Thea D M, Steketee R W, Pliner V, Bornschlegel K, Brown T, Orloff S, Matheson P B, Abrams E J, Bamji M, Lambert G, Schoenbaum E A, Thomas P A, Heagarty M, Kalish M L
Medical and Health Research Association, New York, New York, USA.
AIDS. 1997 Mar 15;11(4):437-44. doi: 10.1097/00002030-199704000-00006.
To determine the effect of maternal viral load at delivery on the risk of perinatal transmission of HIV-1.
A nested case-control study within a prospectively followed cohort of HIV-1-infected pregnant women and their infants.
The multicenter New York City Perinatal HIV Transmission Collaborative Study.
Fifty-one women who gave birth to HIV-1 infected infants were frequency-matched within CD4+ cell count quintiles with 54 non-transmitting mothers.
Maternal quantity of HIV-1 viral RNA was assayed in plasma obtained near delivery using the nucleic acid sequence-based amplification assay system.
Viral RNA was detected in 73 (70%) out of 105 women and the median viral load was 16,000 RNA copies/ml in transmitters and 6,600 in non-transmitters (P < 0.01). When adjusted for maternal CD4+ count near delivery, women with measurable viral load were nearly sixfold more likely to transmit HIV-1 than women with viral load below detection [adjusted odds ratio (AOR), 5.8; 95% confidence interval (CI), 2.2 15.5]. The odds ratio for perinatal transmission of log10 viral load, adjusted for CD4 count was 2.7 (95% CI, 1.5-5.1). When stratified by the stage of HIV-1 disease, the only group with significant association between log10 viral load and transmission were AIDS-free women with CD4+ count > 500 x 10(6)/l (AOR, 9.1; 95% CI, 2.6-31.5).
High maternal viral load increases the likelihood of perinatal transmission of HIV-1 in women without AIDS and advanced immunosuppression. HIV-1 infected pregnant women without advanced disease, shown by others to have the lowest risk of perinatal transmission, may benefit the most from efforts to identify and decrease viral load at delivery.
确定分娩时母体病毒载量对HIV-1围产期传播风险的影响。
在对感染HIV-1的孕妇及其婴儿进行前瞻性随访的队列中开展巢式病例对照研究。
多中心纽约市围产期HIV传播协作研究。
51名分娩出感染HIV-1婴儿的女性按CD4+细胞计数五分位数与54名未发生传播的母亲进行频率匹配。
使用基于核酸序列扩增分析系统对分娩时采集的血浆检测HIV-1病毒RNA的母体含量。
105名女性中有73名（70%）检测到病毒RNA，病毒载量中位数在传播者中为16,000 RNA拷贝/ml，在未传播者中为6,600 RNA拷贝/ml（P<0.01）。调整分娩时母体CD4+计数后，病毒载量可测的女性传播HIV-1的可能性比病毒载量低于检测水平的女性高近6倍[调整后的优势比（AOR），5.8；95%置信区间（CI），2.2-15.5]。经CD4计数调整后，log10病毒载量的围产期传播优势比为2.7（95%CI，1.5-5.1）。按HIV-1疾病阶段分层时，log10病毒载量与传播之间存在显著关联的唯一组是CD4+计数>500×10⁶/l的无艾滋病女性（AOR，9.1；95%CI，2.6-31.5）。
母体病毒载量高会增加无艾滋病和未发生严重免疫抑制的女性围产期传播HIV-1的可能性。其他研究表明，无严重疾病的HIV-1感染孕妇围产期传播风险最低，她们可能从分娩时识别并降低病毒载量的努力中获益最大。
