Villegas-Castrejon H, Paredes-Vivas Y, Flores-Rivera E, Gorbea-Robles M C, Arredondo-Garcia J L
Instituto Nacional de Perinatología, México, D.F.
Ginecol Obstet Mex. 1996 Apr;64:167-76.
Perinatal vertical transmission has increased in all the world; it is considered that at the present time there are about one million of children with HIV. Variation goes from 12 to 40%, at different countries. During the last years antiretroviral drugs as AZT, ddI and others have been used to diminish the virus passage via transplacentary. Eighteen placentaes from HIV seropositive women, three corresponded to first trimester, and 15 to the third trimester of gestation; in four cases they were treated with AZT in weeks fourteen (two patients), 26 and 35 of gestation; and one patient received AZT and ddI at week 28. Control group was with ten normal placentaes. Ultraestructural analysis and immuno-peroxidase and immuno-oro with antibody anti gp 41, were done. Ultraestructurally there were different localizations of HIV virus, at sincitiotrophoblast, decidual cells and umbilical vessels (six cases). In 13 cases there was hyperplasia and hypertrophy of macrophages containing a great amount of lysosomes. In one case, where a girl was seropositive many viriones HIV, were identified in macrophages. With immuno-oro viral proteins were seen in cytoplasm an plasmatic membrane, in endothelium of fetal capillars and trophoblast. With immunoperoxidase, four cases were positive. Placentaes with antiretroviral treatment since week 14, trophoblast was more dense by philaments increment. Placentaes with treatment during the third trimester, showed normal morphology with slight increase of philaments. In the cases treated with AZT and ddI, there were not macrophages hyperplasia and hypertrophy, nor viral particles. It is concluded that in seropositive mothers without treatment, the virus may be present in any part of chorionic villi, and in patients with treatment, virus is not identified, but a viral proteins synthesis.
围产期垂直传播在全球范围内有所增加；据认为，目前约有100万儿童感染了艾滋病毒。不同国家的传播率在12%至40%之间。在过去几年中，齐多夫定（AZT）、去羟肌苷（ddI）等抗逆转录病毒药物已被用于减少病毒通过胎盘传播。18例来自HIV血清阳性女性的胎盘，其中3例对应妊娠早期，15例对应妊娠晚期；4例在妊娠第14周（2例患者）、26周和35周接受了AZT治疗；1例患者在第28周接受了AZT和ddI治疗。对照组为10例正常胎盘。进行了超微结构分析、免疫过氧化物酶法以及用抗gp 41抗体进行的免疫金标法检测。超微结构显示，HIV病毒在合体滋养层、蜕膜细胞和脐血管中有不同定位（6例）。13例中有巨噬细胞增生和肥大，含有大量溶酶体。1例血清阳性女孩的病例中，在巨噬细胞中发现了许多HIV病毒颗粒。免疫金标法显示，病毒蛋白出现在细胞质和质膜、胎儿毛细血管内皮和滋养层中。免疫过氧化物酶法检测中，4例呈阳性。自第14周起接受抗逆转录病毒治疗的胎盘，滋养层因细丝增加而更致密。妊娠晚期接受治疗的胎盘，形态正常，细丝略有增加。在接受AZT和ddI治疗的病例中，没有巨噬细胞增生和肥大，也没有病毒颗粒。结论是，未经治疗的血清阳性母亲，病毒可能存在于绒毛膜绒毛的任何部位，而接受治疗的患者中，未发现病毒，但存在病毒蛋白合成。
