Mwanyumba Fabian, Gaillard Philippe, Inion Ingrid, Verhofstede Chris, Claeys Patricia, Chohan Varsha, Vansteelandt Stijn, Mandaliya Kishorchandra, Praet Marleen, Temmerman Marleen
International Centre for Reproductive Health, Ghent University, Ghent, Belgium.
J Acquir Immune Defic Syndr. 2002 Mar 1;29(3):262-9. doi: 10.1097/00126334-200203010-00006.
The effect of placental membrane inflammation on mother-to-child transmission (MTCT) of HIV-1 is reported. Placentas from HIV-1-infected women were examined as part of a perinatal HIV-1 project in Mombasa, Kenya. Polymerase chain reaction analysis was used to test for HIV-1 in the infants at birth and at 6 weeks. The maternal HIV-1 seroprevalence was 13.3% (298 of 2,235). The overall rate of MTCT of HIV-1 was 25.4%; polymerase chain reaction analysis revealed that of the 201 infants 6.0% (12) were already HIV-1-positive at birth (intrauterine transmission) and 19.4% (39) were infected during the peripartum period or in early neonatal life (perinatal transmission). The prevalence of acute chorioamnionitis was 8.8%, that of deciduitis was 10.8%, and that of villitis was 1.6%. Acute chorioamnionitis was independently associated with peripartum HIV-1 transmission but not with in utero MTCT (17.9% vs. 6.7%, respectively; adjusted odds ratio, 3.9; 95% confidence interval, 1.2-12.5; p =.025). Other correlates of perinatal MTCT were presence of HIV in the genital tract and in the baby's oral cavity and a high maternal viral load in peripheral blood. The adjusted population attributable fraction of 12.8% (95% confidence interval, 1.5%-22.8%) indicated that approximately 3% of MTCT could be prevented if acute chorioamnionitis was eliminated. We suggest that further research on the role of antimicrobial treatment in the prevention of chorioamnionitis and the reduction of peripartum MTCT needs to be performed.
报告了胎盘膜炎症对HIV-1母婴传播(MTCT)的影响。作为肯尼亚蒙巴萨一项围产期HIV-1项目的一部分,对HIV-1感染女性的胎盘进行了检查。采用聚合酶链反应分析对婴儿出生时和6周时的HIV-1进行检测。孕产妇HIV-1血清阳性率为13.3%(2235例中的298例)。HIV-1的总体MTCT率为25.4%;聚合酶链反应分析显示,在201名婴儿中,6.0%(12例)出生时即已感染HIV-1(宫内传播),19.4%(39例)在围产期或新生儿早期感染(围产期传播)。急性绒毛膜羊膜炎的患病率为8.8%,蜕膜炎为10.8%,绒毛炎为1.6%。急性绒毛膜羊膜炎与围产期HIV-1传播独立相关,但与宫内MTCT无关(分别为17.9%和6.7%;调整优势比为3.9;95%置信区间为1.2 - 12.5;p = 0.025)。围产期MTCT的其他相关因素包括生殖道和婴儿口腔中存在HIV以及外周血中孕产妇病毒载量高。调整后的人群归因分数为12.8%(95%置信区间为1.5% - 22.8%),表明如果消除急性绒毛膜羊膜炎,约3%的MTCT可以预防。我们建议需要进一步研究抗菌治疗在预防绒毛膜羊膜炎和降低围产期MTCT中的作用。