Havens P L, Cuene B E, Hand J R, Gern J E, Sullivan B W, Chusid M J
Children's Hospital of Wisconsin, Madison, USA.
Pediatr Infect Dis J. 1997 Sep;16(9):871-5. doi: 10.1097/00006454-199709000-00010.
During a clinical trial (ACTG Study 076), perinatal HIV transmission was reduced by two-thirds when pregnant women with HIV infection and their infants were treated with zidovudine (ZDV). A similar benefit has not been uniformly found in practice settings.
To measure the effectiveness of a nurse case management system in supporting prenatal ZDV use in women with HIV infection and their infants and in decreasing perinatal HIV transmission.
We performed a retrospective cohort study of all children with or at risk for HIV infection cared for in the Wisconsin HIV Primary Care Support Network. The Network uses intensive nurse case management to optimize the care of pregnant women with HIV infection and their children. For children born between January 1, 1992, and April 30, 1996, we measured the association of prenatal case management by a Network nurse with (1) ZDV use by pregnant women with HIV infection and (2) the rate of vertical HIV transmission.
In the 26 months after March 1, 1994 (shortly after the release date of ACTG 076 results), 5 of 39 (13%) infants born to women with HIV infection and enrolled in the Network acquired HIV perinatally compared with 12 of 30 (40%) infants in the 26 months preceding March 1, 1994 (P = 0.01). Between March 1, 1994, and April 30, 1996, 25 of 25 (100%) women whose prenatal care included intensive case management by a Network nurse were treated with prenatal orally administered ZDV, compared with 3 of 14 (21%) women whose prenatal care did not include Network case management (P < 0.0001). There were 2 of 25 (8%) infants who acquired HIV infection in the former group, compared with 3 of 14 (21%) in the latter group (P = 0.2)
Perinatal transmission of HIV was significantly decreased following implementation of national recommendations for ZDV treatment of pregnant women. Prenatal care that included case management by a specialized nurse was significantly more likely to result in appropriate ZDV therapy in women and showed a trend toward a lower rate of HIV infection in their infants, compared with prenatal care that did not include such personnel.
在一项临床试验（美国国立过敏与传染病研究所艾滋病临床试验组076研究）中，感染HIV的孕妇及其婴儿接受齐多夫定（ZDV）治疗后，围产期HIV传播率降低了三分之二。但在实际应用中，类似的益处并未得到一致证实。
评估护士病例管理系统在支持感染HIV的孕妇及其婴儿产前使用ZDV以及降低围产期HIV传播方面的效果。
我们对威斯康星州HIV初级医疗支持网络中所有感染HIV或有感染风险的儿童进行了一项回顾性队列研究。该网络采用强化护士病例管理，以优化对感染HIV的孕妇及其子女的护理。对于1992年1月1日至1996年4月30日期间出生的儿童，我们评估了网络护士进行的产前病例管理与以下两方面的关联：（1）感染HIV的孕妇使用ZDV的情况；（2）HIV垂直传播率。
在1994年3月1日（美国国立过敏与传染病研究所艾滋病临床试验组076研究结果发布后不久）后的26个月里，网络中登记的39名感染HIV的孕妇所生婴儿中有5名（13%）在围产期感染了HIV，而在1994年3月1日前的26个月里，30名婴儿中有12名（40%）感染（P = 0.01）。在1994年3月1日至1996年4月30日期间，产前护理包括网络护士强化病例管理的25名孕妇中有25名（100%）接受了产前口服ZDV治疗，而产前护理未包括网络病例管理的14名孕妇中有3名（21%）接受了治疗（P < 0.0001）。前一组中有2名（8%）婴儿感染了HIV，后一组中有3名（21%）（P = 0.2）。
实施全国关于孕妇ZDV治疗的建议后，HIV围产期传播显著减少。与未包括专业护士病例管理的产前护理相比，包括专业护士病例管理的产前护理更有可能使孕妇接受适当的ZDV治疗，并且其婴儿HIV感染率有降低趋势。
