J Acquir Immune Defic Syndr. 2010 Aug;54(5):533-41. doi: 10.1097/QAI.0b013e3181e36634.
To assess the effectiveness and safety of antiretrovirals (ARVs) used for treatment or prophylaxis in a breastfeeding population of HIV-1-infected women (Burkina-Faso, Kenya, South Africa).
HIV-1-infected pregnant women with <200 CD4 cells per cubic millimeter or with World Health Organization stage 4 disease (cohort A) and asymptomatic women with >500 CD4 cells per cubic millimeter (cohort B) were enrolled into 2 prospective cohorts. Women with 200-500 CD4 cells per cubic millimeter were enrolled in a parallel randomized trial. Women in cohort A initiated antiretroviral therapy. Women in cohort B received zidovudine from 34 to 36 weeks gestation until delivery, with single-dose nevirapine in labor (cohort B). All children received single-dose nevirapine.
Of 248 women enrolled, 111 (cohort A) and 125 (cohort B) infants alive at 24 hours after birth were analyzed. Sixty-nine percent and 42% of women had undetectable viral load at delivery, respectively. Ten children in each cohort died. The 18-month cumulative incidences of HIV-1 infection were 7.5% (95% confidence interval: 3.8% to 14.5%) (cohort A) and 5.8% (2.8% to 11.8%) (cohort B). Sixty-one percent (cohort A) and 78% (cohort B) were breastfed for a median duration of 20 weeks. Four children in cohort A and only 1 in cohort B became HIV-1 infected after 6 weeks of age.
Antiretroviral therapy initiated a median of 7 weeks before delivery in women with advanced HIV-1 disease was associated with a significant residual risk of HIV-1 transmission due to insufficient decrease in viral load by the time of delivery. Among women with >500 CD4 cells per cubic millimeter, the risk of breast-milk transmission was very low despite lack of postnatal prophylaxis.
评估抗逆转录病毒药物（ARV）在治疗或预防感染 HIV-1 的哺乳期妇女中的效果和安全性（布基纳法索、肯尼亚、南非）。
将 <200 个每立方毫米细胞的 CD4 或患有世界卫生组织第 4 期疾病的 HIV-1 感染孕妇（队列 A）和 >500 个每立方毫米细胞的无症状妇女（队列 B）纳入 2 个前瞻性队列。将 200-500 个每立方毫米细胞的妇女纳入平行随机试验。队列 A 中的妇女开始接受抗逆转录病毒治疗。队列 B 的妇女从妊娠 34 至 36 周开始接受齐多夫定治疗，分娩时接受单剂量奈韦拉平（队列 B）。所有儿童均接受单剂量奈韦拉平。
在 248 名入组的妇女中，111 名（队列 A）和 125 名（队列 B）婴儿在出生后 24 小时存活，进行了分析。分别有 69%和 42%的妇女在分娩时病毒载量无法检测到。两个队列各有 10 名儿童死亡。HIV-1 感染的 18 个月累积发生率分别为 7.5%（95%置信区间：3.8%至 14.5%）（队列 A）和 5.8%（2.8%至 11.8%）（队列 B）。队列 A 中有 61%（61%）和队列 B 中有 78%（78%）的儿童中位母乳喂养时间为 20 周。队列 A 中有 4 名儿童和队列 B 中有 1 名儿童在 6 周龄后感染 HIV-1。
在患有晚期 HIV-1 疾病的妇女中，中位在分娩前 7 周开始抗逆转录病毒治疗与由于分娩时病毒载量下降不足而导致 HIV-1 传播的显著残留风险相关。在每立方毫米细胞 >500 个的妇女中，尽管缺乏产后预防措施，但母乳传播的风险非常低。
