人类免疫缺陷病毒急性感染对母乳传播影响的研究

Acute infection of HIV enhanced mother-to-child transmission through breastfeeding

目的了解母亲在产后输血感染HIV导致的母乳传播及其影响因素,为阻断HIV的母婴传播提供依据。方法以116名产后输血感染HIV的母亲及接受其哺乳的118名子女为研究对象,回顾性调查母乳传播率;分析母亲分娩年龄、子女性别、母亲合并感染HCV、哺乳持续时间、以及母亲哺乳期的乳腺疾病对母乳传播的影响,并探讨HIV母乳传播的危险因素;分析未作抗病毒治疗的情况下,母亲及其子女的生存期。结果 118名接受产后输血感染HIV母亲哺乳的子女,43名HIV阳性,母乳传播率为36.4%。78名母亲和27名HIV阳性子女感染的HIV均为B’亚型;母亲分娩年龄是否大于平均年龄、子女性别、母亲是否感染HCV、母乳喂养时间是否超过12个月均未增加HIV母乳传播率;乳腺疾病增加HIV母乳传播;乳腺疾病及母乳喂养时间是HIV母乳传播的危险因素;母亲的平均生存期为11.8年,HIV阳性子女的平均生存期为12.0年,两者差异无统计学意义(χ2=0.426,P=0.514)。结论母亲在产后输血感染HIV造成的HIV母乳传播率较高,乳腺疾病及母乳喂养时间长促进HIV的母乳传播,通过母乳喂养感染HIV的儿童生存期与其母亲相比差异无统计学意义。

Objective To understand the HIV transmission through breastfeeding among mothers acquired HIV postnatally by receiving blood transfusion.Methods One hundred sixteen mothers who got HIV infection postnatally by receiving blood transfusion and their 118 children were enrolled in this study.The rate of HIV transmission through breastfeeding and associated factors（age of mothers fed children,gender of children,duration of breastfeeding,breast diseases,mothers＇ coinfecion with HCV） were investigated;subtypes of HIV were detected by examined sequence of gag;survival time of mothers and HIV positive children without ARV were surveyed.Results Forty three were positive of 118 children（36.4%）;subtypes of HIV that mothers and positive children were infected with were B＇;four factors that were not independently and significantly associated with HIV transmission through breastfeeding were as follows： manternal age,gender of children,duration of breastfeeding greater than 12 months,mothers＇ coinfection with HCV;breast diseases and duration of breastfeeding enhanced the risk of HIV transmission through breastfeeding;the survival time of mothers and children were 11.8 year and 12.0 years respectively before ARV（χ2=0.426,P=0.514）.Conclusions The risk of HIV transmission through breastfeeding among mothers got infection postnatally was high;breast disease and duration of breastfeeding are risk factors for HIV transmission through breastfeeding;there was no significant difference in mortality of mothers and positive children before receiving ARV.