From the Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
Department of Epidemiology and Biostatistics, School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
Pediatr Infect Dis J. 2019 May;38(5):508-512. doi: 10.1097/INF.0000000000002220.
To investigate potential risk factors for perinatal (intrauterine and intrapartum) mother-to-child transmission (MTCT) of HIV in women unexposed to antiretroviral therapy (ART) during pregnancy.
We compared factors according to perinatal MTCT outcome among 2275 ART-naive (until the onset of labor) HIV-infected women in the Breastfeeding, Antiretrovirals and Nutrition study (2004-2010) in Lilongwe, Malawi. Factors included HIV viral load during pregnancy, food security, demographic characteristics, hematologic and blood chemistry measures, medical history and physical factors. Associations with perinatal MTCT and interactions with maternal viral load were assessed using simple and multivariable logistic regression.
There were 119 (115 intrauterine and 4 intrapartum) cases of perinatal MTCT, only one to a mother with <1000 HIV copies/mL. Maternal viral loads >10,000 copies/mL were common (63.1%). Lower maternal viral load (<1000 copies/mL and 1000.1-10,000 copies/mL) was associated with reduced odds of perinatal MTCT [adjusted odds ratio (aOR), 0.1; 95% confidence interval (CI): 0.01-0.4 and aOR, 0.2; 95% CI: 0.1-0.4, respectively), compared with maternal viral load >10,000 copies/mL. Low CD4+ T cell count (≤350 cells/μL) was only associated with perinatal MTCT in unadjusted models. Food shortage (aOR, 1.8; 95% CI: 1.2-2.6), sexually transmitted infection (STI) (past year; aOR, 1.9; 95% CI: 1.0-3.7), histories of herpes zoster (aOR, 3.0; 95% CI: 1.6-5.6) and tuberculosis (aOR, 2.5; 95% CI: 1.1-5.7) were associated with increased odds of perinatal MTCT.
These findings confirm that lowering maternal HIV viral load is most important in preventing perinatal MTCT and support efforts to address food shortage, STI and tuberculosis prevention, while informing programs to improve ART coverage in pregnancy.
为了研究在孕期未接受抗逆转录病毒治疗（ART）的妇女中，HIV 母婴垂直传播（宫内和产时）的潜在危险因素。
我们比较了 2004 年至 2010 年在马拉维利隆圭的母乳喂养、抗逆转录病毒和营养研究（BAN）中 2275 名未经 ART 治疗（直至分娩开始）的 HIV 感染妇女的围产期母婴传播结局的因素。这些因素包括孕期 HIV 病毒载量、食物安全、人口统计学特征、血液学和血液化学指标、既往病史和身体因素。采用简单和多变量逻辑回归评估与围产期母婴传播的关联及其与母体病毒载量的相互作用。
有 119 例（115 例宫内和 4 例产时）发生围产期母婴传播，仅 1 例发生在病毒载量<1000 拷贝/mL 的母亲。母体病毒载量>10000 拷贝/mL 很常见（63.1%）。较低的母体病毒载量（<1000 拷贝/mL 和 1000.1-10000 拷贝/mL）与围产期母婴传播的几率降低相关[调整后的比值比（aOR），0.1；95%置信区间（CI）：0.01-0.4 和 aOR，0.2；95%CI：0.1-0.4]，与病毒载量>10000 拷贝/mL 的相比。低 CD4+T 细胞计数（≤350 个/μL）仅在未调整模型中与围产期母婴传播相关。食物短缺（aOR，1.8；95%CI：1.2-2.6）、性传播感染（STI）（过去一年；aOR，1.9；95%CI：1.0-3.7）、带状疱疹病史（aOR，3.0；95%CI：1.6-5.6）和结核病（aOR，2.5；95%CI：1.1-5.7）与围产期母婴传播的几率增加相关。
这些发现证实，降低母体 HIV 病毒载量是预防围产期母婴垂直传播的最重要因素，支持努力解决食物短缺、性传播感染和结核病预防问题，同时为改善孕期抗逆转录病毒治疗的覆盖范围提供信息。
