Märdärescu Mariana, Cibea Alina, Petre Cristina, Neagu-Drãghicenoiu Ruxandra, Ungurianu Rodica, Petrea Sorin, Tudor Ana Maria, Vlad Delia, Matei Carina, Alexandra Mãrdãrescu
Paediatric Immunodepression Department, Prof. Dr. Matei Bal, National Institute for Infectious Diseases, Bucharest, Romania.
Romanian HIV/AIDS Centre, "Prof. Dr. Matei Bal", National Institute for Infectious Diseases, Bucharest, Romania.
J Int AIDS Soc. 2014 Nov 2;17(4 Suppl 3):19700. doi: 10.7448/IAS.17.4.19700. eCollection 2014.
During the recent years the rate of HIV perinatally exposed children in Romania has increased as a consequence of the expanding number of HIV-infected women. These women belong to Romania's long-terms survivors, aged between 20 and 24 years and to the group of new HIV infection cases (20-24 years), acquired through unsafe sexual contact and use of new psychoactive substance (IV).
We focused on 396 HIV perinatally exposed children born between 2008 and 2013, under surveillance in National Institute for Infectious Diseases "Prof. Dr. Matei Bals," Bucharest. Of them, 43 acquired HIV through materno-foetal transmission. Our aim was to observe the characteristics in their evolution under antiretroviral treatment and to emphasize the causes of treatment failure. Children with perinatally acquired HIV infection were followed in a retrospective case series. We assessed maternal characteristics, HIV vertical transmission prophylaxis, timing of diagnosis, immunological and virologic status and features of the evolution under combined antiretroviral therapy (cART).
The rate of mother-to-child HIV transmission was 10.8% versus the national rate registered in 2013, namely <5%. 16% of mothers belonged to the Romanian 1990s cohort and 84% were recently infected with HIV, through unprotected sexual contact (70%) or use of new psychoactive substances (14%). 51% of mothers were diagnosed postnatally as a consequence of their reluctance to access specific health services and in 57% CD4 value was <350 cell/mm. 41% of the monitored children were diagnosed with HIV infection at birth. Their median entry CD4 value was 23% and 49% had a CD4 >25%; median entry viral load was 7 log. 16 patients (37%) had undetectable viral load after six months of treatment. In 87.5% of them the virologic suppression was achieved and maintained with one single regimen (2 NRTIs+1 NNRTI or 2 NRTIs+1 PI/r). 15 children (35%) did not achieve suppression of viral load. 19 children (44%) faced special issues related to adherence to antiretroviral treatment, due to mothers' poor adherence to a basic set of cares destined for their children.
Prevention programmes in Romania must be designed on the basis of the new economic context and emerging psychoactive substance use. Hence, women who use drugs should benefit from a wider access to medical and social services.
近年来，由于罗马尼亚感染艾滋病毒的女性人数不断增加，围产期感染艾滋病毒儿童的比例有所上升。这些女性属于罗马尼亚的长期幸存者，年龄在20至24岁之间，以及通过不安全的性接触和使用新型精神活性物质（静脉注射）而感染艾滋病毒的新病例群体（20至24岁）。
我们重点关注了2008年至2013年期间在布加勒斯特“马特伊·巴尔什教授”国家传染病研究所接受监测的396名围产期感染艾滋病毒的儿童。其中，43名通过母婴传播感染了艾滋病毒。我们的目的是观察他们在抗逆转录病毒治疗下的病情发展特征，并强调治疗失败的原因。对围产期感染艾滋病毒的儿童进行了回顾性病例系列研究。我们评估了母亲的特征、艾滋病毒垂直传播的预防措施、诊断时间、免疫和病毒学状况以及联合抗逆转录病毒疗法（cART）下的病情发展特征。
母婴艾滋病毒传播率为10.8%，而2013年登记的全国传播率为<5%。16%的母亲属于罗马尼亚20世纪90年代的队列，84%是最近通过无保护的性接触（70%）或使用新型精神活性物质（14%）感染艾滋病毒的。51%的母亲在产后被诊断出感染，原因是她们不愿寻求特定的医疗服务，57%的母亲CD4值<350个细胞/mm。41%的受监测儿童在出生时被诊断出感染艾滋病毒。他们的初始CD4值中位数为23%，49%的儿童CD4>25%；初始病毒载量中位数为7 log。16名患者（37%）在治疗6个月后病毒载量检测不到。其中87.5%的患者通过单一治疗方案（2种核苷类逆转录酶抑制剂+1种非核苷类逆转录酶抑制剂或2种核苷类逆转录酶抑制剂+1种蛋白酶抑制剂/利托那韦）实现并维持了病毒学抑制。15名儿童（35%）未实现病毒载量抑制。19名儿童（44%）面临与抗逆转录病毒治疗依从性相关的特殊问题，原因是母亲对为孩子提供的一套基本护理的依从性差。
罗马尼亚的预防计划必须根据新的经济背景和新型精神活性物质的使用情况来制定。因此，吸毒女性应能更广泛地获得医疗和社会服务。
