HIV和HCV母婴垂直传播影响因素的比较

由于人类免疫缺陷病毒和丙型肝炎病毒有相同的传染途径,在母婴垂直感染中存在着相同因素,也存在着不同因素,共同感染在垂直传播中是常见现象,也产生相互影响.为了更好地预防和控制两病毒引起的疾病,揭示其机制.该文将近几年的研究进展,从母体因素、分娩因素、婴儿喂养方式和宫内感染方面以及人类免疫缺陷病毒和丙型肝炎病毒共同感染对母婴垂直传播的影响作以综述.     

抗病毒药物预防HIV母婴传播的研究进展

人类免疫缺陷病毒母婴传播的致病机制研究已有所进展.HIV母婴传播大部分发生在分娩时和产后哺乳时,因此,中断这种传播主要针对围产期和哺乳期,采取的措施有抗病毒治疗、选择性剖宫产和避免母乳喂养.从用药方案和药物安全性两方面综述了抗病毒药物预防HIV母婴传播的最新研究及进展.     

HCV的垂直传播

目前丙型肝炎病毒传播已成为危害公众健康的主要问题之一，自从90年代初对血液制品进行抗-HCV筛查以来，母婴垂直传播已成为HCV的主要传染方式。但其具体传播机制尚不清楚，可能与母乳喂养和分娩方式等有关。对HCV感染的早期诊断，包括对高危孕妇的筛查，有利于疾病的治疗和预后。     

丙型肝炎病毒母婴垂直传播的危险因素分析与预防对策

目的分析丙型肝炎病毒(HCV)母婴垂直传播的相关因素及危险因素,探讨预防HCV母婴垂直传播的策略,降低HCV的母婴垂直传播发生率,为临床备孕及妊娠女性提高妊娠安全性、提高新生儿质量提供参考。方法选取医院2010年1月-2016年1月收治的126例HCV感染阳性孕妇,对其所分娩的新生儿进行HCV检测,判断是否为HCV感染,对新生儿母亲临床资料、围产期HCV感染相关指标、生产方式、产后喂养方式进行比较,分析影响HCV母婴垂直传播的相关因素。结果 126例HCV感染孕妇娩出新生儿126例,其中11例为HCV感染及母婴垂直传播,感染率8.73%;多因素logistic分析显示,合并HIV感染、HCV载量>1.0×10~6拷贝/ml、ALT>110IU/ml、阴道产、纯母乳喂养是HCV孕妇围产期新生儿发生HCV感染的独立危险因素(P<0.05)。结论 HCV母婴垂直传播危险因素大多数可以通过预防控制加以避免,临床应加强对HCV妊娠患者HCV载量、ALT、AST水平的随访,并采取措施进行控制,选择适合的生产及喂养方式,降低HCV的母婴垂直传播率。     

HIV母婴传播机制研究进展

艾滋病是由人类免疫缺陷病毒引起的人类空前最严重的传染性疾病。母婴垂直传播是该病毒传播的一个重要方式 ,被感染的孕妇可以在宫内经胎盘、经阴道分娩以及产后经母乳感染胎儿和新生儿。该文通过对人类免疫缺陷病毒母婴传播的影响因素和各期传播机制进行综述 ,以期为今后制定更加合理的治疗方案提供理论依据     

HIV母婴传播机制研究进展

艾滋病是由人类免疫缺陷病毒引起的人类空前最严重的传染性疾病。母婴垂直传播是该病毒传播的一个重要方式，被感染的孕妇可以在宫内经胎盘、经阴道分娩以及产后经母乳感染胎儿和新生儿。该文通过对人类免疫缺陷病毒母婴传播的影响因素和各期传播机制进行综述，以期为今后制定更加合理的治疗方案提供理论依据。     

丙型肝炎病毒母婴传播的研究现状

国内外大量研究证实，丙型肝炎病毒（HCV）主要经血传播，但尚有40％～50％的HCV感染者无明显经血暴露史，表明还存在其它非经血传播途径。近年来关于HCV母婴传播的报道较多，现综述如下。一、研究方法进展：（一）血清流行病学研究：早期关于HCV母婴传播的研究是应用第一代或第二代酶联免疫测定法（ELISA）检测血中的抗-HCV。Wejstal等[1]对8名患慢性丙型肝炎的孕妇所生的11名婴儿进行了血清学随访研究，结果在母体被动获得的抗-HCV消失后，一名婴儿在12月龄时重新呈现血清抗-HCV阳性，并在30月龄时仍为阳性，21月龄时肝活俭显…     

丙型肝炎病毒母婴传播的研究进展

丙型肝炎病毒(HCV)可以发生母婴传播,本文就近年来关于HCV母婴传播及其影响因素的研究作一综述。     

HCV的垂直传播

目前丙型肝炎病毒传播已成为危害公众健康的主要问题之一 ,自从 90年代初对血液制品进行抗 HCV筛查以来 ,母婴垂直传播已成为HCV的主要传染方式。但其具体传播机制尚不清楚 ,可能与母乳喂养和分娩方式等有关。对HCV感染的早期诊断 ,包括对高危孕妇的筛查 ,有利于疾病的治疗和预后     

乙型肝炎病毒的母婴垂直传播调查

我国 HBs Ag阳性占据人口的十分之一之强 ,是当前危害人民健康最严重的传染病 [1 ]。乙肝很容易发展为慢性和肝硬化等产生不良的后果 ,少数病例可以发展成为原发性肝癌 [2 ]。目前为止 ,乙肝尚缺乏有效的治疗方法。因此预防乙肝的感染就成为一项重要的工作 ,而预防工作除了对一般人群的预防外 ,还需要对尚未出生和出生不久的婴儿的预防。故首先需要了解该地区母婴垂直传播的情况 ,遂结合平时工作对日照及周边地区的乙型肝炎在母婴中的垂直传播情况进行了调查 ,以期对该地区的预防工作提供建议。现报告如下。1　对象与方法对婚前体检及育龄…     

HIV阳性母亲接受预防艾滋病母婴传播对其所生18月龄儿童体格发育的影响

目的 探讨广西壮族自治区（广西）HIV阳性母亲接受预防艾滋病母婴传播（PMTCT）后对18月龄儿童体格发育的影响,为改进PMTCT方案提供科学依据。方法 选取广西艾滋病疫情位居前3位的钦州市灵山县、柳州市鹿寨县、南宁市横县作为研究现场,按照回顾性病例对照研究设计分为病例组和对照组,病例组研究对象为实施了PMTCT的每年新报告HIV阳性母亲及其所生HIV阴性儿童,来源于全国PMTCT管理信息系统数据库的2010年1月1日至2017年12月31日HIV阳性母亲历史卡片以及其所生HIV阴性儿童,共554例;对照组研究对象为2017年健康母亲及其所生的健康儿童,共1 109例。收集PMTCT相关资料及其18月龄儿童的身高、体重和头围等体格发育资料。儿童体格发育不良的定义为身高、体重和头围的3项主要指标中至少1项指标低于正常值范围。结果 病例组的HIV阳性母亲及其所生儿童分别为667例和554例,其PMTCT率分别为91.15%（608/667）和96.57%（535/554）,儿童的HIV阳性率、死亡率和HIV母婴传播率分别为1.44%（8/554）、3.07%（17/554）和1.91%（8/418）;18月龄儿童健康体检结果显示,体格发育不良者占30.51%（169/554）;对照组儿童1 109例,体格发育不良者占9.83%（109/1 109）,病例组与对照组的体格发育不良率差异有统计学意义（P<0.01）。结论 HIV阳性母亲及其所生儿童的PMTCT率均超过90.00%,但是18月龄儿童的体格发育不良者超过30.00%。PMTCT政策对HIV阳性母亲所生儿童的体格发育不良的可能影响,需做进一步研究。     

河南省2002-2013年HIV母婴阻断效果分析

目的 了解河南省2002-2013年感染HIV孕产妇分娩婴儿的母婴传播情况,分析其影响因素。方法 采取随访研究的方法,分别在婴儿满1、3、6、9、12、18月龄时进行随访,收集2002-2013年度孕产妇检测及感染HIV孕产妇所分娩婴儿的有关干预信息,包括一般人口学特征、妊娠分娩、抗病毒药物应用、婴儿存活及18月龄HIV检测等情况,采用logistic回归对影响HIV母婴传播的有关因素进行分析。结果 2002年1月1日至2013年12月31日,共对8 621 554名孕产妇进行了HIV抗体检测,发现阳性孕产妇共2 264人,检测阳性率0.03%,孕产妇HIV检测阳性率呈现逐年递减趋势（χ²=4.871,P=0.027）。所分娩的1 530名婴儿中,有1 384人存活且满18月龄,已死亡婴儿92人,失访54人。已经检测的满18月龄的1 384名婴儿中阳性60人,阴性1 324人,存活婴儿累计母婴传播率4.34%,校正累计母婴传播率6.33%。产妇孕早期接受预防艾滋病母婴传播服务（OR=0.26,95% CI：0.09～0.77）,产妇及婴儿进行抗病毒药物阻断（OR=0.42,95% CI：0.21～0.82）,婴儿采取人工喂养（OR=0.06,95% CI：0.02～0.21）是预防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=3.91,95% CI：1.74～8.80）是其危险因素。结论 河南省孕产妇HIV检测阳性率保持在较低水平,并呈现逐年递减趋势,HIV的母婴传播率较高,应进一步加强并完善预防艾滋病母婴传播的综合干预措施。     

Prevention of mother-to-child transmission of HIV in a refugee camp setting in Tanzania

Abstract

The objective of this article is to describe the results of a 2-year pilot programme implementing prevention of mother to child HIV transmission (PMTCT) in a refugee camp setting. Interventions used were: community sensitization, trainings of healthcare workers, voluntary counselling and HIV testing (VCT), infant feeding, counselling, and administration of Nevirapine. Main outcome measures include: HIV testing acceptance rates, percentage of women receiving post test counselling, Nevirapine uptake, and HIV prevalence among pregnant women and their infants. Ninety-two percent of women (n=9,346) attending antenatal clinics accepted VCT. All women who were tested for HIV received their results and posttest counselling. The HIV prevalence rate among the population was 3.2%. The overall Nevirapine uptake in the camp was 97%. Over a third of women were repatriated before receiving Nevirapine. Only 14% of male counterparts accepted VCT. Due to repatriation, parent's refusal, and deaths, HIV results were available for only 15% of infants born to HIV-infected mothers. The PMTCT programme was successfully integrated into existing antenatal care services and was acceptable to the majority of pregnant women. The major challenges encountered during the implementation of this programme were repatriation of refugees before administration of Nevirapine, which made it difficult to measure the impact of the PMTCT programme.     

Prevalence of hepatitis C virus infection in a cohort of pregnant women in northern Greece and transmission of HCV from mother to child

The prevalence of hepatitis C virus (HCV) infection and the mother-to-child transmission of HCV were studied in 2408 pregnant women. Positive antiHCV were detected in 47 women (1.95%), 21 of whom (44.7%) were HCVRNA(+), but only seven had abnormal aminotransferases. Three/21 HCVRNA(+) women had an abortion. We lost contact with other 10 women. Thirty-four babies were tested for antiHCV, HCVRNA and levels of aminotransferases at birth and at the age of 6 and 12 months. AntiHCV were detectable in all babies at birth and these maternally acquired antibodies disappeared by the age of 12 months in all but two of who were infected with HCV. HCVRNA was detected at birth in one (6.25%) baby born out of 16 HCVRNA(+) mothers and this baby also had abnormal aminotransferases. However, HCVRNA was undetectable and aminotransferases returned to normal levels by the age of 6 months. In another baby born also from an HCVRNA(+) mother, the HCVRNA was detected for the first time at the age of 12 months. The HCV genotype from both babies was the same as their mother's. These results show that (a) the high prevalence in the group of pregnant women studied can possibly be attributed to the fact that 311/2408 (12.91%) of them came from the former eastern countries, where disposable syringes were not used but lately or were ex-drug addicts and (b) there is a low risk of perinatal mother-to-child transmission of HCV and this risk is related to the presence of HCVRNA in the carrier mother.     

Modeling vertical transmission of HIV: Imperfect vaccines can be of benefit

Reducing mother to child transmission (MTCT) of HIV in resource poor countries continues to be a major challenge. Here, we construct a hazard model to assess the effectiveness of combinations of HIV vaccine, Nevirapine (NVP), and HIV-specific monoclonal antibody (HIVAB) in reducing MTCT of HIV during the intrapartum and breastfeeding periods. The model shows that an intervention that uses three doses of vaccine with 30% initial immunity and 30% boost effect with subsequent doses (giving rise to maximum immunity approximately 66% with 3 doses) could reduce MTCT to 7.7% when used with NVP and to 5.9% when used with NVP and HIVAB. Using a vaccine with 50% initial immunity and 50% boost can reduce the rate to 4.3%. These results indicate that even an imperfect vaccine, when used in combination with other therapies, can be of considerable benefit in preventing MTCT in resource poor countries.     

河南省实施HIV母婴传播干预措施效果分析

目的 了解实施艾滋病母婴传播干预措施对人类免疫缺陷病毒(HIV)母婴传播的影响。方法 对河南省31个重点县HIV阳性孕产妇及所生婴幼儿干预状况进行调查。调查新生儿出生时服药情况、喂养方式及其母亲的分娩方式、服用抗病毒药物等情况,比较服药组与未服药组幼儿人类免疫缺陷病毒(HIV)阳性率的差异。结果 实施药物阻断组艾滋病母婴传播率为3.45%,未实施药物阻断组的母婴传播率为15.38%,2组间差异有统计学意义,P<0.01。阳性产妇实施药物阻断措施后,自然分娩方式HIV传播率明显低于剖宫产方式的传播率。结论 对阳性孕产妇新生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母婴传播率。建议在实施母婴传播干预措施的地区,不主张将HIV抗体阳性作为剖宫产的指征,最好选择自然分娩方式。     

高效抗逆转录病毒治疗阻断母婴HIV传播及对婴儿生长发育的影响

目的 研究高效抗逆转录病毒治疗(HAART)阻断母婴HIV传播及对婴儿生长发育的影响。方法 2005年5月至2010年6月在某医院感染科和妇产科选择HIV感染的确诊育龄妇女及孕妇16例,观察其分娩的17名新生儿为实验组。孕前或妊娠14～28周开展HAART抗病毒治疗。治疗方案：齐多夫定(AZT)0.3∥次（每日2次）+拉米夫定(3TC)0.3 g/次（每日1次）+奈韦拉平( NVP)0.2 g/次（每日2次）或依非韦伦(EFV)0.6 g/次,每日1次,并进行分娩干预和新生儿人工喂养。选取同期分娩的正常婴儿16名为对照组。观察婴幼儿生长发育指标至18个月,同时检测新生儿期和12个月龄时的血红蛋白(Hb)、肝肾功能及血清铁和钙。结果 孕妇一般状况良好,对药物有较好的耐受性。实验组新生儿体重、身长、Apgar评分分别为(3.5 ±0.9) kg、(54.2±3.8)cm、7～10分,对照组分别为(3.6±0.8)kg、(55.6±3.6)cm、8～10分(t体重=1.01,t身长=6.98,P值均＞0.05);12个月龄时实验组体重、身高分别为(9.4±1.8) kg、(76.3±2.7) cm,对照组分别为(9.9±2.5)kg、(76.8±2.9) cm（t体重=0.83,t身长=1.00,P值均＞0.05）。新生儿期实验组Hb含量为(126.2±16.7)g/L,对照组为(148.6±20.5)g/L(t=-5.89,P=0.11)。12个月龄时,实验组Hb含量为( 125.9±19.8)g/L,对照组为(130.1±18.7)g/L;实验组总胆红素(TB)为(11.7±3.5) μmol/L,对照组为(13.2±3.7) μmol/L（tHb=- 3.82,tTB=-2.14,P值均＞0.05）。新生儿期和12个月龄时实验组血清铁和钙分别为(25.4±5.7)、(26.4±7.2)μmol/L和(2.3±0.6)、(2.8±0.6) mol/L,对照组分别为(26.2±4.9)、(28.1±6.9) μmol/L和(2.6±0.5)、(3.1±0.5) mol/L(新生儿期：t铁 =0.80,t钙= -3.00,P值均＞0.05;12个月龄时：t铁=- 1.50,t钙=-1.00,P值均＞0.05)。监测18个月时显示所有HIV阳性母亲所生婴儿均无HIV感染。结论 接受HAART治疗的孕妇不仅可阻断HIV母婴传播,而且在观察期内未发现对婴儿生长发育有影响。     

Placental HIV transmission and vitamin D: Nutritional and immunological implications

Vitamin D is a well‐known immunomodulator. The relationship between vitamin D status and human immunodeficiency virus (HIV) infection has attracted attention in recent literature. Evidence suggests there may be increased prevalence of vitamin D deficiency in HIV‐infected children compared with HIV sero‐negative counterparts. One study has linked increased mother‐to‐child transmission of HIV, child mortality and adverse perinatal outcomes to vitamin D deficiency. This article provides a brief introduction into the emerging information surrounding the role of vitamin D and the placenta on mother‐to‐child transmission of HIV.     

长沙市第一医院23例艾滋病母婴阻断效果分析

目的观察人类免疫缺陷病毒(HIV)阳性孕妇母婴阻断效果,摸索适合开展的艾滋病母婴阻断预防模式。方法回顾性分析某院2005—2015年23例HIV阳性孕产妇的病例资料。结果 23例HIV阳性孕产妇均接受了高效抗逆转录病毒治疗(HAART)及阻断HIV母婴传播综合干预服务。其中,12例HIV阳性患者接受HAART后怀孕,10例在孕早期(28周内)检出HIV阳性而接受HAART治疗,1例在孕28周后检出HIV阳性而接受HAART。23例HIV阳性孕妇均娩出正常新生儿,婴幼儿经随访检测均未感染HIV。结论对HIV阳性孕产妇进行HAART是阻断HIV母婴传播的关键,配合新生儿的预防性用药和人工喂养等干预措施,能有效地预防HIV母婴传播。由专科医生提供对HIV阳性孕产妇的HAART,配合妇幼保健医院提供产检、分娩及婴儿的预防性服药,这种相互转介的艾滋病母婴阻断模式有效率较高。     

Integrating family planning and prevention of mother to child HIV transmission in Zimbabwe

Objective

The objective was to integrate enhanced family planning (FP) and prevention of mother-to-child HIV transmission services in order to help HIV-positive Zimbabwean women achieve their desired family size and spacing as well as to maximize maternal and child health.

Study Design

HIV-positive pregnant women were enrolled into a standard-of-care (SOC, n= 33) or intervention (n= 65) cohort, based on study entry date, and followed for 3 months postpartum. The intervention cohort received education sessions aimed at increasing FP use and negotiation power. Both groups received care from nurses with enhanced FP training. Outcomes included FP use, FP knowledge and HIV disclosure, and were assessed with Fisher’s Exact Tests, binomial tests and t tests.

Results

The intervention cohort reported increased control over condom use (p=.002), increased knowledge about IUDs (p=.002), increased relationship power (p=.01) and increased likelihood of disclosing their HIV status to a partner (p=.04) and having that partner disclose to them (p=.04) when compared to the SOC cohort. Long-acting reversible contraception (LARC) use in both groups increased from ~ 2% at baseline to > 80% at 3 months postpartum (p<.001).

Conclusions

FP and sexual negotiation skills and knowledge, as well as HIV disclosure, increased significantly in the intervention cohort. LARC uptake increased significantly in both the intervention and SOC cohorts, likely because both groups received care from nurses with enhanced FP training. Successful service integration models are needed to maximize health outcomes in resource-constrained environments; this intervention is such a model that should be replicable in other settings in sub-Saharan Africa and beyond.

Implications

This study provides a rigorously evaluated intervention to integrate FP education into ante- and postnatal care for HIV-positive women and also to train providers on FP. Results suggest that this intervention had significant effects on contraception use and communication with sexual partners. This intervention should be adaptable to other areas.