2004-2016年湖北省520例HIV阳性孕妇流行病学特征及终止妊娠情况分析
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摘要
目的了解湖北省人类免疫缺陷病毒(HIV)阳性孕妇的流行病学特征及趋势,探讨终止妊娠情况及相关影响因素,为制定HIV母婴阻断工作策略提供依据。方法对湖北省部分地区2004年1月-2016年12月确诊的HIV阳性孕妇进行调查和随访,收集其流行病学等相关资料,检测其乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)及梅毒合并感染状况,并对HIV阳性孕妇丈夫/性伴HIV感染状况进行检测,采用SPSS 20. 0统计软件对相关资料进行统计分析。结果 520例HIV阳性孕妇共妊娠603次。HIV阳性孕妇首次妊娠时,92. 88%已婚,74. 04%尚无子女。孕妇乙型肝炎病毒表面抗原(HBs Ag)、丙型肝炎病毒抗体(HCV-Ab)、梅毒螺旋体抗体(TP-Ab)阳性率分别为7. 67%、4. 69%、3. 40%,其丈夫/性伴HIV阳性率为26. 02%,性途径感染者472例(90. 77%),2004-2016年,性途径感染者所占比例逐年上升;血途径感染者所占比例逐年下降,2009年之后仅零星发现。2011年首次发现通过母婴途径感染HIV的孕妇。在2004-2007、2008-2011、2012-2016年三个时间段,产前确诊孕妇所占比例呈上升趋势,但孕早期确诊孕妇所占比例变化趋势不明显。HIV阳性孕妇自愿选择终止妊娠的比例为44. 94%,孕妇选择终止妊娠的比例逐年下降。多因素Logistic回归分析显示,未婚(P=0. 009)、已有子女(P=0. 000)、年龄≤20岁(P=0. 016)是HIV阳性孕妇选择终止妊娠的危险因素。结论性传播是湖北省HIV阳性孕妇感染HIV的主要途径。需加大孕期HIV筛查力度,尽早发现HIV阳性孕妇。随着HIV阳性孕妇选择终止妊娠率的下降,应为HIV阳性孕妇提供更优质的阻断服务。
Objective To understand epidemiological characteristics and trend of HIV-positive pregnant women in Hubei,explore termination of pregnancy and related influencing factors,provide a basis for making measures to block mother-to-child transmission of HIV.Methods The HIV-positive pregnant women diagnosed definitely in partial areas of Hubei from January 2004 to December 2016 were surveyed and followed up,the epidemiological data were collected. The infection rates of HBV,HCV,and syphilis were detected. HIV infection rate of husbands/sexual partners of these HIV-positive pregnant women were detected. SPSS 20. 0 software was used to analyze the data.Results A total of 520 HIV-positive pregnant women were enrolled in this study,and they got pregnancy for 603 times. When they got pregnancy for the first time,92. 88% of them were married,and 74. 04% of them had no child. The positive rates of Hbs Ag,HCV-Ab,and TP-Ab were 7. 67%,4. 69%,and 3. 40%,respectively. The positive rate of husbands/sexual partners of these HIV-positive pregnant women was 26. 02%,472 cases (90. 77%) were infected through sexual activities. From 2004 to 2016,the proportion of cases infected through sexual activities increased year by year. The proportion of cases infected through blood transmission decreased year by year,which was very low after 2009. In 2011,pregnant women infected through mother-to-child transmission were observed for the first time. The proportion of pregnant women diagnosed definitely before delivery showed an increasing trend during three time periods (2004-2007,2008-2011,2012-2016). The changing trend of proportion of pregnant women diagnosed definitely during the first trimester of pregnancy was not obvious. Among these HIV-positive pregnant women,44. 94% of them terminated pregnancy voluntarily,the proportion decreased year by year. Multivariate logistic regression analysis showed that singlehood (P = 0. 009),having offsprings (P = 0. 000),and ≤20 years old (P =0. 016) were risk factors of pregnancy termination. Conclusion Sexual transmission is the main route of HIV infection in HIV-positive pregnant women in Hubei. It is imperative to increase HIV screening effort and discover HIV-infected pregnant women as early as possible.With the decrease of termination rate of pregnancy,better service should be provided for HIV-infected pregnant women to block mother-tochild transmission.
Objective To understand epidemiological characteristics and trend of HIV-positive pregnant women in Hubei,explore termination of pregnancy and related influencing factors,provide a basis for making measures to block mother-to-child transmission of HIV.Methods The HIV-positive pregnant women diagnosed definitely in partial areas of Hubei from January 2004 to December 2016 were surveyed and followed up,the epidemiological data were collected. The infection rates of HBV,HCV,and syphilis were detected. HIV infection rate of husbands/sexual partners of these HIV-positive pregnant women were detected. SPSS 20. 0 software was used to analyze the data.Results A total of 520 HIV-positive pregnant women were enrolled in this study,and they got pregnancy for 603 times. When they got pregnancy for the first time,92. 88% of them were married,and 74. 04% of them had no child. The positive rates of Hbs Ag,HCV-Ab,and TP-Ab were 7. 67%,4. 69%,and 3. 40%,respectively. The positive rate of husbands/sexual partners of these HIV-positive pregnant women was 26. 02%,472 cases (90. 77%) were infected through sexual activities. From 2004 to 2016,the proportion of cases infected through sexual activities increased year by year. The proportion of cases infected through blood transmission decreased year by year,which was very low after 2009. In 2011,pregnant women infected through mother-to-child transmission were observed for the first time. The proportion of pregnant women diagnosed definitely before delivery showed an increasing trend during three time periods (2004-2007,2008-2011,2012-2016). The changing trend of proportion of pregnant women diagnosed definitely during the first trimester of pregnancy was not obvious. Among these HIV-positive pregnant women,44. 94% of them terminated pregnancy voluntarily,the proportion decreased year by year. Multivariate logistic regression analysis showed that singlehood (P = 0. 009),having offsprings (P = 0. 000),and ≤20 years old (P =0. 016) were risk factors of pregnancy termination. Conclusion Sexual transmission is the main route of HIV infection in HIV-positive pregnant women in Hubei. It is imperative to increase HIV screening effort and discover HIV-infected pregnant women as early as possible.With the decrease of termination rate of pregnancy,better service should be provided for HIV-infected pregnant women to block mother-tochild transmission.
引文
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[11]陈园生.中国丙型肝炎血清流行病学研究[J].中华流行病学杂志,2011,32(9):888-891.
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[13]Joao EC,Gouvea MI,Menezes JA,et al.Factors associated with viral load suppression in HIV-infected pregnant women in Rio de Janeiro,Brazil[J].Int J STD AIDS,2012,23(1):44-47.
[14]Prieto LM,Gonzalez-Tome MI,Munoz E,et al.Low rates of mother-to-child transmission of HIV-1 and risk factors for infection in Spain:2000-2007[J].Pediatr Infect Dis J,2012,31(10):1053-1058.
[15]Zhou Z,Meyers K,Li X,et al.Prevention of mother-to-child transmission of HIV-1 using highly active antiretroviral therapy in rural Yunnan,China[J].J Acquir Immune Defic Syndr,2010,53(Suppl1):S15-S22.
[16]European,Collaborative Study,Thorne C,Patel D,et al.Mother-tochild transmission of HIV infection in the era of highly active antiretroviral therapy[J].Clin Infect Dis,2005,40(3):458-465.
[17]郭光萍,李燕,王俊,等.HIV感染孕产妇及丈夫生育意愿调查[J].中国艾滋病性病,2008,14(2):175-176.
[18]何丹,吴方银,宋筱,等.四川省HIV感染孕妇终止妊娠情况及其影响因素[J].实用妇产科杂志,2014,30(3):224-226.
[19]Gibb DM,Macdonagh SE,Tookey PA,et al.Uptake of interventions to reduce mother-to-child transmission of HIV in the United Kingdom and Ireland[J].Aids,1997,11(7):F53-F58.
[20]Thackway SV,Furner V,Mijch A,et al.Fertility and reproductive choice in women with HIV-1 infection[J].Aids,1997,11(5):663-667.
[21]Massad LS,Springer G,Jacobson L,et al.Pregnancy rates and predictors of conception,miscarriage and abortion in US women with HIV[J].Aids,2004,18(2):281-286.
[22]Bongain A,Berrebi A,Marine-Barjoan E,et al.Changing trends in pregnancy outcome among HIV-infected women between 1985 and1997 in two southern French university hospitals[J].Eur J ObstetGynecol Reprod Biol,2002,104(2):124-128.
[23]Floridia M,Tamburrini E,Tibaldi C,et al.Voluntary pregnancy termination among women with HIV in the HAART era(2002-2008):a case series from a national study[J].AIDS Care,2010,22(1):50-53.
[2]庄柯,桂希恩,骆嘉拉,等.艾滋病高发农村儿童人类免疫缺陷病毒感染与艾滋病发病的关系[J].中华儿科杂志,2003,41(8):586-589.
[3]梁科,桂希恩,张元珍,等.HIV阳性孕产妇的发现时机及接受阻断情况分析[J].中华疾病控制杂志,2009,13(4):445-447.
[4]梁科,桂希恩,张元珍,等.人类免疫缺陷病毒阳性孕妇终止妊娠情况及影响因素[J].中华围产医学杂志,2011,14(9):550-551.
[5]梁科,桂希恩,张元珍,等.孕前或孕期感染人类免疫缺陷病毒后的母婴传播[J].中华围产医学杂志,2012,15(1):10-15.
[6]吴国敏,韦焘,唐磊,等.湖北省HIV感染儿童抗病毒治疗前生存时间的研究[J].中国艾滋病性病,2017,23(3):206-209.
[7]彭国平,张艺,蒋洪林.湖北省艾滋病流行特征及趋势分析[J].中国艾滋病性病,2009,15(3):292-294.
[8]姚璇,彭国平,詹发先,等.湖北省HIV感染者/AIDS病人现况分析[J].中国艾滋病性病,2005,11(1):37-39.
[9]热孜艳.斯拉夫,古丽.肉孜,李莉,等.新疆伊宁市2007年孕妇HIV检测及感染状况分析[J].中华医学研究杂志,2008,8(3):268.
[10]于兰,桂秀枝,蒙秀宁,等.194例HIV阳性孕妇HBV HCV及梅毒合并感染状况分析[J].中国艾滋病性病,2011,17(3):308-310.
[11]陈园生.中国丙型肝炎血清流行病学研究[J].中华流行病学杂志,2011,32(9):888-891.
[12]张卫东,郗园林,张梅喜,等.血源性艾滋病高发村村民HIV/HBV/HCV混合感染状况调查[J].郑州大学学报(医学版),2006,50(2):254-256.
[13]Joao EC,Gouvea MI,Menezes JA,et al.Factors associated with viral load suppression in HIV-infected pregnant women in Rio de Janeiro,Brazil[J].Int J STD AIDS,2012,23(1):44-47.
[14]Prieto LM,Gonzalez-Tome MI,Munoz E,et al.Low rates of mother-to-child transmission of HIV-1 and risk factors for infection in Spain:2000-2007[J].Pediatr Infect Dis J,2012,31(10):1053-1058.
[15]Zhou Z,Meyers K,Li X,et al.Prevention of mother-to-child transmission of HIV-1 using highly active antiretroviral therapy in rural Yunnan,China[J].J Acquir Immune Defic Syndr,2010,53(Suppl1):S15-S22.
[16]European,Collaborative Study,Thorne C,Patel D,et al.Mother-tochild transmission of HIV infection in the era of highly active antiretroviral therapy[J].Clin Infect Dis,2005,40(3):458-465.
[17]郭光萍,李燕,王俊,等.HIV感染孕产妇及丈夫生育意愿调查[J].中国艾滋病性病,2008,14(2):175-176.
[18]何丹,吴方银,宋筱,等.四川省HIV感染孕妇终止妊娠情况及其影响因素[J].实用妇产科杂志,2014,30(3):224-226.
[19]Gibb DM,Macdonagh SE,Tookey PA,et al.Uptake of interventions to reduce mother-to-child transmission of HIV in the United Kingdom and Ireland[J].Aids,1997,11(7):F53-F58.
[20]Thackway SV,Furner V,Mijch A,et al.Fertility and reproductive choice in women with HIV-1 infection[J].Aids,1997,11(5):663-667.
[21]Massad LS,Springer G,Jacobson L,et al.Pregnancy rates and predictors of conception,miscarriage and abortion in US women with HIV[J].Aids,2004,18(2):281-286.
[22]Bongain A,Berrebi A,Marine-Barjoan E,et al.Changing trends in pregnancy outcome among HIV-infected women between 1985 and1997 in two southern French university hospitals[J].Eur J ObstetGynecol Reprod Biol,2002,104(2):124-128.
[23]Floridia M,Tamburrini E,Tibaldi C,et al.Voluntary pregnancy termination among women with HIV in the HAART era(2002-2008):a case series from a national study[J].AIDS Care,2010,22(1):50-53.