Lepage P, Van de Perre P, Msellati P, Hitimana D G, Simonon A, Van Goethem C, Mukamabano B, Karita E, Stevens A M, Mathieu G
Am J Epidemiol. 1993 Mar 15;137(6):589-99. doi: 10.1093/oxfordjournals.aje.a116716.
The authors report the results of the first 2 years of follow-up of a prospective cohort study on the mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) and its determinants which started in November 1988 in Kigali, Rwanda. The study sample consists of 218 newborns of 215 HIV-1 seropositive women matched to 218 newborns of 216 HIV-1 seronegative women of the same age and parity. They were followed every 2 weeks during the first 2 years of follow-up. HIV-1 antibodies were detected by enzyme-linked immunoadsorbent assay and Western blot at 3-month intervals. Two methods of calculating the mother-to-child transmission rate were used: method 1 combines the information provided by the persistence of HIV-1 antibodies at 15 months of age in children born to HIV seropositive mothers and the excess mortality in this group compared with the cohort of children born to HIV seronegative mothers; method 2 is a case-by-case evaluation of all the children born to HIV seropositive mothers. A logistic regression model was used to study the determinants of transmission. The probability of survival at 24 months of age was 81% (95% confidence interval (CI) 75-86) in children born to seropositive mothers, compared with 95% (95% CI 92-98) in children born to seronegative mothers (p < 0.001). The mother-to-child transmission rate calculated with method 1 was 25.7% (95% CI 18.8-32.5). With method 2, the medium estimate was 24.7%. In the multivariate analysis, a CD4/CD8 ratio < 0.5 was the only maternal factor statistically associated with an increased risk of mother-to-child transmission of HIV-1 (odds ratio = 2.9, 95% CI 1.2-7.2). The authors' findings present evidence for a higher mother-to-child transmission rate of HIV-1 in children born in Rwanda than in industrialized countries.
作者报告了一项关于1型人类免疫缺陷病毒（HIV-1）母婴传播及其决定因素的前瞻性队列研究前两年的随访结果。该研究于1988年11月在卢旺达基加利启动。研究样本包括215名HIV-1血清阳性女性的218名新生儿，与216名年龄和胎次相同的HIV-1血清阴性女性的218名新生儿相匹配。在随访的前两年中，每2周对他们进行一次随访。每隔3个月通过酶联免疫吸附试验和蛋白质印迹法检测HIV-1抗体。使用了两种计算母婴传播率的方法：方法1结合了HIV血清阳性母亲所生儿童在15个月大时HIV-1抗体持续存在情况以及该组与HIV血清阴性母亲所生儿童队列相比的额外死亡率所提供的信息；方法2是对HIV血清阳性母亲所生的所有儿童进行逐例评估。使用逻辑回归模型研究传播的决定因素。血清阳性母亲所生儿童在24个月大时的存活概率为81%（95%置信区间（CI）75 - 86），而血清阴性母亲所生儿童为95%（95% CI 92 - 98）（p < 0.001）。用方法1计算的母婴传播率为25.7%（95% CI 18.8 - 32.5）。用方法2，中位数估计值为24.7%。在多变量分析中，CD4/CD8比值<0.5是唯一与HIV-1母婴传播风险增加有统计学关联的母亲因素（比值比 = 2.9，95% CI 1.2 - 7.2）。作者的研究结果表明，卢旺达出生的儿童中HIV-1的母婴传播率高于工业化国家。
