사람면역결핍바이러스 모자 수직전파 예방 : 일개 대학병원의 경험 = Prevention of Mother-to-child Transmission of HIV :Experiences from an University Teaching Hospital

국문 초록 (Abstract)

해마다 여성 AIDS 감염자 수가 상승하고 있으며, 여성 감염자의 58%가 주 생식 연령대인 20-40대이다. 의료 기술의 발전으로 점차 출산에 대한 욕망도 증가되어 우리나라에서도 향후 사람면역결핍바이러스 감염 여성의 출산이 점차 증가할 것으로 예상된다. 이 연구에서는 각기 다양한 상황으로 내원한 사람면역결핍바이러스 산모 4명의 증례를 통해 사람면역결핍바이러스 감염 산모에서 모자수직전파 예방의 초기 경험을 공유하고자 하였다.
2005년까지 부산대학교병원에는 4명의 사람면역결핍바이러스 산모가 출산을 하였으며, 이 중 3명은 임신 35-38주에 분만이 임박하여 내원하였고, 1명만이 출생 전 면담을 통한 계획된 임신으로 출산을 하였다. 이들에게 각 상황에 따라 임신 중, 분만시, 분만 후 항레트로바이러스 치료를 하였으며, 영아에게도 항레트로바이러스 치료를 시행하여 이들 영아에서 시행한 추적 사람면역결핍바이러스 리보핵산 역가 검사에서 추적 소실된 한 명을 제외하고 모두 측정치 이하였다.
사람면역결핍바이러스 감염 산모가 출산 전 예방없이 분만하는 경우 25%의 영아가 사람면역결핍바이러스에 감염되나, 적절한 예방을 할 경우 전파를 2%까지 감소시킬 수 있는 점과 출생 전 진찰을 하지 않아 감염 사실을 모르고 있다가 분만이 임박해서야 내원하는 경우가 종종 있음을 고려할 때 향후 적극적인 출생 전 검사 및 모자 수직전파 예방을 위한 항레트로바이러스 치료가 필요할 것으로 생각된다.

다국어 초록 (Multilingual Abstract)

The number of HIV infected women continues to rise sharply these days and 58% of these women were childbearing age. The increase in the number of AIDS cases among childbearing women has led to an increase in the maternal - infant transmission of human acquired immunodeficiency virus. The aim of our study is to assess the available evidence for preventing mother-to-infant transmission of HIV infection by experience from University Teaching Hospital. Four pregnant women with HIV infection delivered in Pusan National University Hospital from 1999 to 2005 years. Three women visitied at 3rd trimester, only one woman delivered by planned perinatal care. They received antiretroviral therapy during pregnancy, labor, after delivery, and infant received antiretroviral therapy by consideration of their situation. They were compliant with treatment and had a sustained virologic response below the detectable level. Just 2% of infants were trasmitted by human acquired immunodeficiency virus, if HIV infected women had an appropriate prophylaxis. Therefore HIV infected women must be identified early for prevention of maternal-infant transmission, they must receive effective antiretrovirus therapy.

참고문헌 (Reference)

1 Johnson VA, "Update of the Drug Resistance Mutations in HIV-1:Fall 2005" 13 : 125-131, 2005

2 Sax PE, "Should resistance testing be performed for treatment-naive HIV-infected patients? A cost- effectiveness analysis" 41 : 1316-1323, 2005

3 Simonds RJ, "Sensitivity and specificity of a qualitative RNA detection assay to diagnose HIV infection in young infants" 12 : 1545-1549, 1998

4 Hecht FM, "Resistance testing in drug- nave HIV-infected patients: is it time?" 41 : 1324-1325, 2005

5 Connor, "Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment" 1994

6 No auther list, "Rates of mother-to child transmission of HIV-1 in Africa, America, and Europe: results from 13 perinatal studies" 8 : 506-510, 1995

7 Perinatal HIV Guidelines Working Group, "Public Health Service Task Force Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1- Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1 Transmission in the United States July 6, 2006" 2006

8 Garcia PM, "Maternal levels of plasma human immunodeficiency virus type 1 RNA and the risk of perinatal transmission" 341 : 394-402, 1999

9 Delamare C, "HIV-1 RNA detection in plasma for the diagnosis of infection in neonate" 15 : 121-125, 1997

10 Petra Study team, "Efficacy of three short-course regimens of zidovudine and lamivudine in preventing early and late transmission of HIV-1 from mother to child in Tanzania, South Africa, and Uganda (Petra Study): a randomised, double-blind, placebo-controlled trial" 359 : 1178-1186, 2002

11 Young NL, "Early diagnosis of HIV-1-infected infants in Thailand using RNA and DNA PCR assays sensitive to non-B subtypes" 24 : 401-417, 2000

12 Bremer JW, "Diagnosis of infection with human immunodeficiency virus type 1 by a DNA polymerase chain reaction assay among infants enrolled in the Women and Infants' Transmission Study" 129 : 198-207, 1996

13 Husson RN, "Diagnosis of human immunodeficiency virus infection in infants and children" 86 : 1-10, 1990

14 Cunningham CK, "Comparison of human immunodeficiency virus 1 DNA polymerase chain reaction and qualitative and quantitative RNA polymerase chain reaction in human immunodeficiency virus 1-exposed infants" 18 (18): 1999

15 Cooper ER, "Combination antiretroviral strategies for the treatment of pregnant HIV-1-infected women and prevention of perinatal HIV-1 transmission" 29 : 484-494, 2002

16 Owens DK, "A meta-analytic evaluation of the polymerase chain reaction for the diagnosis of HIV infection in infants" 275 : 1342-1348, 1996