2011-2020年湖北省HIV感染孕产妇母婴传播情况及影响因素分析

Analysis of mother-to-child transmission among HIV-infected pregnant women and the influencing factors in Hubei Province from 2011 to 2020

目的了解HIV感染孕产妇所娩婴儿的母婴传播情况,探讨影响母婴传播的因素,为提高湖北省预防艾滋病母婴传播项目实施效果提供参考依据。方法收集2011年1月1日至2020年12月31日湖北省预防艾滋病母婴传播管理信息系统报告的已分娩的HIV感染孕产妇的相关信息,回顾性分析其人口学特征、孕产史、ART、丈夫/性伴情况和暴露儿童接受预防母婴传播服务等因素,比较不同组间的母婴传播率,采用Logistic回归模型分析其相关影响因素。结果497例研究对象中,HIV感染孕产妇和暴露儿童的平均ART用药比例分别为77.46%(385/497)和85.11%(423/497),10.66%(53/497)的暴露儿童为非人工喂养,HIV感染孕产妇开始ART的时间[M(P25,P75)]为16(9,29)周,暴露儿童早期诊断的确诊时间为98(96,205)天,2011-2020年母婴传播率为4.63%,总体呈逐年下降的趋势(χ^(2)趋势=16.946,P=0.001)。多因素分析结果显示,分娩年份2016-2020年(OR=0.163,95%CI:0.047~0.570)、孕产妇联合用药方案(OR=0.272,95%CI:0.096~0.771)、暴露儿童抗病毒治疗(OR=0.253,95%CI:0.103~0.621)、择期剖宫产(OR=0.167,95%CI:0.035~0.802)、人工喂养(OR=0.201,95%CI:0.103~0.621)是影响艾滋病母婴传播的独立因素(P<0.05)。结论湖北省艾滋病母婴传播情况的总体趋势向好,提高抗病毒药物应用率、推广安全人工喂养可有效降低母婴传播的风险;分娩方式对母婴传播的影响需进一步研究。

Objective To investigate the incidence of mother-to-child transmission among HIV-exposed infants and influencing factors to provide reference for improving the implementation effect of Prevention of Mother-to-child Transmission of HIV(PMTCT)in Hubei Province.Methods Information of HIV-infected pregnant women who had given birth reported in Information System of PMTCT management in Hubei Province from January 1,2011 to December31,2020 was collected.Demographic characteristics,pregnancy and childbirth history,antiviral therapy,husbands/sexual partners status and exposed infants receiving PMTCT services were collected.Logistic regression model was used to analyze the influencing factors.Results Among 497 study subjects,ART medication proportion of HIV-infected pregnant women and exposed infants were 77.46%(385/497)and 85.11%(423/497)respectively.10.66%(53/497)of exposed infants were non-artificial feeding.The startup time of ART for HIV-infected women was 16(9,29)gestational weeks.The time of the early diagnosis of exposed infants was 98(96,205)days.The rate of MTCT was 4.63%with an overall downward trend year by year(χ^(2)trend=16.946,P=0.001)from 2011 to 2020.Multivariate analysis showed that the year of delivery from 2016 to 2020(OR=0.163,95%CI:0.047-0.570),combined drug regimen for pregnant women(OR=0.272,95%CI:0.096-0.771),receiving ART of exposed infants(OR=0.253,95%CI:0.103-0.621),selective caesarean section(OR=0.167,95%CI:0.035-0.802)and artificial feeding(OR=0.201,95%CI:0.103-0.621)were independent factors affecting the rate of MTCT of HIV(P<0.05).Conclusions The overall trend of MTCT of AIDS in Hubei was improving.Enhancing the application rate of ART and promoting safe artificial feeding could effectively reduce the risk of MTCT.The impact of the delivery mode on MTCT needs further research.