Pregnancy with human immunodeficiency virus infection

doi:10.3877/cma.j.issn.2095-3259.2017.03.008

Abstract

Abstract:

The number of pregnant women with human immunodeficiency virus (HIV) and the requirement of delivery increased year by year. To promote the implementation of HIV mother-to-child blocking measure, obstetrician should know and understand not only the mechanisms of vertical transmission, influence factors, laboratory examination and diagnosis methods of HIV, but also the progress and attentions on antenatal care, management of intrapartum, postpartum care, neonatal screening and treatments.

Key words: HIV infections, Pregnant women, Disease transmission, vertical

Zheng Li, Fang Li. Pregnancy with human immunodeficiency virus infection[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2017, 06(03): 166-171.

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References 10

[1]	Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data- United States and 6 dependent areas-2012[J/OL]. HIV Surveillance Supplemental Report, 2014, 19(3). [2017-06-11] URL
[2]	Centers for Disease Control and Prevention and Association of Public Health Laboratories. Laboratory Testing for the Diagnosis of HIV Infection: Updated Recommendations[J/OL]. 2014[2017-06-11]. URL
[3]	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[J/OL]. National Guideline Clearinghouse，2017[2017-06-11]. URL
[4]	汪永忠，李燕. 艾滋病母婴传播及阻断的影响因素研究进展[J]. 现代预防医学，2007, 34(13):2461-2464, 2467.
[5]	Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents[J/OL]. Department of Health and Human Services，2017[2017-06-11]. URL
[6]	中华医学会感染病学分会艾滋病学组. 艾滋病诊治指南第三版(2015版)[J]．中华临床感染病杂志，2015, 8(5):385-401.
[7]	中国疾病预防控制中心，性病艾滋病预防控制中心. 国家免费艾滋病抗病毒药物治疗手册[M]. 4版. 北京：人民卫生出版社，2016: 87-91.
[8]	国家卫生和计划生育委员会妇幼健康服务司．《预防艾滋病、梅毒和乙肝母婴传播工作实施方案(2015年版)》解读[J]．中国妇幼卫生杂志，2015, 6(6):1-2.
[9]	Antiretroviral Pregnancy Registry Steering Committee. Antiretroviral Pregnancy Registry international interim report for 1 Jan 1989－31 January 2015[J/OL]. Wilmington, NC: Registry Coordinating Center, 2017[2017-06-11]. URL
[10]	Kaplan JE, Benson C, Holmes KK, et al. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America[J]. MMWR Recomm Rep, 2009, 58(RR-4):1-207.

HIV病史回顾	实验室评估
1.HIV感染持续时间，传播途径(如果知道)，既往HIV相关疾病和住院治疗情况	1.CD4计数与HIV载量
2.既往和现行的ARV药物使用、疗程，治疗是否从产妇的利益和(或)防止母婴传播出发，依从性和耐受性问题	2.在开始抗病毒治疗或调整抗病毒方案之前，如果患者病毒载量高于耐药检测所需的最低值(例如，>500～1 000拷贝/ml)，需进行ARV药物的耐药检测(有基因型者优先)
3.受HIV感染影响的妊娠结局	3.基线全血细胞计数、血小板及肝肾功能检测
4.CD4细胞计数和HIV载量(血浆HIV RNA血浆/ml/份)及其与抗病毒药物的相互关系，既往HIV抗病毒药物耐药检测的结果	4.通过CD4细胞计数进行血清学评估(当CD4<200个/μl时，需要进行巨细胞病毒血清学和刚地弓形虫血清学检测)
5.评估机会性感染预防用药的必要性	5.如果估计会使用阿巴卡韦，需要进行HLA-B5701检测
6.甲肝、乙肝、丙肝、结核杆菌、肺炎球菌、白喉破伤风百日咳的免疫/感染/血清学状态	6.对于PPD阳性患者，行胸部X线平片检查以排除活动性肺疾病
?	7.如果巴氏涂片异常，需要进行HPV检测及阴道镜检查

HIV病史回顾	实验室评估
1.HIV感染持续时间，传播途径(如果知道)，既往HIV相关疾病和住院治疗情况	1.CD4计数与HIV载量
2.既往和现行的ARV药物使用、疗程，治疗是否从产妇的利益和(或)防止母婴传播出发，依从性和耐受性问题	2.在开始抗病毒治疗或调整抗病毒方案之前，如果患者病毒载量高于耐药检测所需的最低值(例如，>500～1 000拷贝/ml)，需进行ARV药物的耐药检测(有基因型者优先)
3.受HIV感染影响的妊娠结局	3.基线全血细胞计数、血小板及肝肾功能检测
4.CD4细胞计数和HIV载量(血浆HIV RNA血浆/ml/份)及其与抗病毒药物的相互关系，既往HIV抗病毒药物耐药检测的结果	4.通过CD4细胞计数进行血清学评估(当CD4<200个/μl时，需要进行巨细胞病毒血清学和刚地弓形虫血清学检测)
5.评估机会性感染预防用药的必要性	5.如果估计会使用阿巴卡韦，需要进行HLA-B5701检测
6.甲肝、乙肝、丙肝、结核杆菌、肺炎球菌、白喉破伤风百日咳的免疫/感染/血清学状态	6.对于PPD阳性患者，行胸部X线平片检查以排除活动性肺疾病
?	7.如果巴氏涂片异常，需要进行HPV检测及阴道镜检查

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