南非感染艾滋病毒的孕妇中的母婴乙型肝炎及婴儿感染情况
Maternal hepatitis B and infant infection among pregnant women living with HIV in South Africa.
作者信息
Hoffmann Christopher J, Mashabela Fildah, Cohn Silvia, Hoffmann Jennifer D, Lala Sanjay, Martinson Neil A, Chaisson Richard E
机构信息
Center for TB Research, School of Medicine, Johns Hopkins University, Baltimore, MD, USA;
Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
出版信息
J Int AIDS Soc. 2014 May 22;17(1):18871. doi: 10.7448/IAS.17.1.18871. eCollection 2014.
INTRODUCTION
Globally, hepatitis B virus (HBV) infection is the leading cause of liver-related mortality. Newborn vaccination, maternal antiviral therapy and administering hepatitis B immune globulin shortly after birth can greatly reduce the risk of perinatal and infant infection. However, evidence-based policy regarding these interventions in Africa is hampered by gaps in knowledge of HBV epidemiology. We describe maternal chronic hepatitis B (CHB) prevalence and infant infection during the first year of life within a cohort of women living with HIV.
METHODS
We recruited and prospectively followed pregnant women living with HIV and their infants from prenatal clinics in an urban area of South Africa. Hepatitis B surface antigen, anti-hepatitis B surface antibodies and HBV DNA were assessed in all women. Hepatitis B testing was also performed at 6 and 52 weeks for all infants born to mothers with either positive surface antigen or detectable HBV DNA.
RESULTS
We enrolled 189 women with a median age of 29 years and median CD4 count of 348 cells/mm(3). Fourteen had a positive surface antigen (7.4%), of which six were positive for "e" antigen. An additional three had detectable HBV DNA without positive surface antigen. One infant developed CHB and three others had evidence of transmission based on positive HBV DNA assays. HBV vaccinations were delivered at six weeks of life to all infants.
CONCLUSIONS
Our findings highlight the risk of peripartum HBV transmission in this setting. Approaches to reducing this transmission should be considered.
引言
在全球范围内，乙型肝炎病毒（HBV）感染是肝脏相关死亡的主要原因。新生儿接种疫苗、孕产妇抗病毒治疗以及在出生后不久注射乙型肝炎免疫球蛋白可大大降低围产期和婴儿感染的风险。然而，非洲关于这些干预措施的循证政策因HBV流行病学知识的差距而受到阻碍。我们描述了一组感染HIV的女性中孕产妇慢性乙型肝炎（CHB）的患病率以及婴儿出生后第一年的感染情况。
方法
我们从南非一个城市地区的产前诊所招募并前瞻性跟踪感染HIV的孕妇及其婴儿。对所有女性进行乙型肝炎表面抗原、抗乙型肝炎表面抗体和HBV DNA检测。对于表面抗原呈阳性或可检测到HBV DNA的母亲所生的所有婴儿，在6周和52周时也进行乙型肝炎检测。
结果
我们纳入了189名女性，她们的中位年龄为29岁，中位CD4细胞计数为348个/立方毫米。14人表面抗原呈阳性（7.4%），其中6人“e”抗原呈阳性。另外3人可检测到HBV DNA但表面抗原未呈阳性。1名婴儿患上了CHB，另外3名婴儿根据HBV DNA检测呈阳性有传播的证据。所有婴儿在出生六周时接种了HBV疫苗。
结论
我们的研究结果突出了这种情况下围产期HBV传播的风险。应考虑采取减少这种传播的方法。
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