HIV Pathogenesis Programme, The Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa.
Department of Paediatrics, University of Oxford, Oxford, UK.
AIDS. 2021 Aug 1;35(10):1597-1604. doi: 10.1097/QAD.0000000000002915.
The worldwide incidence of pregnancy for women living with perinatal HIV infection is increasing. Subsequently, there is growing risk of second-generation mother-to-child HIV transmission. The infant clinical outcomes for such a phenomenon have yet to be described.
As part of a wider observational study in KwaZulu-Natal, South Africa, six infants with in-utero HIV infection were identified as being born to mothers with perinatal HIV infection.
Blood results and clinical data were collected in the first 3 years of life. In two cases, sample availability allowed confirmation by phylogenetic analysis of grandmother-to-mother-to-child HIV transmission.
Outcomes were poor in all six cases. All six mothers had difficulty administering twice daily combination antiretroviral therapy to their infants due to difficulties with acceptance, disclosure, poor health and being themselves long-term nonprogressors. Nonnucleoside reverse transcriptase inhibitor-resistant virus was detected in all mothers tested. None of the infants maintained suppression of viraemia on combination antiretroviral therapy. One infant died, and another was lost to follow-up.
As the numbers of second-generation mother-to-child transmissions increase, it is important to highlight that this mother-infant dyad represents an extremely vulnerable group. In order for them to survive and thrive, these infants' mothers require their specific needs to be addressed and given intensive support.
全球围产期感染 HIV 的女性妊娠率正在上升。随之而来的是第二代母婴 HIV 传播的风险日益增加。对于这种现象，婴儿的临床结局尚未被描述。
作为南非夸祖鲁-纳塔尔省一项更广泛的观察性研究的一部分，鉴定出 6 名患有宫内 HIV 感染的婴儿，其母亲为围产期 HIV 感染。
在生命的前 3 年中收集了血液结果和临床数据。在两种情况下，通过对祖母-母亲-婴儿 HIV 传播的系统发育分析，确认了样本的可用性。
在所有 6 例中，结果均较差。由于接受性差、披露困难、健康状况不佳以及自身长期非进展者等原因，所有 6 位母亲均难以对婴儿进行每日两次的联合抗逆转录病毒治疗。所有接受检测的母亲均检测到非核苷类逆转录酶抑制剂耐药病毒。没有一个婴儿能在联合抗逆转录病毒治疗中维持病毒血症抑制。1 名婴儿死亡，另 1 名婴儿失访。
随着第二代母婴传播的数量增加，重要的是要强调，这个母婴二人组代表了一个极其脆弱的群体。为了让他们生存和茁壮成长，这些婴儿的母亲需要满足他们的特殊需求并给予他们强化支持。
