aDepartment of Sciences for Woman and Child's Health, University of Florence, Anna Meyer Children's University Hospital, Florence bUniversity of Padua, Italy cVictor Babes Hospital, Bucharest, Romania dHôpital St Pierre, Brussels, Belgium eMedical Research Council Clinical Trials Unit, London, UK fDepartment of Statistics, University of Florence, Italy gPerinatal Prevention of AIDS Initiative, Odessa, Ukraine hHospital Sant Joan de Déu-Universitat de Barcelona, Barcelona iHospital Universitario de Getafe, Madrid jHospital 12 de Octubre, Madrid, Spain kUniversität Basel, Switzerland lUniversity College London, UK.
AIDS. 2013 Mar 27;27(6):991-1000. doi: 10.1097/QAD.0b013e32835cffb1.
To evaluate use of combination neonatal prophylaxis (CNP) in infants at high risk for mother-to-child transmission (MTCT) of HIV in Europe and investigate whether CNP is more effective in preventing MTCT than single drug neonatal prophylaxis (SNP).
Individual patient-data meta-analysis across eight observational studies.
Factors associated with CNP receipt and with MTCT were explored by logistic regression using data from nonbreastfed infants, born between 1996 and 2010 and at high risk for MTCT.
In 5285 mother-infant pairs, 1463 (27.7%) had no antenatal or intrapartum antiretroviral prophylaxis, 915 (17.3%) had only intrapartum prophylaxis and 2907 (55.0%) mothers had detectable delivery viral load despite receiving antenatal antiretroviral therapy. Any neonatal prophylaxis was administered to 4623 (87.5%) infants altogether; 1105 (23.9%) received CNP. Factors significantly associated with the receipt of CNP were later calendar birth year, no elective caesarean section, maternal CD4 cell count less than 200 cells/μl, maternal delivery viral load more than 1000 copies/ml, no antenatal antiretroviral therapy, receipt of intrapartum single-dose nevirapine and cohort. After adjustment, absence of neonatal prophylaxis was associated with higher risk of MTCT compared to neonatal prophylaxis [adjusted odds ratio (aOR) 2.29; 95% confidence interval (95% CI) 1.46-2.59; P < 0.0001]. Further, there was no association between CNP and MTCT compared to SNP (aOR 1.41; 95% CI 0.97-2.5; P = 0.07).
In this European population, CNP use is increasing and associated with presence of MTCT risk factors. The finding of no observed difference in MTCT risk between one drug and CNP may reflect residual confounding or the fact that CNP may be effective only in a subgroup of infants rather than the whole population of high-risk infants.
评估在欧洲母婴传播（MTCT）风险较高的婴儿中联合新生儿预防（CNP）的使用情况，并研究 CNP 是否比单一药物新生儿预防（SNP）更能有效预防 MTCT。
跨越八项观察性研究的个体患者数据荟萃分析。
使用非母乳喂养婴儿的数据，出生于 1996 年至 2010 年，MTCT 风险较高，通过逻辑回归探索与 CNP 接受和 MTCT 相关的因素。
在 5285 对母婴中，1463 名（27.7%）母亲未接受产前或产时抗逆转录病毒预防，915 名（17.3%）仅接受产时预防，2907 名（55.0%）母亲尽管接受了产前抗逆转录病毒治疗，但分娩时病毒载量可检测到。共有 4623 名（87.5%）婴儿接受了任何新生儿预防；1105 名（23.9%）接受了 CNP。与 CNP 接受显著相关的因素是较晚的日历出生年份、非选择性剖宫产、母亲 CD4 细胞计数小于 200 个/μl、母亲分娩时病毒载量大于 1000 个拷贝/ml、无产前抗逆转录病毒治疗、接受产时单剂量奈韦拉平治疗以及队列。调整后，与新生儿预防相比，未接受新生儿预防与 MTCT 风险增加相关[调整后的优势比（aOR）2.29；95%置信区间（95%CI）1.46-2.59；P<0.0001]。此外，与 SNP 相比，CNP 与 MTCT 之间无关联[aOR 1.41；95%CI 0.97-2.5；P=0.07]。
在这一欧洲人群中，CNP 的使用正在增加，并与 MTCT 危险因素相关。在一种药物和 CNP 之间观察到 MTCT 风险无差异的发现可能反映了残留的混杂因素，或者 CNP 可能仅对婴儿的亚组有效，而不是整个高危婴儿人群。
