Elchalal Uriel, Avgil Meytal, Goslitzer Tania, Averbuch Diana, Engelhard Dan, Haouzi Michele, Maayan Shlomo
Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Ein Kerem Campus, Jerusalem, Israel.
Isr Med Assoc J. 2008 Oct;10(10):667-71.
In recent years, mother to child transmission of human immunodeficiency virus in the west has decreased markedly due to the advent of antiretroviral drugs given during pregnancy, cessation of lactation, and careful monitoring of viral load in the perinatal period.
To assess mother to child transmission of HIV among Ethiopian immigrants and non-Ethiopians in the Jerusalem area.
We conducted a prospective analysis of all deliveries of HIV-positive women in the Jerusalem district over a 10 year period.
Between 1996 and 2006, 35 HIV+ women gave birth to 45 infants. Thirty-one (88%) of these women were of Ethiopian origin and gave birth to 39 infants. Of the 35 HIV+ women, 30 were aware of being HIV positive. They gave birth to 40 infants. Another 5 women (14%) were not aware of being HIV+ during delivery. They gave birth to five infants. Of the group of known HIV+ women, 26 (87%) were Ethiopian immigrants who delivered 34 infants and 4 were non-Ethiopians who delivered 6 infants. In the group of five women not aware of being HIV+, all were Ethiopians. Breast-feeding data were available for 32 of the 35 women. Only 2 women (6.2%) breast-fed their babies. Neither was aware of being HIV+. In the Ethiopian immigrant group (both known and unknown HIV status), 11 deliveries (28%) were vaginal, 18 (46%) were elective cesarean section and 10 (26%) were delivered by emergency cesarean section. Of the 26 known HIV+ Ethiopian women, 3 (12%) refused antiretroviral treatment despite repeated counseling. In the non-Ethiopian group, all deliveries were elective cesarean sections. Mother to child transmission of HIV occurred in 4 of the total 45 deliveries (8.8%). Of the 4 transmission cases, 2 occurred among 40 deliveries of known HIV+ women (5%), and 2 occurred among the 5 deliveries of women not aware of being HIV+ (40%, P=0.05). In the group of Ethiopian women only, HIV transmission occurred in 4 of 39 deliveries (10%), of which 2 occurred among 34 deliveries (5.8%) of women know to be HIV+ and 2 among 5 deliveries (40%) of women not aware of being HIV+ (P=0.08).
Pregnant Ethiopian immigrants whose HIV status was known during pregnancy were at relatively high risk of HIV transmission despite the availability of antiretroviral drugs and counseling. This is likely due to inadequate adherence to ART preventive regimens, not dissimilar to the poor adherence observed among other immigrant groups in western countries. The substantial proportion of women, all Ethiopians, unaware being HIV+ at delivery, together with the significantly higher HIV transmission in that group compared to women who knew their HIV status, call for a revision of the current Ministry of Health opt-in policy for prenatal HIV screening.
近年来，由于孕期使用抗逆转录病毒药物、停止哺乳以及围产期对病毒载量的密切监测，西方地区人类免疫缺陷病毒的母婴传播显著减少。
评估耶路撒冷地区埃塞俄比亚移民和非埃塞俄比亚人中HIV的母婴传播情况。
我们对耶路撒冷地区10年间所有HIV阳性女性的分娩情况进行了前瞻性分析。
1996年至2006年间，35名HIV阳性女性分娩了45名婴儿。其中31名（88%）女性为埃塞俄比亚裔，分娩了39名婴儿。在这35名HIV阳性女性中，30名知晓自己HIV阳性，她们分娩了40名婴儿。另外5名女性（14%）在分娩时不知晓自己HIV阳性，她们分娩了5名婴儿。在已知HIV阳性的女性群体中，26名（87%）是埃塞俄比亚移民，分娩了34名婴儿，4名是非埃塞俄比亚人，分娩了6名婴儿。在5名不知晓自己HIV阳性的女性中，均为埃塞俄比亚人。35名女性中有32名的母乳喂养数据可用。只有2名女性（6.2%）母乳喂养了她们的婴儿，两人都不知晓自己HIV阳性。在埃塞俄比亚移民群体（包括已知和未知HIV状态）中，11例分娩（28%）为阴道分娩，18例（46%）为选择性剖宫产，10例（26%）为急诊剖宫产。在26名已知HIV阳性的埃塞俄比亚女性中，3名（12%）尽管多次接受咨询仍拒绝抗逆转录病毒治疗。在非埃塞俄比亚人群体中，所有分娩均为选择性剖宫产。45例分娩中共有4例发生了HIV母婴传播（8.8%）。在4例传播病例中，2例发生在40例已知HIV阳性女性的分娩中（5%），2例发生在5例不知晓自己HIV阳性女性的分娩中（40%，P=0.05）。仅在埃塞俄比亚女性群体中，39例分娩中有4例发生了HIV传播（10%），其中2例发生在34例已知HIV阳性女性的分娩中（5.8%），2例发生在5例不知晓自己HIV阳性女性的分娩中（40%，P=0.08）。
孕期已知HIV状态的埃塞俄比亚移民孕妇，尽管有抗逆转录病毒药物和咨询服务，HIV传播风险仍相对较高。这可能是由于对ART预防方案的依从性不足，与西方国家其他移民群体中观察到的依从性差情况并无不同。相当比例的女性（均为埃塞俄比亚人）在分娩时不知晓自己HIV阳性，且该群体中的HIV传播率明显高于知晓自己HIV状态的女性，这就要求对卫生部目前的产前HIV筛查选择加入政策进行修订。
