Grosch-Wörner I, Belohradsky B H, Debatin K M, Enenkel-Stoodt S, Höger P, Landwehr-Dobberstein C, Wahn V, Wintergerst U
Universitäts-Kinderkliniken, Berlin.
Monatsschr Kinderheilkd. 1993 Mar;141(3):227-36.
In most cases (about 80%) the HIV-infection of children is acquired during pregnancy or birth. Therefore peculiarities for diagnostic procedures and in the natural course of the disease can be expected if compared to AIDS acquired at adult age. Further interesting questions are the frequency of the (vertical) transmission from the infected mother to the child, the influence of mother- and/or child-related factors as well as the method of delivery on this transmission frequency.
In order to answer these questions the children of HIV-infected mothers since April 1, 1988 have been examined virologically, immunologically and clinically since birth by 6 study centers according to a standard protocol. The pregnancy data of the mothers have been documented, according to uniform criteria. Pre- or perinatally infected children not known to be antibody-positive at birth have been separately analysed.
The frequency of pre/perinatal transmission from the mother to the child is 15.3%, the elective caesarean section seems to lower the transmission rate. Mother and/or infant related cofactors of the transmission could not be defined. In comparison to the control groups of the intrauterine HIV-exposed but not infected children, at birth the HIV-infected children were clinically and immunologically not ill. During their first months some of the infected children had a significant increase of serum IgG. Oral candidiasis, chronic recurrent diarrhoea and bacterial infections are indicator symptoms of beginning HIV-disease. The Minimum-AIDS-Prevalence in the child's first year is 24%. The relatively late AIDS manifestation (3.7 years) and the average value of 28 months of survival in retrospective observed children were a remarkable result.
In general, the course of an HIV-infection in children of HIV-positive women in Germany seems to be comparable to results in other countries. The frequency of transmission from mother to child is relatively low (15.3%) and is an important result for maternity care. The caesarean section should be considered. The course of pregnancy must be examined more subtly in order to find out the still unclear causes of transmission. The Minimum-AIDS-Prevalence of 24% and the frequency of HIV-related signs and symptoms of 29% in the child's first year make it necessary to observe these children rather closely during this time.
在大多数情况下（约80%），儿童感染艾滋病毒是在怀孕或分娩期间获得的。因此，与成人期获得的艾滋病相比，预计在诊断程序和疾病自然病程方面会有特殊性。其他有趣的问题包括受感染母亲垂直传播给孩子的频率、母亲和/或孩子相关因素以及分娩方式对这种传播频率的影响。
为了回答这些问题，自1988年4月1日起，6个研究中心按照标准方案，对感染艾滋病毒母亲的孩子从出生起就进行了病毒学、免疫学和临床检查。母亲的怀孕数据已按照统一标准记录。对出生时未知抗体呈阳性的产前或围产期感染儿童进行了单独分析。
母亲向孩子的产前/围产期传播频率为15.3%，选择性剖宫产似乎能降低传播率。无法确定传播的母亲和/或婴儿相关辅助因素。与宫内接触艾滋病毒但未感染儿童的对照组相比，感染艾滋病毒的儿童在出生时临床和免疫方面均无疾病。在最初几个月里，一些受感染儿童的血清IgG显著增加。口腔念珠菌病、慢性复发性腹泻和细菌感染是艾滋病毒疾病开始的指示症状。儿童第一年的最低艾滋病患病率为24%。回顾性观察儿童中相对较晚出现艾滋病表现（3.7岁）以及平均存活28个月是一个显著结果。
总体而言，德国艾滋病毒阳性女性的儿童感染艾滋病毒的病程似乎与其他国家的结果相当。母婴传播频率相对较低（15.3%），这对产科护理来说是一个重要结果。应考虑剖宫产。必须更细致地检查孕期过程，以找出仍不清楚的传播原因。儿童第一年24%的最低艾滋病患病率以及29%的艾滋病毒相关体征和症状频率使得在此期间有必要密切观察这些儿童。
