深圳市孕产妇人群中AIDS流行情况及母婴传播的预防与控制

HIV/AIDS epidemic situation in pregnant women and prevention of mother to child transmission in Shenzhen.

目的 了解深圳市孕产妇人群中艾滋病 (AIDS)流行率及艾滋病病毒 (HIV)母婴垂直传播发生率 ,以及通过采取综合性预防策略降低母婴传播的发生率。方法 对所有产前保健检查的孕妇 ,在首诊时进行自愿咨询和免费HIV抗体筛查 ;对HIV抗体阳性的孕产妇实施综合性干预 ;应用逆转录 聚合酶链式反应 (RT PCR)、套式PCR和基因芯片技术对其新生儿的HIV感染状况进行早期诊断。结果 2 0 0 1～ 2 0 0 3年 4月 ,分别有 80 2 1、6 9976、2 3413名孕产妇接受了AIDS自愿咨询检测 ,分别发现 2、10、4例HIV感染者 ,发生率分别为 2 4 9/万、1 4 3/万、1 71/万。 16名HIV感染孕产妇中 ,经性接触传播占 81 3% (13/ 16 ) ,经血液传播占 18 7% ;有 3人其配偶为HIV抗体阳性。 4名孕妇终止妊娠 (2 5 0 % ) ,6名产妇接受产后干预 (37 5 % ) ,失访 2名 ,转外地 1名。 2名接受综合性干预后分娩 ,1名正接受随访和干预 ;1例新生儿证实为垂直传播感染 (1/ 8,12 5 % )。结论 通过对孕产妇人群提供AIDS自愿咨询检测服务和对该人群中的HIV感染者采取综合性干预措施 ,可有效防止和降低HIV母婴传播的发生率 ,提示将健康教育、行为干预和婚前咨询检查与母婴传播预防控制策略相结合 。

Objective To study the prevalence rate of epidemic in pregnant women and MTCT in Shenzhen,and to reduce the incidence of HIV MTCT by comprehensive intervention measures.Methods Most of pregnant women have received HIV/AIDS voluntary counseling (VCT) and free testing during their first prenatal health check-ups in Shenzhen since 2001.Comprehensive intervention measures were provided to HIV-infected pregnant women.The HIV infection status of newborn was diagnosed by RT-PCR,nested-PCR and HIV gene chip.Results From 2001 to April 2003,8021,69976 and 23413 pregnant women received HIV/AIDS VCT yearly.There were 2,10 and 4 HIV-infected pregnant women to be identified and the prevalence rate was 0.249‰,0.143‰ and 0.171‰,respectively.Of the 16 HIV-infected pregnant women,13 were infected by sexual contact(81.3%),3 were by blood transmission and 3 partners were HIV-positive.Four women including lectopic pregnancy terminated their pregnancies (25%),6 received postnatal interventims (37.5%),2 did not return for post-counseling and follow-up,1 moved to other region,and 2 dilevered their babies after receiving com-prehensive infterventions Eight babies were born and 1 infected with HIV by MTCT.Conclusion This MTCT program adopted in Shenzhen has prevented and reduced the prevalence rate of HIV MTCT by provision of VCT to pregnant women and intervention measures to HIV-infected women.These findings suggest that it is very important to make combination of health education,behavioral intervention and pre-marital counseling and testing on HIV/AIDS with the strategy of prevention of HIV PMTCT so as to have better preventive effect.