Wagner Noémie, Crisinel Pierre-Alex, Kahlert Christian, Martinez De Tejada Begoña
Service de pédiatrie générale, Département Femme, Enfant, Adolescent, HUG, 1211 Genève 14.
Unité d'infectiologie pédiatrique et vaccinologie, Département femme-mère-enfant, CHUV, 1011 Lausanne.
Rev Med Suisse. 2020 Oct 28;16(712):2050-2054.
Mother-to-child transmission (MTCT) is almost inexistent in Switzerland nowadays. This success has been achieved with systematic screening of HIV in pregnant women, provision of antiretroviral treatment (ART), elective cesarean-section (CS), neonatal antiretroviral prophylaxis (ARP) and avoidance of breastfeeding. Elective CS and neonatal ARP are no longer recommended when the viral load (VL) is suppressed. Recent studies have shown that the risk of HIV MTCT through breastfeeding is extremely rare if not zero when the mother is treated, has a suppressed VL and is correctly followed-up. It is time to be open to discuss the risks and benefits of breastfeeding with HIV-infected pregnant women and to enter in a shared decision-making process, as recommended by the new Swiss guidelines. Close monitoring is mandatory in case of breastfeeding.
如今在瑞士，母婴传播（MTCT）几乎不存在。这一成功得益于对孕妇进行系统的HIV筛查、提供抗逆转录病毒治疗（ART）、选择性剖宫产（CS）、新生儿抗逆转录病毒预防（ARP）以及避免母乳喂养。当病毒载量（VL）得到抑制时，不再推荐选择性剖宫产和新生儿ARP。最近的研究表明，如果母亲接受治疗、病毒载量得到抑制且得到正确随访，通过母乳喂养发生HIV母婴传播的风险即使不为零也极其罕见。正如瑞士新指南所建议的，现在是时候与感染HIV的孕妇公开讨论母乳喂养的风险和益处，并进入共同决策过程了。母乳喂养时必须进行密切监测。
