Ekpini E R, Wiktor S Z, Satten G A, Adjorlolo-Johnson G T, Sibailly T S, Ou C Y, Karon J M, Brattegaard K, Whitaker J P, Gnaore E, De Cock K M, Greenberg A E
Project RETRO-CI, Abidjan, Côte d'Ivoire.
Lancet. 1997 Apr 12;349(9058):1054-9. doi: 10.1016/s0140-6736(96)06444-6.
HIV-1 can be transmitted from an infected mother to her infant through breastfeeding, although the precise risk of transmission by this route is unknown. A long-term follow-up of children born to HIV-infected women in Abidjan, Côte d'Ivoire, has enabled us to estimate this risk.
Children born to 138 HIV-1-seropositive women, 132 HIV-2-seropositive women, 69 women seroreactive to both HIV-1 and HIV-2, and 274 HIV-seronegative women were enrolled at birth and followed up for as long as 48 months. All children were breastfed (median duration 20 months). Blood samples for either or both HIV PCR and HIV serology were obtained at 1, 2, and 3 months of age, and every 3 months thereafter. Early HIV infection was defined as a positive HIV-1 PCR result obtained in the first 6 months of life. Late postnatal transmission was diagnosed when a child had a negative PCR at 3 or 6 months of age, followed by either or both a positive HIV-1 PCR at 9 months or older, or persistently positive HIV-1 serology at 15 months or older.
82 children born to HIV-1-seropositive mothers and 57 children born to mothers seropositive for both HIV-1 and HIV-2 had PCR results for samples taken within the first 6 months. By 6 months of age, 23 (28%; 95% CI 19-39) of the 82 children born to HIV-1-seropositive mothers and ten (18%; 95% CI 9-30) of the 57 children born to dually seropositive mothers were HIV-1 infected. Among children whose PCR results were negative at or before age 6 months, and who were followed up beyond 6 months, an additional four (9%) of the 45 children born to HIV-1-seropositive mothers and two (5%) of the 39 children born to dually seropositive mothers became HIV infected. The estimated rates of late postnatal transmission, with account taken of loss to follow-up and the observed pattern of weaning, were 12% (95% CI 3-23) and 6% (0-14), respectively. One of the five children whose mothers seroconverted from HIV-negative to HIV-1, and one of seven children whose mothers seroconverted from HIV-2 to dual reactivity, became HIV-1 positive. No case of late postnatal transmission occurred in children born to HIV-2-positive or persistently HIV-negative mothers.
Breastfed children born to mothers seropositive for HIV-1 alone or seropositive for HIV-1 and HIV-2 in Abidjan are at substantial risk of late postnatal transmission. Early cessation of breastfeeding at 6 months of age should be assessed as a possible intervention to reduce postnatal transmission of HIV.
HIV-1可通过母乳喂养从感染母亲传播给婴儿，尽管通过该途径传播的确切风险尚不清楚。对科特迪瓦阿比让感染HIV的妇女所生孩子进行的长期随访，使我们能够估计这一风险。
138名HIV-1血清阳性妇女、132名HIV-2血清阳性妇女、69名对HIV-1和HIV-2均血清反应阳性的妇女以及274名HIV血清阴性妇女所生的孩子在出生时登记入组，并随访长达48个月。所有孩子均进行母乳喂养（中位持续时间20个月）。在1、2和3月龄时采集血液样本进行HIV PCR检测或同时进行HIV血清学检测，此后每3个月采集一次。早期HIV感染定义为出生后头6个月内HIV-1 PCR检测结果呈阳性。如果儿童在3或6月龄时PCR检测为阴性，随后在9月龄或更大时HIV-1 PCR检测呈阳性或在15月龄或更大时HIV-1血清学检测持续呈阳性，则诊断为产后晚期传播。
82名HIV-1血清阳性母亲所生孩子和57名HIV-1和HIV-2均血清阳性母亲所生孩子在头6个月内采集的样本有PCR检测结果。到6月龄时，82名HIV-1血清阳性母亲所生孩子中有23名（28%；95%CI 19-39）以及57名双阳性母亲所生孩子中有10名（18%；95%CI 9-30）感染了HIV-1。在6月龄及以前PCR检测结果为阴性且随访超过6个月的儿童中，45名HIV-1血清阳性母亲所生孩子中有另外4名（9%）以及39名双阳性母亲所生孩子中有2名（5%）感染了HIV。考虑到失访情况和观察到的断奶模式，产后晚期传播的估计发生率分别为12%（95%CI 3-23）和6%（0-14）。母亲从HIV阴性血清转化为HIV-1阳性的5名儿童中有1名以及母亲从HIV-2血清转化为双反应性的7名儿童中有1名HIV-1检测呈阳性。HIV-2阳性或持续HIV阴性母亲所生孩子未发生产后晚期传播病例。
在阿比让，仅HIV-1血清阳性母亲或HIV-1和HIV-2均血清阳性母亲所生的母乳喂养儿童有产后晚期传播的重大风险。应评估在6月龄时尽早停止母乳喂养作为减少HIV产后传播的一种可能干预措施。
