Sirinavin S S, Phaupradit W, Taneepanichskul S, Atamasirikul K, Hetrakul P, Thakkinstian A, Panburana P
Division of Infectious Diseases, Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Int J Infect Dis. 2000;4(3):148-52. doi: 10.1016/s1201-9712(00)90076-6.
To describe the effects of various short zidovudine (ZDV) prophylactic regimens on vertical transmission of human immunodeficiency virus type 1 (HIV-I) infection, especially the effect of immediate neonatal ZDV prophylaxis.
The study included children of HIV-1-infected mothers who were born at a teaching hospital in Bangkok. The ZDV prophylaxis regimens varied by time periods that included: (1) no ZDV (1991-1996); (2) antenatal oral ZDV, 250 mg given twice a day starting at 34 to 36 weeks gestation and continued until labor (1995-1998); (3) antenatal oral ZDV plus immediate neonatal oral ZDV, 6 mg/0.6 mL/dose started within the first 2 hours after birth and continued at 6-hour intervals for 4 to 6 weeks (1997-1998); and (4) intrapartum intravenous ZDV given in addition to regimen 3 (1998-1999). Neonatal ZDV was administered within 2 hours after birth in 95% of the neonates.
In a cohort of 136 children born at least 9 months before the analysis date, the HIV-1 vertical infection rates were: (1) no ZDV, 11 of 48 (22.9%, 95% confidence interval [CI] = 12.0-37.3); (2) late antenatal ZDV, 10 of 47 (21.3%, 95% CI = 10.7-35.7); (3) late antenatal ZDV plus immediate neonatal ZDV, 0 of 28 (0%, 95% CI = 0-12.3); (4) late antenatal, intrapartum intravenous ZDV, plus immediate neonatal ZDV, 0 of 13 (0%, 95% CI = 0-24.7). An estimated 0% (95% CI = 0-8.6) of the infants who received immediate neonatal ZDV with or without intrapartum ZDV were infected, as compared with 22.1% (95% CI = 14.2-31.8 ) of those who received no ZDV or only late antenatal ZDV (P < 0.001).
The results of this study suggests high protective effect of immediate administration of neonatal ZDV. Perinatal components of antiretroviral prophylaxis provided the best results for protecting against vertical HIV-1 transmission.
描述各种齐多夫定（ZDV）短期预防方案对人类免疫缺陷病毒1型（HIV-1）垂直传播的影响，尤其是新生儿立即进行ZDV预防的效果。
该研究纳入了在曼谷一家教学医院出生的HIV-1感染母亲的子女。ZDV预防方案因时间段而异，包括：（1）不使用ZDV（1991 - 1996年）；（2）产前口服ZDV，从妊娠34至36周开始，每天两次，每次250毫克，持续至分娩（1995 - 1998年）；（3）产前口服ZDV加新生儿立即口服ZDV，出生后2小时内开始，每6小时一次，每次6毫克/0.6毫升，持续4至6周（1997 - 1998年）；（4）在方案3的基础上增加产时静脉注射ZDV（1998 - 1999年）。95%的新生儿在出生后2小时内接受了新生儿ZDV治疗。
在分析日期前至少9个月出生的136名儿童队列中，HIV-1垂直感染率分别为：（1）不使用ZDV，48名中有11名（22.9%，95%置信区间[CI]=12.0 - 37.3）；（2）晚期产前ZDV，47名中有10名（21.3%，95%CI = 10.7 - 35.7）；（3）晚期产前ZDV加新生儿立即ZDV，28名中0名（0%，95%CI = 0 - 12.3）；（4）晚期产前、产时静脉注射ZDV加新生儿立即ZDV，13名中0名（0%，95%CI = 0 - 24.7）。接受或未接受产时ZDV的新生儿立即接受ZDV治疗的婴儿估计感染率为0%（95%CI = 0 - 8.6），而未接受ZDV或仅接受晚期产前ZDV治疗的婴儿感染率为22.1%（95%CI = 14.2 - 31.8）（P < 0.001）。
本研究结果表明新生儿立即使用ZDV具有高度保护作用。抗逆转录病毒预防的围产期方案在预防HIV-1垂直传播方面效果最佳。
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