Ferrero S, Gotta G, Melica G, Biasotti B, Ravera G, Bentivoglio G
Department of Obstetrics and Gynaecology, Section of Biostatistics, University of Genoa, Genoa, Italy.
Minerva Ginecol. 2002 Oct;54(5):373-85.
Aim of this paper is to describe the changes over a 16-year period of the characteristics and management of HIV infected pregnant women.
Prospective study: analysis of data obtained from 162 women and 176 infants. Factors evaluated included: maternal socio-demographic level, immunological and virological parameters, antiretroviral therapy, mode of delivery, pregnancy outcome and babies follow-up.
The proportion of women with heterosexual acquisition of infection has increased significantly from 13.5% in 1985-1989 to 47.1% in 1996-2001 (p<0.0005, Fisher's exact test), while the proportion acquiring HIV through injecting drugs has declined. Mean CD4 cell count at delivery was 535 x 106/l (+/-522.3 x 106/l). In 1990, 50% of mothers received antiretroviral therapy, rising significantly to 87.5% in 2000. The elective cesarean section was introduced in 1998 and its rate has increased to 75% in 2000. The vertical transmission rate changed from 9.5% in 1985-1989 to 14.3% in 1996-2000 (this difference was not statistically significant, Fisher's exact test).
Social characteristics of the HIV-infected women have changed since the mid-1980s: in recent times women are having children at increasingly older ages and are more likely to know that they are HIV infected when they become pregnant. Antiretroviral therapy, elective caesarean delivery and avoidance of breastfeeding can reduce transmission of HIV, but the vertical transmission rate was unaffected by their use in our study and it remains high in comparison with rates reported from other studies.
本文旨在描述16年间HIV感染孕妇的特征及管理变化情况。
前瞻性研究：对162名女性和176名婴儿的数据进行分析。评估的因素包括：产妇社会人口统计学水平、免疫和病毒学参数、抗逆转录病毒疗法、分娩方式、妊娠结局及婴儿随访情况。
经异性传播感染的女性比例从1985 - 1989年的13.5%显著增至1996 - 2001年的47.1%（p<0.0005，Fisher精确检验），而通过注射毒品感染HIV的比例有所下降。分娩时CD4细胞平均计数为535×10⁶/l（±522.3×10⁶/l）。1990年，50%的母亲接受抗逆转录病毒疗法，到2000年显著增至87.5%。1998年引入选择性剖宫产，其比例在2000年增至75%。垂直传播率从1985 - 1989年的9.5%变为1996 - 2000年的14.3%（此差异无统计学意义，Fisher精确检验）。
自20世纪80年代中期以来，HIV感染女性的社会特征发生了变化：近年来，女性生育年龄越来越大，怀孕时更有可能知晓自己感染了HIV。抗逆转录病毒疗法、选择性剖宫产和避免母乳喂养可降低HIV传播，但在我们的研究中，垂直传播率并未因这些措施而受到影响，与其他研究报告的比率相比仍处于高位。
