies to prevent mother-to-child transmission of HIV infection

Mother-to-child transmission (MTCT) is the dominant mode of acquisition of HIV infection for children. Each day an estimated 1600 children born to HIV-infected mothers become infected, 1500 of whom are in sub-Saharan Africa. Mother-to-child transmission can occur before, during and after delivery; overall rates of MTCT range from 15 to 35%. Risk factors for MTCT include maternal viral load levels, vaginal delivery, prematurity and breastfeeding. Approaches to reduce the risk of MTCT include reduction of maternal viral load through antiretroviral prophylaxis, avoidance of exposure through birth canal cleansing or elective caesarean section delivery and refraining from breastfeeding, and boosting the host immune system through nutritional supplementation or immunization. Substantial reductions in the risk of MTCT can be achieved with antiretroviral prophylaxis during pregnancy, delivery and in the neonatal period, both in settings with and without breastfeeding. Elective caesarean section independently decreases the risk, but is not a safe and feasible option in most high prevalence areas. Birth canal cleansing with chlorhexidine does not reduce the rate overall, but may be beneficial in a subgroup of women with prolonged duration of ruptured membranes. Micronutrient supplementation, including vitamin A, does not reduce MTCT of HIV, but may improve pregnancy outcome generally.     

Antenatal and perinatal strategies to prevent mother-to-child transmission of HIV infection

Mother-to-child transmission (MTCT) is the dominant mode of acquisition of HIV infection for children. Each day an estimated 1600 children born to HIV-infected mothers become infected, 1500 of whom are in sub-Saharan Africa. Mother-to-child transmission can occur before, during and after delivery; overall rates of MTCT range from 15 to 35%. Risk factors for MTCT include maternal viral load levels, vaginal delivery, prematurity and breastfeeding. Approaches to reduce the risk of MTCT include reduction of maternal viral load through antiretroviral prophylaxis, avoidance of exposure through birth canal cleansing or elective caesarean section delivery and refraining from breastfeeding, and boosting the host immune system through nutritional supplementation or immunization. Substantial reductions in the risk of MTCT can be achieved with antiretroviral prophylaxis during pregnancy, delivery and in the neonatal period, both in settings with and without breastfeeding. Elective caesarean section independently decreases the risk, but is not a safe and feasible option in most high prevalence areas. Birth canal cleansing with chlorhexidine does not reduce the rate overall, but may be beneficial in a subgroup of women with prolonged duration of ruptured membranes. Micronutrient supplementation, including vitamin A, does not reduce MTCT of HIV, but may improve pregnancy outcome generally.     

Missed opportunities to prevent mother-to-child transmission in Papua New Guinea: results from a retrospective cohort of HIV-exposed infants

Human immunodeficiency virus (HIV) diagnosis in infants born to seropositive mothers is one of the challenges of HIV epidemics in children. No data are currently available on the risk of HIV positivity among children who are exposed to HIV through their parents in Papua New Guinea (PNG). The primary aim of this study was to measure the prevalence of HIV infection among infants born to HIV-infected mothers who attended antenatal clinic of PNG General Hospital. We also determined the factors associated with mother-to-child transmission (MTCT) and hypothetically estimated their population-level impacts. Study population was determined by reviewing the Papua New Guinea General Hospital paediatric clinic HIV registry books and antenatal hospital charts. Univariable and multivariable logistic regression models were used to determine the risk factors associated with the HIV seropositivity of the infants. We also assessed their individual and combined population-level impacts to prevent MTCT using novel statistical method. A total of 58 (38.16%) children tested were HIV-positive. Mothers’ timing of diagnosis and lack of antiretroviral prophylaxis or highly active antiretroviral (HAART) use were significantly correlated with infants’ HIV status and accounted for more than 80% of all the MTCT cases, while 36% (95% confidence interval (CI): 21–54%) and 79% (95% CI: 69–87%) of the transmissions were attributed to the intrapartum and postpartum diagnoses, respectively; their combined impact was estimated to be 86% (95% CI: 82–89%). Current study provided evidence that almost 100% of the MTCT cases would have been prevented if (1) women were diagnosed antenatally, and (2) appropriate treatments (including antiretroviral prophylaxis or HAART) were provided for the mothers and infants without a delay.     

Current issues in the prevention of mother-to-child transmission of HIV-1 infection

Worldwide every year approximately 750,000 children become infected with HIV, mostly through mother-to-child transmission (MTCT). Without specific interventions, the rate of MTCT is approximately 15-20%, with prolonged breastfeeding doubling the rate to 35-40%. Current approaches to intervention to reduce the risk of MTCT focus mainly on antiretroviral prophylaxis during pregnancy, labour and in the early neonatal period, but in some settings also on delivery procedures and avoidance of breastfeeding. To reduce the risk of breastfeeding transmission, shortening the breastfeeding period and/or encouraging exclusive breastfeeding has been suggested. MTCT rates of less than 2% are now reported from countries where antiretroviral prophylaxis, elective Caesarean section and refraining from breastfeeding can be applied, whilst in settings where refraining from breastfeeding is not feasible or safe and where elective Caesarean section is also not a safe option, peripartum antiretroviral therapy can halve the risk to levels of approximately 10% at 6 weeks, although further acquisition of infection through breastfeeding substantially increases the overall rate to 20% or more. In light of the high mortality in all children of HIV-infected women, programmes for prevention of MTCT should be monitored not only in terms of HIV transmission avoided but also in terms of child survival.     

中国部分地区HIV-1流行株基因型分布与母婴传播

目的 了解中国部分地区艾滋病病毒(HIV)-1主要流行区的病毒基因型分布特征及其对母婴传播的影响。方法 通过巢式聚合酶链反应对来自全国11个省(区)的HIV-1阳性病例(包括母婴病例)的gag基因和env基因的部分区域进行扩增并测序,采用DNA分析软件进行系统树和距离等分析。结果 共完成gag基因p17测序60例,env基因C2-V4区测序69例。新疆自治区和河南地区的流行株均很单一,前者为C亚型,河南省及周边地区为泰国B亚型(B'),云南地区主要为C和E亚型,而在北京和上海地区有A、B、C、E等多种不同亚型。新疆的病毒株与云南地区的C亚型极为相似,来源相似。在32对母婴病例中,主要为B和C亚型,E亚型1例,未定型2例。B亚型母亲的母婴传播率(50.0％)较明显地高于C亚型(26.7％),但差异无统计学意义。结论 中国部分地区HIV-1的亚型分布具有明显的地域特性,亚型对母婴传播的影响尚不清楚。     

The incidence of irregular antibodies in pregnancy: a prospective study in the region of the 's-Hertogenbosch

OBJECTIVE: To determine the incidence and clinical relevance of irregular erythrocyte antibodies (IEA), in multiparous women and in primigravidal with a history of blood transfusion. DESIGN: Prospective longitudinal cohort study. METHODS: In the 's-Hertogenbosch area, the Netherlands, both primigravidae with a previous blood transfusion and multiparous women were tested for IEA in addition to the regular blood tests during the first trimester of pregnancy. If IEA were discovered, the partners were tested for the presence of the antigen involved. Blood samples of children of positive fathers were tested immediately post partum for signs of haemolytic disease of the newborn (HDN). RESULTS: During a 2.5-year period (August 1995-January 1998) a total of 2392 pregnant women were screened for IEA: 2204 multiparous women and 188 primigravidae women. In 65 women 81 IEA were discovered. In the group of 30 children positive for the antigen involved, 12 (40%) had clinical symptoms of HDN; intrauterine death was diagnosed once, one child died immediately after delivery. One child had signs of hydrops fetalis and two children needed an exchange transfusion. Phototherapy and/or regular blood transfusion were given to 7 children. Most cases of HDN were caused by anti-D, anti-Kell and anti-c antibodies. CONCLUSION: Non-RhD-IEA were found in 1.6% of pregnant women screened. First-trimester screening for IEA is recommended as it can be of help in early diagnosis and treatment of HDN.     

孕妇乙型肝炎病毒宫内感染相关危险因素研究

目的 探讨厦门市孕妇乙型肝炎病毒（hepatitis B virus,HBV）感染情况和HBV宫内感染的影响因素。方法 在1 064名孕妇第一次到医院建立孕产妇保健卡时进行问卷调查并检测其血清乙肝标志物,根据检测结果选择外周血乙型肝炎表面抗原（hepatitis B surface antigen,HBsAg）阳性的产妇179例随访至其分娩,并采集其分娩时的脐血和胎盘组织。对脐血进行HBsAg和HBV DNA的检测,对胎盘组织进行HBsAg的检测。采用χ2检验和非条件Logistic回归分析相关因素与HBV宫内感染的关系。结果 被调查的1 064名孕妇中,HBsAg阳性的孕妇共179名,感染率为16.8%。对179名HBsAg阳性的孕妇的脐血进行检测发现,发生HBV宫内感染的孕妇共34名,感染率为19.0%。孕妇HBV宫内感染的危险因素为胎盘HBsAg阳性、孕妇血清乙型肝炎E抗原（hepatitis Be antigen,HBeAg）阳性、孕前超重,OR分别为5.123（95%CI:1.422~18.413）、4.619（95%CI:1.225~17.534）、3.343（95%CI:1.233~9.092）。结论 对于HBsAg和HBeAg双阳性的超重/肥胖孕妇,其新生儿可能发生HBV宫内感染,应加强自身防护措施,合理规避HBV宫内感染风险。     

HIV基因芯片在艾滋病母婴传播早期诊断中的应用

目的：建立适用于艾滋病母婴传播早期诊断的HIV基因芯片检测技术。方法：在产后180d内，采集HIV抗体阳性母亲所生婴幼儿的样本进行检测。从HIV基因组Gag区选取3对适宜引物，经逆转录一聚合酶链反应(PT-PCR)扩增3个HIV目的基因片断。扩增产物纯化后与载体连接，转化到JM109宿主菌，接种平板培养，提取质粒。将探针点于尼龙膜上，制成基因芯片。样本提取DNA后与阳性对照质粒混合，地高辛标记显色观察结果，并和抗体检测结果相比较。结果：采用HIV基因芯片对9位HIV抗体阳性母亲所生婴幼儿进行检测，其中阳性2名，阴性7名，与抗体确认结果相比，敏感性和特异性均为100．0％。结论：该方法能够对婴幼儿进行早期诊断，判断HIV母婴传播的方式，便于干预和治疗。