HIV感染孕妇母婴传播的阻断效果及时机的临床研究

Clinical study of the effects and time of interventions to prevent HIV mother-to-child transmission

目的探讨妊娠合并HIV感染孕妇的母婴阻断效果及阻断时机。方法将2010年1月至2013年6月本院收治的126例妊娠合并HIV感染孕妇,按照开始抗反转录病毒治疗的时间,分为孕期治疗组、产前治疗组及未治疗组。并将孕期治疗组分为早中孕治疗组和晚孕治疗组。所有患者均给予三联高效抗反转录病毒药物治疗(HAART),同时采取安全分娩及人工喂养等综合干预措施。观察各组的不良妊娠结局、新生儿不良结局及母婴阻断效果。结果孕期治疗组的不良妊娠结局发生率(3.95%,3/74)显著低于产前治疗组(20.00%,8/45)及未治疗组(42.86%,3/7),差异均具有统计学意义(χ2=14.448,P<0.05)。孕期治疗组的新生儿不良结局发生率(9.46%,7/74)显著低于产前治疗组(22.22%,10/45)及未治疗组(50%,3/6),差异具有统计学意义(χ2=8.742,P<0.05)。对82例存活婴儿完成随访,孕期治疗组无1例婴儿感染HIV,产前治疗组的婴儿HIV感染率(9.68%,3/31)显著低于未治疗组(33.33%,1/3),差异具有统计学意义(χ2=9.235,P<0.05)。早中孕治疗组的不良妊娠结局发生率、新生儿不良结局发生率及婴儿感染HIV率与晚孕治疗组相比,差异均无统计学意义(P>0.05)。结论妊娠合并HIV感染的患者,其妊娠结局及新生儿预后与患者开始HAART的时间密切相关,孕期采用HAART治疗者显著优于产前治疗者和未治疗者,且HAART对胎儿的生长发育未见明显不良影响。

Objective To investigate the effects and time of interventions to prevent HIV motherto- child transmission. Methods Total of 126 pregnant women infected with HIV from January 2010 to June 2013 in our hospital were divided into three groups according to the time of antiretroviral therapy, including pregnancy-treated group, prenatal-treated group and un-treated group. Moreover, pregnancy-treated group was divided into early-pregnancy-treated group and late-pregnancy-treated group. All patients were given triple highly active antiretroviral therapy （HAART）, safety delivery, artificial feeding and other integrated intervention measures. Adverse pregnancy outcomes, newborn’s adverse outcomes and effects of motherinfant block were analyzed, respectively. Results The rate of adverse pregnancy outcomes in pregnancytreated group （3.95%, 3/74） was significantly lower than prenatal-treated group （20.00%, 8/45） and un-treated group （42.86%, 3/7） （χ^2 = 14.448, P 〈 0.05）. The rate of newborn’s adverse outcomes in pregnancy-treated group （20.00%, 8/45） was also significantly lower than prenatal-treated group （22.22%, 10/45） and un-treated group （50.00%, 3/6） （χ^2 = 8.742, P 〈 0.05）. Among 82 cases of survived infants followed-up, no HIV infection in pregnancy-treated group. While, the infection rate of infants in prenatal-treated group （9.68%, 3/31） was evidently lower than un-treated group （33.33%, 1/3） （χ^2 = 9.235, P 〈 0.05）. Furthermore, there was no significant differences in the rate of adverse pregnancy outcomes, newborn’s adverse outcomes and motherto- child transmission in early-pregnancy-treated group and late-pregnancy-treated group. Conclusions Pregnancy outcomes and newborn’s prognosis in HIV-infected mother treated during pregnancy were better than those prenatal-treated or un-treated, which are closely related to the time of starting HAART. HAART seems to have not obvious side effects on newborn’s growth and development.