周産期HIV感染の削減－米国、1985～2005年

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ホーム IMICライブラリ MMWR抄訳 2006年（Vol.55)周産期HIV感染の削減－米国、1985～2005年

MMWR抄訳

2006/06/02Vol. 55 / No. 21

MMWR55(21): 592－597
Reduction in Perinatal Transmission of HIV Infection － United States, 1985-2005

2005年、米国の13才以下の子供における後天性免疫不全症候群（AIDS）の92%（推定）は、ヒト免疫不全ウイルス（HIV）の母から子への感染によるものであった（CDC、未発表データ、2006年）。感染は妊娠、分娩、出産、授乳中に発生すると考えられる。周産期HIV感染の推定数は、1991年に1,650でピークとなり、2002年に144―236の間の推定値まで減少した（CDC、未発表データ、2006年）。この減少は妊婦による通常のHIV検査、治療と予防のための抗レトロウイルス薬使用、母乳で育てることの回避、適切な時期に帝王切開分娩を行うことによるものである。これらの介入により、HIVに感染された母親からの妊娠、分娩、出産中のHIV感染率は、介入の無かった25%から30%の感染率と比較して2%以下まで減少した。しかし、減少する周産期HIV感染への大きな挑戦は継続され、女性が妊娠前にHIV感染かどうか診断されなかったこと、あるいは幼児へのウイルス感染予防のために適切な介入を受けなかったことなど、周産期HIV感染は健康事象を監視することができる。最大限に周産期感染の削減を行うための対策を強化し継続するために、公衆衛生活動は、どこに見逃された機会の発生があるかを確認するデータの収集と標的予防努力を重要視するべきである。小児のエイズ症例は、1982年に報告されている。米国における周産期後天性エイズ症例の推定数は1992年に945とピークとなり、拡大する周産期検査や適切な予防介入改善により急速に減少した。2004年には、推定48件のエイズ周産期後天性症例が報告された。これは1992年からおよそ95%の減少であった。2004年には、周産期後天性エイズ症例のおよそ38%は1才以下の子供であった。HIV症例は、全州で記名に基づくHIV感染報告を実施していないので、子供におけるHIV感染の推定数はエイズより不正確である。米国では、周産期HIV感染と周産期後天性エイズ症例の削減は、公衆衛生上重要な成果である。しかし、HIV周産期感染は依然として発生し続けている。

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