: :
HIV MTCT : Prevention and Measures
HIV Screening in Pregnant Women Is the First Step to Prevent HIV Mother-to-Child Transmission (MTCT)
+ , , , , , , , - - - - - - !- "#$- - ῌ$- % - - & '(.
Noriyuki INABA
+, Kyoko OHSHIMA
,, Masayoshi NISHIKAWA
,, Takayuki OKAZAKI
,, Akiko SHODA
,, Masami NEGISHI
,, Shihou HAYASHIDA
,, Michiyo INABA
,, Yuuichi WADA
-,
Tunekazu KITA
-, Masao TOGAWA
-, Yuuki TSUKAHARA
-, Michiya NATORI
-, Kouji USHIJIMA
-, Ryouzo TOTANI
-, Hideto GOMIBUCHI
-, Yoshikazu OZAKI
-,
Naoto YOSHINO
-, Satoshi HAYAKAWA
-, Kenichi TANAKA
-, Shukang XIONG
.+)*+,- .!/"01H+/ῐ234ῐ**1 H+2ῐ234ῐ*+,5#016
,)*+,7$$+
-.!/"01H+/-234-**1 H+2-234-*+,"8
.%*+,$7+
+Director, Dokkyo Medical University Hospital, Principal Investigator, National Cooperative Study Group supported by The Ministry of Welfare and Labor :
H+/-AIDS-**1, H+2-AIDS-*+,
,Department of OBGY, Dokkyo Medical University School of Medicine
-Coinvestigators, National Cooperative Study Group supported by The Ministry of Welfare and Labor : H+/-AIDS-**1, H+2-AIDS-*+,
.Department of GYOB, Dalian Medical University
+ ! " #
9:;<=>?HIV@ABC&DEFG<HI JK FGBLM;KNB'K(NH?O );K;NB 234P6KQD<RKST:*UVWX Y+Z,:
-[Z\]^_`aVVH? b.cdefghi j,**.&3k lO 9:;Nmno@A6KDE:p /NHI @A0$q1@AKQD:rsKtZ;u 2ῌvw2ῌ*,234NH?O xyB.!5/K23 4ST01z{K01"q|}~&noῌ0$KHIV@ A Z<HIV1@A6|} ῍ 7<
=>?HIV@ASTK\7 ῎.8K;<9|
m:Z1@A;STK<q= ῏HIV 1@ARKST<?*,6KZX>
;?<S?@cῌABKM|}}
tO
9:;<=>?HIVCo0$KBG1@AK
\ ^a}U? ¡2ZSTZ¢<VU}5q|}
D£+2&EKF"K£¤¥¦| HIV1@AST<
VU}§¨?O
, $%&#'(HIV)*+,-./
-01
7<=>?HIV@AῌSTK\7<VU}B a 0$HIV©ª«¬f®K\]G¯ b7+°
/,2.0:±HI.+.-῍bHIVCo0$K²;G¯
c7HIVCo0$K+JK³d´dKsLµ2ῌ
¶Lµ2G¯ b·d+°-,,**°:±HI.1.2῍
U 9:;<=>?HIVCo0$KBGq1@A K\G¯|O
/6%ML:)*+,-- ¸ b¹-,+ῐ*,3- NOº»
PQ·22*
,**1&-k3.¼R
b 0 0
a HIV
++
HIV !"#$%&'()*+,- . /01/23- ῌ4 ()567 ()81HIV9: ῍4 ( )547 ()88;<=;
1HIV9: ῎HIV !"#$
%& >?@ABACDE)FGH*IJ K ῏L11+M;N+,M21O: ῐ PQRHSTU- V.1WP1 XY!Z[*+- WP !"#$%&K "1#\'1]^_F$1.*῍ 46%`Xa23-
HIV !"#$%&K b2() 23/.-῍7c()23*.3῍d- Le ++()&f,*῍5V1gh2 HIV !
"#$%&1i'9Fjk,lmHno= >p +J- qr !"#$%&K1s;+tuvwx!
U(ῌyz{2 5|}~vwx!(ῌ)*vwx!
)+ῌ()vwx! ῌ vwx! vwx
!123+- HtuF@F tu1 S<1,- 1m./
>01GJ < 6Hr.
-
b HIV
2H123u;NHIV91K
:4 KF +223u
-1353u,005¡¢0./51HIV9 F%` 6&£#¤17¥!ῌ¦§£ Y!¨
©ª1lm +1151i8F9IF «¬HIV
® ¯ 18::°.025d±HF9- p,²³£«¬0;HIV9:1
´µF +/V¶<·56-¸V¶
F¹º±HFN;+- ±1»¼=
+ HIV screening rate by year in pregnant women (Hospital)
, HIV-infected pregnant women by year
> 1 J
1
ῌHIV
!" HIV#$%&' (+,*)/0*)-1+-0, )-+-./012345 6-*- 0..1῍7 8 9:;< =5>?@ABC Dῌ E23458FG2345HIJ#$
KLMMN-<#$%" O% !"
P+13 6.+./῍7 QP+.- 6-*.0῍7 <#
$RD< %&++'ST!<Q!
UV WH XY Z[$[$\]
^(_` ^<aD" )b'2cde!-/8
!+,fgh #D! <*+
i N ,jHIV-C.
kD"
c HIV
lhOmnBe?o,*3 HIV /0 1p<2q#$D 63+7" 45r6s<7/$
R t8/0uv5r6sw$x$+*./῍0.1῍y zfD" W ^({ 1 2/.1῍t8/0 uv 5r6s&|9{ :;5r6s&|9 { $R}~+..-῍yzfD" O% /01p"
&<^(45r6s*.0῍O
=s 5r6s 6-uv5r6s7 t8/0
>UN-<?@" -g HIV<Y ART 6antiretroviral therapy7 C
#$DN- 6-7 H:;5r6s
>A4BD-"
d ῌ
{nBe?o&lhO.+ HIV{ t y<C#$D< w tyῌ-"#$
6.7" w DY EFART<#$
-g<-SGvHfI J- fg
&<K?fD 6unknown7 HLM1 tyN%-OP#$"w Q <HAART 6highly active ART7 - -gR¡<S¢ T£<¤4DHIV{ B e?o 6DU7 " N Vh ¥WHIV^(
< Z¦T` fDN- HIV<
§f¨ ^(-©Xª«¬YZH
" O%-.®[HAART¯f¢
H,S° ART/\ 6±²>³ῌARCῌ AIDS7<´µfD¶<Vh"]E- HIV {·¨W ART<^¸¹ |_$
HAART<YOD-&'"HIVHAART
|9{<º`a» Dbc¼%%
+ Outcome of infants born to HIV-positive women by delivery modes (Obstetric file)
Delivery
mode Infected Not
infected
MTCT Rate Elective C/S
Emergent C/S Vaginal Delivery
+ + /
+1, +- +1
*40῍ 14+῍ ,,41῍ C/S : Caesarean section
- Changes of ART by year 6 2 7
2
, HAART
-ῌ HIV῏῍ῑῒ῎
HIV !"#HIV$
%&'()* +,, HIV-- -./0"123450-6 7 8$%&'()*93/3: ;
<=>?93/0 =@.*
ABC42 DEF?G1H+*῍
?I-C!JK ; DEFLM"N#
$?!J "0 OPQ2 ;.*R
%&'(CHIV$%&'()*?G1/0"-.
HHSCT"U6V W H;XC" )Y G1Z[\
&]^?_`3/HIV$%&'()*,**-*a +8bc^de^:fgh/0 iY 8b c^j): f kkl,3mn?oJ/0 Xp5 qH%-rLMsHIV$%&'()
*B?tuvw'xyz{|C}.3/0 HIV/*.*+ῐ*.*,῍X05012iY
~3x$C 45 HIV /09"2" /3 6 /09"C1B/*.,1῍ 6/1.1῍C"0 ῌ7 89C4$%&'()*B$%&'()*
XhH+-6+,X05~
H.H+: +RT-PCR" ,
.H mX0JC;J"<?
=Q2$%&'()*>~?3Q
"9 5V:?3/-63Q H SCvw'xyz{|>$%&'()*
5V:C 8?x$: 5 @A B¡ ¢-645"£C?~2
¤¥hk5
D¦§¨©)$XEª«¬24HIV
ART++2HAART,V®l0X;k
k5 3-3AZT'm7FGH;¯°±
AZTx²]cH;³IJXpi DEFX´µKL¶C·0/¸YYM
=> NC¹º=>9»¼3/0 DEF ῐ . Clinical course of the.+infants born to HIV-positive women
ΐ , Prevention of HIV MTCT +) Mandatory
ῌ HIV screening in pregnant women
῍ Regulation of maternal viral loads by HAART
,) Depends on maternal viral loads ῌ Elective caesarean section
῍ AZT drop infusion at delivery
῎ AZT syrup administration to neonates
῏ Bottle feeding*
* : depends on socioeconomical condition, as well HAART : highly active ART (antiretroviral therapy)
+ 3 , 3
European Collaborative Study ,**/
HAART*./ῌ+.*
῍ !" #$%
&! '()*+ , &-./0 1234567!HIV viral load+,***copiesῌml
!#89:; CDC Report,,**0+ ,./῍<=" HIV>?@A
#$%*-.BCDEFG7HI:
;+ JK@LMN%ῌ32%'OP QR+ S&&OJT:*US"
VW:XHIV*'!" - YZ[\+ ]^_`& ROC abc:X + def:,*῍Pghi jk!"HIV>?lV`HIV viral load
!+ S&mn!Vopq
!rL"
s!HIV>?#9>tuv+
VomXwxy%z{|}+
S&m~&O+ HAART,%
+ 0!AZTH +
defJSsHIV
7G5657!"
῎ ῌ
+ !a+/ "¡2YZ#$¢£¤.¥YZ'
¦ H+/ῌ¤.¥ῌ**1HIV?§¨©ª«
%&¬ixy%ῌ'%YZ ®
¯YZ\:°(±²+ ,**..
, !a+0 "¡2YZ#$¢£¤.¥YZ'
¦ H+/ῌ¤.¥ῌ**1HIV?§¨©ª«
%&¬i'%ῌ³2%YZ ®
¯YZ\:°(±²+ ,**/.
- ´µ)¶*: HIV%&-·¸/G¹. ++ !a+1 "¡2YZ#$¢£¤.¥Y Z'¦ H+/ῌ¤.¥ῌ**1HIV?§¨©ª
«%&¬i'%ῌ³2%YZ
®¯YZ\:°(±²+ ,**0.
. European Collaborative Study : Mother-to-child trans- mission of HIV infection in the era of highly active anti- retroviral therapy. Clin Infect Dis.*:./2ῌ.0/,,**/. / CDC : Achievements in public health. Reduction in peri-
natal transmission of HIV infectionºUnited States, +32/ῌ,**/. MMWR Morb Mortal Wkly Rep //:/3,ῌ /31,,**0.
῍ - MTCT rate by breast and bottle feeding (ROC) Breast feeding Bottle feeding Total Infants(n)
HIV (») infants MTCT rate
03 ,0 -141῍* ,0ῌ03
++
, +24,῍*
,ῌ++
2*
,2 -/4*῍ ,2ῌ2*
* : p¼*.*/ (Shukang Xiong)
+*
+*
