Department of Pediatric Oncology, Center for Child and Adolescent Health, medical faculty, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany.
BMC Pregnancy Childbirth. 2013 Jan 24;13:22. doi: 10.1186/1471-2393-13-22.
Antiretroviral drugs including zidovudine (ZDV) are effective in reducing HIV mother to child transmission (MTCT), however safety concern remains. The optimal duration of postnatal ZDV has not been established in clinical studies and there is a lack of consensus regarding optimal management. The objective of this study was to investigate the effectiveness and safety of a risk adapted two week course of oral postnatal ZDV as part of a combined intervention to reduce MTCT.
118 mother infant pairs were treated according to the German-Austrian recommendations for HIV therapy in pregnancy and in HIV exposed newborns between 2000-2010. In the absence of factors associated with an increased HIV-1 transmission risk, children were assigned to the low risk group and treated with an abbreviated postnatal regimen with oral ZDV for 2 weeks. In the presence of risk factors, postnatal ZDV was escalated accordingly.
Of 118 mother-infant pairs 79 were stratified to the low risk group, 27 to the high risk group and 11 to the very high risk group for HIV-1 MTCT. 4 children were lost to follow up. Overall Transmission risk in the group regardless of risk factors and completion of prophylaxis was 1.8% (95% confidence interval (CI) 0.09-6.6). If transmission prophylaxis was complete, transmission risk was 0.9% (95% CI 0.01-5.7). In the low risk group receiving two week oral ZDV transmission risk was 1.4% (95% CI 0.01-8.4)
These data demonstrate the effectiveness of a short neonatal ZDV regimen in infants of women on stable ART and effective HIV-1 suppression. Further evaluation is needed in larger studies.
包括齐多夫定（ZDV）在内的抗逆转录病毒药物可有效降低艾滋病毒母婴传播（MTCT），但安全性仍令人担忧。在临床研究中尚未确定产后 ZDV 的最佳持续时间，并且对于最佳管理方法也缺乏共识。本研究的目的是调查风险适应的两周疗程口服产后 ZDV 的有效性和安全性，作为降低 MTCT 的联合干预措施的一部分。
在 2000 年至 2010 年间，根据德国-奥地利的 HIV 治疗妊娠和 HIV 暴露新生儿的建议，对 118 对母婴进行了治疗。在没有增加 HIV-1 传播风险的因素的情况下，儿童被分配到低风险组，并接受为期 2 周的口服 ZDV 短程产后治疗。如果存在增加 HIV-1 传播风险的因素，则相应地增加产后 ZDV。
在 118 对母婴中，79 对被分层为低风险组，27 对为高风险组，11 对为 HIV-1 MTCT 的极高风险组。有 4 名儿童失访。无论危险因素和预防措施的完成情况如何，该组的总体传播风险为 1.8%（95%置信区间（CI）0.09-6.6）。如果传播预防措施完全完成，则传播风险为 0.9%（95%CI 0.01-5.7）。在接受两周口服 ZDV 的低风险组中，传播风险为 1.4%（95%CI 0.01-8.4）。
这些数据表明，在接受稳定抗逆转录病毒治疗且 HIV-1 抑制有效的妇女的婴儿中，短期新生儿 ZDV 方案是有效的。需要在更大的研究中进一步评估。
