我国部分地区预防HIV母婴传播不同用药方案效果分析  

Efficacy analysis of different antiretroviral drug regimens in mother to child HIV transmission prevention in some regions of China

作　　者：王临虹[1] 方利文[1] 王前[1] 王潇滟[1] 王芳[1] 王爱玲[1] 乔亚萍[1] 

机构地区：[1]中国疾病预防控制中心妇幼保健中心,北京100050

出　　处：《中华预防医学杂志》2010年第11期1007-1011,共5页Chinese Journal of Preventive Medicine

基　　金：中英艾滋病策略支持项目（CHARTS2009-02-04）

摘　　要：目的研究分析我国HIV感染孕产妇应用抗逆转录病毒药物预防HIV母婴传播（prevention of mother to child transmission of HIV，简称PMTCT）的效果。方法2006年1月1日至2008年12月30日，在我国河北、山西、辽宁等23个省（自治区）的局部县（区）的医疗保健机构接受孕产期保健的1072对HIV感染孕产妇及所生满18月龄并有HIV抗体检测结果的婴幼儿作为研究对象，对感染孕产妇进行问卷调查，收集社会人口学资料、应用抗逆转录病毒药物、安全分娩、人工喂养等一系列PMTCT相关信息，运用Cochran．Mantel．Haenszel（简称CMH）卡方检验，分析不同时期用药方案的变化趋势；运用分层分析及Fisher精确χ^2检验，研究比较不同抗逆转录病毒药物方案对HIV母婴传播率的影响。抗逆转录药物应用方案主要为单一奈伟拉平（NVP）药物方案、预防性抗逆转录病毒药物联合方案及治疗性抗逆转录病毒联合方案。结果共调查1072对HIV感染产妇及所生婴幼儿，31名满18月龄HIV感染孕产妇所生儿童确认感染HIV，HIV母婴传播率为2．9％（31／1072）。（1）HIV感染孕产妇抗病毒药物应用比例从2006年的76．4％（306／395）上升至2008年的83．8％（372／444），呈逐年递增趋势（CMHχ^2=6．4，P〈0．05）。（2）2006年HIV感染孕产妇应用三联抗病毒药物的比例仅为3．4％（6／178），2008年，产妇应用三联药物的比例升至26．3％（104／395），逐年上升（CMHχ^2=53．1，P〈0．01），而单一NVP应用比例逐年下降，由2006年的88．8％（158／178）降至2008年的70．9％（264／372）（CMH）（2=48．5，P〈0．01）。（3）接受阴道分娩服务和人工喂养的产妇，联合抗病毒药物方案组发生HIV母婴传播水平仅为1．0％（1／104），低于应用单一NVP组HIV母婴传播率（5．9％，16／272）（Fisherχ^2=5．5，P〈0．05）。（4）在人工喂养的情况下，阴道Objective To determine the efficacy of different antiretroviral drug regimens in mother to child HIV transmission prevention （PMTCT） in China. Methods From January 1st 2006 to Dee 30tb 2008, a total of 1072 pairs of HIV positive pregnant women and their babies who were HIV antibody positive and older than 18 months were recruited in this study. These women who had received maternal health care in health care institutions were from 23 provinces. Subjects were investigated by questionnaire, including social demographic data, usage of ARVs, safe delivery and artificial feeding, and other PMTCT related informations. The trend of different antiretroviral drug regiments in different period were analyzed by Cochran- Mantel-Haenszel （ CMH ） X2 test. By stratified analysis and Fisher exact χ^2 test, the efficacy of different antiretroviral drug regimens in mother to child HIV transmission prevention were studied. Antiretroviral drug regimens applications mainly included sd-NVP drug regimen, prophylaxis regimen and highly active antiretroviral therapy （HAART）. Results Among 1072 pairs of HIV positive maternities and babies,31 babies older thah 18 months were HIV infected, MTCT rate was 2. 9% （31/1072）. （1）The proportion of using ARVs was increasing from 76.4% （ 306/395 ） in 2006 to 83.8% （ 372/444 ） in 2008, the difference was significant（ CMH χ^2 = 6. 4, P 〈0. 05）. （2）The ratio that HIV infeeted maternities adopted ARVs rose from 3.4% （ 6/178 ） in 2006 to 26. 3 % （ 104/395 ） in 2008, the ratio increased year by year （ CMH χ^2 = 53.1, P 〈 0. 01 ）. On the contrary, usage of sd-NVP declined from 88.8% （ 158/178 ） in 2006 to 70. 9% （ 264/372 ） in 2008 （ CMH χ^2 = 48. 5, P 〈 0. 01 ）. （ 3 ） Among maternities adopted vaginal delivery and artificial feeding, the MTCT rate of ARVs combination group was 1.0% （ 1/104 ）, while the MTCT rate of sd-NVP group was 5.9% （ 16/272 ） （ Fisher χ^2 = 5. 5, P 〈 0. 05 ）. （ 4 ） In the case of artificial f

关 键 词：HIV 疾病传播 垂直 抗逆转录病毒药 评价研究 

分 类 号：R686[医药卫生—骨科学]