Determinants of mother-to-infant human immunodeficiency virus 1 transmission before and after the introduction of zidovudine prophylaxis

被引：21

作者：

de Martino, M ^{[1
]}

Galli, L ^{[1
]}

Tovo, PA ^{[1
]}

Gabiano, C ^{[1
]}

Pezzotti, P ^{[1
]}

Wagner, TM ^{[1
]}

Rezza, G ^{[1
]}

Osimani, P ^{[1
]}

De Mattia, D ^{[1
]}

Di Bari, C ^{[1
]}

Ruggeri, M ^{[1
]}

Baldi, F ^{[1
]}

Ciccia, M ^{[1
]}

Lanari, M ^{[1
]}

Masi, M ^{[1
]}

Venturi, V ^{[1
]}

Battisti, L ^{[1
]}

Duse, M ^{[1
]}

Chiriacò, PG ^{[1
]}

Cavallini, R ^{[1
]}

Dessì, C ^{[1
]}

Pintor, C ^{[1
]}

Anastasio, E ^{[1
]}

Sabatino, G ^{[1
]}

Sticca, M ^{[1
]}

Pomero, G ^{[1
]}

Bezzi, T ^{[1
]}

Chiappini, E ^{[1
]}

De Luca, M ^{[1
]}

Gervaso, P ^{[1
]}

Cecchi, MT ^{[1
]}

Bassetti, D ^{[1
]}

Gotta, C ^{[1
]}

Rosso, R ^{[1
]}

Timitilli, A ^{[1
]}

Tondo, U ^{[1
]}

Mussini, P ^{[1
]}

Bricalli, D ^{[1
]}

Bucceri, A ^{[1
]}

Ferraris, G ^{[1
]}

Giovannini, M ^{[1
]}

Mosca, F ^{[1
]}

Lipreri, R ^{[1
]}

Guarino, A ^{[1
]}

Plebani, A ^{[1
]}

Riva, E ^{[1
]}

Riva, S ^{[1
]}

Viganò, A ^{[1
]}

Zuccotti, GV ^{[1
]}

Cellini, M ^{[1
]}

机构：

[1] Univ Florence, Dept Pediat, I-50132 Florence, Italy

来源：

ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE | 2002年 / 156卷 / 09期

关键词：

D O I：

10.1001/archpedi.156.9.915

中图分类号：

R72 [儿科学];

学科分类号：

100202 ;

摘要：

Background: Randomized controlled trials have demonstrated that zidovudine therapy decreases the mother-to-infant transmission of human immunodeficiency virus 1 (HIV-1). Data from large observational studies may provide further important findings on the effectiveness at the population level of combined treatments in decreasing transmission. Objective: To evaluate time trends in prophylactic interventions and the determinants of transmission both before and after the introduction of antiretroviral prophylaxis, and in treated and untreated mother-infant pairs after 1995. Design and Setting: Analysis of prospective data on 3770 children born to HIV-1-infected women between 1985 and 1999 and reported to the Italian Register for HIV Infection in Children. Main Outcome Measures: Logistic regression random effects models were used to estimate crude and adjusted odds ratios for several factors potentially influencing vertical transmission for 2periods-1985 through 1995 (January 1, 1985, through December 31,1995) and 1996 through 1999 (January 1, 1996, through December 31, 1999), and between treated and untreated children after 1995. Results: The transmission rate was 15.5% in the 19851995 period and 5.8% in the 1996-1999 period. By 1999, prophylactic interventions had greatly increased. Antiretroviral treatment (ART) usage was 89.9%, (55.1% combination ART) and the elective cesarean delivery rate was 81.3%. In multivariate analysis, only elective cesarean delivery was associated with a lower risk of mother-to-infant transmission before 1995. After 1995, nonbreastfeeding and receipt of ART were protective whereas elective cesarean delivery was not significantly protective in multivariate analysis. Transmission risk was reduced by 76% with an incomplete zidovudine regimen, 88% with a complete regimen, and 93% when the mother received combination ART. In the 1996-1999 period, the transmission rate for nonbreastfeeding mother-infant pairs was 8.6% with elective cesarean delivery, 4.4% with any ART, and 2.4% with these interventions combined. Conclusion: Prophylactic interventions, and in particular ART, reduced perinatal HIV-1 transmission at a population level in Italy.

引用

页码：915 / 921

页数：7

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