Shaffer N, Roongpisuthipong A, Siriwasin W, Chotpitayasunondh T, Chearskul S, Young N L, Parekh B, Mock P A, Bhadrakom C, Chinayon P, Kalish M L, Phillips S K, Granade T C, Subbarao S, Weniger B G, Mastro T D
Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
J Infect Dis. 1999 Mar;179(3):590-9. doi: 10.1086/314641.
To determine the rate and risk factors for human immunodeficiency virus (HIV)-1 subtype E perinatal transmission, with focus on virus load, pregnant HIV-infected women and their formula-fed infants were followed prospectively in Bangkok. Of 281 infants with known outcome, 68 were infected (transmission rate, 24.2%; 95% confidence interval, 19.3%-29.6%). Transmitting mothers had a 4.3-fold higher median plasma HIV RNA level at delivery than did nontransmitters (P<.001). No transmission occurred at <2000 copies/mL. On multivariate analysis, prematurity (adjusted odds ratio [AOR], 4.5), vaginal delivery (AOR, 2.9), low NK cell percentage (AOR, 2.4), and maternal virus load were associated with transmission. As RNA quintiles increased, the AOR for transmission increased linearly from 4.5 to 24.8. Two-thirds of transmission was attributed to virus load>10,000 copies/mL. Although risk is multifactorial, high maternal virus load at delivery strongly predicts transmission. This may have important implications for interventions designed to reduce perinatal transmission.
为了确定人类免疫缺陷病毒1型（HIV-1）E亚型围产期传播的发生率和危险因素，重点关注病毒载量，在曼谷对感染HIV的孕妇及其采用配方奶喂养的婴儿进行了前瞻性随访。在281例已知结局的婴儿中，68例被感染（传播率为24.2%；95%置信区间为19.3%-29.6%）。发生传播的母亲在分娩时血浆HIV RNA水平中位数比未发生传播的母亲高4.3倍（P<0.001）。病毒载量<2000拷贝/毫升时未发生传播。多因素分析显示，早产（校正优势比[AOR]为4.5）、阴道分娩（AOR为2.9）、自然杀伤细胞百分比低（AOR为2.4）以及母亲病毒载量与传播有关。随着RNA五分位数增加，传播的AOR从4.5线性增加至24.8。三分之二的传播归因于病毒载量>10,000拷贝/毫升。虽然风险是多因素的，但分娩时母亲病毒载量高强烈预示会发生传播。这可能对旨在减少围产期传播的干预措施具有重要意义。
