Wortley P M, Lindegren M L, Fleming P L
Division of HIV/AIDS Prevention--Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention, USA.
MMWR Recomm Rep. 2001 May 11;50(RR-6):17-28.
In 1994, zidovudine (ZDV) was demonstrated to substantially reduce perinatal transmission of the human immunodeficiency virus (HIV). Guidelines regarding the use of ZDV to reduce transmission and regarding counseling and voluntary testing of pregnant women were issued in 1994 and 1995, respectively. Surveillance methods were used to evaluate the implementation of these guidelines and to understand reasons for continued perinatal transmission of HIV. Population-based enhanced perinatal surveillance was used in seven states to collect information regarding mother-infant pairs in 1993, 1995, and 1996. Birth registries and HIV/Acquired immunodeficiency virus (AIDS) registries were matched to determine the number of HIV-infected women with diagnosis before delivery. Supplemental epidemiologic information was collected for 1,321 pairs. The estimated total number of HIV-infected women giving birth each year was derived from the Survey of Childbearing Women, an anonymous serologic survey of the prevalence of HIV infection among women giving birth. From 1993 through 1996, the proportion of HIV-infected women with diagnosis before delivery increased from 70% to 80%. The proportion of women with a diagnosis who received ZDV prenatally increased from 27% to 83% and intrapartum, 6% to 75%; for neonates, the increase was from 8% to 77%. Overall, 14% of women received no or only one prenatal care visit. A total of 36% of women who used illicit drugs during pregnancy had not had prenatal care. Of the children who received any ZDV, 8% were infected compared with 16% of those who received no ZDV. ZDV, used for treating pregnant HIV-infected women, has been rapidly adopted in clinical practice and has reduced the transmission of HIV. To achieve continued declines in perinatal transmission of HIV infection, continued progress is needed in the following areas: a) increases in the proportion of women who receive prenatal care and an HIV diagnosis; and b) implementation of rapid testing methods (when licensed rapid tests are available) or rapid turnaround of standard tests (expedited EIA tests).
1994年，齐多夫定（ZDV）被证明可大幅降低人类免疫缺陷病毒（HIV）的围产期传播。1994年和1995年分别发布了关于使用ZDV减少传播以及关于孕妇咨询和自愿检测的指南。采用监测方法来评估这些指南的实施情况，并了解HIV围产期持续传播的原因。1993年、1995年和1996年，七个州采用了基于人群的强化围产期监测，以收集有关母婴对的信息。将出生登记册与HIV/获得性免疫缺陷病毒（AIDS）登记册进行匹配，以确定分娩前确诊的HIV感染女性数量。为1321对母婴收集了补充流行病学信息。每年分娩的HIV感染女性的估计总数来自生育女性调查，这是一项关于分娩女性中HIV感染患病率的匿名血清学调查。从1993年到1996年，分娩前确诊的HIV感染女性比例从70%上升到80%。确诊的女性产前接受ZDV的比例从27%上升到83%，产时从6%上升到75%；新生儿的比例从8%上升到77%。总体而言，14%的女性未接受或仅接受过一次产前检查。共有36%在孕期使用非法药物的女性未接受产前检查。在接受任何ZDV治疗的儿童中，8%被感染，而未接受ZDV治疗的儿童中这一比例为16%。用于治疗感染HIV的孕妇的ZDV已在临床实践中迅速得到采用，并减少了HIV的传播。为了使HIV感染的围产期传播持续下降，需要在以下方面继续取得进展：a）增加接受产前检查和HIV诊断的女性比例；b）实施快速检测方法（当有许可的快速检测可用时）或标准检测的快速周转（加速酶免疫测定检测）。
