在冈比亚，孕产妇血浆病毒RNA水平决定了HIV-1和HIV-2母婴传播率的显著差异。MRC/冈比亚政府/伦敦大学学院医学院HIV母婴传播工作组。

Maternal plasma viral RNA levels determine marked differences in mother-to-child transmission rates of HIV-1 and HIV-2 in The Gambia. MRC/Gambia Government/University College London Medical School working group on mother-child transmission of HIV.

作者信息

O'Donovan D, Ariyoshi K, Milligan P, Ota M, Yamuah L, Sarge-Njie R, Whittle H

机构信息

MRC Laboratories, Banjul, The Gambia.

出版信息

AIDS. 2000 Mar 10;14(4):441-8. doi: 10.1097/00002030-200003100-00019.

DOI:10.1097/00002030-200003100-00019

PMID:10770548

Abstract

OBJECTIVES

To determine the rates of, and risk factors for, mother-to-child transmission (MCT) of HIV-1 and HIV-2 infection in The Gambia.

DESIGN

A blinded, prospective, community-based cohort study of 29.549 pregnant women attending the eight largest antenatal clinics in The Gambia.

METHODS

Women were tested for HIV-1 and HIV-2 infection. Infected subjects and a group of HIV-seronegative women were followed with their babies until 18 months after delivery. Maternal CD4 cell count percentages were measured before and 18 months after delivery, and the antenatal plasma viral load was determined. Babies were tested for HIV by the polymerase chain reaction and/or serology at 2, 9 and 18 months of age.

RESULTS

The study enrolled 144 women positive for HIV-1 and 294 for HIV-2 plus 565 seronegative pregnant women: the mean antenatal percentage CD4 cell counts of 96 HIV-1-positive, 223 HIV-2-positive and 125 HIV-seronegative mothers were 31% [95% confidence interval (CI) 28-33], 41% (95% CI 39-42) and 47% (95% CI 45-49), respectively. The geometric mean antenatal plasma viral load of 94 HIV-1-infected women was 15,100 copies x 10(3) ml (95% CI 10,400-19,000) which was much higher than that of 60 randomly selected HIV-2-infected women, which was 410 copies x 10(3) ml (95% CI 150-910) (P < 0.001). The estimated transmission rate of HIV-1 was 24.4% (95% CI 14.6-33.9) and that of HIV-2 was 4.0% (95% CI 1.9-7.4). Five of 17 HIV-1-positive and three of eight HIV-2-positive babies were infected after 2 months of age. Birth in the rainy season [odds ratio (OR) 2.9; 95% CI 1.2-7.2], a low postnatal CD4 cell percentage (OR for a 10% fall 2.4; 95% CI 1.1-5.1) and a high maternal plasma viral load (OR for a 10-fold increase 2.9; 95% CI 1.1-7.8) were risk factors for transmission that applied equally to both viruses.

CONCLUSION

Low maternal HIV-2 RNA levels, which on average are 37-fold less than in HIV-1 infection, relate to the low MCT rate of HIV-2.

摘要

目的

确定冈比亚HIV-1和HIV-2感染的母婴传播（MCT）率及危险因素。

设计

一项对冈比亚八家最大产前诊所的29549名孕妇进行的盲法、前瞻性、基于社区的队列研究。

方法

对女性进行HIV-1和HIV-2感染检测。感染的受试者和一组HIV血清阴性的女性及其婴儿随访至分娩后18个月。在分娩前和分娩后18个月测量母亲的CD4细胞计数百分比，并测定产前血浆病毒载量。婴儿在2、9和18月龄时通过聚合酶链反应和/或血清学检测HIV。

结果

该研究纳入了144名HIV-1阳性女性、294名HIV-2阳性女性以及565名血清阴性的孕妇：96名HIV-1阳性、223名HIV-2阳性和125名HIV血清阴性母亲的产前CD4细胞计数平均百分比分别为31%[95%置信区间（CI）28 - 33]、41%（95%CI 39 - 42）和47%（95%CI 45 - 49）。94名HIV-1感染女性的产前血浆病毒载量几何平均值为15100拷贝×10³/ml（95%CI 10400 - 19000），远高于60名随机选择的HIV-2感染女性，后者为410拷贝×10³/ml（95%CI 150 - 910）（P < 0.001）。HIV-1的估计传播率为24.4%（95%CI 14.6 - 33.9），HIV-2的传播率为4.0%（95%CI 1.9 - 7.4）。17名HIV-1阳性婴儿中有5名以及8名HIV-2阳性婴儿中有3名在2月龄后感染。雨季出生[比值比（OR）2.9；95%CI 1.2 - 7.2]、产后CD4细胞百分比低（下降10%的OR为2.4；95%CI 1.1 - 5.1）以及母亲血浆病毒载量高（增加10倍的OR为2.9；95%CI 1.1 - 7.8）是两种病毒共同的传播危险因素。