HIV母婴阻断的研究进展

人类免疫缺陷病毒（HIV）的广泛流行已成为全球最为瞩目的公共卫生问题和社会问题。据估计全球每年大约有220万妇女和60万儿童感染HIV,其中90％的儿童是通过母婴传播途径感染的,所以进行HIV母婴阻断对控制HIV的流行具有非常重要的意义。目前主要的母婴阻断方式包括抗逆转录病毒治疗、剖官产及人工喂养等。     

Press releases: translating research into news

Context  While medical journals strive to ensure accuracy and the acknowledgment of limitations in articles, press releases may not reflect these efforts. Methods  Telephone interviews conducted in January 2001 with press officers at 9 prominent medical journals and analysis of press releases (n = 127) about research articles for the 6 issues of each journal preceding the interviews. Results  Seven of the 9 journals routinely issue releases; in each case, the editor with the press office selects articles based on perceived newsworthiness and releases are written by press officers trained in communications. Journals have general guidelines (eg, length) but no standards for acknowledging limitations or for data presentation. Editorial input varies from none to intense. Of the 127 releases analyzed, 29 (23%) noted study limitations and 83 (65%) reported main effects using numbers; 58 reported differences between study groups and of these, 26 (55%) provided the corresponding base rate, the format least prone to exaggeration. Industry funding was noted in only 22% of 23 studies receiving such funding. Conclusions  Press releases do not routinely highlight study limitations or the role of industry funding. Data are often presented using formats that may exaggerate the perceived importance of findings.      

Preventing mother-to-child HIV transmission: the first year of Thailand's national program

Pornsinee Amornwichet, MPH; Achara Teeraratkul, MD; R. J. Simonds, MD; Thananda Naiwatanakul, MSc; Nartlada Chantharojwong, MSc; Mary Culnane, MS,CRNP; Jordan W. Tappero, MD,MPH; Siripon Kanshana, MD,MPH

JAMA. 2002;288:245-248.

Context  Each year in Thailand, about 10 000 children are born at risk for mother-to-child human immunodeficiency virus (HIV) transmission. In 2000, Thailand implemented a national program to prevent mother-to-child HIV transmission.

Objective  To describe the results of implementation of the program.

Design  Monthly collection of summary data from hospitals.

Setting  Public health hospitals (n = 822) in all 12 regions of Thailand, representing 75 provinces, excluding Bangkok.

Participants  Women giving birth from October 2000 through September 2001, including HIV-seropositive women and their neonates.

Main Outcome Measures  Percentages of women giving birth who were tested for HIV, HIV-seropositive women giving birth who received antenatal prophylactic antiretroviral drugs, and HIV-exposed neonates who received prophylactic antiretroviral drugs and infant formula.

Results  Among 573 655 women (range, 27 344-77 806 by region) giving birth, 554 912 (96.7%) received antenatal care (range, 91.9%-98.8% by region). Of 554 912 women giving birth who had antenatal care, 517 488 (93.3%) were tested for HIV (range, 87.7%-99.4% by region) before giving birth; of 18 743 women giving birth who did not have antenatal care, 13 314 (71.0%) were tested for HIV (range, 21.7%-92.9% by region). Of 6646 HIV-seropositive women giving birth, 4659 (70.1%) received prophylactic antiretroviral drugs before delivery (range, 55.3%-81.2% by region). Of 6475 neonates of HIV-seropositive women, 5741 (88.7%) received prophylactic antiretroviral drugs (range, 67.4%-96.9% by region) and 5386 (83.2%) received infant formula (range, 65.3%-100% by region).

Conclusions  Major program components of Thailand's national program for preventing mother-to-child HIV transmission were implemented. Thailand's experience may encourage other developing countries to implement or expand similar national programs.

     

Use of interventions for reducing mother-to-child transmission of HIV in Australia

OBJECTIVE: To describe the extent and outcome of use of interventions for reducing the risk of HIV transmission from mother to child in Australia. DESIGN: National surveillance for perinatal exposure to HIV. PARTICIPANTS AND SETTING: Notified cases of HIV infection in women in Australia and their perinatally exposed children, 1982-1999. OUTCOME MEASURES: Trends over time in use of interventions (antiretroviral therapy in pregnancy, elective caesarean delivery and avoidance of breastfeeding) and perinatally acquired HIV infection. RESULTS: By 31 March 2000, 204 children were reported as having been born in 1982-1999 to 162 women whose HIV infection had been diagnosed by 31 December 1999. The child's HIV infection status was established for 182 (89.2%); the mother's HIV infection was diagnosed antenatally in 91 of these cases (50%). Among women diagnosed antenatally, use of elective caesarean delivery and antiretroviral therapy in pregnancy increased significantly, from 3% and 14% by women whose children were born in 1982-1993, to 21% (P=0.01) and 88% (P<0.001), respectively, by women whose children were born in 1994-1999. Most women (95%) diagnosed antenatally avoided breastfeeding their children. The percentage of infected children born to women diagnosed antenatally declined from 26% among children born in 1982-1993 to 19% among those born in 1994-1999. The percentage of infected children was significantly lower among those whose mothers used antiretroviral therapy in pregnancy (11% versus 36%; P=0.03). CONCLUSION: Antiretroviral use in pregnancy, elective caesarean delivery and avoidance of breastfeeding have been effective interventions for reducing the risk of mother-to-child HIV transmission in Australia. While the rate of perinatal HIV transmission has declined, it remains high in comparison with rates reported from other industrialised countries.     

Progress of mother-to-child transmission of HIV programs in China: successes, challenges and way forward

HIV still remains a global public health problem despite decades of interventions to eliminate the virus.In 2010,there were 390 000 children globally,under 15 years old,newly infected with HIV,mainly through mother-to-child transmission.1 China had 780 000 HIV infected people at the end of 2011,of these,28.6％ were women and 1.1％ were children infected through mother-to-child transmission.2 The first case of mother-to-child transmission (MTCT) of HIV in China was reported in 1995.3 Few years later,the proportion of MTCT in China increased from 0.1％ in 1997 to 0.4％ in 2002.4 The Ministry of Health in China in conjunction with the Central for Maternal and Child Healthcare and the Chinese Centre for Disease Control launched prevention of mother-child transmission of HIV (PMTCT) programs in China in 2003.The programs were launched in five provinces with high prevalence of HIV namely,Henan,Guangdong,Yunnan,Guangxi and Xinjiang.     

福建省艾滋病母婴传播病例及其母亲基本情况分析

目的分析福建省母婴传播艾滋病病毒感染者(HIV)/艾滋病病人(AIDS)及其母亲基本情况。方法利用中国疾病预防控制信息系统艾滋病综合防治信息系统收集福建省母婴传播HIV/AIDS的基本信息和随访资料并逐一核实其母亲的基本情况,用SPSS 15.0对相关数据进行统计分析。结果截至2015年12月31日,福建省共发现70例母婴传播病例,11例病例为抱养/弃婴。死亡病例19例,现活51例;现活的51例在2015年100%接受随访管理。在艾滋病综合防治信息系统中共有47例阳性母亲能核实到具体情况,显示阳性母亲文化程度较低,初中以及下文化程度者占89.36%,职业以无业者及农民为主,占74.47%,91.49%的母亲是在患儿出生之后确诊HIV抗体阳性。70例母婴传播病例母亲中外籍女性12例,占17.14%。结论艾滋病母婴传播对儿童的影响深远,应引起足够的重视,还需加强适龄妇女孕前/孕早期HIV抗体检测、外籍新娘的管理以促进母婴阻断的有效实施。     

AIDS treatment and maternal mortality in resource-poor countries

The crisis of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS), particularly in resource-poor countries in Africa, Asia, and Latin America, is one of the most devastating pandemics in history and adds a cruel burden on women. High rates of maternal mortality and morbidity continue to take a drastic toll on women worldwide. These health challenges provide a window of opportunity to combine urgent global health needs with women's fundamental right to health care, including targeting resources to provide woman-centered treatment for HIV/AIDS and to avert pregnancy-associated death and morbidity. Governments and organizations have a tremendous responsibility in addressing these health issues. The Global Fund to Fight AIDS, Tuberculosis and Malaria was established last year to make significant funds available for treatment and care. Programs such as MTCT-Plus, which provides treatment for HIV-positive mothers and prevents mother-to-child transmission of HIV, can begin to alleviate the tremendous health burden women bear. Addressing women's health needs and women's right to health care is the essential first step in providing services to millions living with HIV/AIDS and pregnancy-related complications.     

Lung transplantation in Australia: barriers to translating new evidence into clinical practice

Evidence "beyond reasonable doubt" may never be achievable for low-volume drugs.     

Prevention of Mother-to-infant transmission of HIV: a new programme in China

A new programme called "Prevention of Mother-to-infantTransmission of HIV" was launched recently, and womenof childbearing age from eight cities or counties in fiveprovinces or autonomous regions of China will be thetargeting subjects.     

预防艾滋病母婴传播阻断后儿童健康状况调查研究

目的：探讨预防艾滋病母婴传播阻断后对儿童健康状况的影响。方法：于2014年3月至2015年3月间,在该院选择40例进行分娩的艾滋病阳性孕妇设为阻断组,选择同时期收治的40例健康孕妇设为对照组,对阻断组孕妇进行预防艾滋病母婴传播阻断,对两组进行随访,统计对比两组儿童健康状况。结果：阻断组儿童12月内腹泻病发病率、呼吸道疾病发病率、营养不良发生率及18月内艾滋病检测阳性率、死亡率与对照组相比无明显差异（P＞0.05）。结论：预防艾滋病母婴传播阻断能有效改善儿童健康状况,可在临床推广运用。