授乳によるHIV感染:マラウイでの研究

P G Miotti¹, T E Taha, N I Kumwenda

¹Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD, USA. pm122m@nih.gov

JAMA

|August 27, 1999

まとめ

授乳によるヒト免疫不全ウイルス (HIV) 感染のリスクは,人生の最初の数ヶ月で最も高いです. この発見は,HIVに感染した母親の乳児の栄養に関する効果的な政策を策定する上で極めて重要です.

科学分野:

母親と子供の健康について
感染症の疫学について
公共衛生政策公共衛生政策とは

背景:

授乳によるヒト免疫不全ウイルス (HIV) 感染リスクを理解することは,HIVに感染した母親に助言するために不可欠です.
公共衛生政策の情報提供には,授乳によるHIV感染に関する正確なデータが必要です.

研究の目的:

母乳によるHIV感染の頻度とタイミングを定量化するために.
授乳中のHIV感染に関連する母と乳児の危険因子を特定する.

主な方法:

1994年から1997年までマラウイで前向きなコホート研究が行われました.
HIVに感染した母親から生まれた672人のHIV陰性乳児 (抗レトロウイルス薬への曝露なし) を24ヶ月間追跡調査した.
HIVの発生率を分析し,危険因子を特定するために,比例的な危険モデルが使用されました.

主要な成果:

授乳停止後,HIV感染は発生しなかったが,授乳中に47件の感染が発生した.
5,11,17,23ヶ月の累積HIV感染率はそれぞれ3.5%,7.0%,8.9%,10.3%でした.
高い母子の同位率と高齢の母子の年齢は,出産後のHIV感染のリスクが著しく低下するとの関連がありました.

結論:

授乳によるHIV感染のリスクが最も高いのは,産後最初の数ヶ月です.
これらの発見は,HIV陽性母親のための母乳育児ガイドラインを策定する際に慎重に検討する必要がある.

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