24例感染HIV孕产妇的母婴阻断措施应用研究

目的 了解孕产妇艾滋病病毒(HIV)感染状况,探索一条减少HIV母婴传播的有效途径.方法 为孕产妇提供免费咨询及HIV检测,对有生育意愿的HIV阳性孕妇采取综合性HIV母婴阻断措施.结果 为14 833名孕产妇提供免费咨询,咨询率为84.80%;为愿意接受免费检测服务的12 407名孕产妇提供HIV抗体检测,检测率70.93%,发现HIV阳性孕产妇24例,阳性率为0.19%;16名孕妇完成妊娠并产下16名婴儿,经综合性母婴阻断措施,16名婴儿HIV-DNA期诊断结果:15名为阴性,1名为阳性.结论 艾滋病病毒(HIV)可以在妇女妊娠、分娩或产后母乳喂养的过程中由感染孕、产妇传播给胎、婴儿;在儿童的HIV感染中,90%以上的感染是经母婴传播获得;采取综合性母婴阻断措施,能有效预防新生儿HIV感染.     

8049名产妇HBV HIV梅毒感染情况与分析

目的了解某县产妇中感染乙型肝炎（乙肝）病毒（HBV）、艾滋病病毒（HIV）和梅毒的情况,以便采取早期预防控制措施,减少母婴传播。方法对该县住院分娩的产妇,应用酶联免疫吸附试验（EUSA）检测HBV、HIV、梅毒抗体,对HIV、梅毒阳性产妇所生婴儿,于12月龄、18月龄时随访检测,了解母婴传播结果。采用SPSS13．0统计软件分析。结果共检测在该县4所综合医院住院的8049名产妇。其乙肝病毒表面抗原阳性率10．96％,乙肝病毒e抗原阳性率2．37％,呈现出逐年下降趋势;产妇年龄与抗乙肝病毒表面抗原抗体阳性率呈反比。检出HIV抗体阳性1例,为嫁人本地的广西人,其所产婴儿HIV阳性。梅毒抗体阳性者7例,呈逐年上升,母婴传播率33．33％。结论该县产妇中乙肝带毒率呈下降趋势,而梅毒感染逐年增多,首次从产妇中检出HIV阳性者。应对育龄妇女在孕前、孕期开展HBV、HIV、梅毒的血清学检测,以便及早采取有效干预措施,是预防控制母婴传播的关键。     

中国部分地区艾滋病病毒1型母婴传播回顾性追踪调查

目的：了解中国艾滋病病毒1型（HIV－1）母婴传播的现状，特别是母婴传播的发生率和影响因素，为进一步开展预防阻断工作提供背景资料。方法：以地方卫生防疫和医疗机构的哨点监测，产前筛查，日常检测 和门诊中发现的HIV－1阳性孕产妇为对象，对其所生子女进行追踪调查和检测。结果：对来自云南，河南、新疆等10个省（自治区、直辖市）的87例HIV－1阳性母亲所生的94名儿童进行追踪，最后追踪到75例母亲及其所生的80名儿童，HIV－1母婴传播发生率为35．0％（28／80）。而河南省的母婴传播率为41．7％（10／24），云南省和新疆维吾尔自治区分别为33．3％（11／33）和27．3％（3／11）。对相关影响因素的分析发现，母亲的感染途径，生产胎次和喂养方式对HIV－1母婴传播有一定的影响作用，其中输血传播、初产和母乳喂养是高危因素，相应的母婴传播率分别为45．5％、39．2％和36．2％，而性传播，多胎生产及人工喂养分别为32．1％、25．9％和22．2％，但差异无显著统计学意义。结论：该研究表明，中国HIV－1母婴传播率与亚非发展中国家相似，而高于西方发达国家，对相关的高危因素（如孕妇的感染途径，特别是输血传播）有必要作进一步地研究。     

不同孕周高效抗反转录病毒治疗对HIV母婴阻断效果的比较

目的探讨不同孕周抗反转录病毒治疗对HIV母婴阻断的效果。方法选择2012-01~2014-01就诊HIV感染孕妇,以AZT+3TC+LPV/r方案进行HIV母婴阻断,孕14周组30例,孕28周组30例。检测孕妇治疗前及预产期前一个月的CD4+T淋巴细胞及病毒载量变化,观察婴儿出生情况及是否感染HIV(出生后18月龄进行HIV抗体检测)。结果孕14周组孕妇治疗前及预产期前一个月CD4+T淋巴细胞高于孕28周组,病毒载量低于孕28周组(P0.05)。两组婴儿18月龄时HIV抗体阳性率差异均无统计学意义(P0.05)。结论采用相同高效抗反转录病毒治疗方案对孕14周、孕28周的HIV孕妇进行母婴阻断,婴儿结局相似,但孕14周组应用高效抗反转录病毒治疗比孕28周组在抑制病毒复制,减少病毒负荷量,降低病毒传播性的效果更为显著。     

来宾市2010-2014年艾滋病母婴阻断技术应用效果评价

<正>目前艾滋病母婴阻断技术对控制艾滋病病毒(Human immunodeficiency virus,HIV)的传播已经得到国内外专家的肯定。来宾市从2010年开始在孕检妇女中同时开展艾滋病咨询检测,对检出感染HIV的孕妇进行艾滋病母婴阻断,包括对感染HIV母亲及所生婴儿按艾滋病母婴阻断技术方案应用抗反转录病毒药物、安全助产和喂养指导、定期跟踪和     

HIV感染的孕产妇全程母婴阻断的护理体会

艾滋病的母婴传播是指艾滋病病毒（Human im—munodeficiency virus,HIV）阳性妇女在妊娠、分娩、哺乳等过程中将HIV传染给胎儿或婴儿。近年来妊娠合并HIV有生育要求的夫妇增多,新生儿若感染将给家庭和社会带来很大的损害。目前联合国艾滋病规划署推荐采用母婴传播阻断的方案,     

河南省孕产妇人群中HIV/AIDS流行情况及母婴传播预防与控制

目的 了解河南省开展预防艾滋病母婴传播干预工作以来,孕产妇人群中的艾滋病病毒(HIV)感染情况及母婴传播情况. 方法 对河南省31个重点县产前保健的孕妇开展HIV自愿咨询与检测,对检测过程中发现的HIV抗体阳性孕产妇进行综合干预,对她们分娩的婴儿于12个月、18个月检测HIV抗体;对以往确认HIV抗体阳性且有生育能力的妇女提供随访服务,对发现的阳性孕产妇及其分娩的婴儿进行综合干预. 结果 自2001年到2006年12月底,共有763 514名孕产妇接受了HIV自愿咨询检测,发现742名阳性者,阳性率为0.10%;对既往HIV阳性的育龄妇女,随访中发现74名阳性孕产妇;共816名感染孕产妇中,经血液传播占80.01%,经性传播占12.13%,其他占7.86%;孕产妇的HIV抗体检测阳性率呈现逐年下降趋势,最高年份为0.54%,最低年份为0.06%.采取干预措施后,艾滋病母婴传播率为5.38%. 结论 在艾滋病疫情相对高发地区,通过开展HIV自愿咨询检测服务和对阳性孕产妇提供综合干预服务,可有效降低HIV母婴传播率,并可掌握当地孕产妇人群中HIV的感染状况.     

中国某地区人类免疫缺陷病毒母婴传播与阻断的调查研究

目的了解人类免疫缺陷病毒在血源性艾滋病流行地区的母婴传播情况，分析影响传播的因素并提出对策。方法现场询问调查和常规体检并采静脉血，检测血清抗-HIV及HIV的前病毒DNA或RNA，分析母亲及其子女配对的资料，回顾性分析HIV的母婴传播。结果107例HIV阳性母亲生育的136名子女中．50例HIV阳性．HIV的母婴传播率为36．8％（50／136）。38例经血感染HIV阳性育龄妇女的外周血基因组核酸扩增HIV前病毒DNA gag区。鉴定均为HIV B’亚型。两埘HIV阳性的母婴的外周血核酸扩增HIV gag区P17的片段，Mega软件分析其基因同源性，分别为95．0％、94．9％。基因树显示子女的病毒与其母亲同属一支。艾滋病状态母亲组HIV母婴传播率为67．4％（31／46）显著高于HIV携带状态母亲组的21．1％（19／90），P〈0．05。奈韦拉平（NVP）阻断的7例儿童．6例末被HIV感染，1例感染HIV。结论被调查地区HIV母婴传播是儿童感染HIV的主要途径。未采取干预措施是造成传播的主要原因。NVP阻断母婴传播较易被接受并可能减少母婴传播。     

河南省2005-2007年孕产妇HIV检测情况分析

目的了解河南省孕产妇艾滋病病毒（HIV）感染状况,为开展预防艾滋病母婴传播工作提供决策依据。方法对2005年1月-2007年5月,河南省艾滋病疫情相对集中的31个县（区）孕产妇的HIV检测结果进行分析。结果共对31个艾滋病重点县720605名孕妇和产妇检测HIV抗体,检测率93.11%;检测出HIV抗体阳性541例,阳性率0.08%。其中364例为阳性孕妇,223例自愿终止妊娠（占61.27%）,5例失访（1.37%）,136例选择继续妊娠待分娩（占37.36%）。3年间选择继续妊娠的HIV阳性孕妇,分别为31.51%（46/146）、36.31%（57/157）、54.10%（33/61）,呈逐年上升趋势。284例分娩阳性产妇中,250例（88%）采取了母婴阻断预防措施。结论加强孕产妇HIV检测和阳性育龄妇女的孕检工作,早期发现、早期管理HIV阳性孕妇,可以进一步提高HIV阳性产妇的药物阻断率。     

西藏某VCT门诊自愿咨询检测者HIV感染状况分析

目的分析艾滋病自愿咨询检测（VCT）门诊,自愿咨询检测者的艾滋病病毒（HIV）感染状况,为西藏预防HIV传播提供科学依据。方法收集整理2003-2012年西藏某VCT门诊自愿咨询者的人口学信息及HIV抗体检测结果,用描述性方法进行统计分析。结果1929名自愿咨询检测者中,检出HIV抗体阳性188例,阳性率9．75％;女性阳性率（12．94％）高于男性（8．40％）;15～44岁年龄组阳性率达9．92％,其阳性人数占所有阳性者中的94．15％（177／188）。小学及以下文化程度HIV阳性率较高,为17．92％,无业者高于其他职业;静脉注射吸毒阳性率高达62．50％。性传播占总数的89．89％。结论青壮年、小学及以下文化程度者及无业者是感染HIV的高危人群,性接触是主要的传播方式,应针对高危人群的特点,加强艾滋病的宣传教育以及行为干预工作,阻断HIV传播。     

Efficiency of HAART in the prevention of mother to children HIV–1 transmission at Saint Camille medical centre in Burkina Faso,West Africa

ObjectiveTo evaluate efficiency of HAART in the prevention of mother to child HIV transmission.MethodsA longitudinal study was conducted on 1 300 women attending the antenatal service at Saint Camille Medical Centre from September 2010 to July 2011. The HIV status of mothers was determined by rapid tests and ELISA. Discordant results were confirmed by real-time PCR. PCR was used to determine HIV status of children born from HIV–positive mothers.ResultsAmong 1 300 pregnant women tested for HIV, 378 were seropositive. Mothers were predominantly housewives (69.7%), and their mean age was (28.32±0.15) years. The overall prevalence of HIV transmission from mother to child was 4.8% (18/378). This prevalence differed significantly from 0.0% (0/114) to 6.8% (18/264) in children born from mothers under HAART and those with mothers under New Prophylactic Protocol (AZT + 3TC + NVP), respectively (P< 0.01). Children's mortality rate during the medical follow up was 1.3% (5/378). Among 16 women with HIV dubious status by ELISA, the Real Time PCR confirmed 2/16 (12.5%) as HIV positive.ConclusionsThe protocol of prevention of mother to children HIV transmission (PMTCT) is effective. The rate of HIV vertical transmission is significantly reduced. Early diagnosis determined by PCR of children born from HIV–positive mother is necessary and recommended in the context of PMTCT in Burkina Faso. We also found that PCR is an effective tool to confirm HIV status in pregnant women.     

Initiation of highly active antiretroviral therapy among pregnant women in Cape Town,South Africa

Objective To investigate highly active antiretroviral therapy (HAART) initiation among pregnant women and the optimum model of service delivery for integrating HAART services into antenatal care. Methods We analysed clinic records to reconstruct a cohort of all HIV‐infected pregnant women eligible for HAART at four antenatal clinics representing three service delivery models in Cape Town, South Africa. To assess HAART coverage, records of women determined to be eligible for HAART in pregnancy were reviewed at corresponding HIV treatment services. Results Of 13 208 pregnant women tested for HIV, 26% were HIV‐infected and 15% were HAART‐eligible based on a CD4 cell count of ≤ 200 cells/μl. Among eligible women, 51% initiated HAART before delivery, 27% received another prevention of mother‐to‐child transmission (PMTCT) intervention and 22% did not receive any antiretroviral intervention before delivery. The proportions of women initiating HAART between the different service delivery models were comparable. The median gestational age at first presentation was 26 weeks, and early gestational age at first presentation was the strongest predictor of being on HAART by delivery. Of the women who did not initiate HAART in pregnancy, 24% started treatment within 2 years postpartum. Conclusions In this setting with clear PMTCT and HAART protocols, services failed to prioritize and initiate a high proportion of eligible pregnant women on HAART. The initiation of HAART in pregnancy requires strengthened antenatal and HIV services that target women with advanced stage disease.     

Reduction in mother-to-child transmission of HIV in Thailand, 2001-2003: Results from population-based surveillance in six provinces

BACKGROUND: In 2000, Thailand implemented a national program to prevent mother-to-child HIV transmission (PMTCT). OBJECTIVE: To describe the effectiveness of the prevention of mother-to-child HIV transmission program in Thailand. DESIGN AND METHODS: A register of HIV-exposed children at birth was created with follow-up of infection status. The register included children born to HIV-infected women between 1 January 2001 and 31 December 2003 at 84 public health hospitals in six provinces of Thailand. The main outcome measure was HIV infection in children. RESULTS: A total of 2200 children born to HIV-infected mothers were registered. Of these mother-infant pairs, 2105 (95.7%) received some antiretroviral prophylaxis, including 1358 (61.7%) who received the complete short-course zidovudine regimen during pregnancy and labor for the mother and after birth for the infant, with or without other antiretrovirals. HIV infection outcome was determined for 1667 (75.8%) children, of whom 158 [9.5%, 95% confidence interval (CI), 8.1-11.0%] were infected. Transmission risk was 6.8% (95% CI 5.2-8.9%) among 761 mother-infant pairs that received the complete zidovudine regimen alone, and 3.9% (95% CI, 2.2-6.6%) among 361 mother-infant pairs that received the complete zidovudine regimen combined with other antiretrovirals, usually nevirapine. The overall transmission risk from this cohort, including all antiretroviral prophylaxis combinations, is estimated to be 10.2%. CONCLUSIONS: The Thai national PMTCT program is effective in reducing mother-to-child transmission risk from the historical risk of 18.9-24.2%. The addition of nevirapine to short-course zidovudine beginning in 2004 may further improve program effectiveness in Thailand.     

Prevention of mother to child transmission of HIV (PMTCT) programme in KwaZulu‐Natal,South Africa: an evaluation of PMTCT implementation and integration into routine maternal,child and women’s health services

Objectives To evaluate prevention of mother to child transmission of HIV (PMTCT) implementation and integration of PMTCT with routine maternal and child health services in two districts of KwaZulu‐Natal; to report PMTCT coverage, to compare recorded and reported information, and to describe responsibilities of nurses and lay counsellors. Methods Interviews were conducted with mothers in post‐natal wards (PNW) and immunisation clinics; antenatal and child health records were reviewed. Interviews were conducted with nurses and lay counsellors in primary health care clinics. Results Eight hundred and eighty‐two interviews were conducted with mothers: 398 in PNWs and 484 immunisation clinics. During their recent pregnancy, 98.6% women attended antenatal care (ANC); 60.8% attended their first ANC in the third trimester, and 97.3% were tested for HIV. Of 312 mothers reporting themselves HIV positive during ANC, 91.3% received nevirapine, 78.2% had a CD4 count carried out, and 33.1% had a CD4 result recorded. In the immunisation clinic, 47.6% HIV‐exposed babies had a PCR test, and 47.0% received co‐trimoxazole. Of HIV‐positive mothers, 42.1% received follow‐up care, mainly from lay counsellors. In 12/26 clinics, there was a dedicated PMTCT nurse, PCR testing was not offered in 14/26 clinics, and co‐trimoxazole was unavailable in 13/26 immunisation clinics. Nurses and lay counsellors disagreed about their roles and responsibilities, particularly in the post‐natal period. Conclusions There is high coverage of PMTCT interventions during pregnancy and delivery, but follow‐up of mothers and infants is poor. Poor integration of PMTCT services into routine care, lack of clarity about health worker roles and poor record keeping create barriers to accessing services post‐delivery.     

艾滋病高发地区预防HIV母婴传播项目实施效果分析

目的了解艾滋病高流行的4省（自治区）的6个县（市、区）,预防艾滋病病毒（HIV）母婴传播项目的实施效果。方法通过全国预防艾滋病母婴传播信息管理系统,收集2007年1月至2010年9月研究地区艾滋病病毒（HIV）感染孕产妇个案卡及其所生儿童的随访登记卡,分析预防HIV母婴传播干预措施落实情况及效果。结果2007-2010年,研究地区HIV感染孕产妇抗病毒药物应用比例和孕期抗病毒药物应用比例,分别从78.4%和27.8%增加至93.7%和78.8%（趋势χ2=17.636,P〈0.01;趋势χ2=76.835,P〈0.01）;HIV感染孕产妇应用三联抗病毒药物方案的比例自19.8%增加至89.9%（趋势χ2=161.757,P〈0.01）。满18月龄艾滋病感染孕产妇所生儿童接受HIV抗体检测比例为84.8%（318/375）,13例儿童抗体检测阳性,艾滋病母婴传播水平为4.1%（95%可信区间：2.98%-5.20%）。结论研究地区预防HIV母婴传播干预措施落实指标逐年提高,HIV母婴传播水平显著下降,孕产妇及早抗病毒用药以及儿童随访检测仍为工作中的薄弱环节。     

嘉兴市292507例孕产妇HIV感染状况

目的为了解嘉兴市孕产妇艾滋病病毒（HIV）感染状况,探索适合当地的预防艾滋病母婴传播的运行模式和服务方式,最大程度地减少母婴传播。方法对孕产妇检测HIV抗体,初筛阳性标本进行确认试验;对感染HIV的孕产妇进行监测与管理。结果2006—2012年,孕产妇HIV抗体阳性率为0．19‰（57／292507）,其中本地户籍为0．02％（3／130 299）,流动人口为0．33％0（54／162208）,差异有统计学意义（P〈0．01）。分娩的22例活产婴儿中追踪到18个月的有12例,其中11例HIV抗体阴性,1例阳性。结论嘉兴市孕产妇HIV感染处于较低水平,流动人口是艾滋病防治的重点人群。妇幼保健机构和疾病预防控制中心要明确各自职责、加强合作,加强对感染HIV的孕产妇进行监测管理。     

Prevention of mother-to-child transmission of human immunodeficiency virus among pregnant women using injecting drugs in Ukraine, 2000-10

Aims To compare clinical status, mother‐to‐child transmission (MTCT) rates, use of prevention of (PMTCT) interventions and pregnancy outcomes between HIV‐infected injecting drug users (IDUs) and non‐IDUs. Design and setting Prospective cohort study conducted in seven human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) Centres in Ukraine, 2000–10. Participants Pregnant HIV‐infected women, identified before/during pregnancy or intrapartum, and their live‐born infants (n = 6200); 1028 women followed post‐partum. Measurements Maternal and delivery characteristics, PMTCT prophylaxis, MTCT rates, preterm delivery (PTD) and low birth weight (LBW). Findings Of 6200 women, 1111 (18%) reported current/previous IDU. The proportion of IDUs diagnosed with HIV before conception increased from 31% in 2000/01 to 60% in 2008/09 (P < 0.01). Among women with undiagnosed HIV at conception, 20% of IDUs were diagnosed intrapartum versus 4% of non‐IDUs (P < 0.01). At enrolment, 14% of IDUs had severe/advanced HIV symptoms versus 6% of non‐IDUs (P < 0.001). IDUs had higher rates of PTD and LBW infants than non‐IDUs, respectively, 16% versus 7% and 22% versus 10% (P < 0.001). IDUs were more likely to receive no neonatal or intrapartum PMTCT prophylaxis compared with non‐IDUs (OR 2.81, p < 0.001). MTCT rates were 10.8% in IDUs versus 5.9% in non‐IDUs; IDUs had increased MTCT risk (adjusted odds ratio 1.32, P = 0.049). Fewer IDUs with treatment indications received HAART compared with non‐IDUs (58% versus 68%, P = 0.03). Conclusions Pregnant human immunodeficiency virus‐infected injecting drug users in Ukraine have worse clinical status, poorer access to prevention of mother‐to‐child transmission prophylaxis and highly active antiretroviral therapy, more adverse pregnancy outcomes and higher risk of mother‐to‐child transmission than non‐injecting drug user women.     

Operational evaluation of a service for prevention of mother‐to‐child transmission of HIV in rural Uganda: barriers to uptake of single‐dose nevirapine and the role of birth reporting

Objectives To determine factors associated with pregnant women being HIV positive, barriers to the uptake of single‐dose nevirapine (sdNVP) for prevention of mother‐to‐child transmission (PMTCT) and feasibility and effectiveness of reporting HIV‐exposed infants born in facilities with no PMTCT services so as to receive NVP. Methods From 2002 to 2007, a sdNVP PMTCT service was implemented in 53 rural villages of south‐west Uganda. Twenty‐five of them were HIV‐surveillance study villages. The proportions of mothers testing positive and mother and newborns receiving and ingesting sdNVP and associated factors were determined. Results Women with incomplete primary or no education, aged 25–34 years or not living with their partners were at increased risk of being HIV infected. Seventy‐seven percentage of pregnant women with HIV (PWH) received therapy. Of the 63 PWH who received therapy and had surviving live births, only 39 (62%) reported births and received newborn prophylaxis within 72 h. Women were more likely to collect and ingest NVP if they were from study villages, preferred home administration of newborn NVP or presented at a more advanced stage of pregnancy. Newborns were more likely to be reported and receive NVP if mothers were aged 25–34 years, on antiretroviral therapy (ART) or came from study villages. Conclusions The uptake of PMTCT services was unacceptably low. Asking PWH with less advanced pregnancies to return to collect NVP leads to missed opportunities especially if PWH are less educated. Birth reporting enabled the programme to provide NVP to some infants who otherwise would have missed. Antenatal, delivery and PMTCT services should be integrated.     

Evaluación inicial del programa de prevención de la transmisión materno-infantil de la infección por el virus de la inmunodeficiencia humana en Guinea Ecuatorial

Background

The prevalence of human immunodeficiency virus (HIV)-infected pregnant women in Equatorial Guinea (EG) has been reported as 7.3%. In 2008 an updated version of the PMTCT protocol was accepted according to the current WHO guidelines. The aim of this study was to describe the characteristics and outcome of children exposed to HIV after the introduction of the protocol.

Methods

A retrospective review was conducted on the clinical characteristics of the infants born to HIV-infected mothers in the Hospital Regional de Bata and Primary Health Care Centre Maria Rafols in Bata (EG) between June 2008 and November 2011. The diagnosis of HIV infection in children was based on rapid serology tests.

Results

A total of 103 children were included, of which 47 were males. Fifty three patients (51%) completed the follow-up (51%). Fourteen children (26%) were diagnosed with HIV infection (11 presumptive diagnosis, 3 due to persistence of antibodies at 18 months). Six children (12%) died before a definitive diagnosis. Just over than half (52%) of mothers received antiretroviral therapy (ART) during pregnancy. The transmission rate in children whose mothers received ART was 16% (3/19), compared with 43% (10/23) in children whose mothers did not receive it. Only one child was infected (8%) when the mother received ART, and child received postnatal prophylaxis.

Conclusions

The PMTCT protocol compliance was still very low. Antiretroviral therapy in pregnant women decreased the rate of vertical transmission, but the rate still remains very high. Many children were lost to follow-up. Strategies to prevent loss to follow-up and methods for earlier virological diagnostic are needed.