Gaillard Philippe, Fowler Mary-Glenn, Dabis Francois, Coovadia Hoosen, Van Der Horst Charles, Van Rompay Koen, Ruff Andrea, Taha Taha, Thomas Tim, De Vincenzi Isabelle, Newell Marie-Louise
World Health Organization, Reproductive Health and Research, Geneva, Switzerland.
J Acquir Immune Defic Syndr. 2004 Feb 1;35(2):178-87. doi: 10.1097/00126334-200402010-00013.
The major remaining challenge in the prevention of mother-to-child transmission is the reduction of the risk in settings where breast-feeding is common. This review gives an update on ongoing or planned antiretroviral intervention studies in resource-limited settings that are aimed at reducing the risk of mother-to-infant HIV transmission during lactation. These strategies include antiretroviral therapy given to the mother to reduce viral load in plasma and breast milk as well as antiretroviral regimens providing prophylaxis to uninfected infants during the period of breast-feeding. The rationale for the interventions based on animal models and human studies is described as well as the study designs of clinical trials. Potential risks and benefits of these interventions to mothers and infants are also highlighted. Laboratory studies nested within several of these trials will provide a better understanding of the pathogenesis of postnatal HIV transmission and its potential prevention using antiretroviral drugs.
预防母婴传播中尚存的主要挑战是降低母乳喂养普遍地区的风险。本综述介绍了资源有限地区正在进行或计划开展的抗逆转录病毒干预研究的最新情况，这些研究旨在降低哺乳期母婴间HIV传播的风险。这些策略包括给予母亲抗逆转录病毒疗法以降低血浆和母乳中的病毒载量，以及在母乳喂养期间为未感染婴儿提供预防的抗逆转录病毒治疗方案。基于动物模型和人体研究的干预原理以及临床试验的研究设计均有描述。还强调了这些干预措施对母亲和婴儿的潜在风险和益处。纳入其中几项试验的实验室研究将有助于更好地理解产后HIV传播的发病机制及其使用抗逆转录病毒药物的潜在预防方法。
