HIV母婴传播及母婴阻断的临床研究

随着艾滋病在全球迅速蔓延,孕妇感染人类免疫缺陷病毒(HIV)的人数越来越多。在儿童HIV感染中,90%以上来自母婴传播,因此母婴阻断是预防儿童艾滋病的主要措施。母婴传播的方式有宫内感染、分娩时经产道感染、经母乳感染。针对母婴传播的方式,母婴阻断的措施有抗病毒治疗、选择性剖宫产、人工喂养。随着母婴阻断的研究进展,母婴传播率可降至2%~4%。     

西双版纳州勐海县预防艾滋病母婴传播服务现状与思考

目的分析西双版纳州勐海县预防艾滋病母婴传播服务现状,科学评价勐海县艾滋病母婴传播阻断措施。方法 2005年至2009年,勐海县辖区提供孕产期保健和助产服务的医疗机构按照《云南省预防艾滋病母婴传播实施方案》要求,对所有孕产妇开展HIV抗体免费咨询、检测和母婴阻断服务,对上报资料进行分析。结果勐海县同期孕产妇HIV抗体咨询率为92.89%,抗体检测率为92.38%,HIV感染孕产妇抗病毒药物服药率为86.67%,HIV感染孕产妇所生婴儿抗病毒药物服药率、人工喂养率、住院分娩率均为100%,9例18月龄HIV感染产妇所生婴儿HIV抗体检测结果阴性。结论勐海县预防艾滋病母婴传播工作措施有力,成效明显,通过母婴阻断,降低了婴幼儿感染艾滋病的风险,提高了儿童生存质量。     

江川县孕产妇人群中HIV/AIDS流行情况及预防艾滋病母婴传播

目的 总结江川县自开展预防艾滋病母婴传播工作以来,孕产妇的艾滋病病毒(HIV)感染情况及母婴传播情况.方法 在全县范围开展婚前及孕产妇HIV自愿咨询与检测或由医务人员主动提供的咨询与检测,对婚检确认HIV抗体阳性的妇女提供随访服务,对确认的阳性孕产妇实施预防性干预阻断措施,对阳性孕产妇分娩婴儿进行干预、随访,并于12、18个月进行HIV抗体检测.结果 自2005年1月～2010年12月,江川县共有14341名孕产妇接受了HIV自愿咨询检测,确认HIV阳性11人,阳性率为0.07%.HIV阳性孕产妇中,经吸毒传播一例,占9.09%,经性传播10例,占90.91%,孕产妇的HIV阳性检出率在全市处于平稳低流行态势.经实施母婴阻断措施后,满18个月儿童6例,全部检测均为阴性.结论 在艾滋病疫情相对低发地区,通过开展预防艾滋病母婴传播工作并提供综合干预措施,可掌握当地孕产妇人群中HIV的感染状况,并可有效降低HIV母婴传播率.     

2008-2010年贵州省黔南州27例感染艾滋病病毒孕产妇母婴阻断效果分析

目的分析贵州省黔南州预防艾滋病病毒母婴传播综合干预措施及母婴阻断效果,为进一步开展与推广感染艾滋病病毒孕产妇母婴阻断的预防工作提供参考.方法对2008-2010年我州三个艾滋病示范区通过自愿咨询检测发现的27例HIV感染孕产妇进行综合干预措施(人工终止妊娠或抗病毒治疗+住院分娩+人工喂养指导)资料进行回顾性分析.结果27例HIV阳性的孕产妇中有8例人工终止妊娠(29.63%),19例住院分娩(9例阴道分娩、10例剖腹产)所生儿童均采用人工喂养(国家项目补贴3000元/例奶粉),其中18例孕产妇及所生新生儿予抗病毒治疗,所生儿童有16例满12月龄或18月龄HIV抗体检测阴性,1例于2月龄因“腹泻”死亡,1例于1+月龄因意外窒息死亡,母婴阻断成功率达94.12%.1例孕产妇及所生新生儿拒绝抗病毒治疗(母亲已死亡,儿童送人失访).结论贵州省黔南州HIV感染孕产妇母婴传播的综合干预措施是有效的,通过对HIV抗体阳性的孕产妇做好围产期保健,实施综合性干预措施,可有效降低HIV母婴垂直传播的发生率,值得大力推广实施.     

2008年—2010年红河州预防艾滋病母婴传播工作分析

目的对2008年—2010年红河州预防艾滋病母婴传播工作进行动态分析和评估,发现薄弱环节和问题,分析有利因素和不利因素,为调整策略和措施、合理分配财政和技术资源提供依据。方法根据卫生部、云南省及红河州《预防艾滋病母婴传播工作实施方案》要求收集数据,并严格对数据进行质控。结果 2008年—2010年孕产妇人类免疫缺陷病毒(HIV)抗体检测任务均超额完成;孕产妇孕期HIV抗体检测率、孕产妇HIV抗体检测覆盖率、随访管理的HIV感染孕产妇分娩儿童满18个月龄进行HIV抗体检测的比例、HIV感染孕产妇配偶或固定性伴HIV抗体检测率及艾滋病母婴阻断的各项干预措施呈逐年上升的趋势;2010年全州HIV感染孕产妇配偶或固定性伴HIV抗体检测率、HIV感染孕产妇采取预防艾滋病母婴传播干预措施比例、HIV感染产妇所生婴儿人工喂养率已达目标要求;HIV感染孕产妇妊娠结局主要以分娩、人工终止妊娠为主;HIV感染孕产妇在县(市、区)级助产机构分娩的人数较多;HIV感染孕产妇以阴道分娩及择期剖宫产为分娩的主要方式。结论我州妇幼保健体系,尤其是体系中的核心妇幼保健机构面临挑战;应通过创新工作机制,优化管理模式,加强业务管理,探索新的适宜技术,提高管理效率和服务质量来做好预防艾滋病母婴传播工作。     

河南省2002—2014年预防艾滋病母婴传播干预工作效果研究

目的了解2002—2014年河南省预防艾滋病母婴传播干预工作的效果。方法对HIV感染产妇及其分娩婴儿进行随访,收集不同年度干预措施实施情况及分娩婴儿的生存感染状况,分析不同干预措施对艾滋病母婴传播的影响,采用非条件Logistic回归探索艾滋病母婴传播的有关因素。结果截止2014年12月31日,共对10 208 941名孕产妇提供HIV检测咨询,发现HIV感染孕产妇2 428人,HIV检测阳性率为0.024%,孕产妇HIV检测阳性率呈现逐年递减趋势(χ~2=4.88,P=0.027)。分娩的1 673名婴儿中,有1 515人存活且满18月龄,已经死亡儿101人,失访57人。1 515名婴儿中阳性60人,阴性1 324人,存活婴儿HIV母婴传播率为4.22%,校正死亡后HIV母婴传播率为6.25%。干预措施中产妇药物阻断率为76.96%,婴儿药物阻断率为92.5%,孕早期接受HIV检测率为70.5%。多因素分析显示,孕早期接受预防艾滋病母婴传播服务(OR=0.23,95%CI:0.07~0.72),抗病毒药物阻断(OR=0.46,95%CI:0.23~0.95),婴幼儿采取人工喂养(OR=0.09,95%CI:0.02~0.35)是艾滋病母婴传播的保护因素,产妇分娩过程采取侧切操作(OR=3.52,95%CI:1.49~8.27)是其危险因素。结论河南省预防艾滋病母婴传播综合干预措施比较完善,孕产妇HIV检测阳性率保持在较低水平,但HIV暴露婴儿的母婴传播率及婴儿死亡率较高,应有针对性地加强综合干预措施。     

预防艾滋病母婴传播措施初探

目的:探讨预防艾滋病母婴传播措施.方法:复习文献并结合工作实践经验对预防艾滋病母婴传播措施进行整理分析.结果:预防艾滋病母婴传播措施主要有咨询检测、药物阻断、安全分娩、人工喂养、加强随访、心理关爱等方面.结论:在呼吁关爱HIV感染者的同时,对育龄妇女和HIV感染孕产妇做好HIV检测咨询、药物治疗、剖宫产、人工喂养等措施,以最大限度的阻断HIV母婴传播.     

我国HIV/AIDS母婴感染传播阻断现状

艾滋病在我国流行了20多年,目前已进入快速增长期,而且从高危人群向普通人群扩散,育龄妇女、儿童及老年人发病逐年增多。儿童感染90%是通过母婴传播引起的,所以阻断HIV/AIDS母婴传播是     

龙陵县预防艾滋病母婴传播现状分析

目的:分析笔者所在县母婴阻断工作的结果及现状,探索母婴阻断工作方法,降低艾滋病母婴传播发生率。方法:对2005-2009年进行HIV抗体检测的17613例孕产妇中的72例阳性感染者和53例阳性母亲所生婴儿母婴阻断情况进行分析。结果:孕产妇HIV抗体阳性率为0.41%,经采取干预措施,所生婴儿HIV感染率为零。结论:艾滋病母婴阻断是预防婴儿感染艾滋病的主要手段,采取预防艾滋病母婴传播综合干预措施,能有效降低母婴传播发生率。     

28例HIV感染孕产妇母婴阻断措施临床观察

目的:探讨人类免疫缺陷病毒(HIV)感染孕产妇的母婴阻断的措施及其效果。方法:回顾性分析我院2010年12月~2011年12月收治的28例HIV感染孕妇进行母婴阻断及产科处理的临床观察。结果:出生活产婴儿28例(早产儿2例),未检出新生儿HIV抗体阳性,失访1例,余27例(96.43%)新生儿两次HIV抗体均为阴性。结论:对HIV感染孕产妇采取正确规范的母婴阻断措施可有效降低HIV母婴传播、控制儿童HIV/AIDS流行。     

Treatment choice for infants in the neonatal intensive care unit at risk for AIDS

Many infants admitted to neonatal intensive care units are the children of women infected with the human immunodeficiency virus (HIV); they have approximately a 30% risk of infection. To investigate attitudes surrounding treatment for such newborns, we conducted a survey of professionals at six neonatal intensive care units in New York City. A significant proportion of the 247 respondents recommended less aggressive treatment for non-HIV-related conditions for infants at risk for HIV compared with those not at risk. For example, 97% of respondents recommended open heart surgery for an infant with no known HIV risk but only 77% recommended surgery for an infant whose mother had acquired immunodeficiency syndrome; if certain the infant was infected, 42% of respondents recommended surgery. We conclude that perceived HIV status may influence decision making about treatment for non-HIV-related conditions for critically ill patients, including infants not actually infected. Ethical issues concerning the relevance of HIV status need to be examined.     

The impact of a HIV prevention of mother to child transmission program in a nigerian early infant diagnosis centre

Background:

Mothers infected with human immunodeficiency virus (HIV) can transmit the virus to their babies in utero, intrapartum or postpartum through breastfeeding. Maternal to child transmission can be prevented through administration of antiretroviral drugs to mother and child, and through restriction of breastfeeding. This study evaluated the effectiveness of prevention of mother-to-child transmission (PMTCT) activities in reducing the incidence of HIV infection among exposed babies at the National Hospital Abuja, Nigeria.

Materials and Methods:

Early infant diagnosis laboratory records of 515 exposed babies aged below 18 months who had polymerase chain reaction (PCR) test between January 1^st 2011 and December 31^st 2012 were reviewed. The details of antiretroviral (ARV) therapy commencement for mother and baby, infant feeding choices, mode of delivery and HIV test results were analysed.

Results:

Of the 515 samples tested, 36 (7.0%) were found to be positive. The mean age of exposed children tested was 4 months. Highest prevalence was among children in the age group 6-18 months (16.1%). There was statistically significant association between HIV positive results and age. (P = 0.0000). If the mother and child pairs received ARVs, the prevalence was 1.3%, whereas if the mother only received ARV, then the prevalence was 4.6%, and when only the child received ARV the prevalence was 20.0%. When neither the mother nor the child received ARVs, the prevalence was 66.7%.

Conclusion:

There was a high prevalence of HIV among exposed children in our setting, especially if the mother and child pairs did not receive any form of antiretroviral prophylaxis. This further emphasises the usefulness of ARVs as the single most important intervention in PMTCT. Therefore, there is need to expand antiretroviral coverage, ensure access of the PMTCT program, and provide effective services to support infected children.     

Pediatric HIV infection. An update.

Human immunodeficiency virus infection is a leading cause of immunodeficiency in children. The epidemic in children parallels that in women since most infected women are in the child-bearing age groups. The risk of vertical transmission of HIV from an infected mother to her infant ranges from 13% to 39%. Diagnosis of infection in the infant is complicated by the passive transfer of antibody across the placenta, making the use of standard serologic tests to confirm infection difficult. In children less than 15 months of age, a positive p24 core antigen test, a positive viral culture or AIDS defining criteria with immune abnormalities are required for diagnosis. HIV infection in children is chronic and multisystem characterized by immunologic and clinical deterioration with a higher incidence of serious bacterial infections, neurologic disease, and lymphoid interstitial pneumonitis. The cornerstones of management include close medical follow-up, good nutrition, and prompt diagnosis and treatment of infections. Certain children will benefit from therapeutic modalities such as Pneumocystis carinii pneumonia prophylaxis and/or intravenous gamma globulin. The antiretroviral drugs have improved the quality of life and increased survival. Several newer antiviral agents are presently in clinical trials.     

奈韦拉平在艾滋病母婴阻断中的应用

目的观察奈韦拉平用于艾滋病母婴阻断治疗效果。方法单用奈韦拉平进行艾滋病母婴阻断。用法：母亲在产前2h服用奈韦拉平200mg，婴儿出生后，服用奈韦拉平6mg，如果母亲在服药后2h内分娩者，婴儿出生后服奈韦垃平6mg两次。结果通过118例临床观察，满18个月随访检测77例，75例全程检测为阴性，2例阳性，母婴阻断成功率97．4％，，结论通过自愿咨询、检测、阻断、临床观察证明奈韦拉平用于母婴阻断，临床效果好、价廉、服用方便、安全可靠、无毒副作用、不影响婴幼儿生长发育。     

Perinatal transmission of hiv and diagnosis of hiv infection in infants: A review

Paediatric HIV infection has become a major burden on families, communities and health services worldwide. The vast majority of children now acquire HIV as a result of mother to infant (vertical) transmission. Recent major advances have occurred following the greater understanding of the risk factors for perinatal transmission and the role of antiretroviral therapy in preventing transmission. Now that interruption of vertical transmission is possible, early identification of HIV-infected pregnant women is critical. As of June 1997, HIV infection has been diagnosed in 37 children under 15 yrs of age in the Republic of Ireland; 32 as a result of maternal to infant transmission. The exact timing of HIV transmission during pregnancy is unclear but it is estimated that 60–70 per cent of infants may be infected at the time of delivery with approximately 30 per cent infected earlier in gestation. Vertical transmission rates vary from 15–40 per cent in different global areas. Antenatal and perinatal zidovudine treatment can reduce this rate by 60–70 per cent. Risk factors for the vertical transmission of HIV-1 are multifactorial. These factors include maternal disease status, in particular maternal viral load, route of delivery, duration of membrane rupture, presence of obstetric complications and infant feeding practices. Definitive diagnosis of HIV infection in infancy has been difficult in the past. Direct viral detection methods now allow the reliable diagnosis of HIV infection in the first few months of life.     

艾滋病母婴阻断技术在广西少数民族地区的应用

目的探讨艾滋病母婴阻断技术在来宾地区婚检、产检人群的临床应用提供科学依据。方法利用免费婚检、免费产检平台对婚检、产检人群进行艾滋病（HIV）咨询检测筛查,找出艾滋病（HIV）感染者,对艾滋病（HIV）感染孕妇建议终止妊娠。坚持生育者对其及其所生婴儿进行母婴阻断干预,以避免艾滋病母婴传播发生。结果全市2011—2012年平均婚检率95．87％（90555／94454）、平均产检率98．99％（73591／74341）;婚检、产检人群二年内检出艾滋病（HIV）阳性291例,检出阳性率0．18％。其中检出艾滋病（HIV）阳性孕产妇103例,检出阳性率0．14％。103例孕产妇中,巳终止妊娠18例、分娩活产79例、死胎1例、仍在孕5例。分娩活产孕产妇服用抗病毒药物76例,服药率96．20％,婴儿服用抗病毒药物77例,婴儿系统管理服药率97．47％,死亡婴幼儿1例,失访2例,阳性孕产妇所生婴幼儿产时未检出（HIV）感染者。结论利用婚检、产检平台进行艾滋病咨询检测筛查,可以尽早发现艾滋病（HIV）感染者;对艾滋病（HIV）感染者建立档案并进行跟踪、开展婚育卫生指导、怀孕者建议终止妊娠,可避免艾滋病儿出生;坚持生育者进行艾滋病母婴阻断系统管理,对预防艾滋病母婴传播发生具有非常重要的意义。     

梅州市艾滋病流行状况与控制对策分析

目的分析梅州市艾滋病流行和防治现状,探讨对策。方法对1992～2005年梅州市艾滋病监测结果和防治情况进行分析。结果自1992年发现首例HIV感染者,至2005年底累计报告HIV感染者29例,死亡17例。感染者主要以男性(79.31%)、20～49年青壮年(75.86%)为主;以性传播为主,占62.07%;血液传播占13.79%,母婴传播占3.45%。结论梅州市艾滋病预防控制进入关键时期。今后应继续加强艾滋病监测和预防控制网络建设,实施以宣传教育为主的艾滋病综合性预防措施。     

HIV母婴传播及婴儿预防接种

目前中国艾滋病疫情,女性感染者人数在上升,由此出现人类免疫缺陷病毒(HIV)母婴传播病例,我国HIV母婴传播率为35%左右。临床资料显示,经采取综合性HIV母婴阻断技术后,可使HIV母婴传播的概率下降到8%,在欧美国家甚至可降至2%。作为一种生物制剂,预防接种所使用的疫苗在发挥着巨大的传染病预防功效的同时,也不可避免地会引起一系列生理病理反应。综合各地资料,多数疫苗都曾发生不良反应,其发生率各地不一,以一般反应为主。这是普通婴儿预防接种不良反应的发生情况,对暴露于HIV阳性母亲的婴儿,其预防接种反应如何,有待进一步观察。     

乙型肝炎患儿发病因素分析

目的了解乙型肝炎患儿的发病因素,以期发现和探讨新时期少儿乙型肝炎发病的特点和规律。方法对住院治疗的2000年以后出生的324例慢性乙型肝炎患儿进行回顾性调查。结果与其母亲直接相关的296例,明确有母婴阻断史的58例,新生儿乙肝疫苗的全程接种率仅达到63%,明确未接种乙肝疫苗者41例,接种情况不详者79例。结论母婴阻断的实施率和乙肝疫苗全程率低是患儿发病的重要因素;要加大健康教育力度,提高育龄乙型肝炎患者的防治观念是减少患儿的关键。