HIV 感染的非洲孕妇中支原体生殖器感染与 HIV 母婴传播的关系
Mycoplasma genitalium infection among HIV-infected pregnant African women and implications for mother-to-child transmission of HIV.
机构信息
aDepartment of Medicine bDepartment of Global Health cDepartment of Epidemiology dDepartment of Pediatrics eDepartment of Biostatistics, University of Washington, Seattle, Washington, USA fCentre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya gUNICEF, New York, New York hVaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
出版信息
AIDS. 2019 Nov 15;33(14):2211-2217. doi: 10.1097/QAD.0000000000002335.
OBJECTIVE
Many sexually transmitted infections increase risk of mother-to-child transmission (MTCT) of HIV, but the effect of Mycoplasma genitalium is not known. We hypothesized that M. genitalium infection would be common among HIV-infected pregnant women and could be associated with in-utero and intrapartum MTCT.
DESIGN
Observational case-cohort study.
METHODS
The current study used specimens from a Kenyan perinatal MTCT cohort (1999-2005) involving HIV-infected women and their infants, who received short-course zidovudine for prevention of MTCT. Vaginal swabs collected at 32 weeks gestation were tested for M. genitalium using a transcription-mediated amplification assay. Infant perinatal HIV infection was determined at birth and 4 weeks of age by DNA PCR. Using a case-cohort design, a random sample was generated with 3 : 1 control : case ratio; prevalence and correlates of M. genitalium were assessed with chi-squared and t tests; predictors of infant outcomes were analyzed using logistic regression.
RESULTS
Among 220 HIV-infected pregnant women evaluated, 47 women (21.4%) had M. genitalium. Antenatal M. genitalium infection was associated with higher HIV RNA in plasma (5.0 vs. 4.6 log10 copies/ml in M. genitalium-positive vs. M. genitalium-negative women, P = 0.02) at 32 weeks. Women with M. genitalium were less likely to report prior sexually transmitted infections and genital ulcers (both P = 0.05). There was no association found between exposure to M. genitalium and perinatal MTCT (odds ratio = 0.72, 95% confidence interval 0.35, 1.51, P = 0.39).
CONCLUSION
Vaginal M. genitalium infection was frequently detected among Kenyan HIV-infected pregnant women and was associated with higher plasma HIV levels, but was not associated with perinatal transmission of HIV.
目的
许多性传播感染会增加 HIV 母婴传播（MTCT）的风险，但支原体属生殖器感染的影响尚不清楚。我们假设支原体属生殖器感染在 HIV 感染孕妇中很常见，并且可能与宫内和分娩期 MTCT 相关。
设计
观察性病例对照研究。
方法
本研究使用了肯尼亚围产期 MTCT 队列（1999-2005 年）的标本，该队列涉及 HIV 感染的妇女及其婴儿，她们接受了短疗程齐多夫定预防 MTCT。在 32 周妊娠时采集阴道拭子，使用转录介导的扩增检测法检测支原体属生殖器。通过 DNA PCR 在出生时和 4 周龄时确定婴儿围产期 HIV 感染情况。使用病例对照设计，以 3：1 的对照：病例比例生成随机样本；采用卡方检验和 t 检验评估支原体属生殖器的患病率和相关因素；采用逻辑回归分析婴儿结局的预测因素。
结果
在 220 名接受评估的 HIV 感染孕妇中，47 名（21.4%）有支原体属生殖器感染。在 32 周时，支原体属生殖器感染的孕妇血浆中 HIV RNA 更高（5.0 对数 10 拷贝/ml 与支原体属生殖器阳性孕妇相比，支原体属生殖器阴性孕妇为 4.6 对数 10 拷贝/ml，P=0.02）。有支原体属生殖器感染的孕妇报告的性传播感染和生殖器溃疡较少（均 P=0.05）。未发现暴露于支原体属生殖器与围产期 MTCT 之间存在关联（比值比=0.72，95%置信区间 0.35，1.51，P=0.39）。
结论
在肯尼亚 HIV 感染孕妇中经常检测到阴道支原体属生殖器感染，与较高的血浆 HIV 水平相关，但与 HIV 围产期传播无关。
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