感染艾滋病毒的孕妇中的衣原体和淋病与婴儿艾滋病毒传播
Chlamydia and Gonorrhea in HIV-Infected Pregnant Women and Infant HIV Transmission.
作者信息
Adachi Kristina, Klausner Jeffrey D, Bristow Claire C, Xu Jiahong, Ank Bonnie, Morgado Mariza G, Watts D Heather, Weir Fred, Persing David, Mofenson Lynne M, Veloso Valdilea G, Pilotto Jose Henrique, Joao Esau, Nielsen-Saines Karin
机构信息
From the *David Geffen UCLA School of Medicine, Los Angeles, CA; †Fielding School of Public Health, UCLA, Los Angeles, CA; ‡Westat, Rockville, MD; §Fundacao Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil; ¶Office of the Global AIDS Coordinator, US Department of State, Washington, DC; ∥Cepheid, Sunnyvale, CA; **Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD; ††Hospital Geral de Nova Iguaçu, Nova Iguaçu, RJ, Brazil; and ‡‡Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brazil.
出版信息
Sex Transm Dis. 2015 Oct;42(10):554-65. doi: 10.1097/OLQ.0000000000000340.
BACKGROUND
Sexually transmitted infections (STIs) such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) can lead to adverse pregnancy and neonatal outcomes. The prevalence of STIs and its association with HIV mother-to-child transmission (MTCT) were evaluated in a substudy analysis from a randomized, multicenter clinical trial.
METHODOLOGY
Urine samples from HIV-infected pregnant women collected at the time of labor and delivery were tested using polymerase chain reaction testing for the detection of CT and NG (Xpert CT/NG; Cepheid, Sunnyvale, CA). Infant HIV infection was determined by HIV DNA polymerase chain reaction at 3 months.
RESULTS
Of the 1373 urine specimens, 249 (18.1%) were positive for CT and 63 (4.6%) for NG; 35 (2.5%) had both CT and NG detected. Among 117 cases of HIV MTCT (8.5% transmission), the lowest transmission rate occurred among infants born to CT- and NG-uninfected mothers (8.1%) as compared with those infected with only CT (10.7%) and both CT and NG (14.3%; P = 0.04). Infants born to CT-infected mothers had almost a 1.5-fold increased risk for HIV acquisition (odds ratio, 1.47; 95% confidence interval, 0.9-2.3; P = 0.09).
CONCLUSIONS
This cohort of HIV-infected pregnant women is at high risk for infection with CT and NG. Analysis suggests that STIs may predispose to an increased HIV MTCT risk in this high-risk cohort of HIV-infected women.
背景
沙眼衣原体（CT）和淋病奈瑟菌（NG）等性传播感染可导致不良妊娠和新生儿结局。在一项随机多中心临床试验的子研究分析中，评估了性传播感染的患病率及其与HIV母婴传播（MTCT）的关联。
方法
对分娩时收集的HIV感染孕妇的尿液样本进行聚合酶链反应检测，以检测CT和NG（Xpert CT/NG；赛沛公司，加利福尼亚州桑尼维尔）。婴儿HIV感染通过3个月时的HIV DNA聚合酶链反应确定。
结果
在1373份尿液标本中，249份（18.1%）CT检测呈阳性，63份（4.6%）NG检测呈阳性；35份（2.5%）同时检测出CT和NG。在117例HIV母婴传播病例（传播率8.5%）中，CT和NG未感染母亲所生婴儿的传播率最低（8.1%），而仅感染CT的母亲所生婴儿的传播率为（10.7%），同时感染CT和NG的母亲所生婴儿的传播率为（14.3%；P = 0.04）。CT感染母亲所生婴儿感染HIV的风险几乎增加了1.5倍（比值比，1.47；95%置信区间，0.9 - 2.3；P = 0.09）。
结论
这组HIV感染孕妇感染CT和NG的风险很高。分析表明，在这一HIV感染高危女性队列中，性传播感染可能会增加HIV母婴传播的风险。
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