Kuhn L, Steketee R W, Weedon J, Abrams E J, Lambert G, Bamji M, Schoenbaum E, Farley J, Nesheim S R, Palumbo P, Simonds R J, Thea D M
Columbia University, Medical and Health Research Association Inc., Harlem Hospital Center, New York, USA.
J Infect Dis. 1999 Jan;179(1):52-8. doi: 10.1086/314551.
Predictors and prognosis of intrauterine and intrapartum human immunodeficiency virus (HIV) transmission were investigated among 432 children of HIV-infected women in the Perinatal AIDS Collaborative Transmission Study. Timing of transmission was inferred from polymerase chain reaction or viral culture within 2 days of birth. Proportions of infections due to intrauterine transmission were similar among women using (29%) or not using zidovudine (30%). Preterm delivery was strongly associated with intrapartum transmission (relative risk, 3.7; 95% confidence interval [CI], 2.2-6.1), particularly among infants delivered longer after membrane rupture, but was not associated with intrauterine transmission. Progression to AIDS or death increased 2.5-fold (95% CI, 1.1-5.8) among intrauterine infected children, adjusting for preterm delivery, and maternal CD4 cell count. Early transmission appears unlikely to explain instances of zidovudine failure. Preterm infants may be more vulnerable to HIV acquisition at delivery, especially if membrane rupture is prolonged. Intrauterine infection does not appear to increase risk of preterm delivery.
在围产期艾滋病协作传播研究中，对432名感染人类免疫缺陷病毒（HIV）的女性所生子女进行了宫内和产时HIV传播的预测因素及预后研究。传播时间根据出生后2天内的聚合酶链反应或病毒培养结果推断。使用齐多夫定的女性（29%）和未使用齐多夫定的女性（30%）中，因宫内传播导致感染的比例相似。早产与产时传播密切相关（相对风险为3.7；95%置信区间[CI]为2.2 - 6.1），尤其是在胎膜破裂后较长时间分娩的婴儿中，但与宫内传播无关。在调整早产和母亲CD4细胞计数后，宫内感染儿童进展为艾滋病或死亡的风险增加了2.5倍（95%CI为1.1 - 5.8）。早期传播似乎无法解释齐多夫定治疗失败的情况。早产儿在分娩时可能更容易感染HIV，尤其是胎膜破裂时间延长时。宫内感染似乎不会增加早产风险。
