Burns D N, Landesman S, Muenz L R, Nugent R P, Goedert J J, Minkoff H, Walsh J H, Mendez H, Rubinstein A, Willoughby A
Pediatric, Adolescent, and Maternal AIDS Branch, National Institute of Child Health and Human Development, Rockville, MD 20852.
J Acquir Immune Defic Syndr (1988). 1994 Jul;7(7):718-26.
To examine the possible influence of obstetric factors, substance use during pregnancy, and other maternal factors on the relationship between a low maternal CD4+ level and vertical transmission of human immunodeficiency virus type 1 (HIV-1), data were analyzed from the Mothers and Infants Cohort Study, a prospective cohort followed for up to 4 years between 1986 and 1992 in Brooklyn and the Bronx, New York. The overall transmission rate for the cohort was 25.1% (95% confidence interval (CI) = 19.0-31.3). Prenatal CD4+ lymphocyte measurements were available for 162 HIV-seropositive mothers of infants with known infection outcomes. Among mothers who smoked cigarettes after the first trimester, those whose mean prenatal CD4+ level was < 20% had more than a threefold increased risk of transmitting their infection to their infants [relative risk (RR) = 3.30; 95% CI = 1.46-7.44; p = 0.004]. Among mothers who developed premature rupture of membranes, those with a low CD4+ level had a similarly increased risk of vertical transmission (RR = 4.33; 95% CI = 1.78-10.5; p = 0.003). These relative risks were much higher than those for mothers who did not smoke after the first trimester (RR = 1.14; 95% CI = 0.48-2.70; p = 0.76) or have premature rupture of membranes (RR = 1.29; 95% CI = 0.61-2.74; p = 0.50), indicating that these factors modified the effect of CD4+ level on transmission. Among all mothers without regard to CD4+ level, those who experienced preterm premature rupture of membranes were also at greater risk of transmission (RR = 2.24; 95% CI = 1.07-4.69; p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)
为研究产科因素、孕期物质使用及其他母体因素对母体CD4+水平低下与1型人类免疫缺陷病毒（HIV-1）垂直传播之间关系的可能影响，对母婴队列研究的数据进行了分析。该前瞻性队列于1986年至1992年在纽约布鲁克林和布朗克斯随访了4年。该队列的总体传播率为25.1%（95%置信区间（CI）=19.0 - 31.3）。有162名HIV血清阳性母亲的婴儿有已知感染结局，可获得其产前CD4+淋巴细胞测量值。在孕中期后吸烟的母亲中，产前平均CD4+水平<20%的母亲将感染传播给婴儿的风险增加了三倍多[相对风险（RR）=3.30；95%CI = 1.46 - 7.44；p = 0.004]。在发生胎膜早破的母亲中，CD4+水平低的母亲垂直传播风险同样增加（RR = 4.33；95%CI = 1.78 - 10.5；p = 0.003）。这些相对风险远高于孕中期后不吸烟的母亲（RR = 1.14；95%CI = 0.48 - 2.70；p = 0.76）或未发生胎膜早破的母亲（RR = 1.29；95%CI = 0.61 - 2.74；p = 0.50），表明这些因素改变了CD4+水平对传播的影响。在所有不考虑CD4+水平的母亲中，发生早产胎膜早破的母亲传播风险也更高（RR = 2.24；95%CI = 1.07 - 4.69；p = 0.03）。（摘要截短于250字）
