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。     

河南地区有偿供血者HIV母婴传播危险因素调查

目的探索河南地区艾滋病病毒Ⅰ型(HIV-1)母婴传播率和影响因素,为开展阻断工作提供背景资料。方法以HIV阳性并通过母婴传播导致子女感染HIV的母亲为对象,以未导致子女感染的母亲为对照,分析影响母婴传播的危险因素。结果采取母婴阻断措施前后的母婴传播率分别为23.02%(32/139)、5.00%(1/20)。影响母婴传播的显著危险因素为:CD4细胞数<419个/μl(OR=30.31,95%CI9.59~124.88)、胎次(第1胎/≥2胎:OR=3.16,95%CI1.22~8.33)、产程≥4小时(OR=24.27,95%CI7.69~99.60)。结论Logistic回归分析显示,产程≥4小时(OR=24.24,95%CI7.87~74.64)是影响母婴传播的独立危险因素。     

HIV-1母婴传播的预防措施

1 引言 HIV-1母婴传播在世界多数地区经久不衰,估计已有360万HIV-1感染幼儿死亡,1999年内受HIV-1感染成人和婴幼儿分别有500万（妇女占46％）和 57万[1]。非洲 HIV-1血清阳性母亲所生婴儿死亡率在出生后最初2年中可达50％,当中70％婴幼儿在死前有HIV-1感染证据[2]。世界各地HIV-1的母婴传播率变化范围是7％-48％,HIV-1感染幼儿在生后头5年内有高达50％的人发展成AIDS患者,中位数存活时间是9.4年。 近年来,美国、欧洲高度发达国家通过联合采取产前HIV-1咨询筛检、抗逆转录病毒治疗和选择性剖宫产措施,已将HIV-1的母婴传播率降低到4％-6％,甚至低于2％[3]。然而,许多欠发达地区在实行HIV-1母婴传播预防中遇到了困难,主要障碍包括基本母婴卫生保健机构的机能不全、未进行孕妇产前咨询筛检、资源有限。     

陕西地区孕妇HBV感染现状与母婴传播的危险因素

目的调查陕西省孕妇HBV感染率并筛选母婴传播高危人群。方法自2010年-2015年连续调查了陕西省18家医院13 451名孕妇HBV感染情况,对所有HBs Ag阳性孕妇所生婴儿进行联合免疫,采用单因素及多因素logistic回归分析母婴传播的高危因素。计量资料组间比较采用t检验或Mann-Whitney U检验。计数资料多组间比较采用χ2检验。结果陕西省孕妇HBsAg流行率为7. 07%,陕南地区高达9. 40%。HBV母婴传播率为5. 21%,单因素分析显示母亲HBsAg滴度、HBeAg滴度、HBeAg阳性及HBV DNA载量与婴儿HBV感染相关,多因素分析显示母亲HBV DNA载量是母婴传播的独立危险因素(相对危险度:1. 586,95%可信区间:1. 020～2. 465,P=0. 041)。发生母婴传播的HBV感染孕妇中,84. 62%为HBeAg阳性且HBV DNA 106IU/ml;发生母婴传播的婴儿15. 38%来自于HBeAg阴性的HBV感染孕妇。HBeAg阳性且HBV DNA 10~6IU/ml的孕妇中,婴儿发生母婴传播的相对危险度为1. 210(1. 129～1. 297);而HBeAg阴性,但HBV DNA 2×103IU/ml且HBsAg 104IU/ml的孕妇中,婴儿发生母婴传播的相对危险度为26. 062(2. 633～258. 024)。结论陕西省孕妇HBV感染率仍高,HBeAg阳性且高病毒载量孕妇发生母婴传播风险较高; HBeAg阴性母亲所生婴儿HBV感染率虽然低,但当母亲HBV DNA 2×103IU/ml且HBsAg 104IU/ml时仍有较高母婴传播的风险。     

母乳喂养传播HIV-1的回顾性定群研究

目的探讨母乳喂养传播艾滋病病毒Ⅰ型（HIV-1）的机会及其影响因素。方法对来自某地一次输血感染HIV-1的母亲出生的子女进行回顾性定群研究,并采集血标本检测HIV抗体。结果母乳喂养组的母婴传播率为37.3%（25/67）,远高于非母乳喂养组的11.1%（3/27）。母亲感染1年内是母乳喂养传播率第一峰值期,第1-2年是谷底期,第3-9年逐年上升,第7-9年是第二峰值期,第二峰值高于第一峰值。存在不同母婴传播因素的母乳喂养传播率,均显著高于人工喂养组或家庭日常生活接触组。母乳喂养9个月以下未发现母乳喂养传播者,而母乳喂养10个月以上的传播率逐渐升高。结论母乳喂养是HIV-1传播的主要危险因素。     

实施预防HIV母婴传播措施效果分析

目的了解实施预防艾滋病母婴传播措施对艾滋病病毒(HIV)母婴传播的影响。方法对实施干预试点地区阳性孕产妇及所生幼儿干预状况进行调查,调查幼儿出生时服药情况、喂养方式,及其母亲的分娩方式、服用抗病毒药物等情况,采用单因素χ2分析,比较干预组与未干预组幼儿HIV感染率的差异。结果实施综合干预措施组HIV母婴传播率为2.75%,没有采取任何干预措施组的母婴传播率为50.00%,两组间存在显著性差异。结论对HIV阳性孕产妇及所生婴儿及时服用抗病毒药物,并对婴儿实施纯人工喂养等措施,可有效降低HIV的母婴传播率。     

乙肝疫苗联合HBIG接种阻断HBsAg/HBeAg双阳性孕妇HBV母婴传播的效果研究

目的 比较乙肝疫苗联合乙型肝炎免疫球蛋白（HBIG）与乙肝疫苗接种阻断HBsAg/HBeAg双阳性母亲HBV母婴传播的效果。方法 对血清HBsAg阳性或HBsAg/HBeAg双阳性母亲所生新生儿分别按标准方法接种乙肝疫苗或者乙肝疫苗与HBIG联合接种,比较儿童HBV感染率情况。结果 在110例血清HBsAg阳性母亲所生的110例只接种乙肝疫苗的儿童中,出生和6月龄血清HBsAg阳性率分别为28.2%和10.9%,与240例HBsAg/HBeAg阳性母亲所生的240例只接种乙肝疫苗的新生儿（分别为39.6%和24.2%）比,无显著性相差（P>0.05）;在150例血清HBsAg阳性母亲所生的150例接种乙肝疫苗联合HBIG儿童中,出生和6月龄血清HBsAg阳性率分别为17.3%和3.3%,与100例HBsAg/HBeAg阳性母亲所生的100例新生儿（分别为25.0%和11.0%）比,也无显著性相差（P>0.05）,但无论在血清HBsAg阳性还是血清HBsAg/HBeAg阳性母亲,联合接种儿童HBV感染率均显著低于只接种乙肝疫苗者（P<0.05）。结论 采取乙肝疫苗联合HBIG接种能降低乙型肝炎病毒携带母亲所生儿童的HBV感染率。     

湖北省HIV感染儿童抗病毒治疗前生存时间的研究

目的了解湖北省艾滋病病毒(HIV)阳性儿童的流行病学特征,探讨其接受抗反转录病毒治疗(ART)前的生存时间,为儿童艾滋病的防治工作提供参考。方法自1999年1月至2015年12月,收集湖北部分地区HIV阳性儿童的相关资料并进行随访,SPSS 20.0对相关资料进行统计分析。结果 152例HIV阳性儿童中,115例(75.7%)通过母亲传播给子女,包括85例(55.9%)母婴传播(母亲产前感染HIV)及30例(19.7%)母乳传播(母亲产后输血感染HIV并对所生婴儿进行母乳喂养)。自2004年开始,新发HIV阳性儿童人数呈逐年下降趋势。未及时发现HIV阳性孕产妇,是2004年及以后HIV阳性儿童错过母婴传播阻断的主要原因。母婴、母乳、受血途径感染HIV儿童,ART前的中位生存时间分别为6.2年、11.8年、10.4年,通过母婴途径感染HIV的儿童,ART前的生存时间短于通过母乳途径、受血途径感染的儿童(P0.05)。结论应提高湖北省孕检人群HIV的检测率,尽早发现HIV阳性孕妇并予以阻断。感染时机对HIV阳性儿童ART前的疾病进程有影响。     

乙肝疫苗联合HBIG接种阻断HBsAg/HBeAg双阳性孕妇HBV母婴传播的效果研究

] 目的 比较乙肝疫苗联合乙型肝炎免疫球蛋白（HBIG）与乙肝疫苗接种阻断HBsAg/HBeAg双阳性母亲HBV母婴传播的效果。方法 对血清HBsAg阳性或HBsAg/HBeAg双阳性母亲所生新生儿分别按标准方法接种乙肝疫苗或者乙肝疫苗与HBIG联合接种,比较儿童HBV感染率情况。结果 在110例血清HBsAg阳性母亲所生的110例只接种乙肝疫苗的儿童中,出生和6月龄血清HBsAg阳性率分别为28.2%和10.9%,与240例HBsAg/HBeAg阳性母亲所生的240例只接种乙肝疫苗的新生儿（分别为39.6%和24.2%）比,无显著性相差（P>0.05）;在150例血清HBsAg阳性母亲所生的150例接种乙肝疫苗联合HBIG儿童中,出生和6月龄血清HBsAg阳性率分别为17.3%和3.3%,与100例HBsAg/HBeAg阳性母亲所生的100例新生儿（分别为25.0%和11.0%）比,也无显著性相差（P>0.05）,但无论在血清HBsAg阳性还是血清HBsAg/HBeAg阳性母亲,联合接种儿童HBV感染率均显著低于只接种乙肝疫苗者（P<0.05）。结论 采取乙肝疫苗联合HBIG接种能降低乙型肝炎病毒携带母亲所生儿童的HBV感染率。     

深圳地区HIV-1母婴垂直传播实验室诊断方法探索及其分子流行病学研究

目的 探索艾滋病病毒Ⅰ型(HIV-1)阳性孕产妇新生婴儿核酸检测的辅助性诊断方法,了解深圳地区母婴传播所感染的HIV-1阳性婴儿HIV-1毒株的分子流行情况,帮助分析HIV-1在该人群中传播的危险因素.方法 收集深圳市2000-2007年19例HIV-1阳性孕产妇的血样,她们所生新生儿中28人的血样,应用套式聚合酶链式反应(Nested-PCR),对该样本膜蛋白基因(env基因)和核心蛋白(gag基因)进行扩增,并对其各基因区核苷酸序列进行测定和分析.结果 28例婴儿中共得到6例PCR诊断为阳性的婴儿样本,6例样本中共存在CRF01_AE和CRF07_BC两种重组毒株以及B一种亚型,其在所有分析样本中的比例分别为4/6、1/6和1/6;在env基因区与对应的流行代表株01_AE.TH.90.CM240的基因离散率为(9.200±1.600)%;CRF01_AE重组株组内离散率为(11.700±4.000)%;在gag基因区与对应的流行代表株01_AE.TH.90.CM240、07_BC.CN.97.97CN001和B.CN.RL42的基因离散率分别为(4.075±0.763)%、(5.500±0.566)%和(7.150±1.485)%;CRF01_AE重组株、CRF07_BC重组株和B亚型组内离散率分别为(4.033±1.692)%、0.800%和1.900%.结论 该方法有望成为HIV母婴垂直传播中新生婴儿的早期辅助性诊断方法.在深圳地区HIV-1阳性婴儿中,HIV-1流行株以CRF01_AE重组亚型为主,其次是B亚型.并且在母婴传播过程中,HIV-1 env和gag基因变异性较小.     

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。     

Maternal HIV-1 and HIV-2 infection and child survival in The Gambia

OBJECTIVE: To compare the survival of children born to HIV-1 or HIV-2 seropositive mothers with that of children born to HIV-seronegative mothers and to evaluate risk factors for mortality. DESIGN: Physician-blinded prospective study. METHODS: One hundred and one HIV-1-seropositive, 243 HIV-2-seropositive pregnant women, and 468 HIV-seronegative women (control group) matched by age, parity, and health centre, were followed up in a study of mother-to-child transmission of HIV. Mothers and children were seen at 2 and 6 months of age and subsequently followed at 3-monthly intervals up to 18 months of age. HIV infection in children was diagnosed by polymerase chain reaction at 2, 9 or 18 months and by antibody assays at 18 months. RESULTS: Fifteen per cent of children born to HIV-1-infected mothers died compared with 7% of children born to HIV-2-infected mothers [hazard ratio, 2.3; 95% confidence interval (CI), 1.1-4.7; P = 0.02], and 6% of HIV-seronegative mothers (hazard ratio, 2.6; 95% CI, 1.4-5.0; P = 0.003). Six of the 17 children known to be HIV-1 infected died compared with none among the eight HIV-2-infected children (P = 0.13). High proviral load in the babies, high antenatal maternal RNA plasma viral load, and maternal death increased child mortality significantly. CONCLUSIONS: More children born to HIV-1-infected mothers died in comparison with those born to HIV-2-infected mothers or to mothers from the control group. This effect was due to excess death in HIV-1-infected infants which was associated with a high viral load in the affected mother and child.     

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.     

HIV-1 transmission through breast-milk: appraisal of risk according to duration of feeding.

OBJECTIVES: To estimate the risk of HIV-1 transmission through breast-milk in children born to infected mothers, and to determine the relationship between duration of breast-feeding and risk. DESIGN AND METHODS: The study population included 168 breast-fed and 793 bottle-fed children born to seropositive mothers. All subjects were enrolled and followed-up in the Italian Register for HIV Infection in Children; HIV sero-status was defined in all children. Multivariate analysis was performed using a logistic regression model. Independent variables included biological factors (duration of breast-feeding, gestational age, clinical condition of mother at delivery, mode of delivery, birth-weight and sex). Year of birth and age when HIV infection was diagnosed were also considered in the analysis attempting to control for possible selection biases. RESULTS: Breast-feeding increased the risk of HIV-1 transmission. The estimated adjusted odds ratio for 1 day of breast- versus bottle-feeding was 1.19 (95% confidence interval, 1.10-1.28). The infection odds ratio of breast- versus bottle-feeding increased with the natural logarithm of the duration of practice. CONCLUSIONS: These results are the first to provide an appraisal of the additional risk of HIV-1 transmission associated with a seropositive mother breast-feeding her child. Biological significance of this route of transmission was supported by demonstration of a relationship between duration of breast-feeding and risk of HIV-1 transmission.     

Vertical transmission of HIV-1 in Poland

The aim of our study was to evaluate changes in vertical transmission of HIV infection in Poland after introducing zidovudine prophylactic strategies. Data from the Department of Children's Infectious Diseases (a paediatric HIV referral centre) at the Medical University, Warsaw was studied. Since 1989 vertical transmission of HIV-1 has been studied in 100 children born to 91 HIV-positive mothers (2 sets of twins). Zidovudine therapy, mode and timing of delivery and their relationship to perinatal HIV-1 infection were analysed. From 1989 to 1994 the transmission rate was 31.5%. Since 1995, when recommendations based on ACTG 076 were issued, a decline in a transmission rate to 19.6% was reported. 62% (32 out of 52) mother-infant pairs received zidovudine therapy. None of those children have become HIV infected. Zidovudine chemoprophylaxis regimen reduces the risk for mother to child transmission. It should be recommended for all HIV-infected pregnant women or women in labour and their infants.     

GB virus C coinfection and vertical transmission in HIV-infected mothers before the introduction of antiretroviral prophylaxis

OBJECTIVES: To investigate the prevalence of GB virus C (GBV-C) viraemia and GBV-C antibodies in a cohort of HIV-infected mothers and their infants between 1987 and 1994. METHODS: GBV-C viraemia and antibodies were determined by polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) in 52 HIV-infected mothers and their 53 infants, who were born before antiretroviral prophylaxis for reduction of HIV transmission was introduced at the end of 1994. Ten of these children acquired HIV. RESULTS: Mothers of three children had GBV-C viraemia and mothers of another 14 children carried antibodies against GBV-C. No mother had GBV-C antibodies and GBV-C viraemia simultaneously. GBV-C viraemia was detected in only one infant. This child was delivered by the vaginal route to a mother with GBV-C viraemia, and was not HIV-infected. No vertical transmission of GBV-C occurred from mothers with GBV-C antibodies. However, four of 10 children who were infected with HIV had a mother with past or ongoing GBV-C infection. CONCLUSION: Our findings suggest that the risk of vertical transmission of GBV-C is not elevated in HIV-infected mothers. Furthermore, although the number of HIV-1-infected children was low, we saw no evidence that the presence of ongoing or past GBV-C infection influenced the probability of vertical HIV transmission.     

感染HIV的孕产妇预防艾滋病母婴传播服务利用及影响因素分析

目的了解感染艾滋病病毒（HIV）的孕产妇对预防艾滋病母婴传播（PMTCT）服务的利用状况，分析影响因素。方法在河南、广西、新疆、云南省（自治区）的15个县／市／区，对2004年1月至2006年6月检测发现的感染HIV的孕产妇346人，通过问卷调查方式，结合相关医疗记录在孕期、产时和产后分阶段完成调查。调查内容包括人口学特征、相关行为、感染途径、PMTCT服务的利用情况等。结果346名感染HIV的孕产妇中94.80％接受过产前检查，95．95％住院分娩，其希望住院分娩的原因是医院医疗技术水平高（58．28％），服务质量好（47．27％），收费低（33．33％），能够提供PMTCT服务（33．03％），保密性好（26．97％），交通方便（23.33％）等。87．57％的母婴应用抗艾滋病病毒药物，规范应用抗病毒药物者占46.82％。感染HIV的孕产妇所娩婴儿中，89．02％采取人工喂养方式，满18月龄时进行HIV检测者占93.75％。检测后咨询包含PMTCT内容、民族和文化程度对规范应用抗病毒药物有影响作用（P〈0.05）。结论感染HIV的孕产妇对PMTCT服务的需求特殊，PMTCT服务利用尚不足，检测后咨询及咨询内容影响抗病毒药物的规范应用。建议加强HIV／ADIS高发地区基础妇幼保健服务，提高妊娠妇女早期和孕中期HIV抗体检测水平，重视感染HIV孕产妇抗病毒药物的规范应用和安全助产，为感染HIV的孕产妇及所娩婴儿提供个性化的、综合的PMTCT服务。     

Drinking water quality, feeding practices, and diarrhea among children under 2 years of HIV-positive mothers in peri-urban Zambia

In low-income settings, human immunodeficiency virus (HIV)-positive mothers must choose between breastfeeding their infants and risking transmission of HIV or replacement feeding their infants and risking diarrheal disease from contaminated water. We conducted a cross-sectional study of children < 2 years of age of 254 HIV-positive mothers in peri-urban Zambia to assess their exposure to waterborne fecal contamination. Fecal indicators were found in 70% of household drinking water samples. In a multivariable analysis, factors associated with diarrhea prevalence in children < 2 years were mother having diarrhea (adjusted odds ratio [aOR] = 5.18, 95% confidence interval [CI] = 1.65-16.28), child given water in the past 2 days (aOR = 4.08, 95% CI = 1.07-15.52), child never being breastfed (aOR = 2.67, 95% CI = 1.06-6.72), and rainy (versus dry) season (aOR = 4.60, 95% CI = 1.29-16.42). Children born to HIV-positive mothers were exposed to contaminated water through direct intake of drinking water, indicating the need for interventions to ensure microbiological water quality.     

18-Month mortality and perinatal exposure to zidovudine in West Africa

OBJECTIVES: To study mortality in African children born to HIV-1-infected mothers exposed peripartum to zidovudine. METHODS: A randomized placebo-controlled trial in Abidjan and Bobo-Dioulasso. Pregnant women received either 300 mg zidovudine twice daily from 36-38 weeks' gestation, 600 mg during labour, and 300 mg twice daily for 7 days post-partum or a matching placebo. Determinants of mortality were studied up to 18 months, overall and among the infected children: treatment, centre, timing of infection, mother and child HIV disease. RESULTS: There were 75 infant deaths among 407 live births. The risk of death at 18 months was 176/1000 in the zidovudine arm and 221 for placebo. Relative hazard (RH, zidovudine versus placebo) was 0.47 [95% confidence interval (CI) 0.2-1.0] up to 230 days of life. Maternal CD4 lymphocyte count < 200/mm3 (RH 2.92; CI 1.4-6.1) and child HIV-1 infection (RH 12.6; CI 6.6-24.3) increased mortality of all children born to HIV-1-infected mothers. There were 101 children infected (40 in the zidovudine group), and 51 died. Their 18 month probability of death was 590/1000 in the zidovudine group and 510 in the placebo group. Among infected children, maternal zidovudine reduced the risk of death on or before day 230 (RH 0.18; CI 0.1-0.5). Maternal CD4 lymphocyte count < 200/mm3 (RH 3.25; CI 1.3-8.4), maternal death (RH 9.65; CI 1.7-56.0), diagnosis of paediatric infection on or before day 12 (RH 18.1; CI 4.8-69.0) and between days 13 and 45 (RH 7.63; CI 2.0-29.5), clinical paediatric AIDS (RH 5.37; CI 2.3-12.7) were risk factors for death in HIV-1-infected children. CONCLUSION: Mother-to-child transmission reduction by zidovudine is safe and beneficial to African children. The mortality of HIV-1-infected children is high. Peripartum maternal zidovudine exerts a protective effect for at least 8 months.     

Monophyletic HIV type 1 CRF02-AG in a nosocomial outbreak in Benghazi,Libya

A cluster of HIV-1 infection has been identified in Libya in 1999, involving 402 children admitted to "El-Fath" Children's Hospital in Benghazi (BCH) during 1998 and 19 of their mothers. Nosocomial transmission has been indicated as responsible for the spread of infection. Out of this group, 104 children and 19 adult women have been followed at the National Institute for Infectious Diseases L. Spallanzani in Rome during 1 year. At BCH, all children had received intravenous infusions but not blood or blood products. A single child receiving a blood transfusion in 1997 and the 17 infected mothers were never hospitalized in Benghazi. In addition, two nurses were diagnosed as HIV-1 infected. In 40 subjects out of this group HIV-1 gag, env, and pol fragments were amplified and sequenced. The phylogenetic analyses showed that a monophyletic recombinant HIV-1 form CRF02-AG was infecting all of the HIV-1-seropositive patients admitted at BCH with no close similarities to the other CRF02-AG reported to GenBank. A different strain was found in the child infected by blood transfusion. The data thus suggest a highly contagious nosocomial spread of HIV-1 infection and possibly transmission of the virus from child to mother during breastfeeding in connection with primary HIV-1 infection.