İnsan İmmün Yetmezlik Virüsü ile İnfekte Anne Bebekleri ve Perinatal Geçisin Değerlendirilmesi

Abstract

Amaç: Tüm dünyada ve ülkemizde HIV/AIDS hem bireysel hem de toplumsal sonuçları ağır olan önemli bir halk sağlığı sorunudur. Gelişmekte olan ülkelerde, HIV ile enfekte çocukların %90’ından fazlasında virüs anneden bebeğe bulaşmaktadır. Her yıl tüm dünyada HIV pozitif 1.3 milyon kadın gebe kalmakta ve anneden çocuğa HIV geçişi küresel olarak yeni HIV enfeksiyonlarının %9’unu oluşturmaktadır. Bu çalışmada HIV ile enfekte annelerden doğan bebeklerin ve perinatal geçişi önlem için uygulanan yöntemlerin sonuçlarının değerlendirilmesi amaçlanmıştır.

Gereç ve Yöntemler: Ocak 2015- Aralık 2020 tarihleri arasında Çocuk Enfeksiyon Hastalıkları kliniğinde izlenen HIV ile enfekte annelerden doğan bebeklerin klinik ve laboratuvar özellikleri retrospektif olarak incelendi.

Bulgular: Çalışmamızda 6 yıllık süreçte HIV’li anneden doğan 22 bebek izlendi. Bebeklerin 14’ü (%63.6) erkekti. Bir bebek 34 haftalık prematür diğerleri miad doğumdu. 12 (%54.5) anne gebe kalmadan önce HIV olduğunu biliyordu. 10 anne gebelik sırasında taramalarda tanı almıştı. Bunların 4’ü (%40) ilk trimestirde, 6’sı (%60) son trimestirde idi. 19 (%86.4) anne gebelik sırasında antiretroviral tedavi (ART) aldı. Doğum sırasında annelerin HIV RNA sonucu 14 (%63.6) negatif, 7 (%31.8) pozitif ve 1 (%4.5 ) bilinmiyordu. 7 (%31) anneye doğum sırasında ART profilaksi verildi. Bebeklerin 19’u (%86.4) sezaryen ile doğdu ve hiçbiri anne sütü almamıştı. Hastaların 20’si (%90.9) doğar doğmaz yıkanmıştı. 21 bebeğe doğum sonrası ilk 24 saat içinde oral antiretroviral profilaksi başlandı. 19 hastaya sadece zidovudin, 2 hastaya zidovudin ve nevirapin ikili profilaksi başlandı. Bebeklerinin hiçbiri HIV ile enfekte olmadı.

Sonuç: Çalışmamızda antiretroviral profilaksi ve bir takım önlemler ile HIV’li anne bebeklerinin hiçbirinin enfekte olmadığı saptandı. HIV ile enfekte çocukların %90’dan fazlasında virus vertikal yolla bulaş sonucu kazanılmaktadır. HIV pozitif gebelerin erken tanısı ve gebelerde antiretroviral tedavinin kullanımının artması, sezaryen ile doğum, bebeğe doğum sonrası antiretroviral profilaksi, anne sütü verilmemesi, doğar doğmaz yıkama gibi bir takım önlemler ile anneden bebeğe HIV geçişini önlemek mümkündür.

Keywords

• HIV,
• AIDS,
• gebelik
• Anneden bebeğe geçiş
• Profilaksi

Evaluation of Infants of Mothers Infected with Human Immunodeficiency Virus and Perinatal Transmission

Abstract

Objective: HIV/AIDS is an important public health problem with severe individual and social consequences all over the world and in our country. Every year, 1.3 million women become pregnant worldwide, and mother to child transmission of HIV accounts for 9% of new HIV infections globally. In this study, it was aimed to evaluate infants born to HIV-infected mothers, and to evaluate the results of the methods applied to prevent perinatal transmission.

Material and Methods: The clinical and laboratory characteristics of infants born to HIV-infected mothers, who were followed up in the Pediatric Infectious Diseases clinic between January 2015 and December 2020, were analyzed retrospectively.

Results: In our study, 22 infants born to HIV-infected mothers were followed over a six-year period. 14 (63.6%) of the infants were male. One infant was 34 weeks premature and the others were term. 12 (54.5%) mothers knew they had HIV before they became pregnant. 10 mothers were diagnosed during pregnancy scans. Four (40%) of these were in the first trimester and six (60%) were in the last trimester. 19 (86.4%) patients received antiretroviral therapy (ART) during pregnancy. The HIV RNA result of the mothers at the time of delivery was found to be 14 (63.6%) negative, seven (31.8%) positive and one (4.5%) unknown. Seven (31%) mothers were given ART prophylaxis during delivery. 19 (86.4%) infants were delivered by C-section. None of them had been breastfed. 20 (90.9%) of the patients were bathed as soon as they were born. Oral antiretroviral prophylaxis was started in 21 infants within the first 24 hours after delivery. 19 patients were started only on zidovudine, and 2 patients were started on dual prophylaxis with zidovudine and nevirapine. None of the infants were found to be HIV-infected.

Conclusion: It was determined that none of the infants of HIV-infected mothers followed up in our study were infected. In more than 90% of HIV-infected children, the virus is acquired as a result of vertical transmission. Prevention of HIV transmission from mother to infant is possible with some measures such as early diagnosis of HIV-positive pregnant women, increase of antiretroviral therapy in pregnant women, Cesarean delivery, postpartum antiretroviral prophylaxis, avoidance of breastfeeding and bathing the infant as soon as it is born.

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