Thomas P A, Weedon J, Krasinski K, Abrams E, Shaffer N, Matheson P, Bamji M, Kaul A, Hutson D, Grimm K T
New York City Department of Health, NY 10013.
Pediatr Infect Dis J. 1994 Jun;13(6):489-95. doi: 10.1097/00006454-199406000-00005.
This analysis sought to identify characteristics of pregnant human immunodeficiency virus type 1 (HIV-1)-infected women that predict mother-to-child HIV-1 transmission. Pregnant and immediately postpartum women at risk for HIV were enrolled at obstetric and pediatric care settings in New York City from 1986 to 1992. Demographic and behavioral characteristics, clinical illness, T lymphocyte subsets, immunoglobulin concentration and syphilis serology were collected on the women. Infants were followed to determine HIV infection classification according to Centers for Disease Control and Prevention criteria for HIV-1 in children. Transmission rates were calculated for women who gave birth more than 15 months before the analysis. Of 172 HIV-1-infected women with known outcome 49 (28%) had infected infants. The transmission rate (TR) was significantly higher among women with < 280 CD4+ cells/microliters (lowest CD4+ quartile) than with CD4+ counts > 280 (48% vs. 22%; P = 0.004; odds ratio, 3.4; 95% confidence interval (1.5, 7.8)); a similar trend was seen by CD4+% quartile. No difference in TR was seen comparing women by CD8+ count quartile but marginally higher TR was seen among women with CD8+% > or = 51% than with CD8+% < 51% (TR = 41% vs. 24%; P = 0.076; odds ratio, 2.2; confidence interval (1.0, 5.1)). The highest TR, 62% was seen in women with both CD8+ count above the median and CD4+ count in the lowest quartile. No significant difference in TR was seen between women with and without HIV-related illness, although the TR was 53% among women hospitalized in the previous year for pneumonia compared with 25% in others (P = 0.03). TR was somewhat lower in women who delivered by cesarean section than vaginally (entire cohort: 18% vs. 32%, P = 0.11; prenatal enrollees only, 17% vs. 38%, P = 0.045). No factor or combination of factors was both highly sensitive and specific for predicting mother-to-child HIV transmission. A possible relationship between transmission and mode of delivery deserves further investigation.
本分析旨在确定感染人类免疫缺陷病毒1型（HIV-1）的孕妇的特征，这些特征可预测母婴HIV-1传播。1986年至1992年期间，在纽约市的产科和儿科护理机构招募了有HIV感染风险的孕妇及产后即刻的妇女。收集了这些妇女的人口统计学和行为特征、临床疾病、T淋巴细胞亚群、免疫球蛋白浓度及梅毒血清学信息。对婴儿进行随访，根据美国疾病控制与预防中心关于儿童HIV-1的标准确定HIV感染分类。计算在分析前15个月以上分娩的妇女的传播率。在172名已知结局的HIV-1感染妇女中，49名（28%）有感染的婴儿。CD4+细胞/微升<280（CD4+最低四分位数）的妇女的传播率（TR）显著高于CD4+计数>280的妇女（48%对22%；P=0.004；优势比，3.4；95%置信区间（1.5，7.8））；按CD4+%四分位数也观察到类似趋势。按CD8+计数四分位数比较妇女时，TR无差异，但CD8+%≥51%的妇女的TR略高于CD8+%<51%的妇女（TR=41%对24%；P=0.076；优势比，2.2；置信区间（1.0，5.1））。CD8+计数高于中位数且CD4+计数处于最低四分位数的妇女的TR最高，为62%。有和没有HIV相关疾病的妇女之间的TR无显著差异，尽管前一年因肺炎住院的妇女的TR为53%，而其他妇女为25%（P=0.03）。剖宫产分娩的妇女的TR略低于阴道分娩的妇女（整个队列：18%对32%，P=0.11；仅产前入组者，17%对38%，P=0.045）。没有单一因素或因素组合对预测母婴HIV传播具有高敏感性和特异性。传播与分娩方式之间的可能关系值得进一步研究。
