Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa.
Division of Paediatric Infectious Diseases, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
Int J Infect Dis. 2020 Sep;98:315-320. doi: 10.1016/j.ijid.2020.06.081. Epub 2020 Jun 29.
Vertical transmission is the predominant route for acquisition of HIV infection in children, either in utero, intrapartum or postnatally through breast feeding. Less frequently, children may acquire HIV by horizontal transmission. Horizontal transmission may be healthcare-associated (infusion of HIV-contaminated blood products, use of contaminated needles, syringes and medical equipment, or through ingestion of HIV in expressed breastmilk). Community-acquired HIV transmission to children may occur following surrogate breastfeeding, pre-mastication of food, and sexual abuse.
Children with suspected horizontally acquired HIV infection were identified by retrospective folder review of existing patients (2004-2014) and by prospective interview and examination of new patients (from 2009 onwards), at a hospital-based paediatric antiretroviral clinic in Cape Town, South Africa. The global literature on horizontal HIV transmission to children (1 January 1986-1 November 2019) was reviewed, to contextualize the local findings.
Among the 32 children with horizontal HIV transmission (15 identified retrospectively and 17 prospectively), the median age at first diagnosis was 79 months (interquartile range 28.5-91.5); most children (90.6%) had advanced HIV disease at presentation. HIV transmission was considered healthcare-associated in 15 (46.9%), community-associated in ten (31.3%), possibly healthcare or community-associated in five (15.6 %); and unknown in two children (6.3%).
Horizontal HIV transmission to children is an important public health issue, with prevention efforts requiring intervention at healthcare facility- and community-level. Greater effort should be made to promptly identify and comprehensively investigate each horizontally HIV-infected child to establish possible routes of transmission and inform future prevention strategies.
垂直传播是儿童感染 HIV 的主要途径，包括宫内、分娩期或通过母乳喂养的方式。儿童也可能通过水平传播感染 HIV。水平传播可能与医疗保健相关（输注受 HIV 污染的血液制品、使用污染的针、注射器和医疗器械，或通过摄入受 HIV 污染的母乳）。儿童通过替代母乳喂养、食物未经咀嚼、性虐待而获得社区获得性 HIV 传播。
通过回顾性档案审查现有患者（2004-2014 年）和前瞻性访谈及检查新患者（自 2009 年起），在南非开普敦的一家医院儿科抗逆转录病毒诊所确定疑似水平获得性 HIV 感染的儿童。回顾了全球有关儿童水平 HIV 传播的文献（1986 年 1 月 1 日至 2019 年 11 月 1 日），以了解当地的发现。
在 32 名患有水平 HIV 传播的儿童中（15 名通过回顾性方法确定，17 名通过前瞻性方法确定），首次诊断的中位年龄为 79 个月（四分位间距 28.5-91.5）；大多数儿童（90.6%）在就诊时患有晚期 HIV 疾病。15 例（46.9%）HIV 传播被认为与医疗保健相关，10 例（31.3%）与社区相关，5 例（15.6%）可能与医疗保健或社区相关；2 例（6.3%）原因不明。
儿童水平 HIV 传播是一个重要的公共卫生问题，预防工作需要在医疗保健机构和社区层面进行干预。应更加努力及时识别和全面调查每一例水平感染 HIV 的儿童，以确定可能的传播途径，并为未来的预防策略提供信息。
