Ryder R W, Nsa W, Hassig S E, Behets F, Rayfield M, Ekungola B, Nelson A M, Mulenda U, Francis H, Mwandagalirwa K
Projet SIDA, Department of Public Health, Kinshasa, Zaire.
N Engl J Med. 1989 Jun 22;320(25):1637-42. doi: 10.1056/NEJM198906223202501.
To examine perinatal transmission of the human immunodeficiency virus type 1 (HIV-1) in Zaire, we screened 8108 women who gave birth at one of two Kinshasa hospitals that serve populations of markedly different socioeconomic status. For up to one year, we followed the 475 infants of the 466 seropositive women (5.8 percent of those screened) and the 616 infants of 606 seronegative women matched for age, parity, and hospital. On the basis of clinical criteria, 85 of the seropositive women (18 percent) had the acquired immunodeficiency syndrome (AIDS). The infants of seropositive mothers, as compared with those of seronegative mothers, were more frequently premature, had lower birth weights, and had a higher death rate in the first 28 days (6.2 vs. 1.2 percent; P less than 0.0001). The patterns were similar at the two hospitals. Twenty-one percent of the cultures for HIV-1 of 92 randomly selected cord-blood samples from infants of seropositive women were positive. T4-cell counts were performed in 37 seropositive women, and cord blood from their infants was cultured. The cultures were positive in the infants of 6 of the 18 women with antepartum T4 counts of 400 or fewer cells per cubic millimeter, as compared with none of the infants of the 19 women with more than 400 T4 cells per cubic millimeter (P = 0.02). One year later, 21 percent of the infants of the seropositive mothers had died as compared with 3.8 percent of the control infants (P less than 0.001), and 7.9 percent of their surviving infants had AIDS. We conclude that the mortality rates among children of seropositive mothers are high regardless of socioeconomic status, and that perinatal transmission of HIV-1 has a major adverse effect on infant survival in Kinshasa.
为了研究扎伊尔1型人类免疫缺陷病毒（HIV-1）的围产期传播情况，我们对在金沙萨两家医院之一分娩的8108名妇女进行了筛查，这两家医院服务的人群社会经济地位明显不同。长达一年的时间里，我们对466名血清阳性妇女（占筛查人数的5.8%）的475名婴儿以及606名血清阴性妇女年龄、胎次和医院相匹配的616名婴儿进行了跟踪。根据临床标准，85名血清阳性妇女（18%）患有获得性免疫缺陷综合征（AIDS）。与血清阴性母亲的婴儿相比，血清阳性母亲的婴儿早产更频繁、出生体重更低，且在出生后28天内死亡率更高（6.2%对1.2%；P<0.0001）。两家医院的情况相似。从血清阳性妇女的婴儿中随机选取的92份脐带血样本，其中21%的HIV-1培养结果呈阳性。对37名血清阳性妇女进行了T4细胞计数，并对其婴儿的脐带血进行了培养。18名产前T4细胞计数每立方毫米400个或更少的妇女中，有6名妇女的婴儿培养结果呈阳性，而19名T4细胞计数每立方毫米超过400个的妇女的婴儿培养结果均为阴性（P=0.02）。一年后，血清阳性母亲的婴儿中有21%死亡，而对照婴儿的死亡率为3.8%（P<0.001），其存活婴儿中有7.9%患有AIDS。我们得出结论，无论社会经济地位如何，血清阳性母亲的子女死亡率都很高，并且HIV-1的围产期传播对金沙萨的婴儿存活有重大不利影响。
