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【摘要】 目的探讨以三联高效抗逆转录病毒药物治疗(highly active antiretrorival therapy,HAART)为主的综合措施预防人类免疫缺陷病毒(HIV)和丙型肝炎病毒(HCV)合并感染者HIV母婴传播效果。方3法 给HIV/HCV合并感染的孕妇孕期应用三联高效抗逆转录病毒药物治疗,方案为AZT+3TC+EFV或AZT+3TC+NVP,结合安全分娩和人工喂养预防HIV母婴传播。结果 21例婴儿中有8例年满12月龄行HIV抗体检测结果均阴性,13例年满18月龄行HIV抗体检测结果均阴性,现阶段母婴传播率为零。结论 HIV/HCV合并感染的孕产妇孕期应用三联高效抗逆转录病毒药物治疗为主的综合措施,HIV母婴传播阻断效果与单纯HIV感染母婴阻断效果相比较效果相似。�
【关键词】 人类免疫缺陷病毒;丙型肝炎病毒;高效抗逆转录病毒药物治疗;母婴阻断��
To analyze the interdiction effect of HIV maternal-neonatal transmission on patient who infects concurrently HIV and HCV
PANG Jun, HUANG Shao-biao,PANG lian-hua,et al. The fourth People’s Hospital of Nanning, Guangxi,530023, China
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【Abstract】 Objective To investigate the effect of preventing human immunodeficiency virus(HIV) maternal-neonatal transmission on patient who infects concurrently HIV and hepatitis C virus(HCV) by using comprehensive measures as trigeminal highly active antiretrorival therapy mainly. Methods To apply trigeminal HAART for pregnant woman who infects concurrently HIV and HCV in gestational period, the plan includes AZT and 3TC and EFV, or AZT and 3TC and NVP, combining safe delivery and artificial feeding prevent HIV maternal-neonatal transmission. ResultsIn twenty-one infants’ HIV antibody testing results, eight ones who are twelve month’s age are negative, and thirteen ones who are eighteen month’s age are negative too, the rate of maternal-neonatal transmission is zero at the present stage. Conclusion To compare with the interdiction effect of HIV maternal-neonatal transmission on pregnant woman who infects merely HIV, the patient, who infects concurrently HIV and HCV in gestational period, is similar, by using comprehensive measures as trigeminal HAART mainly.�
【Key words】 Human immunodeficiency virus(HIV); Hepatitis C virus(HCV); Highly active antiretrorival therapy(HAART) ; Interdiction of maternal-neonatal transmission
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人类免疫缺陷病毒(HIV)和丙型肝炎病毒(HCV)具有相似的传播途径,均可经血液传播、性传播和母婴传播,二者可以合并感染。现将我院人类免疫缺陷病毒和丙型肝炎病毒(HIV/HCV)合并感染的孕产妇预防HIV母婴传播的措施和阻断效果分析报告如下。�
1 资料与方法�
1.1 一般资料 入选病例为2006年1月至2009年3月在我院住院分娩,孕期经三联高效抗逆转录病毒药物治疗(HAART)的HIV/HCV合并感染的21例孕产妇,产时年龄最大40岁,最小20岁,平均28岁,初产妇17例,经产妇4例。全部病例经中国广西壮族自治区疾病预防控制中心(CDC)进行免疫印迹试验(western biot,WB),结果阳性后确诊HIV感染,全部病例通过微粒化学发光法检测抗HCV IgM/IgM,荧光定量聚合酶链反应检测 HCV RNA。HCV RNA(+)和(或)抗-HCV(+)诊断为HCV感染(肝功能血清ALT、AST均正常)。�
1.2 方法
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基金项目:广西医疗卫生科学研究基金(项目编号:Z2009014)�
作者单位:530023 南宁市第四人民医院/南宁市传染病医院产科(庞俊 潘莲花 刘冬梅 韦淑珍),感染科(黄绍标)�
1.2.1 抗逆转录病毒治疗的时机 HIV/HCV合并感染的孕妇选择抗病毒治疗的时机是根据孕妇确诊HIV感染的时间结合孕妇的免疫状态选择抗病毒治疗时机,本组病例无艾滋病(AIDS)指征性疾病,以免疫抑制指标为依据,基线CD4+T淋巴细胞250/mm�3孕妇不选择含有NVP的方案,孕前3月及孕早期避免服用EFV,孕前已经开始抗病毒治疗者用AZT替代正在服用方案中的d4T。婴儿出生后尽早选择抗病毒药物(AZT+NVP)预防性治疗,AZT用药时间为母亲用药≥4周,婴儿用药1周,如果母亲用药不足4周,婴儿用药应持续4周;NVP用药1次。�
1.2.3 产科处理 安全分娩是产科处理的总原则。经规范抗病毒治疗有条件在孕晚期产前检测病毒载量(VL)250/mm�3孕妇不选择含有NVP的方案,治疗期间均无药物相关肝毒性的发生。本组21例HIV/HCV合并感染的孕产妇在孕期应用HAART方案治疗,结合安全分娩和人工喂养,HIV母婴传播率为零,HIV/HCV合并感染者HIV母婴传播阻断效果与单纯HIV感染者母婴阻断效抗逆转录病毒药物果相比较效果明显。因本组样本仅有21例,无合并转氨酶升高病例,需扩大样本量后继续研究。�
总之,孕期用药联合抗逆转录病毒药物特别是三联高效抗逆转录病毒药物治疗(HAART),结合安全分娩和人工喂养,HIV/HCV合并感染者HIV母婴传播阻断效果是良好的。�
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