Maguire A, Sánchez E, Fortuny C, Casabona J
Centre for Epidemiological Studies on AIDS in Catalonia CEESCAT, Hospital Universitari Germans Trias i Pujol, Badalona.
AIDS. 1997 Dec;11(15):1851-7. doi: 10.1097/00002030-199715000-00010.
To evaluate the roles of certain potential risk factors on the vertical transmission of HIV-1.
Prospective registry of infants born to HIV-1-infected women in Catalonia (north-east Spain) from 1987 to 1992.
A total of 599 infants, born in Catalan hospitals to 520 women who were identified as being HIV-1-infected during gestation or at delivery, were included. Data on mode of delivery, birth weight, gestational age and breast-feeding as well as the mother's age, her route of HIV-1 infection, clinical stage and p24 antigenaemia, were recorded. HIV-1 infection status of 489 (82%) of the infants was determined according to the criteria of the US Centers for Disease Control and Prevention. Risk estimates and odds ratio (OR) were calculated and logistic regression was performed.
The overall rate of vertical transmission was 18.6% (95% confidence interval, 15.2-22.0%). Multivariate analyses revealed that Cesarean section was associated with a lower rate of vertical transmission (OR = 0.3; P = 0.001), as was maternal HIV-1 infection via injecting drug use (OR = 0.44; P = 0.02). Breast-feeding (OR = 6.9; P = 0.001), very low birth weight (< 1500 g; OR = 6.3; P = 0.001) and p24 antigenaemia (OR = 4.6; P = 0.04) were all related to increased risk. The crude rate of HIV-1 transmission was 6% among Cesarean births compared with 21% for infants born via vaginal deliveries. The population-attributable risk for vaginal deliveries was 61.7%.
The results show a protective effect of Cesarean section in the absence of zidovudine prophylaxis. However, current research should be directed towards the individual and combined effects that antiretroviral agents and Cesarean section may have on mother-to-child HIV-1 infection.
评估某些潜在风险因素在HIV-1垂直传播中的作用。
对1987年至1992年在加泰罗尼亚（西班牙东北部）出生的HIV-1感染女性所生婴儿进行前瞻性登记。
纳入了在加泰罗尼亚医院出生的599名婴儿，其母亲为520名在妊娠期间或分娩时被确诊为HIV-1感染的女性。记录了分娩方式、出生体重、孕周、母乳喂养情况以及母亲的年龄、HIV-1感染途径、临床分期和p24抗原血症情况。根据美国疾病控制与预防中心的标准确定了489名（82%）婴儿的HIV-1感染状况。计算了风险估计值和比值比（OR），并进行了逻辑回归分析。
垂直传播的总体发生率为18.6%（95%置信区间，15.2 - 22.0%）。多因素分析显示，剖宫产与较低的垂直传播率相关（OR = 0.3；P = 0.001），通过注射吸毒感染HIV-1的母亲所生婴儿的垂直传播率也较低（OR = 0.44；P = 0.02）。母乳喂养（OR = 6.9；P = 0.001）、极低出生体重（< 1500 g；OR = 6.3；P = 0.001）和p24抗原血症（OR = 4.6；P = 0.04）均与风险增加有关。剖宫产分娩的婴儿中HIV-1传播的粗发生率为6%，而经阴道分娩的婴儿为21%。阴道分娩的人群归因风险为61.7%。
结果显示在未进行齐多夫定预防的情况下剖宫产具有保护作用。然而，当前的研究应针对抗逆转录病毒药物和剖宫产对母婴HIV-1感染可能产生的个体及联合效应。
