Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS K-34, Atlanta, Georgia 30341, USA.
BMC Infect Dis. 2011 Oct 27;11:292. doi: 10.1186/1471-2334-11-292.
The HIV epidemic in Russia has increasingly involved reproductive-aged women, which may increase perinatal HIV transmission.
Standard HIV case-reporting and enhanced perinatal HIV surveillance systems were used for prospective assessment of HIV-infected women giving birth in St. Petersburg, Russia, during 2004-2008. Trends in social, perinatal, and clinical factors influencing mother-to-child HIV transmission stratified by history of injection drug use, and rates of perinatal HIV transmission were assessed using two-sided χ2 or Cochran-Armitage tests.
Among HIV-infected women who gave birth, the proportion of women who self-reported ever using injection drugs (IDUs) decreased from 62% in 2004 to 41% in 2008 (P<0.0001). Programmatic improvements led to increased uptake of the following clinical services from 2004 to 2008 (all P<0.01): initiation of antiretroviral prophylaxis at ≤28 weeks gestation (IDUs 44%-54%, non-IDUs 45%-72%), monitoring of immunologic (IDUs 48%-64%, non-IDUs 58%-80%) and virologic status (IDUs 8%-58%, non-IDUs 10%-75%), dual/triple antiretroviral prophylaxis (IDUs 9%-44%, non-IDUs 14%-59%). After initial increase from 5.3% (95% confidence interval [CI] 3.5%-7.8%) in 2004 to 8.5% (CI 6.1%-11.7%) in 2005 (P<0.05), perinatal HIV transmission decreased to 5.3% (CI 3.4%-8.3%) in 2006, and 3.2% (CI 1.7%-5.8%) in 2007 (P for trend<0.05). However, the proportion of women without prenatal care and without HIV testing before labor and delivery remained unchanged.
Reduced proportion of IDUs and improved clinical services among HIV-infected women giving birth were accompanied by decreased perinatal HIV transmission, which can be further reduced by increasing outreach and HIV testing of women before and during pregnancy.
俄罗斯的艾滋病疫情逐渐涉及到生育年龄的妇女，这可能会增加围产期艾滋病母婴传播的风险。
采用标准的艾滋病病例报告和强化围产期艾滋病监测系统，对 2004 年至 2008 年期间在俄罗斯圣彼得堡分娩的艾滋病感染妇女进行前瞻性评估。通过双侧 χ2 或 Cochran-Armitage 检验，评估按是否有注射吸毒史分层的社会、围产期和临床因素对母婴传播的影响趋势，以及围产期艾滋病母婴传播率。
在分娩的艾滋病感染妇女中，自我报告曾使用注射毒品（IDUs）的妇女比例从 2004 年的 62%下降到 2008 年的 41%（P<0.0001）。方案的改进导致以下临床服务的利用率从 2004 年到 2008 年增加（均 P<0.01）：在妊娠≤28 周时开始使用抗逆转录病毒预防（IDUs 44%-54%，非 IDUs 45%-72%）、监测免疫状况（IDUs 48%-64%，非 IDUs 58%-80%）和病毒载量（IDUs 8%-58%，非 IDUs 10%-75%）、双重/三重抗逆转录病毒预防（IDUs 9%-44%，非 IDUs 14%-59%）。2005 年，母婴传播率从 2004 年的 5.3%（95%置信区间[CI] 3.5%-7.8%）最初增加到 8.5%（CI 6.1%-11.7%）（P<0.05）后，在 2006 年降至 5.3%（CI 3.4%-8.3%），2007 年降至 3.2%（CI 1.7%-5.8%）（P 趋势<0.05）。然而，没有产前护理以及没有在分娩前进行 HIV 检测的妇女比例没有变化。
在分娩的艾滋病感染妇女中，IDUs 的比例下降以及临床服务的改善伴随着围产期艾滋病母婴传播率的下降，如果在怀孕前和怀孕期间扩大对妇女的宣传和 HIV 检测，这种下降趋势还可以进一步扩大。
