Palladino Claudia, Bellón Jose María, Perez-Hoyos Santiago, Resino Rosa, Guillén Sara, Garcia Dolores, Gurbindo María Dolores, Ramos José Tomás, de José María Isabel, Mellado María Josefa, Muñoz-Fernández María Angeles
Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
AIDS. 2008 Oct 18;22(16):2199-205. doi: 10.1097/QAD.0b013e328310fa96.
To evaluate any possible association between indicators of social inequalities and the geographical distribution of HIV-1 mother-to-child transmission (MTCT) cases in Madrid.
We carried out an observational survey of 224 HIV-1 vertically infected children born in 1980-2006 living in Madrid. We elaborated maps representing the prevalence of HIV-1 MTCT cases. We assessed the association between indicators of social inequalities and the spatial distribution of MTCT cases. Poisson univariate and multivariate analysis of risk factors for MTCT were performed.
We identified core areas of transmission mainly in southern Madrid until 2006. The prevalence of MTCT cases was significantly correlated to the percentage of immigrants, illiterates, unemployed women and the income in 1996 and 2000/2001. The risk of MTCT increased in the periods up to 1996 compared with the calendar period 1980-1989, whereas the risk decreased in 1999-2006 [relative risk, 0.08; 95% confidence interval (CI), 0.03-0.18; P < 0.001]. The risk was especially high in the districts of Usera (absolute relative risk, 11.4; 95% CI, 2.6-49.5; P = 0.001), Puente de Vallecas (absolute relative risk, 14.0; 95% CI, 3.4-57.9; P < 0.001) and San Blas (absolute relative risk, 12.5; 95% CI, 2.9-53.6; P = 0.001). The percentage of illiterates was the indicator that explained the risk of MTCT (absolute relative risk, 1.07; 95% CI, 1.05-1.10; P = 0.001).
We observed a geographic heterogeneity of the HIV-1 vertical transmission with the highest prevalence in disadvantaged districts. What is described in the present review is the HIV-1 vertical transmission within a social context; this approach could be relevant in analysing the pattern of HIV-1 transmission in other Western cities or highlighting the distribution of other infectious diseases.
评估马德里社会不平等指标与HIV-1母婴传播（MTCT）病例地理分布之间的任何可能关联。
我们对1980年至2006年出生在马德里的224名HIV-1垂直感染儿童进行了观察性调查。我们绘制了代表HIV-1 MTCT病例患病率的地图。我们评估了社会不平等指标与MTCT病例空间分布之间的关联。对MTCT的危险因素进行了泊松单变量和多变量分析。
直到2006年，我们确定主要在马德里南部存在传播核心区域。MTCT病例的患病率与移民、文盲、失业妇女的百分比以及1996年和2000/2001年的收入显著相关。与1980 - 1989年的日历期相比，1996年之前MTCT的风险增加，而在1999 - 2006年风险降低[相对风险，0.08；95%置信区间（CI），0.03 - 0.18；P < 0.001]。在尤塞拉区（绝对相对风险，11.4；95% CI，2.6 - 49.5；P = 0.001）、普恩特德巴列卡斯区（绝对相对风险，14.0；95% CI，3.4 - 57.9；P < 0.001）和圣布拉斯区（绝对相对风险，12.5；95% CI，2.9 - 53.6；P = 0.001）风险尤其高。文盲百分比是解释MTCT风险的指标（绝对相对风险，1.07；95% CI，1.05 - 1.10；P = 0.001）。
我们观察到HIV-1垂直传播存在地理异质性，在弱势地区患病率最高。本综述所描述的是社会背景下的HIV-1垂直传播；这种方法可能与分析其他西方城市的HIV-1传播模式或突出其他传染病的分布相关。
