St Louis M E, Kamenga M, Brown C, Nelson A M, Manzila T, Batter V, Behets F, Kabagabo U, Ryder R W, Oxtoby M
Projet SIDA, Kinshasa, Zaire.
JAMA. 1993 Jun 9;269(22):2853-9.
To evaluate how maternal and obstetric factors interact to influence mother-to-child human immunodeficiency virus type 1 (HIV-1) transmission.
Prospective, observational cohort study of children born to HIV-infected women to determine child's HIV infection status. The analysis then compared peripartum maternal, placental, and obstetric variables between HIV-1 transmitter and nontransmitter women.
Two large maternity wards in Kinshasa, Zaire.
Consecutive sample of 324 HIV-1-infected women at delivery, with 254 HIV-seronegative women followed up as control subjects. PRINCIPAL OUTCOME MEASURES: HIV infection status of children, to classify each woman as an HIV-1 transmitter or nontransmitter.
The highest transmission risk (TR) was associated with maternal p24 antigenemia (TR, 71%; relative risk [RR], 3.0; 95% confidence interval [CI], 1.7 to 5.2) and maternal CD8+ lymphocyte counts of at least 1.80 x 10(9)/L (1800/microL) (TR, 50%; RR, 2.2; 95% CI, 1.2 to 4.2). Among women with CD8+ lymphocyte counts of less than 1.80 x 10(9)/L, CD4+ lymphocyte counts of less than 0.60 x 10(9)/L were a risk factor (TR, 29%; RR, 2.2; 95% CI, 1.2 to 4.2). In women with neither high CD8+ nor low CD4+ lymphocyte counts, placental membrane inflammation was associated with perinatal transmission (TR, 40%; RR, 4.2; 95% CI, 1.3 to 13.7). In women with neither p24 antigenemia, high CD8+ or low CD4+ lymphocyte counts, nor placental membrane inflammation, the transmission risk was only 7%. Additional correlates of transmission included maternal anemia and fever, but not maternal sexually transmitted diseases.
Identifiable subgroups of HIV-1-infected women based on maternal and placental characteristics had between a 7% and 71% risk of perinatal HIV-1 transmission. Not only the overall rate of transmission but the impact of different risk factors for transmission appear to vary over the course of HIV infection.
评估孕产妇和产科因素如何相互作用以影响母婴1型人类免疫缺陷病毒（HIV-1）传播。
对感染HIV的女性所生儿童进行前瞻性观察队列研究，以确定儿童的HIV感染状况。然后分析比较HIV-1传播者和非传播者女性的围产期孕产妇、胎盘和产科变量。
扎伊尔金沙萨的两个大型产科病房。
324例分娩时感染HIV-1的女性连续样本，254例HIV血清阴性女性作为对照进行随访。主要观察指标：儿童的HIV感染状况，将每位女性分类为HIV-1传播者或非传播者。
最高传播风险（TR）与孕产妇p24抗原血症相关（TR，71%；相对风险[RR]，3.0；95%置信区间[CI]，1.7至5.2）以及孕产妇CD8+淋巴细胞计数至少为1.80×10⁹/L（1800/μL）（TR，50%；RR，2.2；95%CI，1.2至4.2）。在CD8+淋巴细胞计数低于1.80×10⁹/L的女性中，CD4+淋巴细胞计数低于0.60×10⁹/L是一个危险因素（TR，29%；RR，2.2；9
