分析 HIV 婴儿早期诊断数据，以估计赞比亚围产期 HIV 传播率。
Analysis of HIV early infant diagnosis data to estimate rates of perinatal HIV transmission in Zambia.
机构信息
FHI 360, Durham, North Carolina, United States of America.
出版信息
PLoS One. 2012;7(8):e42859. doi: 10.1371/journal.pone.0042859. Epub 2012 Aug 17.
BACKGROUND
Mother-to-child transmission of HIV (MTCT) remains the most prevalent source of pediatric HIV infection. Most PMTCT (prevention of mother-to-child transmission of HIV) programs have concentrated monitoring and evaluation efforts on process rather than on outcome indicators. In this paper, we review service data from 28,320 children born to HIV-positive mothers to estimate MTCT rates.
METHOD
This study analyzed DNA PCR results and PMTCT data from perinatally exposed children zero to 12 months of age from five Zambian provinces between September 2007 and July 2010.
RESULTS
The majority of children (58.6%) had a PCR test conducted between age six weeks and six months. Exclusive breastfeeding (56.8%) was the most frequent feeding method. An estimated 45.9% of mothers were below 30 years old and 93.3% had disclosed their HIV status. In terms of ARV regimen for PMTCT, 32.7% received AZT+single dose NVP (sdNVP), 30.9% received highly active antiretroviral treatment (HAART), 19.6% received sdNVP only and 12.9% received no ARVs. Transmission rates at six weeks when ARVs were received by both mother and baby, mother only, baby only, and none were 5.8%, 10.5%, 15.8% and 21.8% respectively. Transmission rates at six weeks where mother received HAART, AZT+sd NVP, sdNVP, and no intervention were 4.2%, 6.8%, 8.7% and 20.1% respectively. Based on adjusted analysis including ARV exposures and non ARV-related parameters, lower rates of positive PCR results were associated with 1) both mother and infant receiving prophylaxis, 2) children never breastfed and 3) mother being 30 years old or greater. Overall between September 2007 and July 2010, 12.2% of PCR results were HIV positive. Between September 2007 and January 2009, then between February 2009 and July 2010, proportions of positive PCR results were 15.1% and 11% respectively, a significant difference.
CONCLUSION
The use of ARV drugs reduces vertical transmission of HIV in a program setting. Non-chemoprophylactic factors also play a significant role in HIV transmission. The overall change in the proportions of positive PCR results over time is more likely an indication of better PMTCT implementation. Determination of the outcomes of PMTCT in program settings is feasible but requires accurate documentation and analysis.
背景
艾滋病毒母婴传播（MTCT）仍然是儿童艾滋病毒感染的最主要来源。大多数预防母婴传播（PMTCT）方案都集中监测和评估过程，而不是结果指标。本文通过对 28320 名艾滋病毒阳性母亲所生儿童的服务数据进行评估，估计 MTCT 率。
方法
本研究分析了 2007 年 9 月至 2010 年 7 月期间赞比亚五个省份的 0 至 12 个月大的围产期暴露儿童的 DNA PCR 结果和 PMTCT 数据。
结果
大多数儿童（58.6%）在六周至六个月大时接受了 PCR 检测。纯母乳喂养（56.8%）是最常见的喂养方式。估计 45.9%的母亲年龄在 30 岁以下，93.3%的母亲已经披露了艾滋病毒状况。在 PMTCT 的抗逆转录病毒方案方面，32.7%的母亲接受了 AZT+单剂量 NVP（sdNVP），30.9%的母亲接受了高效抗逆转录病毒治疗（HAART），19.6%的母亲仅接受了 sdNVP，12.9%的母亲没有接受 ARV 治疗。当母亲和婴儿都接受抗逆转录病毒药物、母亲单独接受、婴儿单独接受和都不接受抗逆转录病毒药物时，六周时的传播率分别为 5.8%、10.5%、15.8%和 21.8%。当母亲接受 HAART、AZT+sdNVP、sdNVP 和无干预时，六周时的传播率分别为 4.2%、6.8%、8.7%和 20.1%。基于包括抗逆转录病毒药物暴露和非抗逆转录病毒相关参数的调整分析，结果显示，1）母亲和婴儿都接受预防，2）儿童从未母乳喂养，3）母亲年龄 30 岁或以上，与阳性 PCR 结果的比例较低相关。总体而言，2007 年 9 月至 2010 年 7 月期间，12.2%的 PCR 结果为 HIV 阳性。2007 年 9 月至 2009 年 1 月、2009 年 2 月至 2010 年 7 月期间，阳性 PCR 结果的比例分别为 15.1%和 11%，差异显著。
结论
在方案环境中，抗逆转录病毒药物的使用降低了艾滋病毒母婴垂直传播。非化学预防因素在艾滋病毒传播中也起着重要作用。随着时间的推移，PCR 结果阳性比例的总体变化更有可能表明 PMTCT 的实施情况有所改善。在方案环境中确定 PMTCT 的结果是可行的，但需要准确的记录和分析。
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