齐多夫定预防措施实施前后母婴人类免疫缺陷病毒1型传播的决定因素

Determinants of mother-to-infant human immunodeficiency virus 1 transmission before and after the introduction of zidovudine prophylaxis.

出版信息

Arch Pediatr Adolesc Med. 2002 Sep;156(9):915-21. doi: 10.1001/archpedi.156.9.915.

DOI:10.1001/archpedi.156.9.915

PMID:12197800

Abstract

BACKGROUND

Randomized controlled trials have demonstrated that zidovudine therapy decreases the mother-to-infant transmission of human immunodeficiency virus 1 (HIV-1). Data from large observational studies may provide further important findings on the effectiveness at the population level of combined treatments in decreasing transmission.

OBJECTIVE

To evaluate time trends in prophylactic interventions and the determinants of transmission both before and after the introduction of antiretroviral prophylaxis, and in treated and untreated mother-infant pairs after 1995.

DESIGN AND SETTING

Analysis of prospective data on 3770 children born to HIV-1-infected women between 1985 and 1999 and reported to the Italian Register for HIV Infection in Children.

MAIN OUTCOME MEASURES

Logistic regression random effects models were used to estimate crude and adjusted odds ratios for several factors potentially influencing vertical transmission for 2 periods-1985 through 1995 (January 1, 1985, through December 31, 1995) and 1996 through 1999 (January 1, 1996, through December 31, 1999), and between treated and untreated children after 1995.

RESULTS

The transmission rate was 15.5% in the 1985-1995 period and 5.8% in the 1996-1999 period. By 1999, prophylactic interventions had greatly increased. Antiretroviral treatment (ART) usage was 89.9%, (55.1% combination ART) and the elective cesarean delivery rate was 81.3%. In multivariate analysis, only elective cesarean delivery was associated with a lower risk of mother-to-infant transmission before 1995. After 1995, nonbreastfeeding and receipt of ART were protective whereas elective cesarean delivery was not significantly protective in multivariate analysis. Transmission risk was reduced by 76% with an incomplete zidovudine regimen, 88% with a complete regimen, and 93% when the mother received combination ART. In the 1996-1999 period, the transmission rate for nonbreastfeeding mother-infant pairs was 8.6% with elective cesarean delivery, 4.4% with any ART, and 2.4% with these interventions combined.

CONCLUSION

Prophylactic interventions, and in particular ART, reduced perinatal HIV-1 transmission at a population level in Italy.

摘要

背景

随机对照试验已证明齐多夫定疗法可降低人类免疫缺陷病毒1型（HIV-1）的母婴传播。大型观察性研究的数据可能会提供关于联合治疗在降低传播方面的人群水平有效性的进一步重要发现。

目的

评估预防性干预措施的时间趋势以及在引入抗逆转录病毒预防措施之前和之后、1995年后接受治疗和未接受治疗的母婴对中传播的决定因素。

设计与背景

对1985年至1999年间感染HIV-1的妇女所生的3770名儿童的前瞻性数据进行分析，并向意大利儿童HIV感染登记处报告。

主要观察指标

使用逻辑回归随机效应模型来估计两个时期（1985年至1995年[1985年1月1日至1995年12月31日]和1996年至1999年[1996年1月1日至1999年12月31日]）以及1995年后接受治疗和未接受治疗的儿童之间，几个可能影响垂直传播的因素的粗比值比和调整后比值比。

结果

1985 - 1995年期间传播率为15.5%，1996 - 1999年期间为5.8%。到1999年，预防性干预措施大幅增加。抗逆转录病毒治疗（ART）的使用率为89.9%（联合ART为55.1%），选择性剖宫产率为81.3%。在多变量分析中，1995年前只有选择性剖宫产与较低的母婴传播风险相关。1995年后，非母乳喂养和接受ART具有保护作用，而在多变量分析中选择性剖宫产没有显著的保护作用。不完全齐多夫定方案可使传播风险降低76%，完整方案可降低88%，母亲接受联合ART时可降低93%。在1996 - 1999年期间，非母乳喂养的母婴对在进行选择性剖宫产时传播率为8.6%，接受任何ART时为4.4%，两种干预措施联合时为2.4%。