艾滋病母婴传播与阻断.ppt

HIV母婴传播与阻断 王珊珊 疾控二科 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。 * * * Azt 300 bid, 3tc 150mg bid, and NVP 200 mg bid * Recommended regimen: highly effective regimen, substantially reduces in utero transmission, maternal azt/3tc “tail” may reduce the development of maternal resistance, infant azt reduces risk of nvp resistance Alternative: higher risk of developing NVP resistance because of the single dose. * * RECOMMENDED: Advantages: SD-NVP effective at reducing MTCT by ~40%, tail will reduces the development of maternal resistance, and infant azt will also reduce the risk of infant NVP resistance; Disadvnatages: more complex, unclear if 4 weeks has added benefit Alternative, advantages no risk of NVP resistance Minumum: SD-NVP effective at reducing MTCT by ~40%, tail reduces development of maternal NVP resistance * * * * * * * * * * Monforte 1991, Ometto 1995, Landesman 1996, Thea 1997, MacDonald 1998, OShea 1998, Mofeson 1999, Shapiro 1999, Chuachoowong 2000, Welles 2000, Goedert 2001, Arroyo 2002, Yang 2003, Tuomala 2003, Shapiro 2004, Winchester 2004 Others: anemia, vitamin a deficiency Viral Load: Without treatment: 1000-10,000 (16%) 10,000-50,000 (20%) 50,000-100,000 (30%) * chori * Prematurity: ?related to dosing of steroids Lesions = lmtd evidence Mixed feeding: GI damage due to cow’s milk, allergic rxns, and infections may ? incr. HIV infection rate * * Now regimen has been changed to Azt 300 mg bid * * * * Drug resistance in the Mother 母亲的药物耐药情况 AZT 齐多夫定 1/36 developed resistance mutation 1/36 发展出耐药变异菌株 NVP 奈韦拉平 3/16 developed resistance mutation 3/16 发展出耐药变异菌株 * * * Think of LA if nausea / vomiting abdominal pain SOB Severe leg and arm weakness PACTG 1022: RCT HAART with NVP vs. NFV (Hitti, JAIDS 2004) Incident hepatic toxici