Anova Health Institute, Parktown, Johannesburg, South Africa.
Curr Opin HIV AIDS. 2010 Jan;5(1):48-53. doi: 10.1097/COH.0b013e328333b8ab.
The purpose of the study was to review recent evidence on the use of antiretrovirals during pregnancy and breastfeeding in low-income and middle-income settings.
Access to antiretroviral prophylaxis strategies for HIV-infected pregnant women has increased globally, but two-thirds of women in need still do not receive even the simplest regimen for the prevention of mother-to-child transmission of HIV, and most pregnant women in need of antiretroviral treatment do not receive it. The use of combination antiretroviral treatment in pregnancy in low-resource settings is safe and effective, and increasing evidence supports starting ongoing antiretroviral treatment at a CD4 cell count below 350/microl in pregnant women. The use of appropriate short-course antiretroviral prophylactic regimens is effective for prevention of mother-to-child transmission of HIV in women with higher CD4 cell counts. New data on the use of antiretroviral prophylaxis to prevent transmission through breastfeeding demonstrate that both maternal antiretroviral treatment and extended infant prophylaxis are effective.
Antiretroviral use in pregnancy can benefit mothers in need of treatment and reduce the risk of mother-to-child transmission. Emerging evidence of the effectiveness of antiretroviral prophylaxis in preventing transmission through breastfeeding is encouraging and likely to influence practice in the future.
目的：本研究旨在综述在中低收入国家，抗逆转录病毒药物在妊娠期和哺乳期应用的最新证据。
发现：全球范围内，获得抗逆转录病毒预防策略的机会增加了，但仍有三分之二的有需求的妇女甚至无法获得预防艾滋病毒母婴传播的最简单方案，大多数有需求的孕妇也无法获得抗逆转录病毒治疗。在资源有限的环境中，联合抗逆转录病毒治疗在妊娠期使用是安全有效的，越来越多的证据支持在 CD4 细胞计数低于 350/微升时开始持续抗逆转录病毒治疗。对于 CD4 细胞计数较高的妇女，使用适当的短程抗逆转录病毒预防方案可有效预防艾滋病毒母婴传播。关于使用抗逆转录病毒药物预防通过母乳喂养传播的新数据表明，母亲的抗逆转录病毒治疗和婴儿的延长预防均有效。
总结：抗逆转录病毒在妊娠期的使用可以使有治疗需求的母亲受益，并降低母婴传播的风险。预防通过母乳喂养传播的抗逆转录病毒预防的有效性的新证据令人鼓舞，可能会对未来的实践产生影响。
