Panburana Panyu, Sirinavin Sayomporn, Phuapradit Winit, Vibhagool Asda, Chantratita Wasun
Department of Obstetrics and Gynaecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Am J Obstet Gynecol. 2004 Mar;190(3):803-8. doi: 10.1016/j.ajog.2003.09.034.
The purpose of this study was to evaluate the effect of elective cesarean delivery plus a lamivudine-zidovudine prophylaxis regimen on non-breastfeeding mothers with human immunodeficiency virus type 1 and their infants.
Forty-six antiretroviral-naïve, pregnant women with human immunodeficiency virus type 1 were included. The prophylactic regimen was a lamivudine-zidovudine tablet (150 mg/300 mg) twice daily from week 34 of pregnancy until cesarean delivery at week 38 of gestation, preoperative intravenous zidovudine, and neonatal zidovudine syrup for 4 weeks.
At weeks 34 and 38 of gestation, the median maternal viral loads were, respectively, 3.65 log(10) copies/mL (range, 2.34-4.70 log(10) copies/mL) and 2.51 log(10) copies/mL (range, 2.04-3.66 log(10) copies/mL; P<.001), respectively; the viral reduction was 1.12 log(10) copies/mL (range, -0.16-2.60 log(10) copies/mL), and the CD4(+) cell counts increased from 335 cells/mm(3) (range, 57-974 cells/mm(3)) to 420 cells/mm(3) (range, 84-1,083 cells/mm(3); P=.002). No mother or infant had a serious adverse event. Two infants were infected (4.3%; 95% CI, 0.5%-15.7%); 1 infant had intrapartum infection.
Elective cesarean delivery plus short-course lamivudine-zidovudine is safe but does not eliminate mother-to-child transmission of human immunodeficiency virus type 1.
本研究旨在评估择期剖宫产联合拉米夫定 - 齐多夫定预防方案对非母乳喂养的1型人类免疫缺陷病毒（HIV - 1）感染母亲及其婴儿的影响。
纳入了46例未接受过抗逆转录病毒治疗的1型HIV感染孕妇。预防方案为从妊娠34周开始每日两次口服拉米夫定 - 齐多夫定片（150毫克/300毫克），直至妊娠38周剖宫产，术前静脉注射齐多夫定，并给予新生儿齐多夫定糖浆4周。
在妊娠34周和38周时，母亲的病毒载量中位数分别为3.65 log(10)拷贝/毫升（范围为2.34 - 4.70 log(10)拷贝/毫升）和2.51 log(10)拷贝/毫升（范围为2.04 - 3.66 log(10)拷贝/毫升；P <.001）；病毒载量降低了1.12 log(10)拷贝/毫升（范围为 - 0.16 - 2.60 log(10)拷贝/毫升），CD4(+)细胞计数从335个细胞/立方毫米（范围为57 - 974个细胞/立方毫米）增加到420个细胞/立方毫米（范围为84 - 1,083个细胞/立方毫米；P =.002）。没有母亲或婴儿发生严重不良事件。两名婴儿感染（4.3%；95%可信区间为0.5% - 15.7%）；1名婴儿为产时感染。
择期剖宫产联合短期拉米夫定 - 齐多夫定是安全的，但不能消除1型HIV的母婴传播。
