Alidina Zenita, Wormsbecker Anne E, Urquia Marcelo, MacGillivray Jay, Taerk Evan, Yudin Mark H, Campbell Douglas M
St. Michael's Hospital, University of Toronto, Toronto, ON, Canada M5B 1W8.
St. Michael's Hospital, University of Toronto, Toronto, ON, Canada M5B 1W8; Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada M5G 1X8; Department of Medicine, University of Toronto, Toronto, ON, Canada M5S 1A8.
Can J Infect Dis Med Microbiol. 2016;2016:2782786. doi: 10.1155/2016/2782786. Epub 2016 Apr 3.
Background. Perinatal HIV transmission is less than 1% with antiretroviral (ARV) prophylaxis. Transmission risk appears higher in "high risk" dyads, yet this is not well defined, possibly exposing more infants to combination ARV compared with standard care. Objective. To describe characteristics of mother-infant dyads where infants received ARVs and how these characteristics relate to specific ARV regimens. Methods. Retrospective chart review of ARV-receiving newborns at St. Michael's Hospital from 2007 to 2012 (and their mothers). Numerical and categorical variables were analyzed using t-tests/ANOVA F-tests and Fisher's exact tests, respectively. Results. Maternal HIV status at delivery was as follows: 69% positive and 24% unknown. Maternal factors significantly associated with newborn-triple therapy are Canadian origin, substance abuse, unstable housing, lost custody of previous children, and sex work. Neonatal factors are child protective services involvement, NICU, and lengthier admission. Maternal factors associated with monotherapy are African origin, HIV-positive, employment, and education. Further analysis based on maternal presentation at delivery demonstrated unequal distribution of many aforementioned factors. Discussion. This cohort revealed associations between particular factors and newborn-monotherapy or triple therapy that exist, suggesting that sociodemographic factors may influence the choice of ARV regimen. Canadian perinatal HIV transmission guidelines should qualify how to risk stratify newborns and consider use of rapid HIV antibody testing.
背景。通过抗逆转录病毒（ARV）预防措施，围产期HIV传播率低于1%。在“高危”母婴对中传播风险似乎更高，但这一点尚未明确界定，与标准治疗相比，这可能会使更多婴儿接受联合ARV治疗。目的。描述婴儿接受ARV治疗的母婴对的特征，以及这些特征与特定ARV治疗方案的关系。方法。对2007年至2012年在圣迈克尔医院接受ARV治疗的新生儿（及其母亲）进行回顾性病历审查。分别使用t检验/方差分析F检验和Fisher精确检验分析数值变量和分类变量。结果。分娩时母亲的HIV状态如下：69%为阳性，24%未知。与新生儿三联疗法显著相关的母亲因素包括加拿大国籍、药物滥用、住房不稳定、失去对先前子女的监护权以及性工作。新生儿因素包括儿童保护服务机构的介入、新生儿重症监护病房（NICU）以及住院时间更长。与单一疗法相关的母亲因素包括非洲国籍、HIV阳性、就业和教育。基于分娩时母亲情况的进一步分析表明，许多上述因素分布不均。讨论。该队列揭示了特定因素与新生儿单一疗法或三联疗法之间存在的关联，表明社会人口统计学因素可能会影响ARV治疗方案的选择。加拿大围产期HIV传播指南应明确如何对新生儿进行风险分层，并考虑使用快速HIV抗体检测。
