人类免疫缺陷病毒母婴传播预防

由于人类免疫缺陷病毒（HIV）感染人群的年轻化和治疗后生存质量的提高,有生育要求的HIV感染女性越来越多。目前我国母婴传播阻断成功率与国外发达国家还存在差距。现有的研究证实,越早确诊HIV感染、越早行抗病毒治疗,对于感染个体和预防垂直传播都有着积极的作用。除此之外,还需要根据妊娠期监测的结果,采用对应的分娩方式并配合新生儿用药预防的综合策略,以此达到最佳的阻断效果。     

Vertical transmission of HIV from mother to child in sub-Saharan Africa: modes of transmission and methods for prevention

The impact of the human immunodeficiency virus (HIV) epidemic in sub-Saharan Africa on future mortality rates of infants, children, and mothers, life expectancy, and economic growth is profound. Vertical transmission of HIV, transmission from mother to child, is a major factor in the increasing rates of HIV infection in sub-Saharan Africa. Vertical transmission of HIV occurs in utero, intrapartum during labor and delivery, and postpartum during breast-feeding. Because of the large numbers of HIV-infected mothers in developing countries, the majority trials regarding prevention of vertical transmission of HIV have been conducted in sub-Saharan Africa. Thus, sub-Saharan Africa has become a human laboratory, which demonstrates both the successes and failures of preventative methods to reduce vertical transmission of HIV. This review summarizes the body of research dedicated to understanding the pathophysiology of vertical transmission of HIV and pharmacology of inhibition of vertical transmission of HIV. While many debate the ethics of conducting trials in developing countries where effective prevention modalities have been slow to be implemented for economic, social and political reasons, studies continue and researchers continue to discover therapies and preventative methods, which may reduce the future devastation of HIV both in sub-Saharan Africa and throughout the world.     

Prevention of mother to child transmission of HIV: Our experience in South India

Objectives

To determine the outcomes of various ARV (Anti-Retroviral) prophylactic regimes given to HIV positive pregnant mothers, based on time of presentation, for prevention of vertical transmission.

Methods

During a four year period, 92 pregnant HIV positive women and their newborn infants received various ARV prophylactic regimes for prevention of vertical transmission. The outcome, in terms of presence of HIV infection in the infants born to these mothers was studied.

Results

The prevalence of HIV infection in the antenatal group studied was 0.62%. Of the 92 HIV positive pregnant mothers who delivered live babies, 91.3% received ARV prophylaxis or HAART, and 95.6% of the 92 live infants received ARV prophylaxis. The risk of vertical transmission was only 3.3%.

Conclusions

Judicious PMTCT regimes, even if they appear complex, are possible in the Indian setting, and can result in significant decline of HIV positive children. Duration of treatment and mode of delivery should be based on the time of presentation of the HIV positive pregnant mother.     

Efficacy of single dose nevirapine in prevention of mother to child transmission of HIV-1

Objective(s)

To evaluate the efficacy of single dose nevirapine in the prevention of mother to child transmission of HIV-1 in 30 HIV-1 infected parturients.

Material and Method(s)

This study was necessary since any study has not been conducted in an Indian population, were usually women are not offered antiretroviral therapy during pregnancy but only peripartum. East Go-davari District of Andhra Pradesh, India, has the highest prevalence (2.5%) of HTV-1 positive antenatal women, according to NACO estimations. Therefore, the study was conducted in Lutheran General Hospital, Rajahmundry, East Godavari District, Andhra Pradesh, India, at a 50-bedded hospital offering health care to people living with HIV/AIDS. One year prospective study with 30 Primigravidae infected with HTV-1, were planned for elective cesarean section. Single dose 200mg tablet was administered two hours prior to the cesarean section and all babies were given nevirapine syrup 2mg/kg within 72 hours of birth. Babies were tested for HIV-1 at one and two weeks of birth.

Result(s)

All the women were primigravidae. Nineteen babies born to these mothers tested positive for HTV-1 after two weeks, confirming the transmission rate to be 63.33% (95% CI of proportion 45.36%–78.15%). Thus, the efficacy of single dose nevirapine in preventing mother to child transmission was found to be 36.67%. Neonatal morbidity was more in those babies that were HTV positive. Two neonatal deaths occurred in two weeks and both babies were HTV-1 positive.

Conclusion(s)

Single dose nevirapine is associated with a lower efficacy in preventing mother to child transmission of HTV-1.     

母婴梅毒传播阻断的回顾性研究和总结

目的探讨梅毒感染孕产妇及所生婴儿的干预情况,总结经验与不足。方法分析2011年10月至2013年9月确诊的全程回访的梅毒感染孕产妇43例及所生婴儿的感染情况。结果 2012年梅毒感染孕产妇的干预率为85%(17/20),2013年梅毒感染孕产妇的干预率为95.65%(22/23);孕产妇TRUST滴度高与死胎有关。结论免费的检测和干预在一定程度上能阻止梅毒的垂直传播,要彻底解决梅毒的垂直传播,应做好宣传教育,提高高风险人群的自我保护意识。     

Effect of timing and type of treatment on the risk of mother to child transmission of Toxoplasma gondii

Objective To determine the effects on mother to child transmission of the timing and type of prenatal treatment, taking into account gestational age at maternal seroconversion.
Design Prospective cohort study.
Setting European centres offering prenatal screening for toxoplasmosis.
Population Children born to a cohort of pregnant women with toxoplasma infection.
Methods We determined the effects on mother to child transmission of the interval between seroconversion and start of treatment (treatment delay), and the type of treatment, taking into account gestational age at maternal seroconversion.
Main outcome measure Congenital infection status confirmed by toxoplasma IgG results at one year postnatal age.
Results Of 1208 women analysed, 72% were first prescribed spiramycin, 19% pyrimethamine–sulphonamide and 9% (mostly infected during the last trimester) were untreated. The odds ratios for mother to child transmission for all women treated after a delay of four to seven weeks was 0.77 (95% CI 0.34–1.69), and after eight weeks or more was 1.33 (0.56–2.89) compared with less than four weeks. The odds ratio per week of treatment delay was 1.01 (0.93–1.08). There was no evidence that transmission risk differed in women first treated with pyrimethamine–sulphonamide versus spiramycin: odds ratio 1.10 (0.63–1.91) or in untreated versus treated women: odds ratio 0.57 (0.27–1.17).
Conclusion We were unable to demonstrate a beneficial effect of the timing or type of prenatal treatment on the risk of mother to child transmission but we could not exclude a clinically important effect. Randomised controlled trials are required to determine the effect of prenatal treatment on mother to child transmission.     

Barriers to prevention of HIV transmission from mother to child (PMTCT) in a resource poor setting in the Eastern Cape, South Africa

The aim of this study was to investigate knowledge of PMTCT and to describe potential barriers that might affect acceptability of interventions for PMTCT in a resource poor setting in South Africa. The sample included 1534 pregnant women recruited at first antenatal care visit from 5 clinics implementing PMTCT (61%) and from 5 communities around the 5 clinic areas (39%). In addition, the mothers or mothers-in-law (70.9%) and husbands or partners (58.2%) of the pregnant women were interviewed at their homes. Results indicate that major potential barriers in implementing PMTCT programmes in a resource poor setting included physical access to the health facility, PMTCT knowledge, stigma and support, HIV testing, and delivery preference.     

Search for possible routes of vertical infection of adult T-cell leukemia virus (ATLV): evidence of viral transmission from mother to child

Adult T-cell leukemia (ATL) in Japan is remarkably concentrated in adult T-cell leukemia virus (ATLV)-endemic areas and this limited distribution and other epidemiological analysis have strongly suggested the possibility of familial spreading of ATLV. I am interested in whether ATLV can be transmitted from mother to child and the possible routes of vertical infection of ATLV. I report here the results of a study on them. The results were as follows: No ATLV antigen-positive cells were detected at birth or 1, 3 or 6 months after birth. However, at later stages, the viral antigen-bearing cells became detectable. In 19 of 23 infants examined, the ATLV-positive cells were detected at 9 to 36 months after birth. The titers of antibodies to ATLV in the pairs of samples from mothers and their infants at birth were virtually equal, as expected. After birth, the titer of maternally derived antibody in all infants decreased gradually, and it disappeared within 3 to 9 months. However, ATLV-antibody reappeared in 12 of 24 infants examined, being detected after 12 months old. Further, it was shown that all breast milk samples derived from 12 seropositive mothers contained the ATLV which was capable of being transmitted to peripheral leukocytes of neonates.