中国部分地区HIV阳性孕产妇的调查分析

目的:了解我国部分地区育龄妇女感染人类免疫缺陷病毒(HIV)的情况;调查研究各种阻断方式的效果,探讨适合我国国情的HIV母婴阻断措施。方法:2004年至2007年间,选择我国部分地区为调查地点,对来院进行孕检的妇女及孕期未曾检测HIV住院分娩的产妇进行HIV抗体筛查检测;对HIV阳性孕产妇采取相应阻断措施,此后追踪检测HIV母婴传播状况,综合分析各阻断方案的效果。结果:共筛查119616例孕产妇,检测HIV阳性65例,阳性率0.05%。65例阳性孕产妇中终止妊娠24例,分娩40例,待产1例;孕期、产时及产后发现的HIV阳性孕产妇分别占60.0%、15.4%及24.6%;性途径感染44例(67.7%),血途径感染21例(32.3%),以性传播途径为主;采取完全阻断措施20例(50.0%),1例HIV(+);不完全阻断措施15例(37.5%),1岁内死亡3例,失访2例;未实施阻断5例(12.5%),3例死产,1例HIV(+)。结论:孕产期做好HIV的自愿检测,有利于预防艾滋病母婴传播及阻断工作的开展,根据疫情不同,筛检措施应因地制宜;目前我国部分地区艾滋病流行以性传播为主;HIV母婴阻断应提倡早期发现早期预防,以免错过接受阻断传播的最佳时机;当前预防HIV母婴传播的策略降低了传播率,但也存在一些问题。     

四川省HIV感染孕妇终止妊娠情况及其影响因素

目的:了解四川省人类免疫缺陷病毒(HIV)感染孕妇选择终止妊娠的情况,并分析相关影响因素,促进预防艾滋病母婴传播(PMTCT)工作。方法:对全省2008~2012年间所有县(市、区)确认的HIV感染孕妇1957例,进行面对面问卷调查,收集和分析相关资料。结果:HIV感染孕妇选择终止妊娠的比例是12.91%,随着时间变化,HIV感染孕妇选择终止妊娠的比例呈逐年上升趋势(P0.05),不同地区类别HIV感染孕妇选择终止妊娠的比例不同(P0.05)。多因素Logistic回归分析显示,影响HIV感染孕妇选择终止妊娠的因素为婚姻状况、现有子女数、丈夫/性伴年龄、丈夫/性伴感染状况(P0.05)。结论:应探索个性化的服务模式,动员配偶或家庭成员与其一同参与PMTCT相关检测咨询,有的放矢地提供服务,避免非意愿妊娠,尽可能地减少感染儿童出生。     

湘西少数民族地区孕产妇保健状况分析

目的:分析湘西少数民族地区孕产妇保健现状,为提高孕期保健服务质量和效果提供依据。方法:结合2006～2010年湖南省湘西自治州八县(市)各医疗卫生机构上报的妇幼卫生统计年报表对孕产妇的保健状况进行回顾性分析。结果:孕产妇建卡率、系统管理率、产前检查率、早期孕检率、新法接生率、住院分娩率及产后访视率呈逐年增高趋势;非住院新法接生率逐年下降;剖宫产率呈现逐年增高趋势;2008～2010年间中重度缺铁性贫血总发生率为0.56%,各年度贫血的发生率呈增高趋势;HIV检测率为41.67%,感染率为0.02%;梅毒检测率为31.26%,感染率为0.52%,各年度HIV、梅毒感染率也呈增高趋势。结论:目前湘西少数民族地区孕产妇保健服务状况较好,但仍存在不足,有必要加强自然分娩优势的宣传,严格把握剖宫产指证,降低剖宫产率。进一步加强营养及健康知识宣教,防治孕产妇贫血,提高孕早期HIV、梅毒检测覆盖面,防止母婴传播。     

2002—2010年长春地区46例产科出血死亡原因分析

目的:通过对46例孕产妇产科出血死亡原因分析,提出降低长春地区孕产妇死亡率的干预措施。方法:长春地区13个县(市)、区(开发区),按国家统一要求,填报孕产妇死亡报告卡,死亡调查附卷、报表以及专家评审资料。结果:2002～2010年长春地区死亡孕产妇共144例。其中因产科出血死亡46例,占死亡的31.94%。而在产科出血死亡中,因产后宫缩乏力死亡的孕产妇29例,占产科出血死亡63.04%。因转院途中死亡孕产妇4例,占产科出血死亡8.7%。结论:①加强乡级保健网络建设,提高助产机构质量。②加强基层人员三基培训,提高产科急危重症的诊断、治疗水平,是减少产科出血的发生,降低孕产妇死亡率的重要措施。     

妊娠合并人类免疫缺陷病毒感染

人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染孕产妇人数及分娩需求逐年增加,产科临床医师应对HIV母婴传播机制及影响因素、实验室检查、诊断方法,孕期保健,产时、产后及新生儿处理等方面的新进展以及注意事项应有所认识和了解,以推动HIV母婴阻断措施的实施。     

妊娠合并人类免疫缺陷病毒感染孕妇围产期母婴阻断的研究

近几年，我国获得性免疫缺陷综合征（艾滋病）相关监测数据显示，在人类免疫缺陷病毒（HIV）感染的患者中，妇女感染HIV的比例大幅度增长，由1998年的15．3％上升到2004年的39％，直至2006年的47．8％。尤其年轻妇女正是生育的高峰期，使得HIV母婴传播的危险性更大，婴儿感染HIV的人数快速增加，母婴传播所占HIV人群比例已由0．5％上升或超过1％。因此，预防HIV母婴传播，建立有效的阻断干预模式，是目前妇幼保健和计划生育工作不可忽视的重要内容。     

2007～2009年昆明市艾滋病母婴传播干预效果分析

目的分析昆明市艾滋病病毒(HIV)阳性孕产妇母婴传播综合干预措施实施情况及其效果,为开展与推广HIV母婴阻断的预防工作提供参考。方法对2007～2009年昆明市第三人民医院收治的HIV阳性孕产妇的病历资料进行回顾性分析。结果 2007～2009年收治的临产前检出145例HIV阳性孕产妇中,100%接受了母婴传播干预服务,其中35.17%选择终止妊娠,64.83%选择继续妊娠,100%接受了婴幼儿喂养指导。23例HIV感染孕产妇所生婴幼儿接受了随访,其中11例婴儿HIV抗体为阴性,另12例在继续接受随访。结论昆明市HIV感染孕产妇母婴传播的综合干预措施是有效的,HIV传播阻断综合干预措施是降低HIV母婴传播的关键,值得大力推广实施。     

艾滋病病毒感染者/患者避孕套使用状况调查

目的:探讨艾滋病病毒感染者/患者避孕套使用状况及其影响因素,从而提供相应对策和建议。方法:对111例HIV感染者进行流行病学问卷调查和个人深入访谈。结果:虽然感染后最后三次性生活中使用避孕套的比例都有所上升,其中性途径感染者这一比例由感染前的5.88%上升到感染后25.00%,血液途径感染者由感染前的11.11%上升到感染后的52.63%,吸毒共用注射器感染者则由感染前14.81%上升到感染后20.00%,但是使用避孕套的比例仍然很低。多因素分析显示:年龄在30-45岁和经血感染者更倾向在性生活中使用避孕套。结论:HIV感染者的避孕套使用率较低,应采取有效措施提高其使用率,从而有效控制HIV的传播。     

基于人群的降低STIs和HIV感染的干预措施

在HIV流行地区,性传播感染的医疗服务质量很差,且性传播感染高度流行,改善医疗服务质量可使HIV传播下降高达40%。坦桑尼亚的经验表明这样的干预在发展中国家是可行的。     

2009～2010年南宁市妇幼保健院婚前保健人群和孕产妇HIV监测结果分析及干预措施研究

目的:了解南宁市婚前保健人群和孕产妇中人类免疫缺陷病毒(HIV)抗体检测及艾滋病(AIDS)感染情况。方法:我院HIV抗体初筛实验室对2009～2010年11041份血清标本进行HIV抗体初筛检测,并将初筛阳性的标本送往南宁市疾病预防控制中心(CDC)做确认实验。其后,对所有实验结果进行分析。结果:11041份标本中,HIV抗体阳性的标本有4例,阳性率为0.036%;检查类型分布,孕产妇4例,婚检人群未发现;感染者户籍均为暂住和流动人口。结论:做好婚前保健人群和孕产妇女人群中的HIV抗体初筛工作,能控制AIDS在高危人群流行一定时间后,向一般人群扩散蔓延,并有效防止和降低HIV母婴传播的发生率。     

162 HIV-1 infected pregnant women and vertical transmission. Results of a prospective study

BACKGROUND: Aim of this paper is to describe the changes over a 16-year period of the characteristics and management of HIV infected pregnant women. METHODS: Prospective study: analysis of data obtained from 162 women and 176 infants. Factors evaluated included: maternal socio-demographic level, immunological and virological parameters, antiretroviral therapy, mode of delivery, pregnancy outcome and babies follow-up. RESULTS: The proportion of women with heterosexual acquisition of infection has increased significantly from 13.5% in 1985-1989 to 47.1% in 1996-2001 (p<0.0005, Fisher's exact test), while the proportion acquiring HIV through injecting drugs has declined. Mean CD4 cell count at delivery was 535 x 106/l (+/-522.3 x 106/l). In 1990, 50% of mothers received antiretroviral therapy, rising significantly to 87.5% in 2000. The elective cesarean section was introduced in 1998 and its rate has increased to 75% in 2000. The vertical transmission rate changed from 9.5% in 1985-1989 to 14.3% in 1996-2000 (this difference was not statistically significant, Fisher's exact test). CONCLUSIONS: Social characteristics of the HIV-infected women have changed since the mid-1980s: in recent times women are having children at increasingly older ages and are more likely to know that they are HIV infected when they become pregnant. Antiretroviral therapy, elective caesarean delivery and avoidance of breastfeeding can reduce transmission of HIV, but the vertical transmission rate was unaffected by their use in our study and it remains high in comparison with rates reported from other studies.     

人类免疫缺陷病毒感染对妊娠结局的影响

目的 探讨夫类免疫缺陷病毒（HIV）感染对妊娠结局的影响及母婴垂直传播的发生情况。方法 应用酶联免疫吸附试验对2678例孕妇及其婴幼儿的外周血HIV抗体进行检测,其中资料完整的86例HIV抗体阳性孕妇为HIV组,另选择与HIV组年龄、孕周相匹配的HIV抗体检测阴性的40例健康孕妇及其婴幼儿作为对照组。采用回顾性分析的方法,对两组孕妇的妊娠结局进行跟踪随访。结果 （1）HIV组孕妇中,流产、早产、低体重儿及小于胎龄儿的发生率分别为9．3％（8／86）14．0％（12／86）、16．3％（14／86）及10．5％（9／86）,明显高于对照组的2．5％（1／40）、5．0％（2／40）、7．5％（3／40）及2．5％（1／40）。两组比较,差异有显著性（P＜0．05）。（2）HIV组孕妇中,合并念珠菌性阴道尖及尖锐湿疣的发生率分别为9．3％与8．1％,明显高于对照组的2．5％及2．5％,两组比较,差异有显著性（P＜0．05）。（3）HIV组孕妇中,母婴HIV垂直传播发生率为12．8％;而对照组孕妇所分娩的婴儿中,HIV抗体检测均为阴性,发生率为0％。两组孕妇HIV感染垂直传播率比较,差异有极显著性（P＜0．01）。结论 孕妇感染HIV后可显著增加流产、早产、低体重儿及小于胎龄儿等不良妊娠结局的发生率,同时增加念珠菌性阴道炎、尖锐湿疣的感染机会,母婴HIV垂直传播的发生率亦明显升高。加强孕期保健、预防HIV感染至关重要。     

改善妊娠合并人类免疫缺陷病毒感染者不良结局相关因素分析

目的探讨改善妊娠合并人类免疫缺陷病毒(HIV)感染者不良结局的相关因素。方法对2009年5月至2010年5月广州市第八人民医院收治的65例HIV感染孕妇的临床情况进行分析,并对以下分组妊娠结局进行比较(65例中终止妊娠10例,仅对余55例进行分析)。(1)全程实施母婴阻断措施的39例为研究组,未全程实施母婴阻断措施的16例为对照组。(2)研究组中,孕13~27+6周开始实施母婴阻断措施的23例为中孕期组,孕28周后开始实施母婴阻断措施的16例为晚孕期组。(3)产前7d内末梢血CD4+ T淋巴细胞数大于200个/μL者为A组,小于200个/μL者为B组。结果 (1)研究组与对照组早产、低体重儿、胎膜早破、羊水过少、胎儿畸形、胎儿窘迫发生情况比较,除胎儿窘迫外,差异均有统计学意义(P<0.05)。(2)中孕期组与晚孕期组早产、低体重儿、羊水过少、胎儿窘迫、胎膜早破发生情况比较,除胎膜早破外,差异均有统计学意义(P<0.05)。(3)A组与B组早产、低体重儿、胎儿窘迫、羊水过少、胎儿畸形和产后发热发生情况比较,差异均有统计学意义(P<0.05)。结论婚前检查和产前筛查、孕妇末梢血CD4+ T淋巴细胞数、全程母婴阻断...     

A Paradigm Shift in the Epidemiology of HIV in Pregnancy at ICTC of a Medical College

Objectives

To study the present status and effect of paradigm shift in the epidemiology of HIV amongst pregnant women in urban set up.

Aims

The purpose of the study is to evaluate the paradigm shift in overall screening and management strategy of HIV in antenatal women for last four and half years in an urban medical college.

Methods

The study was conducted from 1st January 2004 to 30th June 2008 and all registered and unregistered pregnant women who attended ICTC clinic and also for emergency admission (unregistered) were counseled and blood samples were tested as per NACO guidelines with cafeteria choice of opt in and opt out strategy. Reactive women in antenatal period were counseled and discussed about anti-retroviral therapy (ART) and universal treatment regime. Seroprevalent women were counseled about their spouse, personal habits and demographic status. Marked improvement was seen in the use of contraceptive and drug abuse. During labor mother and baby were given nevirapine as per NACO guidelines.

Results

The seroprevalence of HIV reactive women in our Centre was 0.23, 0.19, 0.14 and 0.12% in the year 2004, 2005, 2006, 2007 and zero prevalence in 2008 till date. Spouse positivity was noted in 80, 58.33, 72.72 and 70% in the set period from 2004 to 2008.

Conclusion

Marked improvement was noticed in all the strategic points from registration, counseling, screening and availability of improved diagnostic kits for screening HIV 1 and HIV 2.     

Are public antenatal clinics in Blantyre, Malawi, ready to offer services for the prevention of vertical transmission of HIV?

At least 100% of the adult population in Malawi is infected with HIV and vertical transmission is a major mode of transmission. Currently, there are plans to provide widespread antiretroviral therapy to prevent mother to child transmission of HIV. This study was conducted to describe the perceptions of midwives towards selected issues regarding prevention of mother to child transmission of HIV in eleven public health centres in Blantyre, Malawi. A cross-sectional study using a self-administered questionnaire incorporating both open-ended and closed-ended questions was used. Twenty seven midwives participated in the study. Less than half (40.7%), of them reported working at a baby friendly hospital initiative health facility, while 96.3% reported that they would advise an HIV infected woman to breastfeed her infant. HIV prevention messages were reportedly offered routinely by 77.8% of the respondents, but only 22.2% reported that their clinics offered condoms to pregnant women. Also, only 37.0% reported offering routine STI screening, while 37.0% of the midwives would support antenatal women being accompanied by their male partners Majority (81.2%) said that women who know they are HIV infected should not become pregnant, while 37.0% reported that they would be uncomfortable to assist in the delivery of an HIV infected woman. There was lack of appropriate clinic space and sterile gloves for the proper delivery of maternity services. Midwives in Malawi need training, supervision and other support to provide adequate health care services to antenatal women.     

Donor Insemination and Human Immunodeficiency Virus Transmission

Objective: To describe cases of AIDS attributed to donor insemination identified through national human immunodeficiency virus (HIV)/AIDS surveillance and to compare the number identified through surveillance with our estimate of the number of women infected as a result of donor insemination before the initiation of donor screening.Methods: We reviewed national HIV/AIDS surveillance data on women reported through December 1996 and described characteristics of documented and possible cases attributed to donor insemination. We estimated the number of women infected before the initiation of widespread screening of donors using assumptions about the number of women inseminated each year, the average number of inseminations, the proportion of donors who were men who had sex with men, the prevalence of HIV among such men, and the rate of transmission per HIV-infected exposure.Results: A total of six documented and two possible cases of donor insemination–associated AIDS have been reported to the Centers for Disease Control and Prevention as of December 1996. An estimated eight to 141 women were infected through donor insemination in the United States between 1980 and 1984. Reasons for this discrepancy are discussed.Conclusion: Based on surveillance case reports and on our estimate, the total number of women infected as a result of donor insemination before screening was recommended is low. Current sperm bank practices to prevent HIV infection will be strengthened further by a pending proposal from the Food and Drug Administration requiring infectious disease screening and testing of semen donors. The most likely source of risk of new infections associated with donor insemination is self-insemination. (Obstet Gynecol 1998;91:515–8.)     

Effect of protease inhibitor therapy on glucose intolerance in pregnancy

OBJECTIVE: To determine if protease inhibitor use was associated with increased glucose intolerance in our population of pregnant women infected with the human immunodeficiency virus (HIV). METHODS: Women who were infected with HIV from January 1, 1998, to January 8, 2004, and who had a 1-hour and 3-hour glucola test were identified. Medical records were reviewed to obtain demographic characteristics and obstetric and laboratory data. Drug regimens at the time of glucola testing were determined. Human immunodeficiency virus-infected women were then matched 1:3 to HIV-noninfected gravidas by race, age, and year of delivery. RESULTS: One hundred seventy-one HIV-infected women had glucola results available. Twelve percent had an abnormal 1-hour glucola result and 3% had an abnormal 3-hour result. This was similar to the HIV-noninfected population. Forty-five percent of the HIV-infected cohort was on a protease inhibitor at the time of glucola testing. Protease inhibitor exposure had no effect on glucola test results. HIV infection itself also did not increase abnormal glucola test results. CONCLUSION: Glucose intolerance in this obstetric population was not associated with the diagnosis of HIV or with the use of protease inhibitors. Protease inhibitors should continue to be an option for the treatment of HIV in pregnancy.     

Trends in management and outcome of pregnancies in HIV-infected women in the UK and Ireland, 1990-2006

Objective  To describe the changing demographic profile of diagnosed HIV-infected pregnant women over time and trends in pregnancy outcome, uptake of interventions and mother-to-child transmission.
Design  National surveillance study.
Setting  UK and Ireland.
Population  Diagnosed HIV-infected pregnant women, 1990–2006.
Methods  Active surveillance of obstetric and paediatric HIV conducted through the National Study of HIV in Pregnancy and Childhood.
Main outcome measures  Maternal characteristics, pregnancy outcome, use of antiretroviral therapy, mode of delivery and mother-to-child transmission.
Results  A total of 8327 pregnancies were reported, increasing from 82 in 1990 to 1394 in 2006, with an increasing proportion from areas outside London. Injecting drug use as the reported risk factor for maternal HIV acquisition declined from 49.2% (185/376) in 1990–1993 to 3.1% (125/4009) in 2004–2006 ( P < 0.001), while the proportion of women born in sub-Saharan Africa increased from 43.5% (93/214) in 1990–1993 to 78.6% (3076/3912) in 2004–2006 ( P < 0.004). Reported pregnancy terminations decreased from 29.6% (111/376) in 1990–1993 to 3.4% (135/4009) in 2004–2006 ( P < 0.001). Most (56.4%, 3717/6593) deliveries were by elective caesarean section, with rates highest in 1999 (66.4%, 144/217). Vaginal deliveries increased from 16.6% (36/217) in 1999 to 28.3% (321/1136) in 2006 ( P < 0.001). Use of antiretroviral therapy in pregnancy increased over time, reaching 98.4% (1092/1110) in 2006, and the overall mother-to-child transmission rate declined from 18.5% (35/189) in 1990–1993 to 1.0% (29/2832) in 2004–2006.
Conclusions  The annual number of reported pregnancies increased dramatically between 1990 and 2006, with changing demographic and geographic profiles and substantial changes in pregnancy management and outcome.     

Using the Rapid HIV Test to Rescreen Women in the Third Trimester of Pregnancy

Antiretroviral therapy during pregnancy in HIV‐infected women has dramatically reduced the rate of mother to child HIV transmission in the United States. National guidelines strongly recommend universal HIV testing of all pregnant women with repeat screening in the third‐trimester in high‐risk populations. To determine patient attitudes towards third‐trimester rescreening, a convenience sample was recruited during routine prenatal visits at an urban clinic and participants were surveyed to determine attitudes about HIV third‐trimester retesting, acceptability of the rapid HIV testing, condom use, and knowledge of partner's HIV status during pregnancy. Participants were offered a third‐trimester rapid HIV retest with the option to decline the test. Eighty pregnant women participated; 95% agreed to be retested with a rapid HIV test, 100% received immediate HIV results, and 91% reported that the rapid test was less stressful than conventional testing. There were no seroconversions. Although 35% did not know their partner's HIV status, 57% of these women reported never using condoms during pregnancy. There was a significant association between reported stage of behavior change and reported likelihood of using condoms. We found that rescreening with the rapid HIV test in the third trimester of pregnancy was well accepted and is important to prevent perinatal HIV transmission.