Schäfer A P, Koch M A, Grosch-Wörner I, Friedmann W, Dudenhausen J W
Frauenklinik, Universitätsklinikums Rudolf Virchow, Berlin.
Geburtshilfe Frauenheilkd. 1994 Nov;54(11):617-22. doi: 10.1055/s-2007-1022352.
Within a prospective study of the course of HIV-infection in women, 80 HIV-infected women without AIDS were delivered of 80 children between 1985 and September 1992. The median of the age of gestation was 38 weeks. Until 1988 Caesarean section was chosen as mode of delivery (45 women). Later when the mode of delivery appeared to have no influence on the frequency of maternofetal HIV transmission, vaginal delivery was preferred (35 women). None of the infants was breastfed. Three infants --delivered vaginally--died within the first 6 months of life before their infection status could be determined. Seventy-seven children could be observed for 18 months or longer regularly every three months. 10 of the 77 children were found to be HIV- infected by serological, virological and clinical criteria. Taking into account the mode of delivery, of 32 children who were delivered vaginally or by emergency Caesarean section 8 were found to be HIV-infected. None of 26 children delivered by elective Caesarean section after an uneventful pregnancy is infected. In 19 women Caesarean section was performed within 2 hours after onset of labour or after episodes of preterm labour which required hospital admission for treatment. Two children of these women are infected. No differences of CD4+ cell counts and p24 antigenaemia could be determined between the mothers of the three groups. The risk of fetal HIV infection was increased by preterm labour (p < 0.01) and the mode of delivery (p < 0.01). A correlation between loss of CD4 cells in the mother and increased risk of infection for the child is seen in children born spontaneously or delivered by emergency Caesarean section (p < 0.001). No correlation was found between the length of labour at delivery, the time of the rupture of membranes before birth as well as of the parity and the risk of fetal infection in that group. These findings point to labour as an important factor which increases the risk of maternofetal transmission of HIV. The onset of labour is accompanied by dramatic immunological alterations as a sudden increase of chemotactics and inflammatory cytokines at the maternofetal interface. The accumulation and stimulation of maternal immune cells will--if these cells are carriers of HIV--result in production and release of infectious HIV. This virus may accumulate in the maternofetal interface or gain access to the amniotic cavity. Since amniotic fluid is swallowed by the fetus, the largest potential port of entry for HIV in the fetus are the fetal lungs and the gastrointestinal tract. For the prevention of maternofetal transmission of HIV delivery before onset of labour or alternatively the protection of the fetus during parturition by means of potent antiviral compounds can be considered.
在一项关于感染HIV的女性病程的前瞻性研究中，1985年至1992年9月期间，80名未患艾滋病的HIV感染女性产下了80名婴儿。妊娠年龄中位数为38周。1988年前选择剖宫产作为分娩方式（45名女性）。后来当分娩方式似乎对母婴HIV传播频率没有影响时，首选阴道分娩（35名女性）。没有婴儿进行母乳喂养。3名经阴道分娩的婴儿在出生后的头6个月内死亡，其感染状况尚未确定。77名儿童每三个月定期观察18个月或更长时间。根据血清学、病毒学和临床标准，77名儿童中有10名被发现感染了HIV。考虑到分娩方式，在经阴道分娩或急诊剖宫产的32名儿童中，有8名被发现感染了HIV。在妊娠顺利后择期剖宫产的26名儿童中，没有一例感染。19名女性在分娩开始后2小时内或早产发作后需要住院治疗时进行了剖宫产。这些女性中有2名儿童被感染。三组母亲之间的CD4 +细胞计数和p24抗原血症没有差异。早产（p < 0.01）和分娩方式（p < 0.01）会增加胎儿感染HIV的风险。在自然分娩或急诊剖宫产出生的儿童中，母亲CD4细胞减少与儿童感染风险增加之间存在相关性（p < 0.001）。在该组中，分娩时的产程长度、出生前胎膜破裂时间以及产次与胎儿感染风险之间没有相关性。这些发现表明分娩是增加母婴HIV传播风险的一个重要因素。分娩开始伴随着显著的免疫改变，如母婴界面趋化因子和炎性细胞因子的突然增加。如果这些细胞是HIV携带者，母体免疫细胞的聚集和刺激将导致感染性HIV的产生和释放。这种病毒可能在母婴界面积聚或进入羊膜腔。由于胎儿会吞咽羊水，胎儿感染HIV的最大潜在入口是胎儿的肺部和胃肠道。为预防母婴HIV传播，可以考虑在分娩开始前进行分娩，或者在分娩期间通过有效的抗病毒化合物保护胎儿。
