Three Cases of Prevention Therapy to Reduce Perinatal HIV Transmission

사람면역결핍바이러스 수직감염 예방치료 3례

  • Lee, Jae Yo (Department of Pediatrics, National Medical Center) ;
  • Park, Hyang Mi (Department of Pediatrics, National Medical Center) ;
  • Hwang, Se Hee (Department of Pediatrics, National Medical Center) ;
  • Kim, Kyeung Eun (Department of Pediatrics, National Medical Center) ;
  • Shin, Hye Jung (Department of Pediatrics, National Medical Center) ;
  • Kim, Jae Yoon (Department of Pediatrics, National Medical Center)
  • 이재요 (국립중앙의료원 소아청소년과) ;
  • 박향미 (국립중앙의료원 소아청소년과) ;
  • 황세희 (국립중앙의료원 소아청소년과) ;
  • 김경은 (국립중앙의료원 소아청소년과) ;
  • 신혜정 (국립중앙의료원 소아청소년과) ;
  • 김재윤 (국립중앙의료원 소아청소년과)
  • Received : 2010.10.01
  • Accepted : 2010.10.24
  • Published : 2011.06.25

Abstract

In 2008, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that about 430,000 children worldwide became infected with HIV, mostly through mother-to-child transmission (MTCT) during pregnancy, labor, delivery, or breastfeeding. The MTCT prevention program proved to be feasible and effective in reduction of perinatal HIV transmission. Three babies born from HIV-infected mothers were admitted to the National Medical Center in 2009. Only two women received antiretroviral (ARV) therapy during pregnancy, labor, and after delivery, and their infants received zidovudine (AZT) for 6 weeks. The outcome, after a follow-up period of 4 months to 16 months, was favorable in all patients. Thus, we emphasize the need for expansion of antenatal HIV screening of pregnant women, implemented for early HIV diagnosis and effective ARV therapy for reduction of perinatal HIV transmission.

The Joint United Nations Programme on HIV/AIDS (UNAIDS)의 통계에 의하면 2008년 한 해에 43만 명의 어린이가 HIV 에 감염된 것으로 보이며 대부분 수직감염에 의한 것으로 나타났다. 수직감염의 예방 프로그램은 이러한 감염을 줄일 수 있는 가장 효과적인 방법이다. 2009년 국립중앙의료원에는 HIV에 감염된 산모로부터 출생한 신생아 3명이 입원하였다. 이들의 산모 2명은 ARV 치료제를 투여하였고 1명은 투여하지 못했으며 3명의 환아에게는 모두 ARV 치료를 하였다. 추적관찰을 4개월에서 16개월 동안 실시한 결과 아직까지는 HIV 수직감염이 의심될 수 있는 혈청학적 검사의 특이 소견은 보이지 않고 있다. 임산부에 대한 HIV 산전검사의 확대, 조기진단 및 효과적인 ARV 치료만이 수직감염을 낮출 수 있을 것이며 저자는 이에 대한 수직감염 예방치료 3례를 경험하였기에 보고하는 바이다.

Keywords

References

  1. Adeleke SI, Mukhtar-Yola M, Gwarzo GD. Awareness and knowledge of mother-to-child transmission of HIV among mothers attending the pediatric HIV clinic, Kano, Nigeria. Ann Afr Med 2009;8:210-4. https://doi.org/10.4103/1596-3519.59573
  2. Kourtis AP, Bulterys M, Nesheim SR, Lee FK. Understanding the timing of HIV transmission from mother to infant. JAMA 2001;285:709-12. https://doi.org/10.1001/jama.285.6.709
  3. Dao H, Mofenson LM, Ekpini R, Gilks CF, Barnhart M, Bolu O, et al. International recommendations on antiretroviral drugs for treatment of HIV-infected women and prevention of mother-to-child HIV transmission in resource-limited settings: 2006 update. Am J Obstet Gynecol 2007;197:S42-55.
  4. Jamieson DJ, Clark J, Kourtis AP, Taylor AW, Lampe MA, Fowler MG, et al. Recommendations for human immunodeficiency virus screening, prophylaxis, and treatment for pregnant women in the United States. Am J Obstet Gynecol 2007;197:S26-32.
  5. Paintsil E, Andiman WA. Update on successes and challenges regarding mother-to-child transmission of HIV. Curr Opin Pediatr 2009;21:94-101. https://doi.org/10.1097/MOP.0b013e32831ec353
  6. Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States. 2010;1-20. Available from http://aidsinfo.nih.gov/ContentFiles/PerinatalGL.pdf.
  7. Connor EM, Sperling RS, Gelber R, Kiselev P, Scott G, O'Sullivan MJ, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. N Engl J Med 1994;331:1173-80. https://doi.org/10.1056/NEJM199411033311801
  8. Zhou Z, Meyers K, Li X, Chen Q, Qian H, Lao Y, et al. Prevention of mother-to-child transmission of HIV-1 using highly active antiretroviral therapy in rural Yunnan, China. J Acquir Immune Defic Syndr 2010;53:S15-22. https://doi.org/10.1097/QAI.0b013e3181c7d47b
  9. Newell ML. Antenatal and perinatal strategies to prevent mother-to-child transmission of HIV infection. Trans R Soc Trop Med Hyg 2003;97:22-4. https://doi.org/10.1016/S0035-9203(03)90009-5
  10. Coovadia H. Current issues in prevention of mother-to-child transmission of HIV-1. Curr Opin HIV AIDS 2009;4:319-24. https://doi.org/10.1097/COH.0b013e32832a9a17
  11. Mofenson LM, Lambert JS, Stiehm ER, Bethel J, Meyer WA 3rd, Whitehouse J, et al. Risk factors for perinatal transmission of human immunodeficiency virus type 1 in women treated with zidovudine. N Engl J Med 1999;341:385-93. https://doi.org/10.1056/NEJM199908053410601
  12. John GC, Nduati RW, Mbori-Ngacha DA, Richardson BA, Panteleeff D, Mwatha A, et al. Correlates of mother-to-child human immunodeficiency virus type 1 (HIV-1) transmission: association with maternal plasma HIV-1 RNA load, genital HIV-1 DNA shedding, and breast infections. J Infect Dis 2001;183:206-12. https://doi.org/10.1086/317918
  13. O'Gorman MR, Zijenah LS. CD4 T cell measurements in the management of antiretroviral therapy--A review with an emphasis on pediatric HIV-infected patients. Cytometry B Clin Cytom 2008;74:S19-26.
  14. Giaquinto C, Ruga E, Giacomet V, Rampon O, D'Elia R. HIV: mother to child transmission, current knowledge and on-going studies. Int J Gynaecol Obstet 1998;63:S161-5. https://doi.org/10.1016/S0020-7292(98)00200-8
  15. Shaffer N, Chuachoowong R, Mock PA, Bhadrakom C, Siriwasin W, Young NL, et al. Short-course zidovudine for perinatal HIV-1 transmission in Bangkok, Thailand: a randomised controlled trial. Bangkok Collaborative Perinatal HIV Transmission Study Group. Lancet 1999;353:773-80. https://doi.org/10.1016/S0140-6736(98)10411-7
  16. Dunn DT, Simonds RJ, Bulterys M, Kalish LA, Moye J Jr, de Maria A, et al. Interventions to prevent vertical transmission of HIV-1: effect on viral detection rate in early infant samples. AIDS. 2000;14:1421-8. https://doi.org/10.1097/00002030-200007070-00016
  17. Pinkerton SD, Holtgrave DR, Layde PM. Incremental cost-effectiveness of two zidovudine regimens to prevent perinatal HIV transmission in the United States. Prev Med 2000;30:64-9. https://doi.org/10.1006/pmed.1999.0601
  18. Pyrgos V, Shoham S, Roilides E, Walsh TJ. Pneumocystis pneumonia in children. Paediatr Respir Rev 2009;10:192-8. https://doi.org/10.1016/j.prrv.2009.06.010
  19. King SM. American Academy of Pediatrics Committee on Pediatric AIDS; American Academy of Pediatrics Infectious Diseases and Immunization Committee. Evaluation and treatment of the human immunodeficiency virus-1--exposed infant. Pediatrics 2004;114:497-505. https://doi.org/10.1542/peds.114.2.497