Mwapasa Victor, Rogerson Stephen J, Kwiek Jesse J, Wilson Paul E, Milner Danny, Molyneux Malcolm E, Kamwendo Deborah D, Tadesse Eyob, Chaluluka Ebbie, Meshnick Steven R
Department of Community Health, College of Medicine, Blantyre, Malawi, USA.
AIDS. 2006 Sep 11;20(14):1869-77. doi: 10.1097/01.aids.0000244206.41500.27.
To determine the association between maternal syphilis and HIV mother-to-child transmission (MTCT).
Prospective cohort study.
Pregnant women admitted at Queen Elizabeth Central Hospital (Malawi) in late third trimester were screened for HIV (by HIV rapid tests) and syphilis (by rapid plasma regain test and Treponema pallidum hemagglutination assay). HIV-infected women and their infants received nevirapine, according to the HIVNET 012 protocol. They were followed up at 6 and 12 weeks postpartum. Infant HIV infection was diagnosed by DNA PCR.
Of the 1155 HIV-infected women enrolled, 1147 had syphilis test results, of whom 92 (8.0%) were infected. Only 751 HIV-positive women delivered live singleton infants who were tested for HIV at birth. Of these, 65 (8.7%) were HIV-infected, suggesting in utero (IU) HIV MTCT. Of the 686 infants who were HIV-negative at birth, 507 were successfully followed up. Of these, 89 (17.6%) became HIV-infected, suggesting intrapartum/postpartum (IP/PP) HIV MTCT. Maternal syphilis was associated with IU HIV MTCT, after adjusting for maternal log10 HIV-1 viral load and low birth weight (LBW) [adjusted relative risk (ARR), 2.77; 95% CI, 1.40-5.46]. Furthermore, maternal syphilis was associated with IP/PP HIV MTCT (ARR, 2.74; 95% CI, 1.58-4.74), after adjusting for recent fever, breast infection, LBW and maternal log10 HIV-1 viral load.
Maternal syphilis is associated with IU and IP/PP HIV MTCT. Screening and early treatment of maternal syphilis during pregnancy may reduce pediatric HIV infections.
确定孕产妇梅毒与人类免疫缺陷病毒母婴传播（MTCT）之间的关联。
前瞻性队列研究。
对在伊丽莎白女王中央医院（马拉维）孕晚期入院的孕妇进行HIV（通过HIV快速检测）和梅毒（通过快速血浆反应素试验和梅毒螺旋体血凝试验）筛查。根据HIVNET 012方案，感染HIV的妇女及其婴儿接受奈韦拉平治疗。在产后6周和12周对她们进行随访。通过DNA聚合酶链反应诊断婴儿HIV感染。
在纳入的1155名感染HIV的妇女中，1147名有梅毒检测结果，其中92名（8.0%）感染。只有751名HIV阳性妇女分娩了单胎活婴，这些婴儿在出生时接受了HIV检测。其中，65名（8.7%）感染了HIV，提示宫内（IU）HIV母婴传播。在出生时HIV阴性的686名婴儿中，507名得到成功随访。其中，89名（17.6%）感染了HIV，提示产时/产后（IP/PP）HIV母婴传播。在调整孕产妇log10 HIV-1病毒载量和低出生体重（LBW）后，孕产妇梅毒与IU HIV母婴传播相关[调整相对风险（ARR），2.77；95%置信区间（CI），1.40 - 5.46]。此外，在调整近期发热、乳腺感染、LBW和孕产妇log10 HIV-1病毒载量后，孕产妇梅毒与IP/PP HIV母婴传播相关（ARR，2.74；95% CI，1.58 - 4.74）。
孕产妇梅毒与IU和IP/PP HIV母婴传播相关。孕期对孕产妇梅毒进行筛查和早期治疗可能会减少儿童HIV感染。
