Bhoopat Lertlakana, Khunamornpong Surapan, Lerdsrimongkol Piyaporn, Sirivatanapa Punnee, Sethavanich Soisaang, Limtrakul Aram, Gomutbuthra Vorapin, Kajanavanich Suparut, Thorner Paul S, Bhoopat Tanin
Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
J Acquir Immune Defic Syndr. 2005 Dec 15;40(5):545-50. doi: 10.1097/01.qai.0000185572.90849.4d.
Antiretroviral treatment with zidovudine (ZDV) from the 14th week until the end of pregnancy has markedly reduced the vertical transmission rate of HIV-1 in Europe and North America. A shorter duration of treatment has reduced this rate in Africa and Southeast Asia to a lesser degree. In Southeast Asia, subtype E is the major subtype rather than subtype B as in Western countries. The goals of this study were to determine the optimal duration of ZDV prophylaxis for subtype E and to confirm its effectiveness at the histologic level. Fifty pregnant women seropositive for HIV-1 subtype E were given ZDV prophylaxis consisting of 300 mg administered twice daily, switching to 300 mg administered every 3 hours from the onset of labor until delivery. Twenty-seven received "short-term" ZDV lasting 14 to 35 days before delivery, whereas the other 23 received "long-term" ZDV lasting 62 to 92 days. The effectiveness of ZDV prophylaxis was assessed by detection of HIV-1 in the placenta using in situ polymerase chain reaction (PCR). All babies in this study were tested up to one year of age. Three were not positive until after one month of age, but one was positive as a neonate. Four neonates were positive for HIV-1 as detected by PCR on peripheral blood, including one in the neonatal period. All cases were from the short-term prophylaxis group. Decidual glandular epithelial cells were the only cell type in the placenta that expressed HIV proviral DNA under ZDV prophylaxis. Sixty-seven percent of placentas in the short-term ZDV group showed more than occasional positive cells compared with 22% in the group receiving long-term ZDV prophylaxis (P < 0.02). This is first study to compare the effectiveness of short-term and long-term ZDV prophylaxis with respect to the presence of HIV in the placenta. Our study shows that longer (at least 60 days) prophylaxis is more effective in reducing HIV expression in the placenta and is associated with reduced transmission to neonates.
从妊娠第14周起至妊娠结束使用齐多夫定（ZDV）进行抗逆转录病毒治疗，已显著降低了欧洲和北美的HIV-1垂直传播率。在非洲和东南亚，较短疗程的治疗也在一定程度上降低了这一传播率。在东南亚，E亚型是主要亚型，而不像西方国家那样是B亚型。本研究的目的是确定针对E亚型的ZDV预防的最佳疗程，并在组织学水平上证实其有效性。50例HIV-1 E亚型血清学阳性的孕妇接受了ZDV预防治疗，剂量为每日两次，每次300mg，自临产开始至分娩改为每3小时300mg。27例在分娩前接受了持续14至35天的“短期”ZDV治疗，而另外23例接受了持续62至92天的“长期”ZDV治疗。通过原位聚合酶链反应（PCR）检测胎盘内的HIV-1来评估ZDV预防的有效性。本研究中的所有婴儿均接受了长达1岁的检测。3例直到1月龄后才呈阳性，但1例新生儿期即为阳性。4例新生儿外周血PCR检测HIV-1呈阳性，其中1例在新生儿期呈阳性。所有病例均来自短期预防组。在ZDV预防治疗下，蜕膜腺上皮细胞是胎盘中唯一表达HIV前病毒DNA的细胞类型。短期ZDV组67%的胎盘显示有不止偶尔的阳性细胞，而长期ZDV预防组为22%（P<0.02）。这是第一项比较短期和长期ZDV预防在胎盘内HIV存在情况方面有效性的研究。我们的研究表明，更长疗程（至少60天）的预防在降低胎盘中HIV表达方面更有效，且与降低向新生儿的传播有关。
