Anneden Bebeğe HIV Geçişinin Önlenmesi

Öz

Türkiye’de insan immün yetmezlik virüs HIV enfeksi- yonu çok sık görülmemesine karşın, vaka sayısı giderek artmaktadır. Çocuklarda HIV enfeksiyonununda en önemli bulaş perinatal geçiş yoluyla olmaktadır. Anneden bebeğe perinatal geçişi, doğum öncesi, sırası ve sonra- sında alınacak önlemler ile azaltmak mümkündür. Bu önlemler gebelik boyunca antiretroviral tedavi alma, doğumun 38. haftada sezaryen ile yapılması, bebeğe doğum sonrası antiretroviral profilaksi verilmesi ve anne sütü almama şeklinde özetlenebilir. Perinatal HIV enfeksiyonu bulaş oranı hiç tedavi almayan annelerde %12-40 iken standart perinatal profilaksi ile %3’ten, tam viral baskılanma sağlandığında da %1’den daha az oranlara iner. Bu derlemede, bir pediyatrik HIV merke- zindeki anneden bebeğe perinatal geçişi önleme strateji- lerinden bahsedildi

Anahtar Kelimeler

• HIV,perinatal geçiş,HIV ile temaslı bebek

Prevention of Mother to Child Transmisson of HIV Infection

Öz

Despite the rare prevalence of Human İmmunedeficiency Virus HIV infection in Turkey, the number of new cases are rising, year by year. The most common route for trans- mission of HIV infection to children is by perinatal way; thus it can be prevented by special methods if applied pro- perly during peripartum and postnatal periods. Antiretroviral therapy ART during pregnancy, birth by elective cesarian section at 38. weeks of gestational age, ART applied to baby just after birth and cessation of bre- astfeeding are the most important strategies for prevention of mother to child transmission PMTCT of HIV infection. The risk for perinatal HIV transmission is 12-40% in unt- reated mothers whereas this ratio drops to 3% by standart perinatal prophylaxis and less than 1% in the case when total viral supression is enabled. This review is the sugges- ted summary of PMTCT strategies in a pediatric HIV cli- nic

Anahtar Kelimeler

• HIV,perinatal transmission,HIV exposed infant

Kaynakça

1. 1. World Health Organization. HIV/ AIDS. Accessible at: http://www.who.int/hiv/en/
2. 2. World Health Organization. HIV/AIDS. Data and Statistics. Available at: http://www.who.int/hiv/data/en/
3. 3. T.C. Sağlık Bakanlığı. HIV/AIDS verileri, Ekim 1985- Haziran 2014. Türkiye Halk Sağlığı Kurumu, Bulaşıcı Hastalıklar Daire Başkanlığı, Zührevi Hastalıklar Birimi. Erişim: http://www.hatam.hacettepe.edu.tr/ veriler_ Haziran_2014.pdf.
4. 4. World Health Organization, Unicef. Guidance on global scale-up of the prevention of mother to child transmission of HIV: towards universal access for women, infants and young children and eliminating HIV and AIDS among children / Inter-Agency Task Team on Prevention of HIV Infection in Pregnant Women, Mothers and their Children. WHO, 2007, Switzerland. Accessible at: http://www.unicef.org/aids/fi les/ PMTCT_enWEBNov26.pdf
5. 5. Mofenson L, Taylor AW, Rogers M, et al. Achievements in public health. Reduction in perinatal transmission of HIV infection- United States, 1985- 2005. MMWR Morb Mortal Wkly Rep 2006;55(21): 592-97.
6. 6. Townsend CL, Cortina-Borja M, Peckham CS, et al. Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000-2006. AIDS 2008;22(8): 973-81. http://dx.doi.org/10.1097/QAD.0b013e3282f9b67a
7. 7. Warszawski J, Tubiana R, Le Chenadec J, et al. Mother-to-child HIV transmission despite antiretroviral therapy in the ANRS French Perinatal Cohort. AIDS 2008;22(2):289-99. http://dx.doi.org/10.1097/QAD.0b013e3282f3d63c
8. 8. Read JS, Samuel NM, Srijayanth P, et al. Infants of human immunodefi ciency virus type 1-infected women in rural south India: feeding patterns and risk of mother-to-child transmission. Pediatr Infect Dis J 2010;29(1):14-7. http://dx.doi.org/10.1097/INF.0b013e3181b20ffc

9. 9. Hoffman RM, Black V, Technau K, et al. Effects of highly active antiretroviral therapy duration and regimen on risk for mother-to-child transmission of HIV in Johannesburg, South Africa. J Acquir Immune Defic Syndr 2010;54(1):35-41. http://dx.doi.org/10.1097/qai.0b013e3181cf9979
10. 10. Koye DN, Zeleke BM. Mother-to-child transmission of HIV and its predictors among HIV-exposed infants at a PMTCT clinic in northwest Ethiopia. BMC Public Health 2013;13:398. http://dx.doi.org/10.1186/1471-2458-13-398
11. 11. Del Bianco G, Bell CS, Benjamins LJ, et al. Persistently high perinatal transmission of HIV: assessment of risk factors. Pediatr Infect Dis J 2014;33(6): e151-7. http://dx.doi.org/10.1097/INF.0000000000000199
12. 12. Pinnetti C, Baroncelli S, Villani P, et al. Rapid HIVRNA decline following addition of raltegravir and tenofovir to ongoing highly active antiretroviral therapy in a woman presenting with high-level HIV virae mia at week 38 of pregnancy. J Antimicrob Chemother 2010;65(9):2050-52. http://dx.doi.org/10.1093/jac/dkq264
13. 13. Coutsoudis A, Pillay K, Spooner E, et al. Randomized trial testing the effect of vitamin A supplementation on pregnancy outcomes and early mother-to-child HIV-1 transmission in Durban, South Africa. South African Vitamin A Study Group. AIDS 1999;13(12):1517-24. http://dx.doi.org/10.1097/00002030-199908200-00012
14. 14. Landesman SH, Kalish LA, Burns DN, et al. Obstetrical factors and the transmission of human immunodeficiency virus type 1 from mother to child. The Women and Infants Transmission Study. N Engl J Med 1996;334(25):1617-23. http://dx.doi.org/10.1056/NEJM199606203342501
15. 15. Mwanyumba F, Gaillard P, Inion I, et al. Placental inflammation and perinatal transmission of HIV-1. J Acquir Immune Defic Syndr 2002;29(3):262-9. http://dx.doi.org/10.1097/00042560-200203010-00006
16. 16. World Health Organization, Centers for Disease Control and Prevention, Department of Health&Human Services. Prevention of Mother-to-Child Transmission of HIV (PMTCT). Generic Training Package. WHO 2004. Accessible at: www.cdc.gov/globalaids/ Resources/pmtct-care/docs/Complete_Presentation_ Bklt.pdf
17. 17. Menu E, Scarlatti G, Barré-Sinoussi F, et al. Motherto-child transmission of HIV: developing integration of healthcare programmes with clinical, social and basic research studies. Report of the International Workshop held at Chobe Marina Lodge, Kasane, Botswana, 21-25 January 2003. Acta Paediatr 2003;92(11):1343-8. http://dx.doi.org/10.1111/j.1651-2227.2003.tb00507.x
18. 18. Rousseau CM, Nduati RW, Richardson BA, et al. Longitudinal analysis of human immunodeficiency virus type 1 RNA in breast milk and of its relationship to infant infection and maternal disease. J Infect Dis 2003;187(5):741-7. http://dx.doi.org/10.1086/374273
19. 19. UNAIDS, WHO, UNICEF. Joint WHO/UNAIDS/ UNICEF statement on use of cotrimoxazole as prophylaxis in HIV exposed and HIV infected children. 22 November 2004, Geneva. Accessible at: http://www. unaids.org/
20. 20. Coutsoudis A, Kindra G, Esterhuizen T. Impact of cotrimoxazole prophylaxis on the health of breast-fed, HIV-exposed, HIV-negative infants in a resourcelimited setting. AIDS 2011; 25(14):1797-9. http://dx.doi.org/10.1097/QAD.0b013e32834ad699