Fiscus S A, Adimora A A, Schoenbach V J, Lim W, McKinney R, Rupar D, Kenny J, Woods C, Wilfert C
Department of Microbiology, University of North Carolina at Chapel Hill, 27599, USA.
JAMA. 1996 May 15;275(19):1483-8.
To assess health care providers' identification of human immunodeficiency virus (HIV)-exposed infants, to ascertain the prevalence of transplacental or oral zidovudine treatment among infants exposed to HIV, and to estimate the impact of zidovudine use on perinatal transmission in rural and urban North Carolina.
Survey of North Carolina newborns tested for HIV infection in 1993 and 1994 compared with the number of anonymous HIV-positive childbearing women.
North Carolina hospitals, public health clinics, and private physicians' offices.
Rates of identification of HIV-exposed infants and of perinatal HIV-1 transmission, determined by HIV culture and polymerase chain reaction testing in the infants.
The proportion of HIV-exposed children in North Carolina who were identified and tested increased from 60% in 1993 to 82% for all of 1994, and to more than 90% for the last quarter of 1994. The HIV-exposed infants born in rural counties were more likely to be recognized than those born in urban counties (P<.001). In 1994, most infants were evaluated relatively early in life: 39% by 1 week of age, 63% by 6 weeks, and 76% by 3 months. Among infants with recognized HIV exposure, transmission decreased significantly between 1993 and 1994, from 21% to 8.5%, respectively (P=.009). After the announcement of the results of the AIDS Clinical Trials Group Protocol 076, zidovudine was given to 75% of HIV-positive women who delivered infants in North Carolina. Only 5.7% of infants who received any zidovudine became infected, compared with 18.9% of infants who received no zidovudine (P=.007).
Health care providers in North Carolina are identifying most of the state's HIV-seropositive pregnant women, treating them with zidovudine, and testing their infants soon after birth for HIV infection. The use of zidovudine in pregnant women and their infants has reduced perinatal HIV transmission in the state.
评估医疗保健提供者对暴露于人类免疫缺陷病毒（HIV）的婴儿的识别情况，确定暴露于HIV的婴儿中经胎盘或口服齐多夫定治疗的患病率，并估计齐多夫定的使用对北卡罗来纳州农村和城市围产期传播的影响。
对1993年和1994年接受HIV感染检测的北卡罗来纳州新生儿进行调查，并与匿名HIV阳性育龄妇女的数量进行比较。
北卡罗来纳州的医院、公共卫生诊所和私人医生办公室。
通过对婴儿进行HIV培养和聚合酶链反应检测来确定暴露于HIV的婴儿的识别率和围产期HIV-1传播率。
北卡罗来纳州被识别并接受检测的暴露于HIV的儿童比例从1993年的60%增加到1994年全年的82%，在1994年最后一个季度超过90%。农村县出生的暴露于HIV的婴儿比城市县出生的婴儿更有可能被识别（P<0.001）。1994年，大多数婴儿在生命早期接受了评估：1周龄时为39%，6周龄时为63%，3个月龄时为76%。在已识别出HIV暴露的婴儿中，1993年至1994年间传播率显著下降，分别从21%降至8.5%（P=0.009）。在公布艾滋病临床试验组方案076的结果后，北卡罗来纳州75%的HIV阳性分娩妇女接受了齐多夫定治疗。接受任何齐多夫定治疗的婴儿中只有5.7%被感染，而未接受齐多夫定治疗的婴儿中这一比例为18.9%（P=0.007）。
北卡罗来纳州的医疗保健提供者识别出了该州大多数HIV血清学阳性的孕妇，用齐多夫定对她们进行治疗，并在婴儿出生后不久对其进行HIV感染检测。孕妇及其婴儿使用齐多夫定降低了该州围产期HIV传播率。
