艾滋病母婴阻.ppt

HIV母婴传播与阻断 邱云珍 滁州市第一人民医院感染科 MTCT HIV母婴传播是指HIV阳性的妇女在怀孕、阴道分娩以及母乳喂养的过程中，所生的婴儿被HIV感染。它们是HIV传播的重要的途径。 HIV感染的母亲所生的婴儿约有1/3为HIV感染者。 如果给于药物治疗和产前、产时阻断，婴儿生后人工喂养，可使母婴传播率降低50-67%。 如果选择正确的分娩方式（剖宫产）+药物治疗和产前阻断+人工喂养可使传播率降至更低，甚至1-2%。 总结 目前认为母婴传播途径是可以通过干预手段而被阻断。 阻断HIV母婴传播的金标准为： 药物治疗+产科干预+人工喂养。 * * * * Mirochnik P1026 and Stek AIDS 2006: intensive pharmacokinetic study of lopinavir levels in 17 pregnant women between weeks 30 and 36 of pregnancy, and again six to twelve weeks postpartum. Sampling took place at a median of 35 weeks into pregnancy, after participants had received a median of 25 weeks of Kaletra. At the time of delivery 14 of 16 women had viral load below 400 copies/ml, one viral load was not available and one woman had a viral load of 10,313 copies/ml. Third trimester samples showed that only three of 17 women achieved plasma lopinavir levels above 53μg h/ml, a drug level which historical data show should be achieved by 90% of adults receiving Kaletra. None of the women reached the median drug exposure for non-pregnant adults. The authors say that induction of the cytochrome p450 3A4 enzyme responsible for metabolising lopinavir is one likely explanation; induction of this enzyme has been observed previously in pregnant women, and would be expected to increase the speed of drug clearance. They also speculate that increased intestinal p-glycoprotein activity could result in poorer lopinavir absorption. Lyons: 16 women initiated lopinavir/rtv in pregnancy and had trough levels performed in the third trimester. 14(88%) were Black African and all of these were HIV nonB subtype. Median gestation at lopinavir/rtv initiation = 25 weeks (range 14-31). The median trough lopinavir level in the third trimester (median gestation at sampling 34 weeks) = 3660ng/ml (249-5655). 15(94%) had trough levels above the minimum trough required to inhibit WT HIV(1000ng/ml). 14(88%) had undetectable viral loads at that time and adherence issues were identified in the other 2(viral loa