Fox Matthew P, Brooks Daniel, Kuhn Louise, Aldrovandi Grace, Sinkala Moses, Kankasa Chipepo, Mwiya Mwiya, Horsburgh Robert, Thea Donald M
Center for International Health and Development, Boston University, Boston, MA 02118, USA.
J Acquir Immune Defic Syndr. 2008 May 1;48(1):90-6. doi: 10.1097/QAI.0b013e31816e39a3.
In developing countries, where mother-to-child transmission of HIV through breast-feeding is common, little is known about the impact of postpartum transmission on child survival. This study assessed whether children infected postpartum have longer survival from time of infection versus those infected during gestation or delivery.
We used a prospective cohort study to analyze data from 213 HIV-infected children enrolled in a breast-feeding intervention trial in Lusaka, Zambia (2001 to 2004).
We compared mortality 1 year after HIV infection in children stratified by age of infection: 0 to 3 days (intrauterine [IU] group), 4 to 40 days (intrapartum/early postpartum [IP/EPP] group), and >40 days (postpartum [PP] group).
A total of 61, 71, and 81 children were infected in the IU, IP/EPP, and PP groups, respectively. Children with intrauterine or intrapartum/early postpartum transmission had higher mortality over the first 12 months after infection than children with postpartum transmission (P = 0.001 and P = 0.006, respectively); no differences were detected between children with intrauterine and intrapartum/early postpartum transmission. Nearly 20% of the IU and IP/EPP groups died by 100 days after infection, whereas nearly 10% of the PP group had died by this time. After adjusting for birth weight, maternal CD4 cell count, breast-feeding, and maternal death, children infected postpartum had one quarter the mortality rate (hazard ratio [HR] = 0.27, 95% confidence interval [CI]: 0.15 to 0.50) of those infected in utero. Stopping breast-feeding increased mortality in infected children (HR = 3.1, 95% CI: 1.8 to 5.3).
This study demonstrates a survival benefit among children infected postpartum versus children infected during pregnancy or delivery and a benefit to increased breast-feeding duration among infected children. Testing children for HIV early may provide a means to allow for earlier intervention.
在发展中国家，通过母乳喂养实现母婴传播艾滋病毒的情况很常见，但产后传播对儿童生存的影响却鲜为人知。本研究评估了产后感染的儿童与孕期或分娩期感染的儿童相比，从感染时起是否具有更长的生存期。
我们采用前瞻性队列研究，分析了2001年至2004年在赞比亚卢萨卡参加母乳喂养干预试验的213名感染艾滋病毒儿童的数据。
我们比较了按感染年龄分层的儿童在感染艾滋病毒1年后的死亡率：0至3天（宫内感染[IU]组）、4至40天（分娩期/产后早期[IP/EPP]组）和>40天（产后[PP]组）。
IU组、IP/EPP组和PP组分别有61名、71名和81名儿童感染。宫内感染或分娩期/产后早期感染的儿童在感染后的前12个月内死亡率高于产后感染的儿童（分别为P = 0.001和P = 0.006）；宫内感染和分娩期/产后早期感染的儿童之间未发现差异。IU组和IP/EPP组近20%的儿童在感染后100天内死亡，而此时PP组近10%的儿童已经死亡。在调整了出生体重、母亲CD4细胞计数、母乳喂养和母亲死亡情况后，产后感染的儿童死亡率是宫内感染儿童的四分之一（风险比[HR] = 0.27，95%置信区间[CI]：0.15至0.50）。停止母乳喂养会增加感染儿童的死亡率（HR = 3.1，95%CI：1.8至5.3）。
本研究表明，与孕期或分娩期感染的儿童相比，产后感染的儿童具有生存优势，且延长感染儿童的母乳喂养时间有益。早期对儿童进行艾滋病毒检测可能提供一种实现更早干预的方法。
