摘要
目的 了解湖北省HIV母婴阻断效果及影响因素,为HIV母婴阻断工作提供参考.方法 采用前瞻性队列研究的方法,将2004年1月至2016年12月在湖北省部分县市发现的HIV阳性孕妇纳入本次研究,对发现的HIV阳性孕妇及其所娩婴儿进行母婴阻断及随访,并收集相关资料.通过描述性分析及x2检验,了解HIV阳性孕妇及婴儿的一般特征;通过logistic回归分析,探讨HIV母婴传播的影响因素.结果 共发现536例(628孕次)HIV阳性孕妇,其中334例孕妇及其所娩345例婴儿纳入本次研究,共发现HIV阳性婴儿24例,阳性率6.96％(95％CI:4.27％～9.64％).未阻断、仅人工喂养、仅婴儿服药+人工喂养、母婴均服药+人工喂养的HIV母婴传播率分别为35.71％(95％CI:21.61％～51.93％)、8.82％ (95％CI:2.08％～15.57％)、7.41％ (95％CI:0.92％～24.22％)、0.48％(95％CI:0.01％～2.64％).孕妇未服用抗反转录病毒药物(OR=14.484,95％CI:1.740～120.577,P=0.013)、母乳喂养(OR=6.542,95％CI:2.416～17.713,P=0.000)、孕妇产时CD4+T淋巴细胞计数＜200个/μL(OR=3.060,95％CI:1.076～8.703,P=0.036)是HIV母婴传播的独立危险因素.结论 无阻断措施时,湖北省HIV母婴传播率较高,综合阻断措施(母婴均用药+人工喂养)能显著降低HIV母婴传播率.今后应尽早发现HIV阳性孕妇,及时采取“孕妇产前三联服药+婴儿服药+人工喂养”方案,进一步降低HIV母婴传播率.
Abstract
Objective To evaluate the effectiveness and associated factors of prevention of motherto-child human immunodeficiency virus (HIV) transmission in Hubei Province,and to provide a reference for prevention of mother-to-child transmission of HIV.Methods In this prospective cohort study,HIV-positive pregnant women who were in some counties and cities of Hubei Province from January 2004 to December 2016 were enrolled.Prevention of mother-to-child transmission of HIV was conducted for these HIV-positive pregnant women and their infants,and their clinical data were collected.Descriptive analysis and x2 test were used to analyze the general characteristics of HIV-positive pregnant women and their infants.Logistic regression analysis was adopted to explore the associated factors of mother-to-child HIV transmission.Results In total,536 HIV-positive pregnant women (628 pregnancies) were found,among which,334 pregnant women and 345 infants were enrolled in this study.Twenty-four infants were HIV-positive,which was 6.96％ in all infants (95％CI:4.27％-9.64％).The rates of mother-to-child HIV transmission without prevention,formula feeding only,infant medication plus formula feeding,mother and infant medication plus formula feeding were 35.71％ (95％CI:21.61％-51.93％),8.82％ (95％CI:2.08％-15.57％),7.41％ (95％CI:0.92％-24.22％),and0.48％ (95％CI:0.01％-2.64％),respectively.No antiretroviral medications during delivery (OR =14.484,95 ％CI:1.740-120.577,P=0.013),breastfeeding (OR=6.542,95％CI:2.416-17.713,P=0.000),and CD4-T lymphocyte count＜200 cells/μL during delivery (OR=3.060,95％CI:1.076-8.703,P=0.036) were independent risk factors of mother-to-child HIV transmission.Conclusions The rate of mother-to-child HIV transmission without prevention is high in Hubei Province,which can be significantly reduced by comprehensive interventions (mother and infant medication plus formula feeding).Thus,we should diagnose HIV-positive pregnant women as early as possible,and should give pregnant woman antiretroviral therapy plus infant medication and formula feeding to further reduce the rate of mother-to-child HIV transmission.
基金项目
国家自然科学基金(81000758)
中国性病艾滋病防治协会·艾伯维妇幼关爱及预防母婴传播基金(PMTCT2017-005)
湖北省自然科学基金(2010CDB06103)
NETL
NSTL
维普
万方数据