HIV阳性孕妇所生子女低出生体重发生率及影响因素分析
|
摘要
目的探讨感染艾滋病病毒(HIV)的孕妇所生子女低出生体重情况及其相关影响因素,为中国HIV母婴阻断工作提供参考。方法以2003年1月至2014年12月湖北、河北、山西部分县市及新疆伊宁市发现的HIV阳性孕妇及其子女为研究对象,收集相关资料进行卡方检验及Logistic回归分析,探讨其子女低出生体重的危险因素。结果纳入研究的608名子女中,低出生体重31人(5.10%)。多因素Logistic回归分析表明,子女低出生体重的危险因素包括:阻断方案中含有蛋白酶抑制剂(PI)[比值比(OR)=4.491,95%可信区间(CI):1.336~15.093]、子女HIV阳性(OR=4.652,95%CI:1.547~13.995)。结论应尽早发现HIV阳性孕妇并进行抗反转录病毒治疗,同时应警惕PI类药物对子女出生体重的影响,做好早期预防和管理,以降低低出生体重发生率。
Objective To investigate the characteristics of low birth weight infants born to human immunodeficiency virus(HIV) infected women and the associated factors to provide the reference for the prevention of HIV transmission from mother to child in China. Methods Information of HIV positive women and their infants from Hubei, Hebei, Shanxi provinces and Yining city of Xinjiang Uygur Autonomous Region were collected with a delivery date from Jan 2003 to Dec 2014. Chi-Square test and logistic regression were used to analyze the risk factors for infants' low birth weight. ResultsTotally, 608 infants were enrolled and 31 were low birth weight(5.10%). Multi-factor logistic analysis showed that the risk factors of low birth weight consisted of regimen with protease inhibitor(PI)(OR 4.491, 95%CI 1.336-15.093) and infants' HIV infection(OR 4.652, 95%CI 1.547-13.995). Conclusion HIV positive pregnant women should be detected and treated with antiretroviral therapy(ART) as early as possible. Attention should be paid to PI which affects infant's low birth weight. Early prophylactic measures and case management of HIV infected mothers should be taken to decrease the rate of low birth weight infants born to HIV positive mothers.
Objective To investigate the characteristics of low birth weight infants born to human immunodeficiency virus(HIV) infected women and the associated factors to provide the reference for the prevention of HIV transmission from mother to child in China. Methods Information of HIV positive women and their infants from Hubei, Hebei, Shanxi provinces and Yining city of Xinjiang Uygur Autonomous Region were collected with a delivery date from Jan 2003 to Dec 2014. Chi-Square test and logistic regression were used to analyze the risk factors for infants' low birth weight. ResultsTotally, 608 infants were enrolled and 31 were low birth weight(5.10%). Multi-factor logistic analysis showed that the risk factors of low birth weight consisted of regimen with protease inhibitor(PI)(OR 4.491, 95%CI 1.336-15.093) and infants' HIV infection(OR 4.652, 95%CI 1.547-13.995). Conclusion HIV positive pregnant women should be detected and treated with antiretroviral therapy(ART) as early as possible. Attention should be paid to PI which affects infant's low birth weight. Early prophylactic measures and case management of HIV infected mothers should be taken to decrease the rate of low birth weight infants born to HIV positive mothers.
引文
[1]UNAIDS.Global AIDS response progress reporting(2015).[EB/OL]http://www.unaids.orgsitesdefaultfilesmedia_asset JC2702_GARPR 2015 guidelines_en.pdf.
[2]Claire Thorne,Deven Patel,Simona Fiore,et al.Mother-toChild transmission of HIV infection in the era of highly active antiretroviral therapy[J].Clinical Infectious Diseases,2005,40(2):458-465.
[3]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.
[4]Zengquan Zhou,Kathrine Meyers,Xia Li,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(1):15-22.
[5]彭瑞宇,廖戎.HIV感染孕妇所生新生儿体重分析[J].求医问药(下半月),2012,10(3):8,631.
[6]Yu L,Li WY,Chen RY,et al.Pregnancy outcomes and risk factors for low birth weight and preterm delivery among HIV-infected pregnant women in Guangxi,China[J].Chin Med J(Engl),2012,125(3):403-409.
[7]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.
[8]World Health Organization.Scaling up antiretroviarl therapy in resource-limited settings treatment guidelines for a public health approach(2003 Revision).[EB/OL].http://www.who.int/3by5/publications/documents/ART_guidelines/en.
[9]World Health Organization.Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection(2013 Revision)[EB/OL].http://www.who.int/hiv/pub/guidelines/ART2013/en.
[10]卫生部艾滋病临床专家工作组.国家免费艾滋病抗病毒药物治疗手册[M].3版.北京:人民卫生出版社,2012.
[11]中华人民共和国国家卫生和计划生育委员会.预防艾滋病、梅毒和乙肝母婴传播工作实施方案[Z].2011.
[12]Su B,Liu L,Wang F,et al.HIV-1 subtype B'dictates the AIDS epidemic among paid blood donors in the Henan and Hubei provinces of China[J].AIDS,2003,17(17):2515-2520.
[13]Delwart EL,Shpaer EG,Louwagie J,et al.Genetic relationships determined by a DNA heteroduplex mobility assay:analysis of HIV-1 env genes[J].Science,1993,262(5137):1257-1261.
[14]Edelstein RE,Nickerson DA,Tobe VO,et al.Oligonucleotide ligation assay for detecting mutations in the human immunodeficiency virus type 1 pol gene that are associated with resistance to zidovudine,didanosine,and lamivudine[J].J Clin Microbiol,1998,36(2):569-572.
[15]Wei R,Msamanga GI,Spiegelman D,et al.Association between low birth weight and infant mortality in children born to human immunodeficiency virus 1-infected mothers in Tanzania[J].Pediatr Infect Dis J,2004,23(6):530-535.
[16]中华人民共和国国家卫生和计划生育委员会.2013中国卫生统计年[EB/OL].(2014-04-26).http://www.nhfpc.gov.cn/htmlfiles/zwgkzt/ptjnj/year2013/index2013.html.
[17]Tuomala RE,Shapiro DE,Mofenson LM,et al.Antiretroviral therapy during pregnancy and the risk of an adverse outcome[J].N Engl J Med,2002,346(24):1863-1870.
[18]van der Merwe K,Hoffman R,Black V,et al.Birth outcomes in South African women receiving highly active antiretroviral therapy:a retrospective observational study[J].J Int AIDS Soc,2011,14:42.
[19]Goldenberg RL,Culhane JF.Low birth weight in the United States[J].Am J Clin Nutr,2007,85(2):584-590.
[20]Kowalska A,Niemiec T,El MA,et al.Effect of antiretroviral therapy on pregnancy outcome in HIV-1positive women[J].Med Wieku Rozwoj,2003,7(4 Pt 1):459-468.
[21]Suy A,Martinez E,Coll O,et al.Increased risk of preeclampsia and fetal death in HIV-infected pregnant women receiving highly active antiretroviral therapy[J].AIDS,2006,20(1):59-66.
[22]Papp E,Mohammadi H,Loutfy MR,et al.HIV protease inhibitor use during pregnancy is associated with decreased progesterone levels,suggesting a potential mechanism contributing to fetal growth restriction[J].J Infect Dis,2015,211(1):10-18.
[23]Cooper ER,Charurat M,Mofenson L,et al.Combination antiretroviral strategies for the treatment of pregnant HIV-1-infected women and prevention of perinatal HIV-1 transmission[J].J Acquir Immune Defic Syndr,2002,29(5):484-494.
[24]Machado ES,Hofer CB,Costa TT,et al.Pregnancy outcome in women infected with HIV-1 receiving combination antiretroviral therapy before versus after conception[J].Sex Transm Infect,2009,85(2):82-87.
[25]Mwanyumba F,Claeys P,Gaillard P,et al.Correlation between maternal and infant HIV infection and low birth weight:a study in Mombasa,Kenya[J].J Obstet Gynaecol,2001,21(1):27-31.
[26]中华人民共和国国家卫生和计划生育委员会.预防艾滋病、梅毒和乙肝母婴传播工作实施方案[R].2015.
[2]Claire Thorne,Deven Patel,Simona Fiore,et al.Mother-toChild transmission of HIV infection in the era of highly active antiretroviral therapy[J].Clinical Infectious Diseases,2005,40(2):458-465.
[3]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.
[4]Zengquan Zhou,Kathrine Meyers,Xia Li,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(1):15-22.
[5]彭瑞宇,廖戎.HIV感染孕妇所生新生儿体重分析[J].求医问药(下半月),2012,10(3):8,631.
[6]Yu L,Li WY,Chen RY,et al.Pregnancy outcomes and risk factors for low birth weight and preterm delivery among HIV-infected pregnant women in Guangxi,China[J].Chin Med J(Engl),2012,125(3):403-409.
[7]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.
[8]World Health Organization.Scaling up antiretroviarl therapy in resource-limited settings treatment guidelines for a public health approach(2003 Revision).[EB/OL].http://www.who.int/3by5/publications/documents/ART_guidelines/en.
[9]World Health Organization.Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection(2013 Revision)[EB/OL].http://www.who.int/hiv/pub/guidelines/ART2013/en.
[10]卫生部艾滋病临床专家工作组.国家免费艾滋病抗病毒药物治疗手册[M].3版.北京:人民卫生出版社,2012.
[11]中华人民共和国国家卫生和计划生育委员会.预防艾滋病、梅毒和乙肝母婴传播工作实施方案[Z].2011.
[12]Su B,Liu L,Wang F,et al.HIV-1 subtype B'dictates the AIDS epidemic among paid blood donors in the Henan and Hubei provinces of China[J].AIDS,2003,17(17):2515-2520.
[13]Delwart EL,Shpaer EG,Louwagie J,et al.Genetic relationships determined by a DNA heteroduplex mobility assay:analysis of HIV-1 env genes[J].Science,1993,262(5137):1257-1261.
[14]Edelstein RE,Nickerson DA,Tobe VO,et al.Oligonucleotide ligation assay for detecting mutations in the human immunodeficiency virus type 1 pol gene that are associated with resistance to zidovudine,didanosine,and lamivudine[J].J Clin Microbiol,1998,36(2):569-572.
[15]Wei R,Msamanga GI,Spiegelman D,et al.Association between low birth weight and infant mortality in children born to human immunodeficiency virus 1-infected mothers in Tanzania[J].Pediatr Infect Dis J,2004,23(6):530-535.
[16]中华人民共和国国家卫生和计划生育委员会.2013中国卫生统计年[EB/OL].(2014-04-26).http://www.nhfpc.gov.cn/htmlfiles/zwgkzt/ptjnj/year2013/index2013.html.
[17]Tuomala RE,Shapiro DE,Mofenson LM,et al.Antiretroviral therapy during pregnancy and the risk of an adverse outcome[J].N Engl J Med,2002,346(24):1863-1870.
[18]van der Merwe K,Hoffman R,Black V,et al.Birth outcomes in South African women receiving highly active antiretroviral therapy:a retrospective observational study[J].J Int AIDS Soc,2011,14:42.
[19]Goldenberg RL,Culhane JF.Low birth weight in the United States[J].Am J Clin Nutr,2007,85(2):584-590.
[20]Kowalska A,Niemiec T,El MA,et al.Effect of antiretroviral therapy on pregnancy outcome in HIV-1positive women[J].Med Wieku Rozwoj,2003,7(4 Pt 1):459-468.
[21]Suy A,Martinez E,Coll O,et al.Increased risk of preeclampsia and fetal death in HIV-infected pregnant women receiving highly active antiretroviral therapy[J].AIDS,2006,20(1):59-66.
[22]Papp E,Mohammadi H,Loutfy MR,et al.HIV protease inhibitor use during pregnancy is associated with decreased progesterone levels,suggesting a potential mechanism contributing to fetal growth restriction[J].J Infect Dis,2015,211(1):10-18.
[23]Cooper ER,Charurat M,Mofenson L,et al.Combination antiretroviral strategies for the treatment of pregnant HIV-1-infected women and prevention of perinatal HIV-1 transmission[J].J Acquir Immune Defic Syndr,2002,29(5):484-494.
[24]Machado ES,Hofer CB,Costa TT,et al.Pregnancy outcome in women infected with HIV-1 receiving combination antiretroviral therapy before versus after conception[J].Sex Transm Infect,2009,85(2):82-87.
[25]Mwanyumba F,Claeys P,Gaillard P,et al.Correlation between maternal and infant HIV infection and low birth weight:a study in Mombasa,Kenya[J].J Obstet Gynaecol,2001,21(1):27-31.
[26]中华人民共和国国家卫生和计划生育委员会.预防艾滋病、梅毒和乙肝母婴传播工作实施方案[R].2015.