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Received:September 12, 2022 Published Online:December 20, 2022
Received:September 12, 2022 Published Online:December 20, 2022
中文摘要: 目的 分析人类免疫缺陷病毒(HIV)感染孕产妇的妊娠结局,为完善HIV感染母婴阻断措施并消除HIV母婴传播提供依据。方法 收集2017年1月至2020年12月南京市第二医院收治41例HIV感染孕产妇的临床资料,对其妊娠结局、孕产期阻断措施、母婴并发症及母婴阻断临床效果进行分析。结果 11例(26.83%)HIV感染孕妇选择终止妊娠。30例(73.17%)选择继续妊娠至分娩,对其进行HIV母婴阻断干预,尽早使用抗反转录病毒药物治疗,其中21例(70.00%)服用齐多夫定(AZT)+拉米夫定(3TC)+洛匹那韦/利托那韦(LPV/r),9例(30.00%)服用AZT+3TC+依非韦伦(EFV);28例(93.33%)行剖宫产,2例(6.67%)经阴道分娩。孕产妇无严重并发症发生。出生活产婴儿30例,新生儿体重1 790~3 600(2 876.00±556.71) g,出生后Apgar评分9~10分28例,7~9分2例。阻断儿服用抗病毒药物并予人工喂养,其中19例(63.33%)服AZT,11例(36.67%)服奈韦拉平。婴儿随访率100%,≥18月龄30例,早期诊断检测率为100%,早期核酸检测阳性0例,18月HIV抗体检测阳性0例,HIV母婴传播率0,母婴阻断成功率100%。随访的婴儿生长发育情况未见明显异常。结论 对HIV感染孕妇尽早使用抗反转录病毒药物治疗,安全助产,阻断儿服用抗病毒药物并予人工喂养,能有效降低艾滋病母婴传播,是控制儿童艾滋病的重要措施。
Abstract:Objective To analyze the pregnancy outcome of pregnant women infected with human immunodeficiency virus(HIV), so as to provide a basis for improving the measures to block HIV infection from mother to child and eliminating HIV transmission from mother to child. Methods Clinical data of 41 HIV infected pregnant women admitted to Nanjing Second Hospital from January 2017 to December 2020 was collected. The pregnancy outcomes, blocking measures during pregnancy and childbirth, maternal and infant complications, and clinical effects of maternal and infant blocking were analyzed. Results There were 11(26.83%) HIV infected pregnant women chose to terminate their pregnancy. Thirty cases(73.17%) chose to continue their pregnancy to delivery, and they were intervened with HIV maternal and infant blocking, and treated with antiretroviral drugs as early as possible. Among them, 21 cases(70.00%) took zidovudine(AZT)+lamivudine(3TC)+lopinavir/ritonavir(LPV/r), and 9 cases(30.00%) took AZT+3TC+efviren(EFV). Cesarean section was performed in 28 cases(93.33%) and vaginal delivery in 2 cases(6.67%). There was no serious complication. There were 30 live born infants, with a newborn weight of 1 790-3 600(2 876.00±556.71) g, 28 cases with Apgar score of 9-10 points and 2 cases with Apgar score of 7-9 points after birth. Blocked infants were given antiviral drugs and artificial feeding. Among them, 19 cases(63.33%) took AZT, and 11 cases(36.67%) took nevirapine. The follow-up rate of infants was 100%. There were 30 infants older than 18 months and the detection rate of early diagnosis was 100%. There was no infant with positive nucleic acid detection at early stage, and no infant with positive HIV antibody detection at 18 months. The transmission rate of HIV from mother to child was 0, and the success rate of mother to child block was 100%. There was no obvious abnormality in the growth and development of the follow-up infants. Conclusion Early use of antiretroviral drugs for HIV infected pregnant women, safe midwifery, blocking the use of antiretroviral drugs and artificial feeding of children can effectively reduce mother to child transmission of AIDS, which is an important measure to control children's AIDS.
keywords: Human immunodeficiency virus Acquired immunodeficiency syndrome Pregnancy outcome Maternal and infant block Zidovudine Nevirapine Lamivudine Lopinavir/litonavir Antiretroviral drugs
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