Tess B H, Rodrigues L C, Newell M L, Dunn D T, Lago T D
London School of Hygiene and Tropical Medicine, UK.
AIDS. 1998 Mar 26;12(5):513-20. doi: 10.1097/00002030-199805000-00013.
To evaluate the effect of maternal, obstetric, neonatal and post-natal factors on the risk of vertical transmission of HIV-1.
Multicentre retrospective cohort study.
Obstetric and paediatric clinics in four cities in Sao Paulo State, Brazil.
Child's HIV-1 infection status.
Data were collected by standardized record abstraction and interview on 553 children born to women identified as HIV-1-infected before or at delivery. Paediatric infection was determined by immunoglobulin G anti-HIV-1 tests at age 18 months or by AIDS diagnosis at any age. Multivariate logistic regression was used to assess the effect of potential risk factors on vertical transmission of HIV-1.
HIV-1 infection status was determined for 434 children (follow-up rate of 78%); 69 were classified as HIV-1-infected [transmission risk, 16%; 95% confidence interval (CI), 13-20%]. In multivariate analysis, advanced maternal HIV-1 disease [odds ratio (OR), 4.5; 95% CI, 2.1-9.5], ever breastfed (OR, 2.2; 95% CI, 1.2-4.2), child's negative Rhesus blood group (OR, 2.5; 95% CI, 1.2-5.5), third trimester amniocentesis (OR, 4.1; 95% CI, 1.2-13.5) and black racial group (OR, 0.3; 95% CI, 0.1-0.9) were independently and significantly associated with mother-to-child transmission of HIV-1. Transmission was increased marginally with prematurity, more than 10 lifetime sexual partners and prolonged duration of membrane rupture. No association was found between child's HIV-1 infection and mode of delivery or serological evidence of syphilis during pregnancy.
These findings support the importance of severity of maternal HIV-1 disease in the risk of vertical transmission of HIV-1, indicate measures to reduce transmission by avoiding amniocentesis and breastfeeding and suggest that race and Rhesus blood type may be markers for genetic susceptibility to infection.
评估孕产妇、产科、新生儿及产后因素对HIV-1垂直传播风险的影响。
多中心回顾性队列研究。
巴西圣保罗州四个城市的产科和儿科诊所。
儿童的HIV-1感染状况。
通过标准化记录摘要和访谈收集了553名在分娩前或分娩时被确定为HIV-1感染的妇女所生儿童的数据。儿童感染情况通过18个月龄时的免疫球蛋白G抗HIV-1检测或任何年龄的艾滋病诊断来确定。采用多变量逻辑回归评估潜在危险因素对HIV-1垂直传播的影响。
确定了434名儿童的HIV-1感染状况（随访率为78%）；69名被归类为HIV-1感染[传播风险为16%；95%置信区间（CI），13 - 20%]。在多变量分析中，孕产妇HIV-1疾病晚期[比值比（OR），4.5；95%CI，2.1 - 9.5]、曾经母乳喂养（OR，2.2；95%CI，1.2 - 4.2）、儿童恒河猴血型阴性（OR，2.5；95%CI，1.2 - 5.5）、孕晚期羊膜腔穿刺术（OR，4.1；95%CI，1.2 - 13.5）和黑人种族群体（OR，0.3；95%CI，0.1 - 0.9）与HIV-1母婴传播独立且显著相关。早产、终身性伴侣超过10个和胎膜破裂时间延长使传播略有增加。未发现儿童HIV-1感染与分娩方式或孕期梅毒血清学证据之间存在关联。
这些发现支持了孕产妇HIV-1疾病严重程度在HIV-1垂直传播风险中的重要性，表明通过避免羊膜腔穿刺术和母乳喂养来降低传播的措施，并提示种族和恒河猴血型可能是感染遗传易感性的标志物。
