Lolekha Rangsima, Chokephaibulkit Kulkanya, Phanuphak Nittaya, Chaithongwongwatthana Surasith, Kiertiburanakul Sasisopin, Chetchotisakd Pleonchan, Boonsuk Sarawut
Division of Global HIV and TB, Thailand Ministry of Public Health - U.S. CDC Collaboration, Nonthaburi 11000, Thailand.
Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Asian Biomed (Res Rev News). 2017 Apr;11(2):145-159. doi: 10.5372/1905-7415.1102.547.
Thailand has made progress in reducing perinatal HIV transmission rates to levels that meet the World Health Organization targets for so-called "elimination" (<2%) of mother-to-child transmission (MTCT).
To highlight the Thailand National Guidelines on HIV/AIDS Treatment Prevention Working Group issued a new version of its National Prevention of MTCT guidelines in March 2017 aimed to reduce MTCT rate to <1% by 2020.
The guidelines include recommending initiation of antepartum antiretroviral therapy (ART) containing tenofovir disoproxil fumarate (TDF) plus lamivudine (3TC)/emtricitabine (FTC) plus efavirenz regardless of CD4 cell count as soon as HIV is diagnosed for ART naïve HIV-infected pregnant women. An alternative regimen is TDF or zidovudine (AZT) plus 3TC/FTC plus lopinavir/ritonavir (LPV/r) for HIV-infected pregnant women suspected resistant to non-nucleoside reverse transcriptase inhibitors. Treatment should be started immediately irrespective of gestational age and continued after delivery for life. Raltegravir is recommended in addition to the ART regimen for HIV-infected pregnant women who present late (gestational age (GA) ≥32 weeks) or those who have a viral load (VL) >1000 copies/mL at GA ≥32 weeks. HIV-infected pregnant women who conceive while receiving ART should continue their treatment regimen during pregnancy. HIV-infected pregnant women who present in labor and are not receiving ART should receive single-dose nevirapine immediately along with oral AZT, and continue ART for life. Infants born to HIV-infected mothers are categorized as high or standard risk for MTCT. High MTCT risk is defined as an infant whose mother has a viral load (VL) > 50 copies/mL at GA > 36 weeks or has received ART <12 weeks before delivery, or has poor ART adherence. These infants should be started on AZT plus 3TC plus NVP for 6 weeks after delivery. Infants with standard MTCT risk should receive AZT for 4 weeks. Formula feeding exclusively is recommended for all HIV-exposed infants.
泰国在降低围产期艾滋病毒传播率方面取得了进展，已达到世界卫生组织所谓“消除”（<2%）母婴传播（MTCT）的目标水平。
强调泰国艾滋病毒/艾滋病治疗预防工作组于2017年3月发布了新版国家预防母婴传播指南，旨在到2020年将母婴传播率降至<1%。
指南建议，对于未接受过抗逆转录病毒治疗（ART）的艾滋病毒感染孕妇，一旦确诊艾滋病毒，无论其CD4细胞计数如何，应立即开始使用含替诺福韦酯（TDF）加拉米夫定（3TC）/恩曲他滨（FTC）加依非韦伦的产前抗逆转录病毒疗法（ART）。对于怀疑对非核苷类逆转录酶抑制剂耐药的艾滋病毒感染孕妇，替代方案是TDF或齐多夫定（AZT）加3TC/FTC加洛匹那韦/利托那韦（LPV/r）。无论孕周如何，均应立即开始治疗，并在分娩后终身持续。对于孕晚期（孕周（GA）≥32周）就诊或在GA≥32周时病毒载量（VL）>1000拷贝/mL的艾滋病毒感染孕妇，除ART方案外，建议加用拉替拉韦。正在接受ART治疗的艾滋病毒感染孕妇在怀孕期间应继续其治疗方案。临产时未接受ART治疗的艾滋病毒感染孕妇应立即接受单剂量奈韦拉平以及口服AZT治疗，并终身继续ART治疗。艾滋病毒感染母亲所生婴儿被归类为母婴传播的高风险或标准风险。母婴传播高风险定义为母亲在GA>36周时病毒载量（VL）>50拷贝/mL或在分娩前<12周接受过ART治疗，或ART依从性差的婴儿。这些婴儿应在出生后6周开始使用AZT加3TC加NVP治疗。母婴传播标准风险的婴儿应接受4周的AZT治疗。建议所有暴露于艾滋病毒的婴儿纯配方奶喂养。
