夫妇单方艾滋病病毒感染家庭生育问题研究
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摘要
目的:由于艾滋病抗病毒治疗不断取得进展,艾滋病病毒(HIV)感染者寿命延长和生活质量的改善,处于生育期的HIV感染者家庭对生育子女的需求越来越强烈。夫妇单方HIV感染家庭的生育需求是导致其配偶感染HIV的重要原因。为生育孩子,不能坚持使用安全套和(或)没有接受规范的抗病毒治疗,并且在缺乏医护人员的正确指导下受孕,会导致配偶感染和母婴传播发生。本文综合国内外文献资料探讨夫妇单方HIV感染家庭如何低风险生育。
As progress has been made in HIV antiretroviral treatment, the life span of HIV-infected individuals has been prolonged and the quality of life has been improved, the childbearing desire of HIV-infected individuals and their families in childbearing period has become more and more intense. The childbearing desire in discordant couples is the important reason for spouse HIV positive seroconversion. In order to born child, discordant couples may be not constantly use of condoms or not receive antiretroviral treatment, and lacks of proper guidance of conceive from medical staff, which will result in negative spouses infected with HIV and mother-to-child transmission. This article synthesizes the domestic and foreign literature material to explore how to reduce the risk of HIV infection for discordant couples who have childbearing desire.
As progress has been made in HIV antiretroviral treatment, the life span of HIV-infected individuals has been prolonged and the quality of life has been improved, the childbearing desire of HIV-infected individuals and their families in childbearing period has become more and more intense. The childbearing desire in discordant couples is the important reason for spouse HIV positive seroconversion. In order to born child, discordant couples may be not constantly use of condoms or not receive antiretroviral treatment, and lacks of proper guidance of conceive from medical staff, which will result in negative spouses infected with HIV and mother-to-child transmission. This article synthesizes the domestic and foreign literature material to explore how to reduce the risk of HIV infection for discordant couples who have childbearing desire.
引文
[1] 中国疾病预防控制中心性病艾滋病预防控制中心,性病控制中心.2017年12月全国艾滋病性病疫情[J].中国艾滋病性病,2018,24(2):111.
[2] 中国疾病预防控制中心性病艾滋病预防控制中心.2011年全国艾滋病防治工作年会资料[R].2011.
[3] 中华人民共和国卫生部,联合国艾滋病规划署,世界卫生组织.2011年中国艾滋病疫情估计[R].2011.
[4] 汤后林,吴尊友.HIV单阳配偶间性传播预防策略的研究进展[J].中华预防医学杂志,2012,46(11):1030-1033.
[5] 乔晓春,申俊萍,卫军,等.山西省家庭内夫妻间HIV性传播及影响因素的研究[J].中国预防医学杂志,2009,10(11):976-979.
[6] 李林,李敬云,鲍作义,等.影响艾滋病病毒异性性传播有关因素的研究[J].中华流行病学杂志,2003,24(11):980-983.
[7] 潘晓红,杨介者,陈琳,等.浙江省农村外省来源婚嫁女艾滋病病毒感染和家庭内传播研究[J].中华预防医学杂志,2010,45(11):1023-1026.
[8] 单多,段松,崔岩,等.云南省德宏州2009年新报告HIV感染者溯源调查[J].中华预防医学杂志,2011,45(11):965-970.
[9] 国务院办公厅.国务院办公厅印发《中国遏制与防治艾滋病“十三五”行动计划》(国办发[2017]8号)[R] .2017.
[10] Heard I,Sitta R,Lert F.Reproductive choice in men and women living with HIV:evidence from a large representative sample of outpatients attending French hospitals (ANRS-EN12-VESPA Study)[J].Aids,2007,21:77-82.
[11] Barreiro P,del Romero J,Leal M,et al.Natural pregnancies in HIV-serodiscordant couples receiving successful antiretroviral therapy[J].JAIDS Journal of Acquired Immune Deficiency Syndromes,2006,43(3):324-326.
[12] 汤后林.艾滋病单阳家庭配偶阳转的影响因素及传播模型研究[D].中国疾病预防控制中心,2014.
[13] Brubaker S,Bukusi E,Odoyo J,et al.Pregnancy and HIV transmission among HIV‐discordant couples in a clinical trial in Kisumu,Kenya[J].HIV medicine,2011,12(5):316-321.
[14] Mmeje O,Cohen CR,Cohan D.Evaluating safer conception options for HIV-serodiscordant couples (HIV-infected female/HIV-uninfected male):a closer look at vaginal insemination[J].Infectious diseases in obstetrics and gynecology,2012:587651.
[15] Berhan Y,Berhan A.Meta-analyses of fertility desires of people living with HIV[J].BMC Public Health,2013,13:409.
[16] Wanyenze RK,Wagner GJ,Tumwesigye NM,et al.Fertility and contraceptive decision-making and support for HIV infected individuals:client and provider experiences and perceptions at two HIV clinics in Uganda[J].BMC Public Health,2013,13(1):98.
[17] 中国疾病预防控制中心性病艾滋病预防控制中心.2017年全国艾滋病丙肝性病防治工作年会[R].2017.
[18] 云南网.实施HIV母婴阻断干预云南婴儿感染率仅1.5%[EB/OL].http://ya.yunnan.cn/htnd/2013-05-31/content_2751806.
[19] 詹会莲,池开丰,和志奇,等.2008～2013年丽江市艾滋病母婴传播趋势及母婴阻断效果[J].中国妇幼保健,2014,29(21):3377-3379.
[20] 赵慧贞,程黎,戚小兵,等.珠海市香洲区2008—2013年孕产妇艾滋病感染及母婴阻断分析[J].中外医疗,2014,(14):130-132.
[21] Matthews LT,Baeten JM,Celum C,et al.Periconception pre-exposure prophylaxis to prevent HIV transmission:benefits,risks,and challenges to implementation[J].Aids,2010,24(13):1975-1982.
[22] Cook R,Hayden R,Weiss SM,et al.Desire for fertility among HIV-seroconcordant and -discordant couples in Lusaka,Zambia[J].Culture Health & Sexuality,2014,16(7):741-751.
[23] Adilo TM,Wordofa HM.Prevalence of fertility desire and its associated factors among 15- to 49-year-old people living with HIV/AIDS in Addis Ababa,Ethiopia:a cross-sectional study design[J].HIV/AIDS - Research and Palliative Care,2017,9:167-176.
[24] Mindry D,Wagner G,Lake J,et al.Fertility Desires Among HIV-Infected Men and Women in Los Angeles County:Client Needs and Provider Perspectives[J].Maternal and Child Health Journal,2013,17:593-600.
[25] Cohen MS,Chen YQ,McCauley M,et al.Prevention of HIV-1 infection with early antiretroviral therapy[J].N Engl J Med,2011,365(6):493-505.
[26] Anglemyer A,Horvath T,Rutherford G.Antiretroviral therapy for prevention of HIV transmission in HIV-discordant couples[J].JAMA,2013,310(15):1619-1620.
[27] Del Romero J,Castilla J,Hernando V,et al.Combined antiretroviral treatment and heterosexual transmission of HIV-1:cross sectional and prospective cohort study[J].BMJ:British Medical Journal,2010,340.
[28] Chen JL,Phillips KA,Kanouse DE,et al.Fertility desires and intentions of HIV-positive men and women[J].Family planning perspectives,2001:144-165.
[29] Barreiro P,Castilla JA,Labarga P,et al.Is natural conception a valid option for HIV-serodiscordant couples?[J].Human reproduction,2007,22(9):2353-2358.
[30] Mandelbrot L,Heard I,Henrion-Geant E,et al.Natural conception in HIV-negative women with HIV-infected partners[J].The Lancet,1997,349(9055):850-851.
[31] Vernazza PL,Graf I,Sonnenbergschwan U,et al.Preexposure prophylaxis and timed intercourse for HIV-discordant couples willing to conceive a child[J].Aids,2011,25(16):2005-2008.
[32] Savasi V,Mandia L,Laoreti A,et al.Reproductive assistance in HIV serodiscordant couples[J].Human Reproduction Update,2013,19(2):136-150.
[33] Barreiro P,Castilla JA,Labarga P,et al.Is natural conception a valid option for HIV-serodiscordant couples?[J].Human Reproduction,2007,22(9):2353-2358.
[34] Vernazza P,Hirschel B,Bernasconi E,et al.Les personnes sropositives ne souffrant daucune autre MST et suivant un traitment antirtroviral efficace ne transmettent pas le VIH par voie sexuelle[J].Bull Med Suisses,2008,89(5):165-169.
[35] Medicine ECoASfR.Human immunodeficiency virus (HIV) and infertility treatment:a committee opinion[J].Fertility & Sterility,2015,104(1):1-8.
[36] Zakarin SL,Sauer MV.Fertility care interventions should be provided as the first line options for HIV+ serodiscordant couples who desire children in settings with affordable access to care,regardless of their fertility status[J].Journal of the International Aids Society,2017,20(Suppl 1):12-17.
[37] Vernazza PL,Graf I,Sonnenberg-Schwan U,et al.Preexposure prophylaxis and timed intercourse for HIV-discordant couples willing to conceive a child[J].Aids,2011,25(16):2005-2008.
[38] Chadwick RJ,Mantell JE,Moodley J,et al.Safer conception interventions for HIV-affected couples:implications for resource-constrained settings[J].Topics in Antiviral Medicine,2011,19(4):148-155.
[39] Bekker LG,Black V,Myer L,et al.Guideline on safer conception in fertile HIV-infected individuals and couples[J].Southern African Journal of Hiv Medicine,2011,12(2):31-44.
[40] Harper KN.The best way to proceed when an HIV-discordant couple desires a child[J].Aids,2015,29(16):23.
[41] 《国家免费艾滋病抗病毒药物治疗手册》编写组.国家免费艾滋病抗病毒药物治疗手册[M].第3版.北京:人民卫生出版社,2014:18.
[42] Sun L,Wang F,Liu A,et al.Natural Conception May Be an Acceptable Option in HIV-Serodiscordant Couples in Resource Limited Settings[J].Plos One,2015,10(11):142085.
[43] 卢瑞朝,张勇,蔡卫平.6例健康孕妇非职业暴露于HIV后的妊娠报道[J].检验医学与临床,2011,8(7):824-825.
[44] 中国疾病预防控制中心 .中国艾滋病诊疗指南(2018 版)[J].中华内科杂志,2018,57(12):1-18.
[2] 中国疾病预防控制中心性病艾滋病预防控制中心.2011年全国艾滋病防治工作年会资料[R].2011.
[3] 中华人民共和国卫生部,联合国艾滋病规划署,世界卫生组织.2011年中国艾滋病疫情估计[R].2011.
[4] 汤后林,吴尊友.HIV单阳配偶间性传播预防策略的研究进展[J].中华预防医学杂志,2012,46(11):1030-1033.
[5] 乔晓春,申俊萍,卫军,等.山西省家庭内夫妻间HIV性传播及影响因素的研究[J].中国预防医学杂志,2009,10(11):976-979.
[6] 李林,李敬云,鲍作义,等.影响艾滋病病毒异性性传播有关因素的研究[J].中华流行病学杂志,2003,24(11):980-983.
[7] 潘晓红,杨介者,陈琳,等.浙江省农村外省来源婚嫁女艾滋病病毒感染和家庭内传播研究[J].中华预防医学杂志,2010,45(11):1023-1026.
[8] 单多,段松,崔岩,等.云南省德宏州2009年新报告HIV感染者溯源调查[J].中华预防医学杂志,2011,45(11):965-970.
[9] 国务院办公厅.国务院办公厅印发《中国遏制与防治艾滋病“十三五”行动计划》(国办发[2017]8号)[R] .2017.
[10] Heard I,Sitta R,Lert F.Reproductive choice in men and women living with HIV:evidence from a large representative sample of outpatients attending French hospitals (ANRS-EN12-VESPA Study)[J].Aids,2007,21:77-82.
[11] Barreiro P,del Romero J,Leal M,et al.Natural pregnancies in HIV-serodiscordant couples receiving successful antiretroviral therapy[J].JAIDS Journal of Acquired Immune Deficiency Syndromes,2006,43(3):324-326.
[12] 汤后林.艾滋病单阳家庭配偶阳转的影响因素及传播模型研究[D].中国疾病预防控制中心,2014.
[13] Brubaker S,Bukusi E,Odoyo J,et al.Pregnancy and HIV transmission among HIV‐discordant couples in a clinical trial in Kisumu,Kenya[J].HIV medicine,2011,12(5):316-321.
[14] Mmeje O,Cohen CR,Cohan D.Evaluating safer conception options for HIV-serodiscordant couples (HIV-infected female/HIV-uninfected male):a closer look at vaginal insemination[J].Infectious diseases in obstetrics and gynecology,2012:587651.
[15] Berhan Y,Berhan A.Meta-analyses of fertility desires of people living with HIV[J].BMC Public Health,2013,13:409.
[16] Wanyenze RK,Wagner GJ,Tumwesigye NM,et al.Fertility and contraceptive decision-making and support for HIV infected individuals:client and provider experiences and perceptions at two HIV clinics in Uganda[J].BMC Public Health,2013,13(1):98.
[17] 中国疾病预防控制中心性病艾滋病预防控制中心.2017年全国艾滋病丙肝性病防治工作年会[R].2017.
[18] 云南网.实施HIV母婴阻断干预云南婴儿感染率仅1.5%[EB/OL].http://ya.yunnan.cn/htnd/2013-05-31/content_2751806.
[19] 詹会莲,池开丰,和志奇,等.2008～2013年丽江市艾滋病母婴传播趋势及母婴阻断效果[J].中国妇幼保健,2014,29(21):3377-3379.
[20] 赵慧贞,程黎,戚小兵,等.珠海市香洲区2008—2013年孕产妇艾滋病感染及母婴阻断分析[J].中外医疗,2014,(14):130-132.
[21] Matthews LT,Baeten JM,Celum C,et al.Periconception pre-exposure prophylaxis to prevent HIV transmission:benefits,risks,and challenges to implementation[J].Aids,2010,24(13):1975-1982.
[22] Cook R,Hayden R,Weiss SM,et al.Desire for fertility among HIV-seroconcordant and -discordant couples in Lusaka,Zambia[J].Culture Health & Sexuality,2014,16(7):741-751.
[23] Adilo TM,Wordofa HM.Prevalence of fertility desire and its associated factors among 15- to 49-year-old people living with HIV/AIDS in Addis Ababa,Ethiopia:a cross-sectional study design[J].HIV/AIDS - Research and Palliative Care,2017,9:167-176.
[24] Mindry D,Wagner G,Lake J,et al.Fertility Desires Among HIV-Infected Men and Women in Los Angeles County:Client Needs and Provider Perspectives[J].Maternal and Child Health Journal,2013,17:593-600.
[25] Cohen MS,Chen YQ,McCauley M,et al.Prevention of HIV-1 infection with early antiretroviral therapy[J].N Engl J Med,2011,365(6):493-505.
[26] Anglemyer A,Horvath T,Rutherford G.Antiretroviral therapy for prevention of HIV transmission in HIV-discordant couples[J].JAMA,2013,310(15):1619-1620.
[27] Del Romero J,Castilla J,Hernando V,et al.Combined antiretroviral treatment and heterosexual transmission of HIV-1:cross sectional and prospective cohort study[J].BMJ:British Medical Journal,2010,340.
[28] Chen JL,Phillips KA,Kanouse DE,et al.Fertility desires and intentions of HIV-positive men and women[J].Family planning perspectives,2001:144-165.
[29] Barreiro P,Castilla JA,Labarga P,et al.Is natural conception a valid option for HIV-serodiscordant couples?[J].Human reproduction,2007,22(9):2353-2358.
[30] Mandelbrot L,Heard I,Henrion-Geant E,et al.Natural conception in HIV-negative women with HIV-infected partners[J].The Lancet,1997,349(9055):850-851.
[31] Vernazza PL,Graf I,Sonnenbergschwan U,et al.Preexposure prophylaxis and timed intercourse for HIV-discordant couples willing to conceive a child[J].Aids,2011,25(16):2005-2008.
[32] Savasi V,Mandia L,Laoreti A,et al.Reproductive assistance in HIV serodiscordant couples[J].Human Reproduction Update,2013,19(2):136-150.
[33] Barreiro P,Castilla JA,Labarga P,et al.Is natural conception a valid option for HIV-serodiscordant couples?[J].Human Reproduction,2007,22(9):2353-2358.
[34] Vernazza P,Hirschel B,Bernasconi E,et al.Les personnes sropositives ne souffrant daucune autre MST et suivant un traitment antirtroviral efficace ne transmettent pas le VIH par voie sexuelle[J].Bull Med Suisses,2008,89(5):165-169.
[35] Medicine ECoASfR.Human immunodeficiency virus (HIV) and infertility treatment:a committee opinion[J].Fertility & Sterility,2015,104(1):1-8.
[36] Zakarin SL,Sauer MV.Fertility care interventions should be provided as the first line options for HIV+ serodiscordant couples who desire children in settings with affordable access to care,regardless of their fertility status[J].Journal of the International Aids Society,2017,20(Suppl 1):12-17.
[37] Vernazza PL,Graf I,Sonnenberg-Schwan U,et al.Preexposure prophylaxis and timed intercourse for HIV-discordant couples willing to conceive a child[J].Aids,2011,25(16):2005-2008.
[38] Chadwick RJ,Mantell JE,Moodley J,et al.Safer conception interventions for HIV-affected couples:implications for resource-constrained settings[J].Topics in Antiviral Medicine,2011,19(4):148-155.
[39] Bekker LG,Black V,Myer L,et al.Guideline on safer conception in fertile HIV-infected individuals and couples[J].Southern African Journal of Hiv Medicine,2011,12(2):31-44.
[40] Harper KN.The best way to proceed when an HIV-discordant couple desires a child[J].Aids,2015,29(16):23.
[41] 《国家免费艾滋病抗病毒药物治疗手册》编写组.国家免费艾滋病抗病毒药物治疗手册[M].第3版.北京:人民卫生出版社,2014:18.
[42] Sun L,Wang F,Liu A,et al.Natural Conception May Be an Acceptable Option in HIV-Serodiscordant Couples in Resource Limited Settings[J].Plos One,2015,10(11):142085.
[43] 卢瑞朝,张勇,蔡卫平.6例健康孕妇非职业暴露于HIV后的妊娠报道[J].检验医学与临床,2011,8(7):824-825.
[44] 中国疾病预防控制中心 .中国艾滋病诊疗指南(2018 版)[J].中华内科杂志,2018,57(12):1-18.