Fernández-Ibieta M, Ramos Amador J T, Guillén Martín S, González-Tomé María I, Navarro Gómez M, Iglesias González-Nicolás E, Rubio Gribble B, de José Gómez M I, Beceiro Mosquera J, Regidor J, De Santos Butragueño M J, Martínez Guardia N, Roa Francia M A
Servicio de Pediatría, Hospital Universitario de Getafe, Madrid, España.
An Pediatr (Barc). 2007 Aug;67(2):109-15. doi: 10.1016/s1695-4033(07)70570-2.
Despite the success of preventive measures against mother-to-child transmission (MTCT) of human immunodeficiency virus-1 and -2 (HIV-1 and -2) in developed countries, HIV-infected infants continue to be born. The aim of this study was to evaluate failures in the prevention of MTCT and the clinical characteristics of infected infants.
The Foundation for the Investigation and Prevention of AIDS in Spain (FIPSE) Cohort in Madrid prospectively follows up children at risk of MTCT HIV born in eight public hospitals in Madrid. From May 2000 to December 2005, 632 children born to HIV-infected mothers were evaluated. Data from pregnancy follow-up, antiretroviral therapy (ART), and symptoms at diagnosis in infected infants were analyzed.
Nine infants were infected. The rate of vertical transmission was 1.42 (95% CI 0.7-2.68). Of the nine mothers, seven had not received ART during pregnancy (and five had not received ART at delivery). Of the mothers who received ART, one had only done so for the last month of pregnancy. Two infants were given three drugs as prevention of MTCT, one received bitherapy and six received monotherapy. The median age at diagnosis was 2.4 months (range 7 days-2 years). The mean plasma viral load at diagnosis was 276,000 copies/ml (range: 11,900-1,000,000). Five of the infants were symptomatic at diagnosis (P. jirovaci pneumonia in two, sepsis in one, recurrent bacterial infections in one, hepatosplenomegaly in one). Four of the nine infants had been admitted to hospital prior to HIV diagnosis.
Missed opportunities for the prevention of MTCT were identified in eight of the nine HIV-infected infants (89%). Administration of AZT during labor in HIV-infected mothers and triple therapy for the prevention of MTCT in high risk infants is not universal. Hospital admission in young infants at risk might lead to suspicion of infection in infants born to HIV-infected mothers. Improved implementation of all the preventive measures for MTCT should be encouraged.
尽管发达国家在预防人类免疫缺陷病毒1型和2型（HIV-1和HIV-2）母婴传播（MTCT）方面取得了成功，但仍有HIV感染的婴儿出生。本研究的目的是评估MTCT预防失败情况以及感染婴儿的临床特征。
西班牙马德里艾滋病调查与预防基金会（FIPSE）队列前瞻性地跟踪马德里八家公立医院中出生的有MTCT HIV风险的儿童。2000年5月至2005年12月，对632名HIV感染母亲所生儿童进行了评估。分析了妊娠随访、抗逆转录病毒治疗（ART）以及感染婴儿诊断时症状的数据。
9名婴儿被感染。垂直传播率为1.42（95%可信区间0.7-2.68）。9名母亲中，7名在孕期未接受ART（5名在分娩时也未接受ART）。接受ART的母亲中，1名仅在妊娠最后1个月接受了治疗。2名婴儿接受三种药物预防MTCT，1名接受双药治疗，6名接受单药治疗。诊断时的中位年龄为2.4个月（范围7天至2岁）。诊断时的平均血浆病毒载量为276,000拷贝/毫升（范围：11,900-1,000,000）。5名婴儿在诊断时有症状（2名患耶氏肺孢子菌肺炎，1名患败血症，1名反复发生细菌感染，1名肝脾肿大）。9名婴儿中有4名在HIV诊断前已住院。
9名HIV感染婴儿中有8名（89%）被发现存在预防MTCT的错失机会。HIV感染母亲分娩时给予齐多夫定以及对高危婴儿采用三联疗法预防MTCT并不普遍。有风险的幼儿住院可能会引发对HIV感染母亲所生婴儿感染情况的怀疑。应鼓励更好地实施所有MTCT预防措施。
