HIV-1母婴传播的预防措施
王树坤,李万林,李六九
摘要(Abstract)：
<正>1 引言 HIV-1母婴传播在世界多数地区经久不衰,估计已有360万HIV-1感染幼儿死亡,1999年内受HIV-1感染成人和婴幼儿分别有500万（妇女占46％）和 57万[1]。非洲 HIV-1血清阳性母亲所生婴儿死亡率在出生后最初2年中可达50％,当中70％婴幼儿在死前有HIV-1感染证据[2]。世界各地HIV-1的母婴传播率变化范围是7％-48％,HIV-1感染幼儿在生后头5年内有高达50％的人发展成AIDS患者,中位数存活时间是9.4年。 近年来,美国、欧洲高度发达国家通过联合采取产前HIV-1咨询筛检、抗逆转录病毒治疗和选择性剖宫产措施,已将HIV-1的母婴传播率降低到4％-6％,甚至低于2％[3]。然而,许多欠发达地区在实行HIV-1母婴传播预防中遇到了困难,主要障碍包括基本母婴卫生保健机构的机能不全、未进行孕妇产前咨询筛检、资源有限。
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作者(Author): 王树坤,李万林,李六九
参考文献(References)：
- 1 Mofenson LM, Mclntyre JA. Advances and research directions in I he prevention of mother - to - child HIV - 1 transmission. Lancet, 2000, 355:world AIDS(WA)27-33
- 2 Katzenstein DA, Mbizvo M, Zijenah L, et al.Serum level of maternal human immunodeficiency virus RNA, infant mortality and vertical transmission of HIV in Zimbabwe.] Infect Dis, 1999, 179: 1 382 ?1387
- 3 Fowler MG, Simonds RJ, Roongpisuthipong A. Update on perinatal HIV transmission.Pediatr Clin North Am, 2000, 47:21-38
- 4 Connor EM, Sperling RS, Gelber R, et al. Reduction of maternal ?in-fant transmission of HIV - 1 with zidovudine treatment. N Engl J Med, 1994,331:1 173-1 180
- 5 Shaffer N, Chuachoowong R, Mock PA, et al. Short - course zidovudine for perinatal HIV - 1 transmission in Bangkok, Thailand: a ran domized controlled trial.Lancet, 1999,353:773-780
- 6 Cohen J.Cheap treatment cuts HIV transmission. Science, 1999,283: 916
- 7 Guay LA, Musoke P, Fleming T, et al. Intrapartum and neonatal single - dose nevirapine compared with zidovudine for prevention of mother-to- child transmission of HIV- 1 in kampala, Uganda: HIVNET 012 randomized trial.Lancet, 1999,354:795-802
- 8 Culnane M, Fowler MG, Lee ss, et al. Lack of long - term effects of in utero exposure to zidovudine among uninfected children born to HIV - infected women. JAMA, 1999,281:151 - 157
- 9 Nathan S, Anuvat R, Wimols, et al. Maternal virus load and perinatal HIV- 1 subtype E transmission.Tailand.J Infect Dis, 1999,179:590 -599
- 10 Internal Perinatal HIV Group.The mode of delivery and the risk of vertical transmission of HIV-1:a meta- analysis of 15 prospective cohort studies.N Engl J Med, 1999, 340:977-987
- 11 Nduati R, John G, Mbori - Ngacha D, et al. Effect of breastfeeding and formula feeding on transmission of HIV- l:a randomized clinical trial. JAMA, 2000,283:1 167-1 174
- 12 Coutsoudis A, Pillay k, Spooner E, et al. Influence of infant - feeding patterns on early mother - to - child transmission of HIV - 1 in Durban, south Africa:a prospective cohort study.Lancet, 1999, 354:471-476
- 13 Leroy V, Newell ML, Dabies F, et al. International multicentre pooled analysis of late Postnatal mother-to-child transmission of HIV - 1 infection. Lancet, 1998,352:597 - 600
- 14 Miotti PG, Tanha TE, Kumwenda NI, et al.HIV transmission through breast- eeding:a study in Malswi.JAMA, 1999, 282:744 -749