Gupte N, Brookmeyer R, Bollinger R, Gray G
JHU-BJMC MIT Study, Pathology Museum, BJ Medical College and Sassoon General Hospitals, Sassoon Road, Pune 411001, India.
Biometrics. 2007 Dec;63(4):1189-97. doi: 10.1111/j.1541-0420.2007.00777.x. Epub 2007 Apr 9.
An important public health question is to determine the probabilities of perinatal HIV transmission and when it occurs, whether antepartum, intrapartum, or postpartum through breastfeeding. However, this is a difficult problem because the presence of HIV infection in an infant can only be ascertained through viral assays in the postpartum period. We propose a model that simultaneously estimates the risks of antepartum, intrapartum, and postpartum transmissions together with the sensitivity of the screening tests for HIV infection. The model allows estimating of infectivity through breast milk during postpartum periods. The methods are illustrated on a South African randomized clinical trial of extended AZT versus a short course of nevirapine in infants whose mothers had no access to antenatal antiretroviral therapy.
一个重要的公共卫生问题是确定围产期HIV传播的概率以及传播发生的时间，无论是在产前、产时还是产后通过母乳喂养传播。然而，这是一个难题，因为婴儿是否感染HIV只能在产后通过病毒检测来确定。我们提出了一个模型，该模型可以同时估计产前、产时和产后传播的风险以及HIV感染筛查测试的敏感性。该模型还可以估计产后通过母乳传播的感染性。我们以南非一项随机临床试验为例说明了这些方法，该试验比较了在母亲无法获得产前抗逆转录病毒治疗的婴儿中，延长使用齐多夫定（AZT）与短期使用奈韦拉平的效果。
