McNeeley D F, Laroche L, Bhutra S, Suarez E, Rao S, Rajegowda B
Department of Pediatrics, Lincoln Medical and Mental Health Center, The Bronx, New York, USA.
Am J Perinatol. 1999;16(10):503-7. doi: 10.1055/s-1999-7288.
New advances in the diagnosis and treatment of HIV infection continue to propel changes in public understanding of HIV infection and the administration of public health law. Over the past decade, New York State has moved from a policy of blind newborn screening for seroprevalence data to mandatory HIV testing as part of the statewide Newborn Screening (NBS) Program. A new statewide program of expedited HIV testing (48-hr turnaround results) of pregnant women and newborns (whose HIV status is unknown at the time of delivery) began in the summer of 1999. To better understand the impact this program might have on the patients who receive health care at Lincoln Medical and Mental Health Center (Lincoln Hospital), we evaluated our experience with the current NBS program prior to inauguration of the new expedited testing program. We evaluated the NBS program from February 1, 1997, to January 31, 1999, including total number of HIV-exposed/infected infants born, mother's HIV status (if known) at the time of delivery, amount of time between blood sampling and return of the test results to the Hospital, and medical follow-up of infants with positive newborn screening test results. This was a retrospective study of the NBS registry and the medical records of patients who receive primary health care from the Pediatric Immunology Service of the Department of Pediatrics at Lincoln Hospital. One hundred and four newborns were identified with positive-HIV antibody (HIV-Ab-positive), and 13 (12.5%) were confirmed to be HIV-infected by positive polymerase chain reaction (PCR) test of viral DNA. Sixty-five (62.5%) of the newborns with positive NBS screening test results were born to mothers who were known to be HIV-infected prior to delivery; 39 (37.5%) were unanticipated. Four (30%) of the 13 HIV-infected babies were born to mothers who were known to be HIV-infected prior to delivery, and 9 (70%) were born to mothers whose HIV status was unknown at the time of delivery. Eighty percent (80%) of HIV-Ab-positive infants continued to receive follow-up care at Lincoln Hospital. Relocation to other health-care facilities occurred as a result of parental choice or due to foster care placement. No babies were "lost" from the NBS program. The average time between sampling and receipt of results for all blood tests was 16 days (range 10 to 141). Nearly 40% of newborns who acquired HIV infection from their mothers were unanticipated because the mother's HIV status was unknown at the time of delivery. These unanticipated HIV-infected infants represent missed opportunities for prevention of maternal-to-child transmission of HIV infection and early therapeutic intervention for HIV-infected infants. The new expedited HIV-testing program for New York State will facilitate early diagnosis, prevention and treatment of the HIV-exposed/infected infant for whom maternal HIV status is unknown at the time of delivery.
艾滋病毒感染诊断和治疗方面的新进展持续推动着公众对艾滋病毒感染理解的转变以及公共卫生法的实施。在过去十年中，纽约州已从盲目进行新生儿血清流行率数据筛查的政策转向将强制性艾滋病毒检测作为全州新生儿筛查（NBS）计划的一部分。一项针对孕妇和新生儿（分娩时艾滋病毒状况未知）的全州快速艾滋病毒检测新计划（48小时出结果）于1999年夏天启动。为了更好地理解该计划可能对在林肯医疗和心理健康中心（林肯医院）接受医疗服务的患者产生的影响，我们在新的快速检测计划启动之前评估了我们在当前NBS计划中的经验。我们评估了1997年2月1日至1999年1月31日的NBS计划，包括出生的艾滋病毒暴露/感染婴儿总数、分娩时母亲的艾滋病毒状况（如果已知）、采血与检测结果返回医院之间的时间、以及新生儿筛查检测结果呈阳性的婴儿的医学随访情况。这是一项对NBS登记册以及在林肯医院儿科接受初级医疗保健的患者病历的回顾性研究。共识别出104例艾滋病毒抗体阳性新生儿，其中13例（12.5%）经病毒DNA聚合酶链反应（PCR）检测呈阳性，被确诊为艾滋病毒感染。NBS筛查检测结果呈阳性的新生儿中，65例（62.5%）的母亲在分娩前已知感染艾滋病毒；39例（37.5%）为意外情况。13例艾滋病毒感染婴儿中，4例（30%）的母亲在分娩前已知感染艾滋病毒，9例（70%）的母亲在分娩时艾滋病毒状况未知。80%的艾滋病毒抗体阳性婴儿继续在林肯医院接受后续护理。因家长选择或寄养安置，部分婴儿转至其他医疗机构。NBS计划中没有婴儿“失访”。所有血液检测从采样到收到结果的平均时间为16天（范围为10至141天）。近40%从母亲那里感染艾滋病毒的新生儿是意外情况，因为母亲在分娩时艾滋病毒状况未知。这些意外感染艾滋病毒的婴儿代表了预防艾滋病毒母婴传播以及对艾滋病毒感染婴儿进行早期治疗干预的错失机会。纽约州新的快速艾滋病毒检测计划将有助于对分娩时母亲艾滋病毒状况未知的艾滋病毒暴露/感染婴儿进行早期诊断、预防和治疗。
