孕期与产时启动抗病毒治疗阻断艾滋病母婴传播效果评价

Effect contrast of blocking mother-to-infant AIDS transmission by antiretroviral treatment initiated in pregnancy and in labor

目的对比艾滋病病毒(HIV)感染的孕产妇,经孕期与产时不同时期启动抗反转录病毒治疗(ART)后艾滋病母婴阻断的效果,探讨最大程度地减少通过母婴传播导致儿童艾滋病感染的方法。方法以30对临产时才发现HIV感染并采取紧急方案ART的孕产妇及其婴儿为观察组,以90对孕期开始应用ART的HIV感染孕产妇及其婴儿为对照组,两组均结合适宜的助产服务和人工喂养,婴儿进行HIV-1核酸和HIV抗体检测,判断HIV感染情况并进行对比分析。结果观察组有1例婴儿出生3个月死亡,有2例婴儿2次HIV-1脱氧核糖核酸检测结果均阳性,诊断婴儿HIV感染,其余27例满12~18月龄婴儿HIV抗体检测结果阴性,校正后婴儿HIV感染率为8.17%,对照组90例婴儿早期诊断和满12~18月龄HIV抗体检测结果均为阴性,婴儿HIV感染率为0,两组比较差异有统计学意义(χ~2=6.102,P<0.05)。结论 HIV感染的孕产妇抗病毒治疗可以降低母婴传播的风险,孕期开始启动ART预防艾滋病母婴传播的效果明显优于产时紧急ART,结合安全分娩和人工喂养可明显降低HIV母婴传播率。

Objective To contrast the effects on blocking mother-to-infant AIDS transmission by antiretroviral treatment（ART）initiated in pregnancy or in labor and to investigate to minimize the AIDS infection of the infants through mother-to-infant transmission.Methods 30 HIV positive cases of maternal women in labor,as the observation group,received urgent measures to ART.90 HIV positive cases of maternal women in pregnancy started ART as the control group.Both groups received suitable services of delivering and artificial feeding.The babies received the tests of HIV-1 nucleic acid and HIV antibody,to detect HIV infection followed by the contrast analysis.Results The observation group of the 30 cases had 1death of infant in 3months,and 2infants were detected as HIV-1 DNA positive.The other 27 infants in 12-18 months were detected HIV negative with 8.17% of mother-to-infant transmission.However,the control group got zero of HIV positive.The difference between two groups had statistical significance（χ^2=6.102,P〉0.05）.Conclusion HIV-infected maternal women receiving ART will decrease the risk of mother-infant transmission.Maternal women starting ART in pregnancy can achieve better effect than those starting ART in labor on blocking mother-child transmission of AIDS.With safe delivery and artificial feeding,maternal women starting ART in pregnancy can significantly decrease the rate of mother-to-infant transmission.We should promote the strategy with early ART and better effect for HIV positive maternal women.