Taylor G P, Lyall E G, Mercey D, Smith R, Chester T, Newell M L, Tudor-Williams G
Department of GU Medicine and Communicable Diseases, Imperial College School of Medicine, St Mary's Hospital, London.
Sex Transm Infect. 1999 Apr;75(2):90-7. doi: 10.1136/sti.75.2.90.
The aim of antiretroviral therapy in pregnancy is to deliver a healthy uninfected child to a healthy mother, without prejudicing the future treatment opportunities of the mother. The use of zidovudine monotherapy rapidly became standard practice once it had been shown to reduce by 67% mother to child transmission in women with CD4+ lymphocyte counts above 200 x 10(6)/l. High rates of transmission are seen when maternal disease is advanced (high viral load, low CD4+ lymphocyte counts) despite zidovudine. In these women highly active antiretroviral therapy gives the best prospect for prolonged health and it is anticipated that reducing plasma viral load below the limits of detection will further reduce transmission rates. However, safety data for antiretroviral therapy in pregnancy are limited and each additional treatment exposes a significant proportion of uninfected infants to potential long term hazards. Where maternal therapy is not indicated and the sole objective of treatment is to reduce mother to child transmission, recent data suggest that short course zidovudine (especially in conjunction with prelabour caesarean section) is a reasonable option. This may minimise the emergence of viruses with reduced sensitivity to zidovudine and preserve maternal options for later therapy.
孕期抗逆转录病毒疗法的目标是，在不影响母亲未来治疗机会的前提下，让健康的母亲诞下健康且未受感染的婴儿。一旦齐多夫定单药疗法被证明可使CD4+淋巴细胞计数高于200×10⁶/l的女性母婴传播率降低67%，它很快就成为了标准疗法。尽管使用了齐多夫定，但当母亲病情严重（病毒载量高、CD4+淋巴细胞计数低）时，传播率仍很高。对于这些女性，高效抗逆转录病毒疗法为长期健康提供了最佳前景，预计将血浆病毒载量降至检测限以下会进一步降低传播率。然而，孕期抗逆转录病毒疗法的安全性数据有限，每增加一种治疗方法都会使相当一部分未受感染的婴儿面临潜在的长期风险。在不建议进行母亲治疗且治疗的唯一目的是降低母婴传播的情况下，近期数据表明，短期使用齐多夫定（尤其是与临产前剖宫产联合使用）是一个合理的选择。这可以最大限度地减少对齐多夫定敏感性降低的病毒的出现，并保留母亲日后治疗的选择。
