Institute for Global Health, Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94105, USA.
J Acquir Immune Defic Syndr. 2010 Jan;53(1):28-35. doi: 10.1097/QAI.0b013e3181bdf65a.
Highly active antiretroviral therapy (HAART) drastically reduces mother-to-child transmission of HIV, but where breastfeeding is the only safe infant feeding option, HAART for the prevention of mother-to-child transmission needs to be evaluated in relation to both HIV transmission and infant mortality.
One hundred and two > or = 18-year old women on HAART in rural Uganda who delivered one or more live infants between March 1, 2003 and January 1, 2007 were enrolled in a prospective study to assess HIV transmission and infant survival. All pregnant women were counseled to exclusively breastfeed for 3-6 months according to national guidelines at the time. Infants were followed-up for > or = 7 months and were offered HIV polymerase chain reaction testing quarterly from 6 weeks of age until > or = 6 weeks after complete weaning.
Of 118 infants born during follow-up, 109 (92%) were breastfed. Median durations of exclusive and total breastfeeding were 4 months (interquartile range 3-6) and 5 months (interquartile range 3-7), respectively. None of the infants tested HIV polymerase chain reaction positive over follow-up but 16 infants died without a definitive HIV status at a median age of 2.6 months. In total, 23 (19%) infants died during follow-up at a median age of 3.7 months; 15 (65%) of whom with severe diarrhea and/or vomiting in the week preceding their death. In multivariate analysis, there was a 6-fold greater risk of death among infants breastfed for less than 6 months independent of maternal CD4 count closest to delivery, maternal marital status or maternal death (adjusted hazard ratio = 6.19; 95% confidence interval 1.41-27.0, P = 0.015).
In resource-constrained settings, HIV-infected pregnant women should be assessed for HAART eligibility and treated as needed without delay, and should be encouraged to breastfeed their infants for at least 6 months.
高效抗逆转录病毒疗法（HAART）可显著降低母婴传播艾滋病毒的风险，但如果母乳喂养是唯一安全的婴儿喂养方式，那么预防母婴传播的 HAART 需要评估其对艾滋病毒传播和婴儿死亡率的影响。
2003 年 3 月 1 日至 2007 年 1 月 1 日期间，在乌干达农村地区接受 HAART 的 102 名年龄在 18 岁及以上的妇女分娩了一个或多个活产婴儿，她们被纳入一项前瞻性研究，以评估 HIV 传播和婴儿存活率。当时根据国家指南，所有孕妇都被建议纯母乳喂养 3-6 个月。婴儿在随访期间 > 7 个月，并在 6 周龄时开始每季度进行 HIV 聚合酶链反应检测，直至完全断奶后 > 6 周。
在随访期间出生的 118 名婴儿中，有 109 名（92%）进行母乳喂养。纯母乳喂养和总母乳喂养的中位数持续时间分别为 4 个月（四分位距 3-6）和 5 个月（四分位距 3-7）。在随访期间，没有婴儿 HIV 聚合酶链反应检测呈阳性，但有 16 名婴儿在中位数年龄为 2.6 个月时死亡，且没有明确的 HIV 状态。共有 23 名（19%）婴儿在随访期间死亡，中位数年龄为 3.7 个月；其中 15 名（65%）婴儿在死亡前一周有严重腹泻和/或呕吐。在多变量分析中，与母乳喂养 < 6 个月的婴儿相比，母乳喂养 6 个月以上的婴儿死亡风险增加了 6 倍，独立于分娩时最近的母亲 CD4 计数、母亲婚姻状况或母亲死亡（调整后的危险比=6.19；95%置信区间 1.41-27.0，P=0.015）。
在资源有限的环境中，应评估感染艾滋病毒的孕妇是否有资格接受 HAART 治疗，并在需要时立即进行治疗，同时应鼓励她们至少母乳喂养婴儿 6 个月。
