Chasela Charles, Chen Ying Qing, Fiscus Susan, Hoffman Irving, Young Alicia, Valentine Megan, Emel Lynda, Taha Taha E, Goldenberg Robert L, Read Jennifer S
University of North Carolina Project, Kamuzu Central Hospital, Lilongwe, Malawi.
Pediatr Infect Dis J. 2008 Mar;27(3):251-6. doi: 10.1097/INF.0b013e31815b4960.
We conducted secondary data analyses of a clinical trial (HIVNET 024) to assess risk factors for late postnatal transmission (LPT) of human immunodeficiency virus type 1 (HIV-1) through breast-feeding.
Data regarding live born, singleton infants of HIV-1-infected mothers were analyzed. The timing of HIV-1 transmission through 12 months after birth was defined as: in utero (positive HIV-1 RNA results at birth), perinatal/early postnatal (negative results at birth, positive at 4-6 week visit), or LPT (negative results through the 4-6 week visit, but positive assays thereafter through the 12-month visit). HIV-1-uninfected infants were those with negative HIV-1 enzyme immunoassay results at 12 months of age, or infants with negative HIV-1 RNA results throughout follow-up.
Of 2292 HIV-1-infected enrolled women, 2052 mother/infant pairs met inclusion criteria. Of 1979 infants with HIV-1 tests, 404 were HIV-1-infected, and 382 had known timing of infection (LPT represented 22% of transmissions). Further analyses of LPT included infants who were breast-feeding at the 4-6 week visit (with negative HIV-1 results at that visit) revealed 6.9% of 1317 infants acquired HIV-1 infection through LPT by 12 months of age. More advanced maternal HIV-1 disease at enrollment (lower CD4 counts, higher plasma viral loads) were the factors associated with LPT in adjusted analyses.
In this breast-feeding population, 6.9% of infants uninfected at 6 weeks of age acquired HIV-1 infection by 12 months. Making interventions to decrease the risk of LPT of HIV-1 available and continuing research regarding the mechanisms of LPT (so as to develop improved interventions to reduce such transmission) remain essential.
我们对一项临床试验（HIVNET 024）进行了二次数据分析，以评估1型人类免疫缺陷病毒（HIV-1）通过母乳喂养发生产后晚期传播（LPT）的风险因素。
分析了有关HIV-1感染母亲的活产单胎婴儿的数据。HIV-1在出生后12个月内的传播时间定义为：宫内传播（出生时HIV-1 RNA检测结果呈阳性）、围产期/产后早期传播（出生时检测结果为阴性，4至6周访视时为阳性）或产后晚期传播（4至6周访视时检测结果为阴性，但此后至12个月访视期间检测结果为阳性）。HIV-1未感染婴儿是指12个月龄时HIV-1酶免疫测定结果为阴性的婴儿，或在整个随访期间HIV-1 RNA检测结果均为阴性的婴儿。
在2292名登记入组的HIV-1感染女性中，2052对母婴符合纳入标准。在1979名接受HIV-1检测的婴儿中，404名感染了HIV-1，其中382名婴儿的感染时间已知（产后晚期传播占传播病例的22%）。对产后晚期传播的进一步分析包括在4至6周访视时正在母乳喂养（该访视时HIV-1检测结果为阴性）的婴儿，结果显示，1317名婴儿中有6.9%在12个月龄时通过产后晚期传播感染了HIV-1。在多因素分析中，入组时母亲HIV-1疾病进展更严重（CD4细胞计数更低、血浆病毒载量更高）是与产后晚期传播相关的因素。
在这个母乳喂养人群中，6.9%在6周龄时未感染的婴儿在12个月龄时感染了HIV-1。提供降低HIV-1产后晚期传播风险的干预措施，并继续研究产后晚期传播的机制（以便开发更好的干预措施来减少此类传播）仍然至关重要。
