Yunnan AIDS Care Center, Kunming, China.
J Acquir Immune Defic Syndr. 2010 Feb;53 Suppl 1:S15-22. doi: 10.1097/QAI.0b013e3181c7d47b.
To demonstrate that the use of highly active antiretroviral therapy (HAART) to interrupt transmission of HIV-1 from mother to baby is effective, safe, and feasible in a remote rural region of China.
Between November 2005 and May 2009, we enrolled 279 HIV-1-infected pregnant women to receive HAART to interrupt transmission of HIV-1 to their newborns across 16 counties in Yunnan. All women were started on triple combination therapy and submitted to regular blood draws to monitor CD4 T cells and viral load in their blood plasma. Infants received a single dose of nevirapine at birth and 1 or 4 weeks of zidovudine depending on the length of the mother's regimen. Exclusive formula feeding was recommended, and families were provided with 12-month supply of formula. Mothers and infant pairs were followed for 12-18 months postdelivery.
Of 279 enrolled HIV-infected women, 222 (79.6%) were identified and started treatment by 28 weeks of pregnancy. Viral load was undetectable at time of delivery for 62.4% (136 of 218) at delivery, with a mean 1.76 log viral load reduction between enrollment and delivery. Two of 193 babies (1.0%) who have already been tested became infected with HIV-1. Seven of 223 babies have died. By Kaplan-Meier analysis, cumulative one-year survival was 96.3%.
The project demonstrated that HAART for all infected pregnant women is effective with a vertical transmission rate of approximately 1%. Thus, this project provides a model for China to scale up its efforts to prevent mother-to-child transmission of HIV-1.
在中国偏远农村地区证明，使用高效抗逆转录病毒疗法（HAART）阻断 HIV-1 从母亲传播给婴儿是有效、安全且可行的。
2005 年 11 月至 2009 年 5 月，我们招募了 279 名 HIV-1 感染孕妇，在云南省 16 个县接受 HAART 以阻断 HIV-1 向新生儿传播。所有女性均开始接受三联疗法，并定期采血以监测其血浆中的 CD4 T 细胞和病毒载量。婴儿在出生时接受单剂量奈韦拉平，根据母亲疗程的长短，在 1 或 4 周时接受齐多夫定。建议采用纯母乳喂养，并为家庭提供 12 个月的配方奶粉。母婴对在产后 12-18 个月进行随访。
在 279 名入组的 HIV 感染女性中，有 222 名（79.6%）在妊娠 28 周时被发现并开始接受治疗。在分娩时，136 名（218 名中的 62.4%）的病毒载量不可检测，与入组时相比，病毒载量平均降低了 1.76 对数。193 名已接受检测的婴儿中有 2 名（1.0%）感染了 HIV-1。223 名婴儿中有 7 名死亡。根据 Kaplan-Meier 分析，一岁时的累积生存率为 96.3%。
该项目表明，对所有感染孕妇进行 HAART 的有效性为垂直传播率约为 1%。因此，该项目为中国扩大努力预防 HIV-1 母婴传播提供了一个模式。
