Duliège A M, Amos C I, Felton S, Biggar R J, Goedert J J
Biocine Company, Emeryville, California, USA.
J Pediatr. 1995 Apr;126(4):625-32. doi: 10.1016/s0022-3476(95)70365-9.
We evaluated data from prospectively identified twins to understand better the mechanisms and covariates of mother-to-infant transmission of human immunodeficiency virus (HIV).
Using data obtained from an international collaboration and multivariate quasilikelihood modeling, we assessed concordance, birth order, route of delivery, and other factors for HIV infection in 115 prospectively studied twin pairs born to HIV-infected women. Actuarial methods were used to evaluate overall survival and survival free of acquired immunodeficiency syndrome for HIV-infected twins.
Infection with HIV occurred in 35% of vaginally delivered firstborn (A) twins, 16% of cesarean-delivered A twins, 15% of vaginally delivered second-born (B) twins, and 8% of cesarean-delivered B twins. In a multivariate model, the adjusted odds ratios for HIV infection were 11.8 (confidence interval: 3.1 to 45.3) for concordance of infection with the co-twin, 2.8 (confidence interval: 1.6 to 5.0) for A versus B twins, and 2.7 (confidence interval: 1.1 to 6.6) for vaginally delivered versus cesarean-delivered twins. Among A twins, 52% (lower confidence limit: 6%) of the transmission risk was related to vaginal delivery. Comparing vaginally delivered A twins (infants most exposed to vaginal mucus and blood) to cesarean-delivered B twins (infants least exposed), 76% (lower confidence limit: 48%) of the transmission risk was related to vaginal exposure. Infected B twins had slightly reduced Quetelet indexes and more rapid development of illnesses related to acquired immunodeficiency syndrome.
These results indicate that HIV infection of B twins occurs predominantly in utero, whereas infection of A twins (and, by implication, singletons) occurs predominantly intrapartum. We propose that intrapartum transmission is responsible for the majority of pediatric HIV infections and that reducing exposure to HIV in the birth canal may reduce transmission of the virus from mother to infant.
我们评估了前瞻性确定的双胞胎的数据，以更好地了解人类免疫缺陷病毒（HIV）母婴传播的机制和协变量。
利用从国际合作中获得的数据和多变量拟似然模型，我们评估了115对由感染HIV的女性所生的前瞻性研究双胞胎中HIV感染的一致性、出生顺序、分娩方式及其他因素。采用精算方法评估HIV感染双胞胎的总体生存率和无获得性免疫缺陷综合征生存率。
经阴道分娩的头胎（A）双胞胎中35%感染HIV，剖宫产的A双胞胎中16%感染，经阴道分娩的二胎（B）双胞胎中15%感染，剖宫产的B双胞胎中8%感染。在多变量模型中，感染与双胞胎一致时HIV感染的校正比值比为11.8（置信区间：3.1至45.3），A双胞胎与B双胞胎相比为2.8（置信区间：1.6至5.0），经阴道分娩与剖宫产的双胞胎相比为2.7（置信区间：1.1至6.6）。在A双胞胎中，52%（下限置信区间：6%）的传播风险与经阴道分娩有关。将经阴道分娩的A双胞胎（最易接触阴道黏液和血液的婴儿）与剖宫产的B双胞胎（最不易接触的婴儿）进行比较，76%（下限置信区间：48%）的传播风险与阴道接触有关。感染的B双胞胎的体重指数略低，与获得性免疫缺陷综合征相关疾病的发展更快。
这些结果表明，B双胞胎的HIV感染主要发生在子宫内，而A双胞胎（以及由此推断的单胎）的感染主要发生在分娩期间。我们认为分娩期间传播是大多数儿童HIV感染的原因，减少在产道中接触HIV可能会降低病毒从母亲传播给婴儿的几率。
