广西945例HIV阳性孕产妇母婴传播综合干预措施利用情况

Effect of applications of comprehensive PMTCT intervention services for 945 HIV-infected pregnant women in Guangxi

目的了解广西艾滋病病毒（HIV）感染孕产妇母婴传播综合干预措施的利用情况,为制定HIV阳性孕产妇综合管理策略提供依据。方法对2011年1月至2014年12月,945例HIV感染孕产妇及其所生满18月龄儿童的信息,进行回顾性分析。结果 88.47%（836/945）HIV感染孕产妇应用抗病毒治疗,其中孕期用药率为78.73%（744/945）。在孕期用药的感染孕产妇中,25.94%（193/744）为孕14周前开始用药,52.69%（392/744）为孕14-28周开始用药。在分娩方式的选择上,62.22%（588/945）为阴道分娩,22.43%（212/945）为择期剖宫产,15.34%（145/945）为急诊剖宫产。945例HIV阳性产妇所生儿童中,93.86%（887/945）应用抗病毒治疗,0.32%（3/945）的婴儿1月龄时曾接受过母乳喂养,暴露儿童HIV抗体检测阳性30人,阴性915人。孕产妇是否应用抗病毒治疗（χ^2=21.340,P〈0.01）,孕产妇选择不同的分娩方式（χ^2=6.497,P〈0.05）,儿童是否应用预防性抗病毒治疗,均与儿童最终的感染状况有关（χ^2=10.335,P〈0.01）。多因素分析结果显示,未应用抗病毒治疗的孕产妇与用药的孕产妇相比,其母婴传播的风险高[比值比（OR）=4.349,95%可信区间（CI）：1.658～11.408]。结论HIV感染孕产妇应用抗病毒治疗、分娩方式、儿童预防性应用抗病毒治疗等因素,与暴露儿童最终感染状态有关,孕产妇应用抗病毒治疗是降低母婴传播风险的关键性因素。

Objective To learn the effects on prevention of mother-to-child transmission（PMTCT）intervention among HIV-infected pregnant women in Guangxi and to provide scientific evidence of integrated management strategies for HIV-infected pregnant women.Methods Retrospective analysis was conducted on the data of 945HIV-infected pregnant women and their children of 18 months from January 2011 to December 2014.Results Among 945HIV-infected pregnant women,88.47%（836/945）took antiviral therapy,78.73%（744/945）took antiviral therapy during gestation.Among HIV-infected pregnant women received antiretroviral therapy,25.94%（193/744）received antiretroviral therapy before 14 weeks pregnant,52.69%（392/744）from 14 to 28weeks pregnant.About modes of delivery,62.22%（588/945）were with vaginal delivery,22.43%（212/945）were with elective cesarean section,15.34%（145/945）were with emergency cesarean section.Among children born to those 945HIV-infected pregnant women,93.86%（887/945）received antiretroviral therapy,0.32%（3/945）received breastfeeding in the first month of birth;and 30HIV-positive and 915HIV-negative were found through HIV antibody testing.HIV infection in children born to HIV-infected women was related to maternal antiretroviral therapy（χ2=21.340,P〈0.01）,modes of delivery（χ2=6.497,P〈0.05）,and prophylactic antiretroviral therapy in children（χ2=10.335,P〈0.01）.The results of multivariate analysis showed that the risk of mother-to-child transmission（MTCT）was higher in HIV-infected pregnant women without antiretroviral therapy than that in women with antiretroviral therapy（OR=4.349,95%CI：1.658-11.408）.Conclusion HIV infection in children born to HIV-infected women was related to factors such as maternal antiretroviral therapy,modes of delivery and prophylactic antiretroviral therapy in children.Maternal antiretroviral therapy was the key factor to reduce MTCT.