广西壮族自治区HIV感染孕产妇分娩高暴露风险儿童影响因素分析

Analysis on influencing factors of high HIV exposure risk in infants of HIV positive pregnant women in Guangxi

目的分析广西壮族自治区(广西)HIV感染孕产妇分娩高暴露风险儿童的影响因素。方法通过全国“预防艾滋病、梅毒和乙肝母婴传播管理信息系统”选取广西各级医疗保健机构报告且出生日期为2016年1月1日至2020年12月31日的HIV感染孕产妇分娩的儿童;收集其母亲人口学特征、确诊感染时间、孕期保健情况、抗病毒治疗情况和病毒载量等信息。采用χ^(2)检验进行单因素分析,采用多因素logistic回归模型,分析分娩HIV高暴露风险儿童的影响因素。结果研究对象2707例,其中普通暴露风险儿童2277例,高暴露风险儿童的430例。多因素分析结果显示,HIV感染孕产妇文化程度高是避免儿童发生高暴露风险的保护因素;本次妊娠确诊HIV感染的孕产妇分娩高暴露风险儿童的可能性高于孕前已确诊的孕产妇,OR值(95%CI)为10.928(8.140~14.671);与初检孕周在孕早期的感染孕产妇相比,初检孕周在孕晚期的孕产妇分娩高暴露风险儿童可能性更高,OR值(95%CI)为21.997(15.253~31.723)。高暴露风险儿童HIV母婴传播率为13.44%,普通暴露风险儿童HIV母婴传播率为0.43%。结论HIV感染孕产妇确诊时期、初检孕周与所生儿童HIV暴露风险程度密切相关。不同年龄、文化程度、婚姻状况、分娩史与新生儿HIV暴露风险因素也有关系,应给予感染孕产妇针对性的宣传教育,提高早检比例,可减少HIV感染产妇分娩高暴露风险儿童,减少HIV母婴传播。

Objective To analyze the high HIV exposure risk in infants of HIV positive pregnant women and influencing factors in Guangxi Zhuang autonomous region.Methods A total of 2707 infants of HIV positive pregnant women,who were born between January,2016 and December 312020,reported by medical and health care institutions at all levels in Guangxi were selected through National Information System for Mother-to-Child Transmission of AIDS,Syphilis and Hepatitis B Management.The information about their mothers’demographic characteristics,the time of HIV diagnosis,receipt of health care during pregnancy,receipt of antiviral therapy,and HIV viral load were collected.Throughχ^(2) test,univariate analysis and multivariate Logistic regression model was used to analyze the influencing factors of high HIV exposure risk in infants of HIV positive pregnant women.Results A total of 2707 infants were included in the analysis,in whom 2277 had general HIV exposure risk and 430 had high HIV exposure risk.The results of multivariate analysis showed that high education level of HIV positive mother was a protective factor for high HIV exposure risk in infants.Pregnant women diagnosed with HIV infection in pregnancy were more likely to have infants at high risk for HIV exposure compared with those diagnosed before pregnancy(OR=10.928,95%CI:8.140–14.671).Compared with the HIV positive pregnant women with the first antenatal examination in early pregnancy,HIV positive pregnant women with the first antenatal examination at late pregnancy were more likely to have infants at high risk for HIV exposure(OR=21.997,95%CI:15.253–31.723).The mother-to-child transmission rate of HIV was 13.44%in infants at high HIV exposure risk and 0.43%in those at general HIV exposure risk.Conclusion The diagnosed date of HIV infection and gestational week of the first antenatal examination in HIV positive pregnant women were closely related to the HIV exposure risk level in their infants.Moreover,factors such as age,education level,marital status and delivery history were also related to the level of HIV exposure risk in infants.Targeted health education should be conducted in HIV positive pregnant women and the early detection of HIV infection should be promoted to reduce the high HIV exposure risk in infants.