Tulane University Health Sciences, New Orleans, LA 70112, United States.
Life Sci. 2011 May 23;88(21-22):922-5. doi: 10.1016/j.lfs.2011.03.006. Epub 2011 Mar 31.
Since the use of combination antiretroviral therapy (HAART) to treat pregnant women, the rate of mother-to-child transmission (MTCT) of HIV in the United States has dropped dramatically to less than 2%. With this, the principal determinants of the risk of transmission are the maternal viral load and her use of antiretroviral therapy (ART). However, in the pre-HAART era, the MTCT ranged from 12 to 45% and was influenced by a variety of risk factors for transmission including no ART during pregnancy or delivery, advanced maternal HIV infection (high viral load, low CD4 count, and AIDS diagnosis), prolonged rupture of membranes, first-born of twins, prematurity/low birth weight, chorioamnionitis, vaginal delivery or non-elective Cesarean section, and maternal drug use. Several studies in the pre-HAART era found maternal illicit drug use to be an independent predictor of MTCT. Reasons for this association may be both behavioral and biological. Drug use is associated with poor adherence to ART and medical care. Opioids enhance infection of macrophages by HIV.
自采用联合抗逆转录病毒疗法（HAART）治疗孕妇以来，美国母婴传播（MTCT）艾滋病毒的比率已大幅下降至低于 2%。如此一来，传播风险的主要决定因素是母体病毒载量和她使用抗逆转录病毒治疗（ART）。然而，在 HAART 时代之前，MTCT 的范围在 12%至 45%之间，并受到多种传播风险因素的影响，包括怀孕或分娩期间未使用 ART、HIV 感染的母体晚期（高病毒载量、低 CD4 计数和 AIDS 诊断）、羊膜早破时间延长、双胞胎的第一胎、早产/低出生体重、绒毛膜羊膜炎、阴道分娩或非选择性剖宫产，以及产妇药物使用。HAART 时代之前的几项研究发现，母体非法药物使用是 MTCT 的独立预测因素。这种关联的原因可能既有行为上的，也有生物学上的。药物使用与抗逆转录病毒治疗和医疗护理的依从性差有关。阿片类药物增强了 HIV 对巨噬细胞的感染。
