Paediatric Infectious Diseases Unit, Department of Health Sciences, Anna Meyer Children University Hospital, Firenze, Italy.
Department of Paediatric Medicine Anna Meyer Children's University Hospital, Firenze, Italy.
J Acquir Immune Defic Syndr. 2018 Sep 1;79(1):54-61. doi: 10.1097/QAI.0000000000001774.
Strategies for prevention of HIV-1 mother-to-child transmission (PMTCT) have been continuously optimized. However, cases of vertical transmission continue to occur in high-income countries.
To investigate changes in PMTCT strategies adopted by Italian clinicians over time and to evaluate risk factors for transmission.
Data from mother-child pairs prospectively collected by the Italian Register, born in Italy in 1996-2016, were analyzed. Risk factors for MTCT were explored by logistic regression analyses.
Six thousand five hundred three children (348 infections) were included. In our cohort, the proportion of children born to foreign mothers increased from 18.3% (563/3078) in 1996%-2003% to 66.2% (559/857) in 2011-2016 (P < 0.0001). Combination neonatal prophylaxis use significantly (P < 0.0001) increased over time, reaching 6.3% (56/857) after 2010, and it was largely (4.2%) adopted in early preterm infants. The proportion of vaginal deliveries in women with undetectable viral load (VL) increased over time and was 9.9% (85/857) in 2011-2016; no infection occurred among them. In children followed up since birth MTCT, rate was 3.5% (96/2783) in 1996-2003; 1.4% (36/2480) in 2004-2010; and 1.1% (9/835) in 2011-2016. At a multivariate analysis, factors associated with MTCT were vaginal delivery with detectable or missing VL or nonelective caesarean delivery, prematurity, breastfeeding, lack of maternal or neonatal antiretroviral therapy, detectable maternal VL, and age at first observation. Previously described increased risk of offspring of immigrant women was not confirmed.
Risk of MTCT in Italy is ongoing, even in recent years, underling the need for implementation of the current screening program in pregnancy. Large combination neonatal prophylaxis use in preterm infants was observed, even if data on safety and efficacy in prematures are poor.
预防艾滋病毒母婴传播（PMTCT）的策略一直在不断优化。然而，在高收入国家，垂直传播的病例仍时有发生。
调查意大利临床医生在不同时期采用的 PMTCT 策略的变化，并评估传播的风险因素。
对 1996 年至 2016 年在意大利出生的前瞻性收集的母婴对数据进行分析。采用逻辑回归分析探讨 MTCT 的风险因素。
共纳入 6530 名儿童（348 例感染）。在我们的队列中，外国母亲所生儿童的比例从 1996-2003 年的 18.3%（563/3078）增加到 2011-2016 年的 66.2%（559/857）（P<0.0001）。联合新生儿预防用药的使用率随着时间的推移显著增加（P<0.0001），2010 年后达到 6.3%（56/857），且在早产婴儿中广泛应用（4.2%）。在病毒载量（VL）未检测到的妇女中，阴道分娩的比例随着时间的推移而增加，2011-2016 年为 9.9%（85/857），其中未发生感染。在出生后随访的儿童中，MTCT 发生率为 1996-2003 年的 3.5%（96/2783）；2004-2010 年为 1.4%（36/2480）；2011-2016 年为 1.1%（9/835）。多变量分析表明，与 MTCT 相关的因素有 VL 可检测或缺失或非选择性剖宫产、早产、母乳喂养、母婴抗逆转录病毒治疗缺失、母亲 VL 可检测以及首次观察时的年龄。先前描述的移民妇女后代的风险增加未得到证实。
即使在最近几年，意大利的 MTCT 风险仍在持续，这强调了需要在妊娠期间实施当前的筛查计划。在早产儿中大量应用联合新生儿预防用药，尽管早产儿的安全性和有效性数据较差。
