Prevention of mother-to-child HIV transmission in resource-poor countries: translating research into policy and practice

Kevin M. De Cock, MD; Mary Glenn Fowler, MD, MPH; Eric Mercier, MD, MPH; Isabelle de Vincenzi, MD, PhD; Joseph Saba, MD; Elizabeth Hoff, MSc; David J. Alnwick, MSc; Martha Rogers, MD; Nathan Shaffer, MD

JAMA. 2000;283:1175-1182.

Each year, an estimated 590,000 infants acquire human immunodeficiency virus type 1 (HIV) infection from their mothers, mostly in developing countries that are unable to implement interventions now standard in the industrialized world. In resource-poor settings, the HIV pandemic has eroded hard-won gains in infant and child survival. Recent clinical trial results from international settings suggest that short-course antiretroviral regimens could significantly reduce perinatal HIV transmission worldwide if research findings could be translated into practice. This article reviews current knowledge of mother-to-child HIV transmission in developing countries, summarizes key findings from the trials, outlines future research requirements, and describes public health challenges of implementing perinatal HIV prevention interventions in resource-poor settings. Public health efforts must also emphasize primary prevention strategies to reduce incident HIV infections among adolescents and women of childbearing age. Successful implementation of available perinatal HIV interventions could substantially improve global child survival.

     

Incidence of cervical squamous intraepithelial lesions in HIV-infected women

CONTEXT: Women infected with human immunodeficiency virus (HIV) are at increased risk for cervical squamous intraepithelial lesions (SILs), the precursors to invasive cervical cancer. However, little is known about the causes of this association. OBJECTIVES: To compare the incidence of SILs in HIV-infected vs uninfected women and to determine the role of risk factors in the pathogenesis of such lesions. DESIGN: Prospective cohort study conducted from October 1,1991, to June 30, 1996. SETTING: Urban clinics for sexually transmitted diseases, HIV infection, and methadone maintenance. PARTICIPANTS: A total of 328 HIV-infected and 325 uninfected women with no evidence of SILs by Papanicolaou test or colposcopy at study entry. MAIN OUTCOME MEASURE: Incident SILs confirmed by biopsy, compared by HIV status and risk factors. RESULTS: During about 30 months of follow-up, 67 (20%) HIV-infected and 16 (5%) uninfected women developed a SIL (incidence of 8.3 and 1.8 cases per 100 person-years in sociodemographically similar infected and uninfected women, respectively [P<.001]). Of incident SILs, 91% were low grade in HIV-infected women vs 75% in uninfected women. No invasive cervical cancers were identified. By multivariate analysis, significant risk factors for incident SILs were HIV infection (relative risk [RR], 3.2; 95% confidence interval [CI], 1.7-6.1), transient human papillomavirus (HPV) DNA detection (RR, 5.5; 95% CI, 1.4-21.9), persistent HPV DNA types other than 16 or 18 (RR, 7.6; 95% CI, 1.9-30.3), persistent HPV DNA types 16 and 18 (RR, 11.6; 95% CI, 2.7-50.7), and younger age (<37.5 years; RR, 2.1; 95% CI, 1.3-3.4). CONCLUSIONS: In our study, 1 in 5 HIV-infected women with no evidence of cervical disease developed biopsy-confirmed SILs within 3 years, highlighting the importance of cervical cancer screening programs in this population.     

福建省部分地区吸毒者和暗娼艾滋病KABP研究

目的：了解福建省吸毒者和暗娼艾滋病相关知识水平、态度和危险行为，为其他艾滋病防治活动提供依据。方法：在戒毒所、妇教所和劳教所按照随机抽样的方法选择了185名吸毒者和159名暗娼，由调查员对调查对象进行一对一的问卷调查。问卷内容包括人口学信息、性行为、吸毒史、艾滋瘕相关知识及态度等，随后对两类人群的部分结果进行了比较。结果：很多调查对象对自己的高危行为认识不足。吸毒者的艾滋病知识水平高于暗娼，暗娼比吸毒者对艾滋病和感染者歧视更重。与危险行为相关的因素主要有男性、收入低及对高危行为认识不足。与艾滋病知识水平相关的因素主要有文化程度、婚姻状况及知道了解和检查艾滋病的场所。结论：应采用多种方式在监管场所开展艾滋病宣传教育，提高吸毒者和暗娼的艾滋病知识知晓率及对自身危险行为认识，促使他们改变自己的高危行为。     

种子招募的静脉吸毒人群高危行为及HIV、HCV和梅毒感染特征

目的：了解在四川省凉山州地区队列组建中不同招募途径的静脉吸毒人群高危行为及HIV、HCV和梅毒感染特征情况。方法：在队列组建时调查研究对象的招募方式、社会人口学和高危行为特征，采集血样检测HIV、HCV和梅毒感染情况。结果：在379名招募的静脉吸毒人群中，309人（81．5％）是通过种子推荐来的，70人（18．5％）是从其他途径获得信息来的。种子介绍的与其他方式招募的研究对象在民族构成、近3个月静脉注射吸毒频率、近3个月海洛因混合安定使用频率差异有统计学意义。近3个月毒品使用的其他方式、注射器具共用情况、性行为和血样HIV、HCV和梅毒检测结果上差异无统计学意义（P〉O,05）。结论：采用应答驱动抽样方法是招募静脉吸毒人员行之有效的方法，但尚需进一步探讨其对参加者高危行为特征与血清学检测结果的影响。     

社区美沙酮维持治疗对海洛因成瘾者吸毒行为影响的初步研究

目的 了解四川省西昌市社区美沙酮维持治疗对海洛因成瘾者吸毒行为的影响情况。方法于2004—05／07，以社区为基础招募海洛因成瘾者，调查其社会人口学、毒品使用及共用注射器具行为特征，了解社区美沙酮维持治疗（MMT）对吸毒行为的影响情况。结果 在调查的海洛因成瘾者中参加过MMT的为30．4％（105／346），参加MMT时间的中位数为49d。在控制社会人口学等因素后，多因素Logistic分析结果显示，MMT与海洛因成瘾者近3个月吸毒行为的关系有统计学意义的变量为：静脉吸毒频率（OR：0．40；95％CI：0．24～0．66）、海洛因口吸频率（OR：3．06；95％CI：1．87～5．00）、海洛因混合其他毒品使用频率（OR：0．43；95％CI：0．26～0．73）、共用针头或注射器（OR：0．03；95％CI：0．01-0．13）、共用洗针头或注射器用水（OR：0．06；95％CI：0．01～0．24）和共用吸毒器皿（OR：0．02；95％CI：0．00～0．18）。结论 研究结果表明我国第一批海洛因成瘾者美沙酮维持治疗试点项目在减少吸毒人群毒品使用和艾滋病相关高危吸毒行为等方面具有明显的效果。     

艾滋病实名制检测的政策和策略分析

目的从政策角度探讨艾滋病实名制检测的合法性,以及由此引发的隐私权和知情权问题。方法采用政策梳理和文献收集、分析方法。结果近期社会上有关艾滋病实名制检测的争议,其焦点实质上是有关隐私权和知情权的问题。从相关的法律、法规和政策规定上,实名制检测不违反现行规定,也并不意味一定侵犯隐私权。对于隐私权与知情权和生命健康权之间出现的冲突,要根据利益衡量和优先的原则解决。结论需进一步完善隐私保护和知情告知的具体规程和操作办法。     

用于HIV新发感染检测的亲和力方法的研究进展

艾滋病病毒(HIV)新发感染率的估算方法主要有三种:队列研究、数学模型法和实验室方法。其中利用实验室方法检测横断面样本,从而估算新发感染率,已经成为HIV新发感染率重要的估算方法之一,越来越受到重视。在所有实验室检测方法中亲和力方法出现较早,发展历史较长,从20世纪90年代前后至今,已有20多年的研究历史,最近几年更是有了较大的发展。文章通过对亲和力方法的原理、亲和力指数方法用于HIV新发感染检测的现场应用研究,以及亲和力方法的最新研究进展,限制性抗原亲和力方法的研发和初步评价三部分内容的介绍,综述亲和力方法用于HIV新发感染检测的最新进展。