河南省HIV母婴传播的影响因素分析

Risk factors associated with Mother-to-child transmission of HIV in Henan province

目的了解河南省HIV母婴传播情况，分析HIV母婴传播的危险和保护因素。方法通过国家预防艾滋病母婴传播信息管理系统，收集2002-2013年HIV感染孕产妇及所分娩婴幼儿的有关干预信息，包括孕产妇HIV检测咨询、围产期保健服务、抗病毒药物阻断、婴幼儿随访检测等情况，采用非条件logistic回归对HIV母婴传播的影响因素进行分析。结果截至2013年12月底，共有1384例婴幼儿存活至18月龄，检测阳性婴幼儿60人，检测阴性婴幼儿1324人。存活婴幼儿累计母婴传播率4．34％，存活婴幼儿分年度母婴传播率无明显降低趋势（X^2=2．82，P=0．093）。产妇孕早期接受预防HIV母婴传播服务（OR=O．22，95％C．I．0．06-0．77），产妇及婴幼儿进行抗病毒药物阻断（OR=O．46，95％C．I．0．21～0．91），婴幼儿采取人工喂养（OR=0．08，95％C．I．0．02～0．30）是HIV母婴传播的保护因素，产妇分娩过程采取侧切操作（OR=3．17，95％C．I．1．37～7．36）是其危险因素。结论河南省存活婴幼儿HIV母婴传播率较高，应针对主要影响因素一步完善预防HIV母婴传播的综合干预措施。

Objective To investigate the situation of the mother-to-child transmission of HIV in Henan province so as to explore the risk and protective factors. Methods The data regarding HIV- infected pregnant women and their infants from 2002 to 2013 were collected from （national notifiable disease reporting system）, including PITC, perinatal health service, ART and follow-up examination for infants. Univariate and multivariate logistic regression model were used to explore the influencing factors. Results A total of 1 384 infants survived to 18 months old, including a 60 HIV-positive infants and 1 324 HIV-negative infants. The MTCT rate was 4.34% which did not show significant decreasing from 2002 to 2013 （X^2=2.82, P=0.093）. VCT in early pregnancy （0R=0.22, 95% C.I. 0.06-0.77）, standardized ARV regimen in early pregnancy （0R=0.46, 95% C.I. 0.21-0.91）, artificial feeding （0R=0.08, 95% C.I. 0.02-0.30） may be the main protective factors; episiotomies on delivery （0R=3.17, 95% C.I. 1.37-7.36） may be the risk factors. Conclusions The MTCT rate is higher in Henan province, and the targeted interventions of MTCT should be further improved.