[孕妇感染人类免疫缺陷病毒。孕期识别感染的重要性及围产期传播的危险因素]

Ovalle Alfredo, Vizueta Eloísa, Casals Alejandro, Northland Rebeca, González Reinaldo, Labbe Eduardo

Servicio y Departamento de Obstetricia, Ginecología y Neonatología, Hospital Clínico San Borja Arriarán, Facultad de Medicina, Universidad de Chile.

Rev Med Chil. 2003 Jun;131(6):633-40.

BACKGROUND

Using adequate infection control measures, the rate of vertical transmission of human immunodeficiency virus (HIV) during pregnancy, has been reduced to 3% in Chile.

AIM

To determine vertical transmission rate and risk factors associated to perinatal infection in pregnant women with known (KI) and unknown HIV infection (UI).

PATIENTS AND METHODS

HIV infected pregnant women whose deliveries were attended at the San Borja Arriaran Hospital were included. Antiretroviral therapy (ART) has been used since 1995 (Zidovudine 13 patients, biOtherapy 4 and triple therapy 14 patients). Newborns have received ART since 1995. Premature labor without evident cause, premature rupture of membranes, and rupture of membranes over 4 h before delivery were evaluated. Delivery was by elective cesarean section since 1993. Breast feeding was avoided. Pregnant women with UI (suspected disease after delivery due to child or mother pathology) did not received ART. Delivery and breast feeding were managed with common obstetrical-neonatal criteria.

RESULTS

Fifty three HIV infected pregnant women were studied (43 with KI and 10 with UI). Four children (36.4%) from the KI group and seven (63.6%) from the UI group became infected. The global rate of vertical transmission among KI group was significantly lower than UI group: 9.5% (4/42) vs 70.0% (7/10) p < 0.001. Using ART, this rate was further reduced to 6.5% (2/31) and with bitherapy or triple therapy to 0% (0/18). Breast feeding, vaginal delivery, premature delivery with no clinical cause, premature rupture of membranes, rupture of membranes longer than 4 h and lack of ART, were significantly more common in the UI group, compared with KI group.

CONCLUSIONS

Vertical transmission in pregnant women with KI is significantly lower compared with UI. Risk factors increasing HIV perinatal infection are: breast feeding, lack of ART, vaginal delivery, premature rupture of membranes, rupture of membranes > 4 h and premature labor without a clinical cause.

背景

通过采取适当的感染控制措施，智利孕妇中人类免疫缺陷病毒（HIV）的垂直传播率已降至3%。

目的

确定已知感染（KI）和未知HIV感染（UI）的孕妇围产期感染的垂直传播率及相关危险因素。

患者与方法

纳入在圣博尔哈·阿里亚兰医院分娩的HIV感染孕妇。自1995年起使用抗逆转录病毒疗法（ART）（13例患者使用齐多夫定，4例使用双联疗法，14例使用三联疗法）。自1995年起新生儿接受ART治疗。对无明显原因的早产、胎膜早破以及分娩前4小时以上的胎膜破裂情况进行评估。自1993年起采用选择性剖宫产分娩。避免母乳喂养。UI孕妇（产后因儿童或母亲病理情况怀疑患病）未接受ART治疗。分娩和母乳喂养按照普通妇产科 - 新生儿标准进行管理。

结果

对53例HIV感染孕妇进行了研究（43例KI孕妇和10例UI孕妇）。KI组4名儿童（36.4%）和UI组7名儿童（63.6%）感染。KI组的总体垂直传播率显著低于UI组：9.5%（4/42）对70.0%（7/10），p<0.001。使用ART后，该率进一步降至6.5%（2/31），双联疗法或三联疗法时降至0%（0/18）。与KI组相比，UI组母乳喂养、阴道分娩、无临床原因的早产、胎膜早破、胎膜破裂超过4小时以及未接受ART治疗的情况明显更为常见。