Nourse C B, Butler K M
Department of Paediatrics, University College Dublin, Crumlin, Dublin.
Ir J Med Sci. 1998 Jan-Mar;167(1):28-32. doi: 10.1007/BF02937550.
Paediatric HIV infection has become a major burden on families, communities and health services worldwide. The vast majority of children now acquire HIV as a result of mother to infant (vertical) transmission. Recent major advances have occurred following the greater understanding of the risk factors for perinatal transmission and the role of antiretroviral therapy in preventing transmission. Now that interruption of vertical transmission is possible, early identification of HIV-infected pregnant women is critical. As of June 1997, HIV infection has been diagnosed in 37 children under 15 yrs of age in the Republic of Ireland; 32 as a result of maternal to infant transmission. The exact timing of HIV transmission during pregnancy is unclear but it is estimated that 60-70 per cent of infants may be infected at the time of delivery with approximately 30 per cent infected earlier in gestation. Vertical transmission rates vary from 15-40 per cent in different global areas. Antenatal and perinatal zidovudine treatment can reduce this rate by 60-70 per cent. Risk factors for the vertical transmission of HIV-1 are multifactorial. These factors include maternal disease status, in particular maternal viral load, route of delivery, duration of membrane rupture, presence of obstetric complications and infant feeding practices. Definitive diagnosis of HIV infection in infancy has been difficult in the past. Direct viral detection methods now allow the reliable diagnosis of HIV infection in the first few months of life. The most effective intervention to reduce perinatal HIV infection will be the better identification of HIV positive pregnant women with the subsequent introduction of measures to interrupt vertical transmission of HIV.
小儿艾滋病毒感染已成为全球家庭、社区和卫生服务的一项主要负担。现在，绝大多数儿童感染艾滋病毒是母婴（垂直）传播所致。随着对围产期传播风险因素以及抗逆转录病毒疗法在预防传播中作用的进一步了解，最近取得了重大进展。既然可以阻断垂直传播，那么尽早识别感染艾滋病毒的孕妇至关重要。截至1997年6月，爱尔兰共和国已诊断出37名15岁以下儿童感染艾滋病毒；其中32名是母婴传播所致。孕期艾滋病毒传播的确切时间尚不清楚，但据估计，60%至70%的婴儿可能在分娩时感染，约30%在妊娠早期感染。全球不同地区的垂直传播率在15%至40%之间。产前和围产期使用齐多夫定治疗可使这一比率降低60%至70%。艾滋病毒-1垂直传播的风险因素是多方面的。这些因素包括母亲的疾病状况，尤其是母亲的病毒载量、分娩方式、胎膜破裂时间、产科并发症的存在以及婴儿喂养方式。过去，婴儿期艾滋病毒感染的确切诊断一直很困难。现在，直接病毒检测方法可在出生后的头几个月可靠地诊断艾滋病毒感染。降低围产期艾滋病毒感染的最有效干预措施将是更好地识别艾滋病毒呈阳性的孕妇，随后采取措施阻断艾滋病毒的垂直传播。
