Wiktor S Z, Pate E J, Rosenberg P S, Barnett M, Palmer P, Medeiros D, Maloney E M, Blattner W A
Viral Epidemiology Branch, National Cancer Institute, Bethesda, Maryland 20816, USA.
J Hum Virol. 1997 Nov-Dec;1(1):37-44.
We assessed the risk of transmitting human T-cell lymphotropic virus type I (HTLV-I) through breast-feeding.
STUDY DESIGN/METHODS: To assess the risk of mother-to-child transmission of HTLV-I, 212 HTLV-I-seropositive women and 145 HTLV-I-seronegative women were enrolled in a prospective cohort study conducted in Kingston, Jamaica. Their offspring were examined at regular intervals, and HTLV-I serostatus was determined at each visit.
Twenty-eight of the 181 children with at least one postnatal visit born to HTLV-I-seropositive women (and none of the children born to HTLV-I-seronegative women) were persistently seropositive and were considered HTLV-I infected (Kaplan-Meier estimated cumulative incidence, 18%; 95% CI, 12%-24%). Among children observed for at least 24 months, 19 (32%) of 60 children breast fed for 12 months or longer were HTLV-I seropositive, compared with only 8 (9%) of 86 children breast-fed for less than 12 months (relative risk, 3.4; 95% CI, 1.7-6.9). Compared with children weaned at younger ages, transmission of HTLV-I was associated with continued breast-feeding of children who were 12 to 18 months of age (relative hazard, 6.4; 95% CI, 2.1-180.2) and older than 18 months (relative hazard, 18.1; 95% CI, 1.4-29.5). Transmission was also associated with higher maternal antibody titer (a possible marker of virus load), prolonged duration of ruptured membranes during childbirth, and lower maternal income.
These results suggest that limiting the duration of breast-feeding to less than 12 months for children born to HTLV-I-seropositive mothers may significantly reduce mother-to-child transmission of HTLV-I.
我们评估了通过母乳喂养传播I型人类嗜T细胞病毒（HTLV-I）的风险。
研究设计/方法：为评估HTLV-I的母婴传播风险，在牙买加金斯敦开展了一项前瞻性队列研究，纳入了212名HTLV-I血清反应阳性的女性和145名HTLV-I血清反应阴性的女性。定期对她们的后代进行检查，并在每次就诊时确定HTLV-I血清状态。
在181名至少有一次产后随访的HTLV-I血清反应阳性女性所生子女中，有28名（HTLV-I血清反应阴性女性所生子女均未出现这种情况）持续血清反应阳性，被认为感染了HTLV-I（Kaplan-Meier估计累积发病率为18%；95%置信区间为12%-24%）。在观察至少24个月的儿童中，60名母乳喂养12个月或更长时间的儿童中有19名（32%）HTLV-I血清反应阳性，而86名母乳喂养时间少于12个月的儿童中只有8名（9%）HTLV-I血清反应阳性（相对风险为3.4；95%置信区间为1.7-6.9）。与断奶较早的儿童相比，HTLV-I传播与12至18个月大（相对风险为6.4；95%置信区间为2.1-180.2）以及18个月以上（相对风险为18.1；95%置信区间为1.4-29.5）儿童的持续母乳喂养有关。传播还与母亲抗体滴度较高（病毒载量的一个可能标志物）、分娩时胎膜破裂时间延长以及母亲收入较低有关。
这些结果表明，对于HTLV-I血清反应阳性母亲所生子女，将母乳喂养时间限制在12个月以内可能会显著降低HTLV-I的母婴传播。
