Bulterys M, Landesman S, Burns D N, Rubinstein A, Goedert J J
Viral Epidemiology Branch, National Cancer Institute, Rockville, Maryland 20852, USA.
J Acquir Immune Defic Syndr Hum Retrovirol. 1997 May 1;15(1):76-82. doi: 10.1097/00042560-199705010-00012.
We evaluated maternal sexual behavior and injection drug use practices as possible risk factors for vertical transmission of human immunodeficiency virus type 1 (HIV-1). Data were analyzed from the Mothers and Infants Cohort Study, a prospective study in Brooklyn and the Bronx, New York. A total of 207 mother-infant sets were enrolled between 1986 and 1991 and followed for up to 4 years after the enrollment visit during pregnancy. HIV-1 transmission occurred in 49 of 201 mother-infant sets, yielding an overall transmission rate of 24.4% (95% confidence interval (CI) = 18.7% to 31.0%). Increased frequency of vaginal intercourse after the first trimester of pregnancy was positively associated with vertical transmission of HIV-1 (trend p = 0.03). A lifetime history of injection drug use was not associated with vertical transmission. However, a history of combined cocaine and heroin injection after the first trimester of pregnancy was associated with vertical HIV-1 transmission, particularly among women with CD4+ lymphocyte levels of 20% or higher (risk ratio = 4.0; 95% CI = 2.0 to 8.1). Cocaine and heroin injection drug use after the first trimester accounted for most of the relation between preterm birth and vertical HIV-1 transmission in this cohort. Maternal coinfection with hepatitis C virus or human T-cell lymphotropic virus types I and II could not explain these observations, because coinfection with these viruses had no detectable effect on HIV-1 transmission. These results suggest that maternal sexual behavior and injection drug use practices during the second and third trimester of pregnancy may modify the risk of vertical HIV-1 transmission.
我们评估了孕产妇的性行为和注射吸毒行为，将其作为人类免疫缺陷病毒1型（HIV-1）垂直传播的可能风险因素。分析了母婴队列研究的数据，该研究是在纽约布鲁克林和布朗克斯进行的一项前瞻性研究。1986年至1991年间共纳入了207对母婴组合，并在孕期登记访视后随访长达4年。201对母婴组合中有49例发生了HIV-1传播，总体传播率为24.4%（95%置信区间（CI）=18.7%至31.0%）。妊娠中期后性交频率增加与HIV-1垂直传播呈正相关（趋势p=0.03）。注射吸毒史与垂直传播无关。然而，妊娠中期后联合使用可卡因和海洛因注射与HIV-1垂直传播有关，尤其是在CD4+淋巴细胞水平为20%或更高的女性中（风险比=4.0；95%CI=2.0至8.1）。在该队列中，妊娠中期后使用可卡因和海洛因注射吸毒占早产与HIV-1垂直传播之间关系的大部分。孕产妇合并感染丙型肝炎病毒或人类T细胞嗜淋巴细胞病毒I型和II型无法解释这些观察结果，因为这些病毒合并感染对HIV-1传播没有可检测到的影响。这些结果表明，妊娠第二和第三孕期的孕产妇性行为和注射吸毒行为可能会改变HIV-1垂直传播的风险。
