HIV感染孕妇性传播感染的综合评估与婴儿HIV传播
Combined evaluation of sexually transmitted infections in HIV-infected pregnant women and infant HIV transmission.
作者信息
Adachi Kristina, Xu Jiahong, Yeganeh Nava, Camarca Margaret, Morgado Mariza G, Watts D Heather, Mofenson Lynne M, Veloso Valdilea G, Pilotto Jose Henrique, Joao Esau, Gray Glenda, Theron Gerhard, Santos Breno, Fonseca Rosana, Kreitchmann Regis, Pinto Jorge, Mussi-Pinhata Marisa M, Ceriotto Mariana, Machado Daisy Maria, Bryson Yvonne J, Grinsztejn Beatriz, Moye Jack, Klausner Jeffrey D, Bristow Claire C, Dickover Ruth, Mirochnick Mark, Nielsen-Saines Karin
机构信息
David Geffen UCLA School of Medicine, Los Angeles, CA, United States of America.
Westat, Rockville, MD, United States of America.
出版信息
PLoS One. 2018 Jan 5;13(1):e0189851. doi: 10.1371/journal.pone.0189851. eCollection 2018.
BACKGROUND
Sexually transmitted infections (STIs) including Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Treponema pallidum (TP), and cytomegalovirus (CMV) may lead to adverse pregnancy and infant outcomes. The role of combined maternal STIs in HIV mother-to-child transmission (MTCT) was evaluated in mother-infant pairs from NICHD HPTN 040.
METHODOLOGY
Urine samples from HIV-infected pregnant women during labor were tested by polymerase chain reaction (PCR) for CT, NG, and CMV. Infant HIV infection was determined by serial HIV DNA PCR testing. Maternal syphilis was tested by VDRL and confirmatory treponemal antibodies.
RESULTS
A total of 899 mother-infant pairs were evaluated. Over 30% had at least one of the following infections (TP, CT, NG, and/or CMV) detected at the time of delivery. High rates of TP (8.7%), CT (17.8%), NG (4%), and CMV (6.3%) were observed. HIV MTCT was 9.1% (n = 82 infants). HIV MTCT was 12.5%, 10.3%, 11.1%, and 26.3% among infants born to women with CT, TP, NG or CMV respectively. Forty-two percent of HIV-infected infants were born to women with at least one of these 4 infections. Women with these infections were nearly twice as likely to have an HIV-infected infant (aOR 1.9, 95% CI 1.1-3.0), particularly those with 2 STIs (aOR 3.4, 95% CI 1.5-7.7). Individually, maternal CMV (aOR 4.4 1.5-13.0) and infant congenital CMV (OR 4.1, 95% CI 2.2-7.8) but not other STIs (TP, CT, or NG) were associated with an increased risk of HIV MTCT.
CONCLUSION
HIV-infected pregnant women identified during labor are at high risk for STIs. Co-infection with STIs including CMV nearly doubles HIV MTCT risk. CMV infection appears to confer the largest risk of HIV MTCT.
TRIAL REGISTRATION
NCT00099359.
背景
包括沙眼衣原体（CT）、淋病奈瑟菌（NG）、梅毒螺旋体（TP）和巨细胞病毒（CMV）在内的性传播感染（STIs）可能导致不良妊娠和婴儿结局。在国家儿童健康与人类发展研究所（NICHD）围产期艾滋病临床试验网络（HPTN）040研究的母婴对中，评估了孕产妇合并性传播感染在HIV母婴传播（MTCT）中的作用。
方法
对分娩时HIV感染孕妇的尿液样本进行聚合酶链反应（PCR）检测，以检测CT、NG和CMV。通过连续HIV DNA PCR检测确定婴儿HIV感染情况。通过性病研究实验室试验（VDRL）和梅毒螺旋体抗体确证试验检测孕产妇梅毒。
结果
共评估了899对母婴。超过30%的孕妇在分娩时检测出至少一种以下感染（TP、CT、NG和/或CMV）。观察到TP（8.7%）、CT（17.8%）、NG（4%）和CMV（6.3%）的感染率较高。HIV母婴传播率为9.1%（n = 82名婴儿）。CT、TP、NG或CMV感染孕妇所生婴儿的HIV母婴传播率分别为12.5%、10.3%、11.1%和26.3%。42%的HIV感染婴儿出生于患有这4种感染中至少一种的孕妇。患有这些感染的孕妇生出HIV感染婴儿的可能性几乎是未感染者的两倍（调整后的优势比[aOR]为1.9，95%置信区间[CI]为1.1 - 3.0），尤其是患有两种性传播感染的孕妇（aOR为3.4，95% CI为1.5 - 7.7）。单独来看，孕产妇CMV感染（aOR为4.4，1.5 - 13.0）和婴儿先天性CMV感染（优势比[OR]为4.1，95% CI为2.2 - 7.8）与HIV母婴传播风险增加相关，但其他性传播感染（TP、CT或NG）则不然。
结论
分娩时确诊的HIV感染孕妇感染性传播感染的风险很高。包括CMV在内的性传播感染合并感染使HIV母婴传播风险几乎增加一倍。CMV感染似乎带来了最大的HIV母婴传播风险。
试验注册
NCT00099359。
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