Vermund S H, Galbraith M A, Ebner S C, Sheon A R, Kaslow R A
Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892.
Ann Epidemiol. 1992 Nov;2(6):773-803. doi: 10.1016/1047-2797(92)90072-x.
A pregnant woman experiences selective immunosuppression as a physiologic response to the presence of a genetically heterologous fetus. Case reports early in the acquired immunodeficiency syndrome (AIDS) epidemic suggested that adverse human immunodeficiency virus (HIV)-related clinical outcomes might be causally associated with pregnancy. A review of relevant published data indicates that: (1) Adverse clinical outcomes of pregnancy are common among HIV-infected pregnant women, but no studies to date have fully disentangled the many confounding factors. (2) HIV-related complications are common in pregnancy only among immunosuppressed (< 300 CD4+ cells/mm3) women. (3) The distinct effect of pregnancy on the expression of HIV infection cannot be evaluated in the absence of appropriately controlled observations. (4) Cofactors for perinatal transmission are poorly understood. (5) Research into the motives for reproductive decisions and behaviors is of critical importance for improving our health education and outreach efforts for high-risk women. (6) Adequate clinical treatment and prophylactic health care services must be made easily accessible and available to women at high risk of HIV disease. (7) Treatment with available antiviral and anti-Pneumocystis drugs is advisable for HIV-infected pregnant women with fewer than 300 to 350 CD4+ cells/mm3, though data to definitively guide therapeutic decision making are not available. (8) Large multicenter studies are needed to recruit patients and to retain them in sufficient numbers, allowing for better evaluation of the many variables determining clinical outcomes for HIV-infected mothers and their infants. The natural history of HIV in pregnant women must be studied to facilitate clinical decision making, and to design and implement interventions, including prevention (behavior change, vaccines) and treatment (chemotherapy, immunotherapy).
孕妇会经历选择性免疫抑制，这是对基因异源胎儿存在的一种生理反应。在获得性免疫缺陷综合征（艾滋病）流行早期的病例报告表明，与人类免疫缺陷病毒（HIV）相关的不良临床结局可能与妊娠存在因果关系。对相关已发表数据的综述表明：（1）妊娠不良临床结局在感染HIV的孕妇中很常见，但迄今为止尚无研究能完全厘清众多混杂因素。（2）仅在免疫抑制（CD4 +细胞计数<300个/mm³）的孕妇中，与HIV相关的并发症在孕期很常见。（3）在缺乏适当对照观察的情况下，无法评估妊娠对HIV感染表达的独特影响。（4）围产期传播的辅助因素了解甚少。（5）对生殖决策和行为动机的研究对于改善针对高危女性的健康教育和外展工作至关重要。（6）必须让感染HIV疾病风险高的女性能够轻松获得并利用充足的临床治疗和预防性医疗保健服务。（7）对于CD4 +细胞计数少于300至350个/mm³的感染HIV的孕妇，建议使用现有的抗病毒和抗肺孢子菌药物进行治疗，尽管尚无明确指导治疗决策的数据。（8）需要开展大型多中心研究来招募患者并使其保持足够数量，以便更好地评估众多决定感染HIV的母亲及其婴儿临床结局的变量。必须研究孕妇中HIV的自然史，以促进临床决策，并设计和实施干预措施，包括预防（行为改变、疫苗）和治疗（化疗、免疫疗法）。
