Fawzi Wafaie, Msamanga Gernard, Spiegelman Donna, Renjifo Boris, Bang Heejung, Kapiga Saidi, Coley Jenny, Hertzmark Ellen, Essex Max, Hunter David
Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
J Acquir Immune Defic Syndr. 2002 Nov 1;31(3):331-8. doi: 10.1097/00126334-200211010-00010.
Transmission of HIV-1 through breastfeeding is a major problem, although its timing is not well characterized.
The authors examined the timing and correlates of HIV-1 transmission through breastfeeding among 1078 HIV-infected pregnant women from Dar es Salaam, Tanzania enrolled in a trial to examine the effect of vitamin A and other vitamin supplements on mother-to-child transmission of HIV-1 and other health outcomes. Cumulative incidence was measured among children of women not randomized to vitamin A (n = 312), given the higher risk of infection observed among those in the vitamin A arm. For analyses of correlates, data from all children not infected by age 6 weeks were used (p = 659).
Mean duration of breastfeeding was 20.3 months (SD = 4.4 months; median = 20.5 months). Thirty-seven infections were observed during 4372 child-months of follow-up evaluation, or 10.2 cases per 100 child-years. Infection risk by age 4 months was 3.8% (95% confidence interval [CI], 1.6%-6.1%) and increased to 17.9% (95% CI, 11.2%-24.5%) by age 24 months. In a multivariate proportional hazards model, high maternal viral load (p =.0001), low CD4 cell count (p =.004), and high maternal erythrocyte sedimentation rate (ESR; p=.004) were significant predictors of transmission of HIV-1 through breastfeeding. Mothers who had breast lesions during pregnancy were 2.00 times more likely to transmit the virus during breastfeeding than mothers without these lesions (95% CI, 1.29-3.08; p=.002).
The rate of breastfeeding transmission of HIV-1 is high, and early weaning is likely to be associated with reduced transmission. Antiretroviral drugs given to HIV-infected mothers are likely to reduce the risk of breastfeeding transmission. In their absence, interventions that enhance immune reconstitution, such as micronutrient supplements, may be beneficial against transmission. Methods to prevent and treat nipple cracks and mastitis may also be important.
尽管艾滋病毒-1通过母乳喂养传播的时间特征尚不明确，但这仍是一个主要问题。
作者对来自坦桑尼亚达累斯萨拉姆的1078名感染艾滋病毒的孕妇进行了研究，这些孕妇参与了一项试验，以检验维生素A和其他维生素补充剂对艾滋病毒-1母婴传播及其他健康结局的影响。鉴于在维生素A组中观察到的较高感染风险，对未随机分配到维生素A组的妇女的子女（n = 312）测量了累积发病率。为了分析相关因素，使用了所有6周龄时未感染儿童的数据（p = 659）。
母乳喂养的平均持续时间为20.3个月（标准差 = 4.4个月；中位数 = 20.5个月）。在4372个儿童月的随访评估中观察到37例感染，即每100儿童年有10.2例。4个月龄时的感染风险为3.8%（95%置信区间[CI]，1.6%-6.1%），到24个月龄时增至17.9%（95%CI，11.2%-24.5%）。在多变量比例风险模型中，高母体病毒载量（p = 0.0001）、低CD4细胞计数（p = 0.004）和高母体红细胞沉降率（ESR；p = 0.004）是艾滋病毒-1通过母乳喂养传播的显著预测因素。孕期有乳房病变的母亲在母乳喂养期间传播病毒的可能性是没有这些病变的母亲的2.00倍（95%CI，1.29-3.08；p = 0.002）。
艾滋病毒-1的母乳喂养传播率很高，早期断奶可能与传播减少有关。给感染艾滋病毒的母亲服用抗逆转录病毒药物可能会降低母乳喂养传播的风险。在没有这些药物的情况下，增强免疫重建的干预措施，如微量营养素补充剂，可能有助于预防传播。预防和治疗乳头皲裂和乳腺炎的方法也可能很重要。
